The Texas Board of Nursing (BON) serves as the regulatory authority overseeing nursing practice within the state, ensuring that nurses adhere to established professional standards. As a governing body, the BON derives its authority from the Texas Nursing Practice Act (NPA) and is responsible for rulemaking, licensure, enforcement, and discipline within the nursing profession. The Texas Administrative Code (TAC), Title 22, Part 11, further outlines the specific rules and responsibilities that govern registered nurses (RNs), licensed vocational nurses (LVNs), and advanced practice registered nurses (APRNs).

As nursing professionals, it is imperative that we have a firm grasp of these regulations, not only to maintain compliance but also to uphold the highest standards of patient care and professional ethics. Understanding the scope of practice, licensure requirements, continuing education mandates, and disciplinary procedures ensures that we operate within the legal framework while advocating for safe and effective nursing practice. This article provides a technical, in-depth examination of the Texas BON’s rules and regulations, offering insight into how they shape our daily practice and long-term career trajectory.

The NPA is the statutory foundation governing the nursing profession in Texas. It defines the legal scope of practice for RNs, LVNs, and APRNs and outlines the responsibilities, limitations, and protections for nursing professionals. The NPA is embedded within the Texas Occupations Code, Chapter 301, and grants the Texas BON the authority to enforce regulations, investigate complaints, and implement disciplinary actions.

One of the key provisions of the NPA is the scope of practice, which establishes the legal parameters within which a nurse can operate. For instance, LVNs work under delegated authority and must have supervision from an RN, APRN, physician, or dentist. RNs, in contrast, function independently within their scope but must adhere to standards of professional practice that include patient assessment, nursing diagnosis, planning, and evaluation. APRNs have an expanded scope that allows them to diagnose, treat, and prescribe medications, but this privilege is regulated through additional licensure and oversight requirements.

Additionally, the NPA establishes peer review requirements, safe harbor protections, and whistleblower safeguards, all of which are critical in maintaining professional integrity and protecting nurses from retaliation when advocating for patient safety.

The Texas Administrative Code (TAC), Title 22, Part 11, provides the regulatory details that bring the NPA’s statutory provisions into action. The TAC outlines licensing procedures, competency expectations, enforcement actions, and professional practice standards. The most critical sections include:

• Chapter 211 – General provisions, definitions, and BON authority
• Chapter 213 – Disciplinary procedures and enforcement guidelines
• Chapter 217 – Licensure rules, competency requirements, and standards of nursing practice

By understanding the TAC, nurses gain clarity on the precise operational guidelines that affect their daily responsibilities. This knowledge is especially critical when interpreting delegation rules, handling peer review requirements, or navigating disciplinary processes.

While the BON enforces nursing regulations, it does not create them in isolation. The Texas Legislature plays a critical role in shaping nursing law by passing new statutes or amending the NPA. Every two years, the Legislature convenes, during which time new bills may be introduced that can directly impact nursing practice. For instance, recent legislative updates have expanded APRN prescriptive authority, revised continuing education mandates, and introduced new safety protocols related to telehealth and controlled substances.

Nurses should stay informed about legislative changes because they can affect licensure, patient care responsibilities, and disciplinary risks. The BON is responsible for implementing these laws by adjusting its rules, and the process often involves public comment periods, allowing nursing professionals to voice their concerns or support.

Licensure is the gateway to professional nursing practice, and the BON establishes strict criteria to ensure that only competent and qualified individuals receive a nursing license. For RNs and LVNs, licensure is obtained through either examination or endorsement.

• Licensure by Examination – New nursing graduates must pass the NCLEX-RN (for RNs) or NCLEX-PN (for LVNs) to demonstrate competency.
• Licensure by Endorsement – Nurses licensed in another state can apply for a Texas license through the endorsement process, provided they meet Texas BON requirements.

APRNs, which include nurse practitioners (NPs), clinical nurse specialists (CNSs), nurse anesthetists (CRNAs), and nurse midwives (CNMs), must fulfill additional education, certification, and practice requirements.

• Educational Requirement – APRNs must hold a master’s or doctoral degree in their specialty.
• National Certification – APRNs must be certified by a recognized national certifying body.
• Prescriptive Authority – APRNs must obtain prescriptive authority from the BON if they intend to prescribe medications, which requires a collaborative agreement with a physician.

Texas APRN regulations are strict compared to other states, particularly in areas such as prescriptive authority and independent practice. Unlike some states where APRNs have full practice autonomy, Texas still requires a delegation agreement with a physician for prescribing controlled substances.

Texas is part of the Nurse Licensure Compact (NLC), which allows RNs and LVNs to hold a multistate license, enabling them to practice in other NLC-participating states without needing additional licenses. This is particularly beneficial for nurses who provide telehealth services or travel nursing.

