BON Differentiated Essential · PDF fileDifferentiated Essential Competencies (DECs) of...

Differentiated Essential Competenciesof Graduates of Texas Nursing Programs

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Differentiated Essential Competencies (DECs)of Graduates of Texas Nursing Programs

Evidenced By Knowledge, Clinical Judgments, andBehaviors

Vocational (VN)Diploma/Associate Degree (Diploma/ADN)

Baccalaureate Degree (BSN)(2010)

Published bythe

Texas Board of Nursing2011

Table of Contents

Introduction..........................................................................................vHistory and Methodology................................................................vCompetencies..............................................................................viiEffectiveness of the 2002 DELC andTransition to the DECs.....................................................................viiiValues and Ethics in Nursing...........................................................viiiImplications................................................................................ix

Executive Summary...........................................................................xBackground.................................................................................xPurpose......................................................................................xDefinition of Competency...............................................................xOutline of the DECs.........................................................................xImplications of the DECs..................................................................xi

Vocational Nursing Education................................................................1Essential Competencies of Graduates of Texas

Vocational Nursing Education Programs........................................3Diploma and Associate Degree Nursing Education...............................5Essential Competencies of Graduates of Texas Diploma

and Associate Degree Nursing Education Programs........................7Baccalaureate Degree Nursing Education.............................................9Essential Competencies of Graduates of Texas Baccalaureate

Degree Nursing Education Programs..........................................11

Texas Board of Nursing Differentiated Essential Competencies......13-89Member of the Profession............................................................19Provider of Patient-Centered Care................................................31Patient Safety Advocate................................................................62Member of the Health Care Team..................................................72

Glossary............................................................................................................91References..................................................................................................................93Implementing the DECs........................................................................96

Appendices...............................................................................99-105Appendix A - Committee Members................................................99Appendix B - Survey Respondents - Nursing

Education Programs...........................................................101Appendix C - Survey Respondents- Clinical

Affiliating Agencies.......................................................103Appendix D - Employer Focus Groups

for DECs......................................................................105

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Introduction

Differentiated Essential Competencies of Graduatesof Texas Nursing Programs Evidenced by

Knowledge, Clinical Judgments, and Behaviors2010

Nursing practice in Texas by licensed nurses flows along a scope of practicecontinuum based upon educational preparation from the LicensedVocational Nurse (LVN) to the doctorally prepared Registered Nurse (RN).While selected aspects of nursing care may be assigned or delegated bylicensed practicing nurses to ancillary persons such as nursing assistantsor aides, LVNs and RNs currently form the core in the roles identified asmembers of the profession, providers of patient-centered care, patientsafety advocates, and members of the health care team.

Basic educational preparation for the LVN examination is provided at thevocational level in Texas Board of Nursing (BON or Board) approvedprograms in community colleges, hospitals, career schools, and themilitary. Educational preparation for the RN licensure examination maybe obtained through Texas BON approved diploma, associate degree, andbaccalaureate degree programs (including generic master’s degreeprograms). Each of these programs provides the necessary preparationfor practice as a registered professional nurse. The curricula of each ofthe nursing programs differ and the outcomes of the educational levelsdictate a differentiated set of essential competencies of graduates. Thecompetency statements describe progression in expected behaviors acrossthe types of programs from vocational nursing (VN) to diploma andassociate degree nursing (ADN) to baccalaureate degree nursing (BSN).The competencies of each educational level build upon the previous level.

History and Methodology

On January 20, 2000, the then Board of Nurse Examiners (BNE) chargedthe Advisory Committee on Education (ACE) to review and revise theoriginal competency document, the Essential Competencies of TexasGraduates of Education Programs in Nursing (BNE, 1993). The Board ofVocational Nurse Examiners (BVNE, later merged with the BNE) conducteda parallel process to survey vocational programs for review and revisionof the VN competencies and then joined the ACE to finalize the process.

ACE instituted a subcommittee which included six nurses who representedDiploma, ADN, and BSN education in addition to Texas League for Nursing(TLN) and Texas Organization of Nurse Executives (TONE) members whorepresented nursing practice. This subcommittee met August 9, 2000 tobegin the process of review and revision. The subcommittee analyzed theEssentials of Baccalaureate Education (American Association of Collegesof Nursing, 1998) and the Educational Competencies for Graduates ofAssociate Degree Nursing Programs (National League for Nursing, 2000)

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and found that the original 14 competencies in the Texas document wereconsistent with these two publications. The subcommittee also recognizedthat over the preceding seven years, schools of nursing used the 14 corecompetencies in various ways, one of which was to revise course objectivesand outcome statements. The revised document was approved in 2002.

