Texas Board of Nursing Rules & Regulations: Guide for NPs

Texas Board of Nursing (BON) rules and regulations, found in Title 22, Part 11 of the Texas Administrative Code, put the Texas Nursing Practice Act into practice and govern how nurses in Texas are licensed, practice, and are disciplined.

Whether you’re a registered nurse (RN), licensed vocational nurse (LVN), or advanced practice registered nurse (APRN), understanding these regulations can help you protect your license, meet your professional obligations, and provide safe, compliant patient care. For nurse practitioners (NPs), knowing how BON rules intersect with prescriptive authority, physician delegation, and practice requirements is especially important when starting or growing a practice. Texas NPs do not have full practice authority, so prescribing requires a prescriptive authority agreement with a physician.

As a team of NPs and PAs, we know that navigating state regulations can feel like one more job on top of patient care and practice management. This guide breaks down the Texas Nursing Practice Act, BON rules, licensure and renewal requirements, scope of practice, disciplinary processes, and key compliance considerations, with practical context for clinicians working in Texas.

What Is the Texas Board of Nursing, and What Does It Regulate?

The Texas Board of Nursing is the state agency responsible for regulating nursing practice and protecting the public through licensure, education standards, practice rules, and enforcement. Its authority comes from the Texas Nursing Practice Act (NPA), found in Chapter 301 of the Texas Occupations Code.

The BON regulates RNs, LVNs, and APRNs, including nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives. Its rules establish professional responsibilities, define nursing practice standards, and outline the circumstances under which a nurse’s license may be disciplined.

For NPs, BON regulations are particularly relevant to advanced practice authorization, scope of practice, prescriptive authority, continuing competency, and professional accountability.

What Is the Difference Between the Texas Nursing Practice Act and BON Rules?

The NPA establishes the statutory foundation for nursing regulation, while the Texas Administrative Code (TAC) contains the rules adopted to implement that law.

Both are important when determining what is permitted in practice. The BON cannot override state law, and a nurse must comply with both applicable statutes and regulations.

Key sections of Title 22, Part 11 of the TAC include:

NPs should pay particular attention to Chapters 221 and 222, along with Rule 217.11, which outlines standards of nursing practice. These provisions help clarify professional responsibilities and the requirements associated with advanced practice and prescribing.

The Texas Legislature may amend the NPA, while the BON adopts and updates rules within its statutory authority. For that reason, we recommend checking the current statute and BON rules rather than relying solely on older articles or summaries.

What Are the Texas BON Licensure Requirements for RNs, LVNs, and NPs?

Texas nursing licensure requirements vary by license type. RNs and LVNs must meet the requirements for their respective licenses, while NPs must also qualify for APRN licensure in their advanced practice role and population focus.

RN and LVN Licensure

Applicants generally qualify for Texas RN or LVN licensure through examination or endorsement.

• Licensure by examination: Applicants complete an approved nursing education program, pass the Texas Nursing Jurisprudence Examination, complete a fingerprint-based criminal background check, and pass the NCLEX-RN or NCLEX-PN.
• Licensure by endorsement: Nurses who hold a license in another state may apply for Texas licensure by meeting the BON’s endorsement requirements, including a fingerprint-based criminal background check.

Texas participates in the Nurse Licensure Compact (NLC). Eligible RNs and LVNs with a multi-state license may practice in other compact states, subject to compact rules and the laws of the state where they provide care.

What Are the APRN Licensure Requirements in Texas?

NPs and other APRNs must meet additional requirements beyond RN licensure. These generally include:

• Completion of qualifying graduate-level advanced practice nursing education.
• National certification appropriate to the APRN role and population focus
• Texas APRN licensure and compliance with BON requirements for the applicable role and population focus.

NPs who intend to prescribe medications must also obtain Texas prescriptive authority and comply with the physician-delegation requirements that apply to their practice.

Texas does not provide APRNs with a separate multi-state license through the NLC. An NP providing care to patients in another state must verify that state’s licensure and practice requirements, including those that apply to telehealth.

Official application and eligibility details are available through the Texas BON’s APRN application and licensure page.

How Often Do Texas Nurses Renew, and What CE Is Required?

Texas nursing licenses are generally renewed every two years. RNs and LVNs must meet the BON’s continuing competency requirements for each renewal cycle. APRNs renew their RN and APRN licenses together. Effective September 1, 2026, Texas nurses must upload documentation of their continuing competency activities to the BON’s continuing education tracking system before license renewal.