However, APRNs are not covered under the NLC and must obtain separate licensure for each state in which they wish to practice.

• License Renewal – Nurses must renew their license every two years.
• Continuing Nursing Education (CNE) – Nurses must complete 20 contact hours of approved continuing education per renewal cycle.
• APRNs with prescriptive authority must complete an additional 5 contact hours in pharmacotherapeutics.

Failure to meet these requirements can result in license suspension, fines, or disciplinary action.

Scope of practice refers to the legally permissible tasks, interventions, and responsibilities that a nurse may perform. The Texas BON enforces a strict division of responsibilities among RNs, LVNs, and APRNs.

• LVNs – Perform basic nursing care, cannot independently initiate nursing interventions, and must always operate under supervision.
• RNs – Function independently within their scope, conduct patient assessments, develop care plans, and delegate to LVNs and unlicensed personnel.
• APRNs – Have a significantly expanded scope, including diagnostic evaluation, treatment planning, and medication prescription under a delegated practice agreement.

Texas imposes specific rules regarding nurse delegation, particularly when assigning tasks to unlicensed assistive personnel (UAPs) or LVNs.

• RNs can delegate certain tasks to LVNs and UAPs, provided the task is within the individual’s competence level.
• APRNs have broader delegation authority, particularly in clinical decision-making and prescribing.

Failure to follow delegation laws can result in disciplinary action against the delegating nurse.

The Texas Board of Nursing has the legal authority to investigate complaints, enforce disciplinary actions, and ensure compliance with Texas Nursing Practice Act) and Texas Administrative Code regulations. This authority extends to RNs, LVNs, and APRNs and is exercised to protect public safety by addressing violations of nursing standards.

Disciplinary actions can range from fines and reprimands to license suspension or revocation, depending on the severity of the offense. The BON follows a structured investigative process, ensuring that nurses are afforded due process rights before any disciplinary decision is made. The Board also operates within the broader Texas State Office of Administrative Hearings (SOAH) framework when handling contested cases.

The most frequent violations leading to BON investigations and potential disciplinary action include:

1. Unprofessional Conduct – Includes failure to maintain professional boundaries, breach of confidentiality, falsification of records, and unethical behavior.
2. Failure to Meet Standards of Care – Negligence, failure to follow protocols, and practicing outside the scope of practice.
3. Substance Use and Impairment – Drug or alcohol impairment while on duty, diversion of controlled substances, and failure to comply with the Texas Peer Assistance Program for Nurses (TPAPN).
4. Criminal Convictions and Background Violations – Felony or misdemeanor convictions directly related to nursing practice, such as fraud, abuse, or drug-related offenses.
5. Practicing Without a Valid License – Allowing licensure to lapse, practicing without required endorsements, or working under fraudulent credentials.

Each of these violations is evaluated based on intent, severity, patient harm, and previous disciplinary history. The BON’s disciplinary actions can include:

• Remediation and Continuing Education Requirements
• Fines or Administrative Penalties
• Probationary Status with Mandatory Reporting
• Suspension or Revocation of License

When a complaint is filed against a nurse, the Texas BON initiates a structured review process, which includes:

1. Initial Complaint Review – The Board determines whether the allegation falls within its jurisdiction.
2. Investigation – The nurse is formally notified, and evidence (witness statements, medical records, employment records) is collected.
3. Informal Settlement Process – The nurse may be offered an agreed order (settlement) before a formal hearing.
4. Formal Disciplinary Hearing – If no settlement is reached, the case proceeds to the State Office of Administrative Hearings.
5. Final Board Decision – The BON renders a final ruling and enforces disciplinary actions if necessary.

A nurse has the right to legal representation throughout this process and may appeal BON decisions through state court proceedings.

For nurses struggling with substance abuse, mental health disorders, or physical conditions that may impair their ability to practice safely, Texas offers the Peer Assistance Program for Nurses (TPAPN). This is a confidential, voluntary program designed to assist nurses in obtaining treatment and rehabilitation without immediate disciplinary action.

Nurses who voluntarily enter TPAPN before formal disciplinary proceedings may avoid license suspension, provided they comply with treatment, monitoring, and reporting requirements. However, noncompliance with the program’s stipulations can result in escalation to formal disciplinary action.

To maintain an active license, Texas nurses must fulfill continuing nursing education (CNE) requirements. These requirements ensure ongoing professional development and competency in clinical practice, patient safety, and regulatory compliance.

• RNs and LVNs must complete 20 contact hours of approved CNE every two years.
• APRNs with prescriptive authority must complete an additional 5 contact hours in pharmacotherapeutics.
• Certain specialty practice areas (e.g., forensic nursing, geriatric care) may require specific CNE topics.