At the July 17-18, 2008 meeting of the Texas BON, the Board charged theACE to review and revise the 2002 Differentiated Entry Level Competencies(DELC). This was the first review and revision after the merger of the BVNEand BNE in 2004. Following the methodology used for the 2002 revision,ACE appointed a DELC Work Group to lead the revision process. Membersof the DELC Work Group represented VN, Diploma, ADN, and BSNeducation; vocational and professional nursing practice; the LicensedVocational Nurses Association of Texas (LVNAT); the Texas NursesAssociation (TNA); and the Texas Organization of Nurse Executives (TONE).Through meetings and telephone conference calls over a period of about20 months, the work group revised the DELC, changing the title to theDifferentiated Essential Competencies (DECs) and expanding the threenursing roles to four.

The four roles are listed with a brief rationale for the change:

$ Member of the Profession: listed as primary role tofocus on the profession

$ Provider of Patient-Centered Care: a change in currentliterature from “client” to “patient”, emphasizingpatient-centered care

$ Patient Safety Advocate: based upon new concernsabout patient safety

$ Member of the Health Care Team: relates to the nurse’sparticipation in the health care team

The core competencies were increased from 14 in the DELC to 25 in theDECs with an increasing focus on patient safety. All competencies wereupdated using current literature, national standards, and research (e.g.,the Quality and Safety Education for Nurses Competencies, the Instituteof Medicine Reports, the Carnegie Report), and incorporated new focusconcepts including safety, advocacy, patient-centered care, evidence-basedpractice, and informatics. The 25 core competencies fall under the fournursing roles and are further delineated into a series of more specificexpected clinical judgments and behaviors related to each corecompetency. These more detailed competencies are preceded by thenecessary content (or knowledge) needed as a basis for competencydevelopment. The knowledge statements indicate the student learningneeds during the educational experience; the content determines thesubject matter to be taught. The knowledge should provide the tools tothe student for critical thinking and reflection in clinical decision-makingfor safe, compassionate, and effective patient care. The program of studyprepares the students (and graduates) with a knowledge base to makesound clinical judgments for their nursing behaviors and interventions.

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The revised competencies were distributed to all Texas BON approvednursing programs for comments in September 2009. ACE members andBoard staff presented information about the revised document to deans,directors, and coordinators at meetings of the vocational and professionalprogram directors. Comments and responses were considered as furtherrevisions of the document continued. The revised document wasdisseminated to affiliating agencies (including long term care, hospitals,and public health settings) and other stakeholders during the spring andsummer of 2010. The final revision of the DECs was presented to the Boardfor adoption at the October 2010 meeting. Programs will beginimplementation during the 2011-2012 academic year.

Competencies

The competencies are written to guide nursing programs to meet theapproval criteria established by the BON and to ensure that programsprepare graduates to provide safe, competent care to the people of Texas.A competency is described as “an expected level of performance thatintegrates knowledge, skills, abilities, and judgment” (American NursesAssociation, 2008, p. 3).

Competencies were designed to demonstrate the progression ofexpectations across the types of nursing programs based upon educationalpreparation. It is acknowledged that it may be impossible to evaluatestudents’ abilities on some of the competencies since new graduates willgrow from novice to advanced beginner as they transition into practice(Benner, 1984; National Council of State Boards of Nursing, 2006). It isexpected that the education should have prepared the graduate with abackground to demonstrate these advanced competencies which areitalicized and identified by an asterisk in the document. All of thecompetencies may be utilized to develop curriculum.

There may seem to be redundancy in the competencies within the DECsbut the redundancy is intentional. The document was designed so thatsections related to a specific competency or educational level could beseparated and could stand alone from the larger document. Mostcompetencies build across educational levels and yet some of thecompetencies are the same across levels. For example, a general highlevel of safety is expected across all levels of nursing practice.

The scope of nursing practice for which the student is being prepared isreflected in the competencies. The scope of practice defines the extent ofthe provision of care within each level of educational preparation. Patientsfor the LVN are individuals in the context of their families; patients for thediploma graduate or the ADN are individuals and their families; andpatients for the BSN are individuals, families, populations, andcommunities. Rule 215 lists specific content areas for BSN programs:research, community, and leadership, all of which affect scope of practice.