For most nurses, the BON allows two primary ways to meet the general continuing competency requirement:

• Complete 20 contact hours of approved continuing nursing education (CNE) in the nurse’s area of practice.
• Achieve, maintain, or renew a BON-approved national nursing certification in the nurse’s area of practice, when eligible.

APRNs complete one set of 20 contact hours appropriate to their advanced practice role and population focus, or maintain the national certification recognized for that role, and those hours also satisfy the RN renewal requirement. Additional targeted education requirements may apply depending on the nurse’s credentials and practice.

What Continuing Education Do Texas NPs With Prescriptive Authority Need?

An APRN with prescriptive authority must complete at least five additional contact hours of pharmacotherapeutics CNE during each licensing period. These hours are in addition to the general 20-hour requirement.

Additional targeted CNE may apply to APRNs who prescribe opioids or have other practice-specific obligations. For example, an APRN whose prescriptive authority agreement authorizes opioid prescribing must complete at least two hours of continuing education each year on safe and effective pain management under BON Rule 216.3(c)(4). Nurses whose practice includes older adult or geriatric populations must complete at least two contact hours relating to those populations each licensing period or maintain a certification in that area of practice. Other targeted requirements apply more broadly. Nurses who provide direct patient care must complete an HHSC-approved human trafficking prevention course, and every nurse must complete two contact hours in nursing jurisprudence and ethics before the end of every third licensing period.

NPs should review the BON’s current requirements rather than assume that completing 20 general CNE hours satisfies every renewal obligation.

The Texas BON Continuing Education and Competency page provides current requirements, approved certification information, and guidance on maintaining CNE records.

What Are the Texas BON Standards of Nursing Practice?

Texas BON Rule 217.11 establishes standards that apply to nurses across practice settings. These standards address patient safety, professional accountability, documentation, communication, and the nurse’s responsibility to practice within their authorized scope.

Understanding the distinctions among LVN, RN, and APRN practice is essential, especially when delegating care or working in a team-based clinical setting.

How Do Scope of Practice and Delegation Differ for LVNs, RNs, and APRNs?

LVNs provide nursing care under appropriate supervision and within their education, competency, and authorized scope. They must comply with applicable rules governing nursing assignments and delegated tasks.

RNs are responsible for nursing assessments, care planning, implementation, evaluation, and delegation within their scope. RNs remain accountable for their own nursing judgments and for appropriate delegation decisions.

APRNs, including NPs, practice within their advanced practice role and population focus, while remaining subject to the NPA, BON rules, and applicable physician-delegation requirements. An NP’s APRN license does not eliminate the need to comply with Texas requirements governing delegated medical acts and prescriptive authority.

What Should Nurses Know About Delegation and Supervision?

• Delegation involves assigning appropriate tasks to another qualified person while retaining accountability for the delegation decision. A nurse must consider the task, the patient’s condition, the individual’s competence, and the level of supervision required.

• Before accepting a new role or expanding clinical services, we recommend reviewing the BON’s applicable rules and position statements, along with any additional requirements imposed by the practice setting.

What Happens If a Nurse Violates Texas BON Rules?

The Texas BON investigates complaints and may take disciplinary action when a nurse violates the NPA or applicable BON rules. The purpose of enforcement is to protect the public and address conduct that raises concerns about a nurse’s ability or authority to practice safely.

Depending on the circumstances, disciplinary outcomes may include remedial education, fines, practice restrictions, probation, suspension, or license revocation. The specific outcome depends on the facts, applicable law, and the Board’s review of the case.

What Are Common Reasons for BON Disciplinary Action?

Conduct that may lead to a complaint or disciplinary investigation includes:

• Practicing outside the nurse’s authorized scope or without a required license.
• Failing to meet applicable standards of nursing practice.
• Falsifying records or engaging in dishonest or unprofessional conduct.
• Breaching patient confidentiality or professional boundaries.
• Impairment or substance-related conduct that affects safe practice.
• Violating BON orders or failing to meet disciplinary requirements.

Not every complaint results in discipline. The BON evaluates allegations based on the evidence and applicable law.

How Does the Texas BON Disciplinary Process Work?

The process varies by case, but may include complaint screening, investigation, an opportunity for the nurse to respond, and an informal resolution process.

If a case proceeds to a contested hearing, it may be referred to the State Office of Administrative Hearings (SOAH). The BON then acts in accordance with the applicable legal process and issues a final decision when appropriate.

Nurses have procedural rights throughout the process, including applicable opportunities to respond, obtain legal representation, and seek judicial review of a final decision.