The Texas BON recognizes multiple ways for nurses to meet their continuing competency requirements, including:

• Completion of BON-approved CNE courses.
• Academic coursework in nursing-related fields.
• Certification or recertification by a national nursing certification board.
• Authorship of published peer-reviewed nursing articles or textbooks.
• Active practice hours in an approved healthcare setting.

Failure to meet CNE requirements may result in license renewal denial or disciplinary action.

Texas law mandates Nursing Peer Review Committees (NPRCs) for healthcare facilities that employ 10 or more nurses. The purpose of peer review is to evaluate nursing practice, uphold professional standards, and determine whether disciplinary actions should be taken against a nurse.

There are two main types of peer review:

1. Incident-Based Peer Review (IBPR) – Evaluates cases where a nurse’s conduct or practice is called into question.
2. Safe Harbor Peer Review (SHPR) – Allows nurses to request protection from discipline when asked to engage in potentially illegal, unethical, or unsafe practice.

Safe Harbor provisions protect nurses from retaliation, termination, or licensure discipline when they refuse assignments or actions that violate nursing standards or laws. Nurses invoking Safe Harbor must follow BON Rule 217.20, which includes:

• Submitting a written Safe Harbor request before engaging in the assignment.
• Documenting concerns related to patient safety, staffing, or unlawful orders.
• Awaiting a peer review determination regarding the safety and legality of the assignment.

Nurses who properly invoke Safe Harbor are legally shielded from retaliatory employment actions and BON disciplinary measures.

Texas imposes strict regulations on APRNs with prescriptive authority. Prescriptive privileges require:

• Delegation from a collaborating physician.
• Registration with the Texas Prescription Monitoring Program (PMP) for controlled substance prescriptions.
• Compliance with federal DEA regulations.

APRNs must follow specific limits on Schedule II medications, and failure to adhere to prescriptive oversight rules can result in disciplinary action or loss of prescriptive authority.

With the expansion of telehealth services, the Texas BON has developed regulations governing nursing practice across state lines. While Texas participates in the Nurse Licensure Compact (NLC), APRNs still require individual licensure in each state where they practice.

Telehealth nurses must comply with state privacy laws, informed consent requirements, and telemedicine standards. Violations, such as practicing across state lines without proper licensure, can result in disciplinary action.

Healthcare organizations must ensure compliance with Texas BON regulations to mitigate legal risks and liability. Best practices include:

• Annual nursing compliance audits to ensure adherence to state laws.
• Mandatory staff training on BON rules, Safe Harbor protections, and delegation guidelines.
• Legal counsel consultation for complex regulatory matters.

Failure to implement these strategies exposes organizations to fines, liability claims, and patient safety violations.

As nursing professionals, we must continuously engage with Texas BON regulations to maintain compliance, uphold professional integrity, and advocate for safe, ethical nursing practice. Given the evolving nature of healthcare law, telemedicine, and prescriptive authority, staying informed about regulatory changes is essential for career longevity and patient safety.

Understanding and adhering to these rules and regulations not only safeguards our licenses but also enhances the quality of care provided to patients across Texas.

Navigating Texas Board of Nursing regulations, particularly when it comes to licensure, collaborative agreements, and scope of practice, can be a challenging process for nurse practitioners and physician assistants (PAs) seeking independence in their careers. One of the most complex aspects of Texas nursing law is the requirement for APRNs to establish a formal collaborating agreement with a supervising physician to obtain prescriptive authority and expand their scope of practice. This requirement can create significant barriers for NPs looking to provide high-quality, autonomous care.

At Collaborating Docs, we specialize in removing these obstacles by connecting NPs and PAs with qualified collaborating physicians across the United States, including those practicing in Texas. Founded by Dr. Annie DePasquale, a seasoned Family Medicine physician, we understand the difficulties faced by NPs in securing compliant collaborative agreements, which are essential for legally practicing and prescribing medications under Texas BON rules. Our team ensures that every NP and PA is matched with the right collaborating physician within 14 days, eliminating the administrative burden and allowing clinicians to focus on patient care rather than legal complexities.

We don’t just facilitate connections—we handle the legalities, compliance, and malpractice insurance for physicians so you can confidently step into your independent practice without worrying about regulatory roadblocks. Our expert team, which includes experienced NPs and legal professionals, stays up to date on state-specific nursing laws, ensuring that every collaboration we facilitate meets the latest Texas BON requirements. Whether you’re an individual NP or an organization seeking a solution for your workforce, we provide tailored support to make the process seamless and stress-free.

If you’re an NP or PA navigating Texas BON regulations and seeking the right collaborating physician, let Collaborating Docs take care of the process for you. Join the 5,000+ NPs/PAs we’ve already helped—so you can focus on what matters most: providing exceptional patient care.