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In addition to the DECs being used for curriculum development, the DECsmay also be used in the practice area to assist employers in developingorientation and internship programs, establishing career ladders,determining entry level competencies, determining job descriptions, andreviewing and revising policies and procedures.

Effectiveness of the 2002 DELC and Transition to the DECs

Texas programs have used the competencies since 1993 and haveexperienced a statewide NCLEX examination pass rate above the nationalaverage. The DELC could be viewed as a type of core curriculum for nursingprograms in Texas and established the framework for the preparation ofsafe, competent nursing graduates. The DELC provided guidelines forcurriculum development and evaluation, as well as benchmarks forprogram effectiveness. The new document will continue to provide acommon core competency statement for all Texas BON approved nursingprograms; provide guidelines for curriculum development, benchmarking,and evaluation; and support the mission of the BON to protect the publicand ensure safe, competent nursing graduates.

Values and Ethics in Nursing

Through the educational process, students are provided the necessaryexperiences to develop the knowledge, behaviors, and skills expected ofpracticing nurses. In addition, the clinical judgments of the nurse areguided by various values and beliefs about oneself and society. It isrecommended that nursing educators strive to foster commitment to thefollowing values and ethical principles believed to be inherent to thenursing profession:

1) Altruism - Concern for the welfare of others seen through caring,commitment, and compassion

2) Human Dignity - Belief in the inherent worth and uniqueness of theindividual seen through respect, empathy, humanness, and trust

3) Truth - Faithfulness to fact seen through honesty, accountability, andauthenticity

4) Justice - Upholding moral and legal principles seen through courage,advocacy, and objectivity

5) Freedom - Capacity to exercise choice seen through openness, self-direction, and self-discipline

6) Equality - Having the same rights and privileges seen throughacceptance, tolerance, and fairness

7) Esthetics - Identifying the qualities of objects, events, and personsthat provide satisfaction as seen through creativity, sensitivity, andappreciation

Values and beliefs about oneself and society guide the clinical judgmentsof the nurse. To act as a moral agent and to advocate on behalf of patients,the nurse must be sensitive to ethical issues inherent in health care settingsand health care policies. Through the educational process, students clarify

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personal and professional values and develop the knowledge, judgments,behaviors, and skills expected of nurses practicing ethically.

Professional values are enduring beliefs or ideals that guide practitionersand serve as a framework for professional decisions and action. Thesevalues are the foundation for moral standards of right and wrong,established in accordance with the profession’s norms and traditions. Asa practice discipline, nursing’s fundamental value is caring, growing fromaltruism — a concern for the well-being of others. Caring, as a humanendeavor, places demands on the character, knowledge, judgments,behaviors, and skills of the nurse. A nurse’s first moral obligation is to bea competent practitioner.

Nursing ethics offer general moral principles and rules to address potentialand actual ethical issues arising within the health care encounter. Thissystem of valued beliefs and behaviors (identified as rights, duties, andobligations as well as good professional character) guides the conduct ofnurses. A code of ethics for nursing embodies the profession’s centralvalues and standards of conduct, reflecting nursing’s responsibility tosociety and its collegial solidarity. The code provides the framework fordecision-making for the profession and the parameters of professionalintegrity. Violation of the code’s professional standards may result indisciplinary action.

Implications

This document has the potential to add clarity and consistency to educationoutcomes. It may be used by nursing programs to review curricula throughcontent mapping for evidence that knowledge, clinical judgments andbehaviors, and skills of new graduates are relevant and consistent withthe education program. This document provides a foundation for the state’snursing educational programs to design seamless articulation plans foreducation mobility and for employers to create differentiated jobdescriptions for entry-level nursing practice.

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Executive Summary

Differentiated Essential Competenciesof Graduates of Texas Nursing Programs

Evidenced by Knowledge, Clinical Judgments,and Behaviors

2010

Background:

The Differentiated Essential Competencies (DECs) is the third generationof Texas Board of Nursing (BON or Board) education competencies withdifferentiation based upon the education outcomes of the three levels ofprelicensure nursing education programs. Previous documents wereapproved in 2002 (Differentiated Entry Level Competencies) and 1993(Essential Competencies). All revisions were developed within the BONAdvisory Committee for Education (ACE) with input from nursing programs,nursing organizations, affiliating agencies, employers, and otherstakeholders. The 2010 revision incorporates concepts from currentliterature, national standards, and research.

