The Framework
Section summaryTexas nursing regulation is layered: statute (Occupations Code Chapter 301), rules (22 TAC Chapter 217), interpretive guidance (position statements), and clinical context (employer policies, evidence-based practice, professional standards).
The hierarchy matters for discipline. A nurse cannot defend conduct that violated §217.11 by pointing to compliance with a hospital policy that contradicted the statute. Conversely, a hospital policy more restrictive than §217.11 does not expand BON disciplinary jurisdiction beyond what the statute and rules authorize.
Within this framework, three role-specific scopes are most heavily litigated: RN, LVN, and APRN. Each scope reflects the educational preparation, the licensure requirements, and the historical division of nursing labor in Texas.
RN Scope
Section summaryThe Registered Nurse provides comprehensive nursing assessments, plans care, executes interventions, and evaluates outcomes. The RN can perform any nursing function within the scope of the license.
Occupations Code §301.002 defines professional nursing. The RN scope includes:
- Comprehensive assessment of the health status of patients.
- Identification of nursing diagnoses.
- Planning, implementing, and evaluating nursing care.
- Administering medications and treatments prescribed by an authorized provider.
- Supervision of LVN and unlicensed assistive personnel within the framework of delegation.
- Patient education and counseling.
- Acts requiring substantial specialized judgment and skill based on knowledge of biological, physical, and behavioral science.
LVN Scope
Section summaryThe Licensed Vocational Nurse provides nursing care under the direction of an RN, an advanced practice nurse, a physician, a physician assistant, a podiatrist, or a dentist. The LVN scope is narrower than the RN scope.
Occupations Code §301.002 defines vocational nursing. The LVN scope includes:
- Performing focused nursing assessments (not the comprehensive assessment of the RN).
- Implementing the nursing plan of care developed by the RN.
- Administering medications and treatments prescribed by an authorized provider.
- Contributing to evaluation of patient outcomes.
- Performing functions specifically authorized under the supervision of an RN, APRN, physician, PA, podiatrist, or dentist.
The LVN does not develop the nursing plan of care, does not perform comprehensive assessments, and does not supervise other LVNs except in limited contexts.
APRN Scope
Section summaryAdvanced Practice Registered Nurses (CRNA, CNM, CNS, NP) practice under role- and population-specific scopes with prescriptive authority delegation framework. APRN regulation includes both the RN license and the APRN licensure.
The four APRN roles are: Certified Registered Nurse Anesthetist (CRNA), Certified Nurse-Midwife (CNM), Clinical Nurse Specialist (CNS), and Nurse Practitioner (NP). Each role is further specified by population focus (e.g., Family Nurse Practitioner, Adult-Gerontology Acute Care NP). Scope is defined by the role-and-population combination and by the Board's APRN rules.
APRN prescriptive authority in Texas operates through a physician delegation framework (Occupations Code Chapter 157). The APRN does not have independent prescriptive authority; the prescription is issued under the authority of a delegating physician under a prescriptive authority agreement.
Delegation
Section summaryDelegation rules at 22 TAC Chapter 225 govern what an RN can delegate to unlicensed personnel. The RN remains responsible for the delegation decision and for ongoing supervision.
Delegation framework:
- Only an RN can delegate nursing tasks to unlicensed assistive personnel.
- The RN must assess the patient, evaluate the unlicensed person's competence, and determine that the task is appropriate for delegation.
- Some acts cannot be delegated (e.g., comprehensive nursing assessment, formulation of the plan of care, evaluation of nursing care, judgment-based interventions).
- The RN remains responsible for delegated tasks and must supervise.
Inappropriate delegation is a discrete violation under §217.11 and a common subject of standard-of-care complaints.
Position Statements
Section summaryThe Board publishes position statements that interpret the standards and address specific situations (e.g., "Role of LVN in Hospice Care", "Delegated Medical Acts"). Position statements are persuasive authority in discipline.
Position statements are the Board's official interpretation of the standards as applied to specific contexts. They do not have the force of rule, but the Board treats them as authoritative guidance. Common position statements relevant to discipline include those addressing medication administration, scope-of-practice questions, supervision and delegation, prescriptive authority, telephone orders, and verbal orders.
Counsel defending a standards-of-care complaint will identify the position statements applicable to the conduct and frame the defense in terms of compliance with — or, if the conduct was outside scope, justification for — the published standard.
Evaluation of Complaints
Section summaryStandards-of-care complaints are evaluated against §217.11, the relevant position statements, the scope for the nurse's license, and the clinical context. The evidentiary standard is preponderance.
The Board's review of a standards-of-care complaint asks: What was the standard applicable to this nurse, at this license level, performing this task? Did the nurse meet that standard? If not, what is the explanation, and what does the explanation say about fitness to practice?
Mitigation matters. A medication error caused by chronic understaffing and forced overtime sits differently from a medication error following a documented refusal to follow established procedures. The Board considers context, patterns, prior history, and remediation.
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Call (972) 370-5060 →The Texas Nursing Practice Act framework
The Texas Nursing Practice Act is codified at Texas Occupations Code Chapter 301 and establishes the legal framework for nursing practice in Texas. The statute defines the practice of nursing, establishes the Board of Nursing as the regulatory body, specifies the requirements for licensure, and provides the disciplinary framework for licensees. The Act is supplemented by extensive Board rules at 22 Texas Administrative Code Chapter 211 through Chapter 226 that elaborate on specific aspects of practice and regulation.