If you receive notice of a BON complaint or investigation, review the notice carefully and consider consulting an attorney experienced in professional licensing matters.

What Is the Texas Peer Assistance Program for Nurses (TPAPN)?

The Texas Peer Assistance Program for Nurses (TPAPN) supports eligible nurses whose substance use or other potentially impairing conditions may affect safe nursing practice. TPAPN is a program of the Texas Nurses Foundation and operates under a contract with the Texas Board of Nursing. It helps nurses access evaluation, treatment, and monitoring while addressing patient safety.

Participation may be voluntary or connected to a BON-related process. It is not an automatic exemption from disciplinary action, and outcomes depend on the nurse’s situation and compliance with program requirements.

Nurses who are concerned about impairment should review eligibility and referral information directly through the Texas Peer Assistance Program for Nurses.

What Are Nursing Peer Review and Safe Harbor Protections in Texas?

Texas nursing peer review provides a structured process for examining nursing practice concerns. It is intended to support professional accountability, patient safety, and fair review of nursing conduct.

Texas law recognizes incident-based nursing peer review and safe harbor nursing peer review. These processes serve different purposes.

What Is Incident-Based Nursing Peer Review?

Incident-based nursing peer review (IBPR) is used to evaluate nursing conduct or practice that has been called into question. It may be initiated by a facility or other entity under applicable law and BON rules.

Texas Occupations Code Chapter 303 establishes requirements for nursing peer review committees. An employer must establish a committee for vocational nurses if it regularly employs, hires, or contracts for the services of eight or more nurses, and for professional nurses if it regularly employs, hires, or contracts for eight or more nurses, at least four of whom are RNs. Employers may contract with another entity to conduct peer review.

What Is Safe Harbor Nursing Peer Review?

Safe Harbor nursing peer review allows an LVN, RN, or APRN to request review when asked to accept an assignment or engage in conduct that the nurse believes in good faith could violate the NPA, BON rules, or the nurse’s duty to a patient.

When properly invoked, Safe Harbor provides protections against BON licensure discipline and employer retaliation, as established by law.

Key points include:

• Safe Harbor must be invoked before engaging in the assignment or conduct at issue.
• A nurse may invoke it when an initial assignment changes during the work period.
• The initial request must generally be in writing. If immediate patient care needs prevent that, the nurse may invoke Safe Harbor orally and the supervisor must document the request. A comprehensive written request is due before the nurse leaves the work setting at the end of the work period.
• Safe Harbor is a formal peer review process with documentation requirements, not an informal objection to an assignment.

Safe Harbor may be relevant when a nurse believes staffing, patient acuity, an assignment, or a requested action could create an unsafe or unlawful situation.

The BON provides forms and instructions through its Safe Harbor Nursing Peer Review resources. Nurses should familiarize themselves with the process before a high-pressure situation arises.

Do Nurse Practitioners Have Full Practice Authority in Texas?

No. Texas is a restricted-practice state. NPs provide care within their APRN role and population focus, but prescribing and ordering medications and devices requires physician delegation through a written prescriptive authority agreement (PAA) under Texas Occupations Code Chapter 157.

Under Texas law, a PAA must include:

• A written agreement signed by the NP and the delegating physician
• Registration of the delegation with the Texas Medical Board (TMB) by the physician
• Regular meetings between the NP and physician, at least monthly, in a manner the physician determines
• Chart review, with the number of charts set by the NP and physician
• A limit of seven full-time-equivalent APRNs and PAs per delegating physician, with exceptions for certain medically underserved and facility-based practices

The BON regulates the NP’s license and scope. The TMB regulates the physician’s delegation. NPs must meet both. Terms and costs vary widely between physicians, and the lowest-cost arrangement can carry compliance risk. 

For a full breakdown, see our guide to collaborating physician requirements in Texas.

What Texas BON Rules Apply to Prescriptive Authority and Controlled Substances?

Texas APRNs must follow specific requirements when prescribing medications. The BON regulates APRN licensure and prescriptive authority, while physician delegation, pharmacy regulations, and federal controlled-substance laws may also apply.

For NPs, this means prescribing authority should be verified against the NP’s credentials, the applicable delegation arrangement, and the medication involved. The delegating physician registers the delegation with the Texas Medical Board (TMB) and signs a written prescriptive authority agreement with the NP.

What Should Texas NPs Know About Controlled-Substance Prescribing?