Purpose:

The DECs were designed to provide guidance to nursing educationprograms for curriculum development and revision and for effectivepreparation of graduates who will provide safe, competent, compassionatecare. The DECs outline knowledge, clinical behaviors, and judgmentsnecessary to meet the essential competencies, but it is acknowledged thatnot all competencies can be evaluated upon graduation. It is intendedthat the graduate will have received the educational preparation todemonstrate each competency, but it will not be reasonable to evaluatesome advanced competencies (italicized and identified by an asterisk) untilthe nurse has transitioned into nursing practice.

Definition of Competency:

The American Nurses Association (2008) defined a competency as “anexpected level or performance that integrates knowledge, skills,abilities, and judgment” (p. 3).

Outline of the DECs:

Twenty-five core competencies are categorized under four main nursingroles:$ Member of the Profession$ Provider of Patient-Centered Care$ Patient Safety Advocate$ Member of the Health Care Team

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Each core competency is further developed into specific knowledge areasand clinical judgments and behaviors based upon the knowledge areas.Redundancy is intentional so that all sections of the document arecomplete even as stand-alone documents. Competencies for each levelof educational preparation are presented in a table format. Thecompetencies are differentiated and progressive across the levels, andthe scope of practice and expectations may be compared across the table.

Implications of the DECs:

Nursing Education:$ Guideline and tool for curriculum development and revision$ Tool for benchmarking and evaluation of the program$ Statewide standard to ensure graduates will enter practice as

safe and competent nurses

Employers:$ Guide for development of employee orientation and internship

programs$ Guide for job descriptions and career ladders$ Information for determining entry-level competencies$ Information for reviewing and revising policies and procedures

for nursing care

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Texas Board of NursingVocational Nursing Education

The curriculum for vocational nursing (VN) education is delivered in aclinically intensive certificate program of approximately one year inlength. The Texas Board of Nursing (BON or Board) education rules forVN programs require a minimum of 558 theory and 840 clinical hours,although most programs include more than the total 1,398 hours. VNeducation is provided in community colleges, hospital settings, careerschools, and the military.

The BON approved curriculum includes requirements for instruction inthe five basic areas of nursing care: (1) adults; (2) mothers and newborns;(3) children; (4) elderly; and (5) individuals with mental health problems.The initial clinical instruction takes place in the skills and simulationlaboratories, progressing to faculty supervised, hands-on clinicalexperiences in health care agencies. Clinical experience in a unit or facilityspecifically designed for psychiatric care is optional.

Required support courses should provide instruction in biological, physical,social, behavioral, and nursing sciences, including body structure andfunction; microbiology; pharmacology; nutrition; signs of emotionalhealth; human growth and development; vocational adjustments; andnursing skills. Content may be integrated within the core nursingcurriculum or may be taken as stand-alone courses. With advances ineducation and practice, programs may include content in the use oftechnology and informatics through learning experiences in the clinicalpractice arena, simulated practice, and skills laboratories.

All levels of prelicensure nursing education prepare graduates todemonstrate the Differentiated Essential Competencies of Graduates ofTexas Nursing Programs Evidenced by Knowledge, Clinical Judgments,and Behaviors (DECs). The competencies for each educational level arebased upon the preparation in the program of study. Licensure to practiceis issued by the BON to individuals who pass the National CouncilLicensure Examination for Practical Nurses (NCLEX-PN7). Qualifiedgraduates of VN programs, who have completed all aspects of theapplication for examination, typically receive a temporary permit topractice under direct supervision for a 75-day period while awaitingtesting and licensure.

The entry-level graduate of a VN program provides nursing care within adirected scope of practice under appropriate supervision. The vocationalnurse uses a systematic problem-solving process in the care of multiplepatients with predictable health care needs to provide individualized, goal-directed nursing care. The vocational nurse contributes to the plan of careby collaborating with interdisciplinary team members and with thepatient’s family. The new graduate can readily integrate technical skillsand use of computers and equipment into practice.

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Educational opportunities exist for Licensed Vocational Nurses (LVNs) toarticulate into professional nursing programs. Vocational nursingrepresents the beginning level of the nursing practice continuum in theroles of Member of the Profession, Provider of Patient-Centered Care,Patient Safety Advocate, and Member of the Health Care Team. The entry-level competencies of the VN graduate are listed on the following pages:

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Essential Competencies of Graduates of TexasVocational Nursing Educational Programs

I. Member of the Profession:

A. Function within the nurse’s legal scope of practice and inaccordance with the policies and procedures of the employinghealth care institution or practice setting.