The Act applies different standards to different categories of nursing licensure. Registered nurses (RNs) practice under standards specified for RN practice. Licensed vocational nurses (LVNs) practice under standards specified for LVN practice. Advanced practice registered nurses (APRNs) practice under enhanced standards including additional educational and certification requirements. Each category has its own scope of practice and standards of care that govern the licensee professional obligations.
The standards of care framework draws on multiple sources including the Nursing Practice Act and Board rules, professional standards published by national nursing organizations, evidence-based practice guidelines, institutional policies and procedures, and the customary practice of the profession. The applicable standards in any specific case depend on the practice setting, the patient population, the nurse role, and the specific clinical situation. The defense in standards-of-care cases must identify the specific applicable standards and the basis for them.
The scope of practice analysis and the role-specific standards
The scope of practice analysis is central to many BON disciplinary cases. The Board considers whether the nurse practiced within the scope authorized for the specific licensure category and whether the nurse engaged in activities that exceeded the scope. Practicing beyond the scope of authorization can produce disciplinary action regardless of whether the practice was clinically appropriate, because the unauthorized scope is itself a violation of the Practice Act.
The role-specific standards depend on the nurse practice category and the specific role within that category. RN standards include independent assessment, planning, intervention, and evaluation of nursing care, with delegation authority to other categories of providers. LVN standards include focused assessment, intervention, and evaluation under the supervision of an RN, physician, or other authorized provider. APRN standards include advanced assessment, diagnosis, treatment planning, and prescribing within specialty certification.
The delegation framework under Board Rule 217.11 specifies the requirements for RN delegation of nursing tasks to other categories of providers. The delegation analysis considers whether the task is delegable, whether the delegee has the capacity to perform it, whether appropriate supervision is in place, and whether the patient situation is appropriate for delegation. Delegation errors can produce discipline against both the delegating RN and the receiving provider, and the defense should carefully analyze the delegation chain in cases involving alleged delegation issues.
The standards of care in specific practice contexts
The standards of care vary substantially by practice setting and patient population. Acute care hospital nursing involves standards that reflect the high-acuity patients, multiple concurrent interventions, and complex care coordination typical of hospital settings. Long-term care nursing involves standards that reflect the chronic conditions, polypharmacy concerns, and quality-of-life considerations typical of nursing home settings. Home health nursing involves standards that reflect the independent practice, episodic patient contact, and home environment considerations of community-based care.
Specialty practice areas have additional standards specific to the patient population and the clinical interventions involved. Critical care, emergency, pediatric, obstetric, psychiatric, oncology, and other specialty areas all have professional standards published by national specialty organizations that supplement the general nursing standards. The defense in cases involving specialty practice should identify the specialty-specific standards and should evaluate whether the nurse conduct met those standards in addition to the general standards.
The institutional policies and procedures of the employer also affect the standards of care analysis. Hospitals, nursing homes, home health agencies, and other healthcare entities typically have written policies that specify the procedures for various clinical situations. The institutional policies often reflect or elaborate on the general professional standards, and adherence to institutional policy is typically considered evidence of compliance with the broader professional standards. The defense should obtain the applicable institutional policies and should evaluate the nurse conduct against both the policies and the broader standards.
Evidence and expert testimony in standards-of-care cases
The proof of standards of care in BON disciplinary cases typically depends on expert testimony. The Board designates an expert nursing witness who testifies about the applicable standards and the alleged deviations. The defense typically designates its own expert who provides alternative testimony about the standards and the conduct. The expert testimony shapes the fact-finder analysis of the underlying clinical situation and the appropriate response.
The defense expert selection is critical. The expert should have practice experience in the same setting, patient population, and clinical role as the respondent. The expert should be familiar with the applicable institutional and professional standards. The expert should be able to articulate the standards clearly and to apply them to the specific facts in a way that supports the defense position. The expert credibility depends on both the expert qualifications and the quality of the expert reasoning, and the defense should select experts who can perform effectively in both dimensions.
The documentary evidence in standards-of-care cases includes patient records, medication administration records, nursing notes, incident reports, and any other clinical documentation. The documentation can support or undermine the testimonial evidence depending on what it shows. The defense should carefully analyze the documentation for evidence supporting the respondent conduct and for any gaps or inconsistencies that affect the State case. The integrated presentation of expert testimony and documentary evidence is typically the most effective approach to standards-of-care cases.
Frequently Asked Questions
What does §217.11 actually require?
Can I be disciplined for following an unsafe order from a physician?
What is the difference between a standards-of-care complaint and an unprofessional conduct complaint?
Are position statements binding?
How does the Board handle a single error in an otherwise unblemished career?
Read the full Texas Nursing License Defense Guide
This article is one section of our comprehensive Texas Nursing License Defense Guide. The pillar guide covers recent developments, official resources, and the complete framework with deeper analysis.
Read the Pillar Guide →Next Steps
If you are facing a situation described here, consult counsel promptly. Many issues in this area run on strict deadlines.
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Cite this guide
Bluebook: Reggie London & Njeri London, Nursing Practice Act Standards of Care, L&L Law Group (May 30, 2026), https://landllawgroup.com/insights/nursing-practice-act-standards-of-care/.
APA: London, R., & London, N. (2026, May 30). Nursing Practice Act Standards of Care. L&L Law Group.