Texas permits physician-delegated APRN prescribing of certain controlled substances, subject to statutory restrictions. Schedule III–V prescribing is subject to limits, including a 90-day prescription period and consultation requirements for refills beyond the initial 90-day supply and for pediatric prescribing.

Schedule II prescribing is restricted to qualifying hospital facility-based practice or hospice circumstances. NPs must verify that the applicable delegation, practice setting, and DEA registration support the prescribing activity.

APRNs who prescribe controlled substances must also comply with applicable Texas Prescription Monitoring Program (PMP) requirements and federal DEA rules.

Because controlled-substance requirements can be highly specific, NPs should consult the current BON, Texas State Board of Pharmacy, and DEA guidance before prescribing or changing prescribing workflows.

What Texas BON Rules Apply to Telehealth and Multistate Nursing Practice?

Nurses providing telehealth must follow the licensing laws of the state where the patient is located. Texas APRNs have no multistate license, so an NP treating patients in another state needs an APRN license in that state.

A virtual practice model does not change Texas requirements for APRN scope of practice or delegated prescriptive authority. Telehealth NPs still need a valid prescriptive authority agreement, appropriate documentation, protection of patient information, and the same standard of care as in-person visits. Review BON guidance and applicable state and federal rules before expanding across state lines.

How Can NPs and Healthcare Organizations Stay Compliant With Texas BON Rules?

For NPs and healthcare organizations, compliance is an ongoing responsibility. A practical compliance process should account for licensure, continuing education, scope of practice, delegation, documentation, and any requirements specific to the clinical setting.

We recommend focusing on a few core practices:

• Track license and certification renewals. Maintain a calendar for RN and APRN renewals, national certification deadlines, and required continuing education, and upload CE documentation to the BON’s tracking system before each renewal.
• Review scope and delegation. Confirm that clinical responsibilities, delegated tasks, and prescribing activities align with applicable laws and rules.
• Maintain accurate documentation. Keep records that support clinical decisions, delegation, required meetings, and quality assurance activities
• Train staff on patient safety and peer review. Make sure nurses understand the appropriate processes for raising concerns, including Safe Harbor.
• Review regulatory updates. Monitor official BON announcements, rule changes, and relevant legislative updates.
• Seek legal guidance when needed. Complex practice structures, delegation arrangements, disciplinary matters, and multistate operations may warrant review by qualified healthcare counsel.

The Texas BON’s official website should be the starting point for current rules, practice guidance, and regulatory updates.

How CollabDocs Supports NPs and PAs Navigating Texas Regulations

As a team of NPs and PAs, we understand that navigating Texas BON requirements can be challenging, particularly when you’re also building a practice, managing patients, and handling the business side of healthcare.

At CollabDocs, we help NPs and PAs connect with collaborating physicians who align with their clinical needs and practice goals. Our team supports the collaboration process, including physician matching, agreement coordination, and physician collaboration malpractice insurance.

We’ve helped more than 7,500 NPs and PAs, and we guarantee a match with a collaborating physician in 14 days or less.

If you’re a Texas NP or PA looking for a collaborating physician, we’re here to help you understand your options and take the next step.

Ready to find a collaborating physician? Get a free quote from CollabDocs.

References

The following official resources provide the statutory, regulatory, and practice guidance discussed in this article.

• Texas Legislature. Texas Occupations Code, Chapter 301: Nursing Practice Act
• Texas Legislature. Texas Occupations Code, Chapter 303: Nursing Peer Review
• Texas Legislature. Texas Occupations Code, Chapter 157: Authority of Physician to Delegate Certain Medical Acts
• Texas Board of Nursing. Rules and Regulations: 22 Texas Administrative Code, Part 11, Chapters 211, 213, 216, 217, 221, and 222
• Texas Board of Nursing. Continuing Nursing Education and Competency Requirements
• Texas Board of Nursing. CNE Tracking Information
• Texas Board of Nursing. Advanced Practice Registered Nurse Application
• Texas Board of Nursing. Nursing Peer Review: Incident-Based and Safe Harbor
• Texas Board of Nursing. Safe Harbor Forms
• Texas Nurses Foundation. Texas Peer Assistance Program for Nurses (TPAPN)
• Texas Board of Nursing. APRN Practice FAQs
• Texas State Board of Pharmacy. Texas Prescription Monitoring Program

Disclaimer: This article is intended for educational purposes only and does not constitute legal or regulatory advice. Texas nursing laws and regulations may change. Always verify current requirements with the appropriate licensing board and consult qualified legal counsel regarding your specific practice.