B. Assume responsibility and accountability for the quality ofnursing care provided to patients and their families.

C. Contribute to activities that promote the development andpractice of vocational nursing.

D. Demonstrate responsibility for continued competence innursing practice, and develop insight through reflection, self-analysis, self-care, and lifelong learning.

II. Provider of Patient-Centered Care:

A. Use clinical reasoning and established evidence-based policiesas the basis for decision-making in nursing practice.

B. Assist in determining the physical and mental health status,needs, and preferences of culturally, ethnically, and sociallydiverse patients and their families based on interpretation ofhealth-related data.

C. Report data to assist in the identification of problems andformulation of goals/outcomes and patient-centered plans ofcare in collaboration with patients, their families, and theinterdisciplinary health care team.

D. Provide safe, compassionate, basic nursing care to assignedpatients with predictable health care needs through asupervised, directed scope of practice.

E. Implement aspects of the plan of care within legal, ethical, andregulatory parameters and in consideration of patient factors.

F. Identify and report alterations in patient responses totherapeutic interventions in comparison to expected outcomes.

G. Implement teaching plans for patients and their families withcommon health problems and well-defined health learningneeds.

H. Assist in the coordination of human, information, and materielresources in providing care for assigned patients and theirfamilies.

III. Patient Safety Advocate:

A. Demonstrate knowledge of the Texas Nursing Practice Act (NPA)and the Texas Board of Nursing Rules that emphasize safety, aswell as all federal, state, and local government andaccreditation organization safety requirements and standards.

B. Implement measures to promote quality and a safeenvironment for patients, self, and others.

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C. Assist in the formulation of goals and outcomes to reducepatient risks.

D. Obtain instruction, supervision, or training as needed whenimplementing nursing procedures or practices.

E. Comply with mandatory reporting requirements of the TexasNPA.

F. Accept and make assignments that take into considerationpatient safety and organizational policy.

IV. Member of the Health Care Team:

A. Communicate and collaborate with patients, their families, andthe interdisciplinary health care team to assist in the planning,delivery, and coordination of patient-centered care to assignedpatients.

B. Participate as an advocate in activities that focus on improvingthe health care of patients and their families.

C. Participate in the identification of patient needs for referral toresources that facilitate continuity of care, and ensureconfidentiality.

D. Communicate and collaborate in a timely manner withmembers of the interdisciplinary health care team to promoteand maintain optimal health status of patients and theirfamilies.

E. Communicate patient data using technology to supportdecision-making to improve patient care.

F. Assign nursing care to LVNs or unlicensed personnel based uponan analysis of patient or unit need.

G. Supervise nursing care provided by others for whom the nurseis responsible.

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Texas Board of NursingDiploma and Associate Degree Nursing Education

Although the programs for Diploma nursing and Associate Degree Nursing(ADN) may vary in the missions and philosophies of the sponsoringinstitutions, competencies have been identified as common for graduatesof both programs. These competencies are the expectations for entry-level into registered nursing practice.

Diploma programs are hospital-based, single purpose schools of nursingthat consist of two to three years of general education and nursing courses.These programs are based on the missions, values, and purposes of thegoverning institutions, and prepare graduates to provide and coordinatehealth care of individuals and their families throughout the life span acrossthe health continuum.

General education courses, from an accredited college or university, maybe required as prerequisites to or offered concurrently with nursingcourses. The general education courses provide a foundation incommunication, psychology, human growth and development, and relatedsciences to support the nursing courses. A Diploma program of study thatis completed on or after December 31, 2014, must entitle a student toreceive a degree [Texas Occupation Code 301.157(a-1)].

ADN programs, located in community colleges, senior colleges, and careerschools, require a minimum of two years of full-time study, integrating abalance between courses in liberal arts; natural, social, and behavioralsciences; and nursing. Academic associate degrees consist of 60 to 72 credithours with approximately half the program requirements in nursingcourses. General education courses provide a foundation for nursingcontent in ADN programs and enable graduates to apply theoreticalcontent and evidence-based findings in the provision of nursing care. TheTexas Board of Nursing (BON or Board) approved curriculum includesrequirements for didactic instruction and clinical learning experiences infour content areas: medical-surgical, maternal/child health, pediatrics, andmental health nursing.

Nursing courses in Diploma and ADN programs provide opportunities todemonstrate competence in the application of nursing knowledge andclinical judgments and behaviors in health care settings. The entry-levelgraduate from a Diploma or ADN program integrates knowledge fromgeneral education and sciences for the delivery of safe and compassionatecare for patients and their families. Nursing content includes theimportance of establishing partnerships with patients and their familiesin the promotion, prevention, rehabilitation, maintenance, and restorationof health of individuals of all ages. Nursing care supervision, basic nursingmanagement, and legal/ethical content are imbedded in the curriculum.

All levels of prelicensure nursing education prepare graduates todemonstrate the Differentiated Essential Competencies of Graduates ofTexas Nursing Programs Evidenced by Knowledge, Clinical Judgments, and

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Behaviors (DECs). The competencies for each education level are basedupon the preparation in the program of study.

The Texas BON licenses individuals who pass the National Council LicensureExamination for Registered Nurses (NCLEX-RN7). Qualified graduates ofDiploma and ADN programs typically receive a temporary permit topractice under direct supervision of a registered professional nurse for a75-day period while awaiting testing and licensure.

The primary role of the entry-level graduate of a Diploma or ADN programis to provide direct nursing care to or coordinate care for a limited numberof patients in various health care settings. Such patients may have complexmultiple needs with predictable or unpredictable outcomes.

With additional experience and continuing education, the Diploma or ADNgraduate can increase the numbers of assigned patients, provideindependent direct care, supervise health care of patients and theirfamilies, and receive certification in various specialty areas. Througharticulation, graduates may continue their education to prepare forexpanded roles.

The entry-level competencies of the Diploma and ADN graduate build uponthe entry-level competencies of the Vocational Nursing graduate and arelisted on the following pages:

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Essential Competencies of Graduates of TexasDiploma and Associate Degree Nursing Education Programs


A. Function within the nurse’s legal scope of practice and inaccordance with the policies and procedures of the employinghealth care institution or practice setting.

B. Assume responsibility and accountability for the quality ofnursing care provided to patients and their families.

C. Participate in activities that promote the development andpractice of professional nursing.



A. Use clinical reasoning and knowledge based on the diploma orassociate degree nursing program of study and evidence-basedpractice outcomes as a basis for decision-making in nursingpractice.

B. Determine the physical and mental health status, needs, andpreferences of culturally, ethnically, and socially diverse patientsand their families based upon interpretation of comprehensivehealth assessment findings compared with evidence-basedhealth data derived from the diploma or associate degreenursing program of study.

C. Analyze assessment data to identify problems, formulate goals/outcomes, and develop plans of care for patients and theirfamilies using information from evidence-based practice incollaboration with patients, their families, and theinterdisciplinary health care team.

D. Provide safe, compassionate, comprehensive nursing care topatients and their families through a broad array of health careservices.

E. Implement the plan of care for patients and their familieswithin legal, ethical, and regulatory parameters and inconsideration of disease prevention, wellness, and promotionof healthy lifestyles.

F. Evaluate and report patient outcomes and responses totherapeutic interventions in comparison to benchmarks fromevidence-based practice, and plan follow-up nursing care.

G. Develop, implement, and evaluate teaching plans for patientsand their families to address health promotion, maintenance,and restoration.

H. Coordinate human, information, and materiel resources inproviding care for patients and their families.

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A. Demonstrate knowledge of the Texas Nursing Practice Act (NPA)and the Texas Board of Nursing Rules that emphasize safety, aswell as all federal, state, and local government andaccreditation organization safety requirements and standards.


C. Formulate goals and outcomes using evidence-based data toreduce patient risks.



F. Accept and make assignments and delegate tasks that take intoconsideration patient safety and organizational policy.


A. Coordinate, collaborate, and communicate with patients, theirfamilies, and the interdisciplinary health care team to plan,deliver, and evaluate patient-centered care.

B. Serve as a health care advocate in monitoring and promotingquality and access to health care for patients and their families.

C. Refer patients and their families to resources that facilitatecontinuity of care; health promotion, maintenance, andrestoration; and ensure confidentiality.

D. Communicate and collaborate in a timely manner withmembers of the interdisciplinary health care team to promoteand maintain the optimal health status of patients and theirfamilies.

E. Communicate and manage information using technology tosupport decision-making to improve patient care.

F. Assign and/or delegate nursing care to other members of thehealth care team based upon an analysis of patient or unitneed.

G. Supervise nursing care provided by others for whom the nurseis responsible by using evidence-based nursing practice.

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Texas Board of NursingBaccalaureate Degree Nursing Education

Baccalaureate education, offered in college and university settings,provides students with a broad perspective and understanding of nursing;health and healing; the environment; and persons as diverse individuals,families, populations, and communities. The Baccalaureate DegreeNursing (BSN) program of study integrates approximately 60 hours fromliberal arts and natural, social, and behavioral science courses andapproximately 60-70 hours of nursing courses. In addition to a liberalarts education that provides a solid foundation for the development ofclinical judgment skills, baccalaureate education includes instruction incommunity health, public health, research, nursing leadership, andnursing management with preparation in skills and knowledge neededto practice evidence-based nursing (U.S. Department of Health andHuman Services, 2008). Baccalaureate education provides a strongfoundation for future critical-thinking and problem-solving skills with itsinclusion of a broad range of basic sciences, behavioral and socialmanagement sciences, communication, and data analysis content.Community health nursing, research, and courses that provide depth andbreadth in the understanding of leadership, management, healthpromotion, and care of vulnerable groups are required by the Texas Boardof Nursing (BON or Board) education rules for inclusion in thebaccalaureate curriculum, and these areas of study are generally notaddressed in the preceding levels of education. The BSN from Boardapproved nursing programs meets the educational requirements foreligibility to take the National Council Licensure Examination forRegistered Nurses (NCLEX-RN7) as mandated for practice in the State ofTexas by the Nursing Practice Act and regulated by the Texas BON.

Baccalaureate graduates synthesize information from various disciplines,think logically, analyze critically, and communicate effectively with patientsand other health care professionals. The baccalaureate graduate “usesresearch findings and other evidence in designing and implementing carethat is multi-dimensional, high quality, and cost-effective” (AmericanAssociation of Colleges of Nursing, 2008, p. 9). Graduates are expected todemonstrate all the competencies (knowledge, clinical judgments, andbehaviors) of the preceding levels of education, but with greater depthand breadth of application and synthesis.

Graduates of baccalaureate programs are prepared to provide and directcare for patients, families, populations, and communities experiencingcomplex and unpredictable health care needs in structured andunstructured settings. With additional experience and continuingeducation, BSN graduates are able to provide care for communities andsociety within the context of the environment, available resources, andtechnology.

Qualified graduates of BSN programs typically receive a temporary permitto practice under direct supervision of a registered professional nurse fora 75-day period while awaiting testing and licensure. These graduates

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routinely begin their careers in structured settings but rapidly move intocommunity-based settings and/or leadership roles. A BSN degree is themost common requirement for entry into graduate nursing educationwhere nurses may further develop their professional roles to become nurseeducators, researchers, administrators, or advanced practice nurses.

All levels of prelicensure nursing education prepare graduates todemonstrate the Differentiated Essential Competencies of Graduates ofTexas Nursing Programs Evidenced by Knowledge, Clinical Judgments, andBehaviors (DECs). The competencies for each educational level are basedupon the preparation in the program of study.

The entry-level competencies of the BSN graduate which build uponthe entry-level competencies of the Diploma or Associate DegreeNursing graduate are listed on the following pages:

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Essential Competencies of Graduates of TexasBaccalaureate Degree Nursing Education Programs


A. Function within the nurse’s legal scope of practice and inaccordance with the policies and procedures of theemploying health care institution or practice setting.

B. Assume responsibility and accountability for the quality ofnursing care provided to patients, families, populations, andcommunities.

C. Promote the practice of professional nursing throughleadership activities and advocacy.



A. Use clinical reasoning and knowledge based on thebaccalaureate degree nursing program of study, evidence-based practice outcomes, and research studies as the basisfor decision-making and comprehensive patient care.

B. Determine the physical and mental health status, needs, andpreferences of culturally, ethnically, and socially diversepatients, families, populations, and communities based uponinterpretation of comprehensive health assessment findingscompared with evidence-based health data and a synthesisof knowledge derived from a baccalaureate degree nursingprogram of study.

C. Synthesize comprehensive assessment data to identifyproblems, formulate goals/outcomes, and develop plans ofcare for patients, families, populations, and communitiesusing information from evidence-based practice andpublished research in collaboration with the above groupsand the interdisciplinary health care team.

D. Provide safe, compassionate, comprehensive nursing care topatients, families, populations, and communities through abroad array of health care services.

E. Implement the plan of care for patients, families,populations, and communities within legal, ethical, andregulatory parameters and in consideration of diseaseprevention, wellness, and promotion of healthy lifestyles.

F. Evaluate and report patient, family, population, andcommunity outcomes and responses to therapeuticinterventions in comparison to benchmarks from evidence-based practice and research findings, and plan follow-upnursing care.

G. Develop, implement, and evaluate teaching plans forpatients, families, populations, and communities to address

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health promotion, maintenance, restoration, and populationrisk reduction.

H. Coordinate human, information, and materiel managementresources in providing care for patients, families,populations, and communities.


A. Demonstrate knowledge of the Texas Nursing Practice Act(NPA) and the Texas Board of Nursing Rules that emphasizesafety, as well as all federal, state, and local government andaccreditation organization safety requirements andstandards.


C. Formulate goals and outcomes using an evidence-based andtheoretical analysis of available data to reduce patient andcommunity risks.



F. Accept and make assignments and delegate tasks that takeinto consideration patient safety and organizational policy.


A. Coordinate, collaborate, and communicate with patients,families, populations, communities, and the interdisciplinaryhealth care team to plan, deliver, and evaluate care.

B. Serve as a health care advocate in monitoring and promotingquality and access to health care for patients, families,populations, and communities.

C. Use multiple referral resources for patients, families,populations, and communities considering cost,confidentiality, effectiveness and efficiency of care,continuity and continuum of care, and health promotion,maintenance, and restoration.

D. Communicate and collaborate in a timely manner withmembers of the interdisciplinary health care team topromote and maintain the optimal health status of patients,families, populations, and communities.

E. Communicate and manage information using technology tosupport decision-making to improve patient care anddelivery systems.

F. Assign and/or delegate nursing care to other members of thehealth care team based upon an analysis of patient ororganizational need.

G. Supervise nursing care provided by others for whom thenurse is responsible by using best practices of management,leadership, and evaluation.

Vocational Nursing Baccalaureate Degree NursingDiploma and AssociateDegree Nursing


A. Function within the nurse’s legal scopeof practice and in accordance with thepolicies and procedures of theemploying health care institution orpractice setting.

B. Assume responsibility andaccountability for the quality ofnursing care provided to patients andtheir families.

C. Contribute to activities that promotethe development and practice ofvocational nursing.

D. Demonstrate responsibility forcontinued competence in nursingpractice, and develop insight throughreflection, self-analysis, self-care, andlifelong learning.


A. Use clinical reasoning and knowledgebased on the vocational nursingprogram of study and establishedevidence-based policies as the basisfor decision-making in nursingpractice.


A. Function within the nurse’s legal scope ofpractice and in accordance with thepolicies and procedures of the employinghealth care institution or practicesetting.

B. Assume responsibility and accountabilityfor the quality of nursing care providedto patients and their families.

C. Participate in activities that promote thedevelopment and practice ofprofessional nursing.

D. Demonstrate responsibility for continuedcompetence in nursing practice, anddevelop insight through reflection, self-analysis, self-care, and lifelong learning.


A. Use clinical reasoning and knowledgebased on the diploma or associatedegree nursing program of study andevidence-based practice outcomes as abasis for decision-making in nursingpractice.



B. Assume responsibility andaccountability for the quality ofnursing care provided to patients,families, populations, and communities.

C. Promote the practice of professionalnursing through leadership activitiesand advocacy.



A. Use clinical reasoning and knowledgebased on the baccalaureate degreenursing program of study, evidence-based practice outcomes, and researchstudies as the basis for decision-making and comprehensive patient care.

Texas Board of NursingDifferentiated Essential Competencies (DECs)

13

B. Assist in determining the physical andmental health status, needs, andpreferences of culturally, ethnically,and socially diverse patients and theirfamilies based on interpretation ofhealth-related data derived from thevocational nursing program of study.

C. Report data to assist in theidentification of problems andformulation of goals/outcomes andpatient-centered plans of care incollaboration with patients, theirfamilies, and the interdisciplinaryhealth care team.

D. Provide safe, compassionate, basicnursing care to assigned patients withpredictable health care needs througha supervised, directed scope ofpractice.

B. Determine the physical and mental healthstatus, needs, and preferences ofculturally, ethnically, and socially diversepatients and their families based uponinterpretation of comprehensive healthassessment findings compared withevidence-based health data derived fromthe diploma or associate degree nursingprogram of study.

C. Analyze assessment data to identifyproblems, formulate goals/outcomes, anddevelop plans of care for patients andtheir families using information fromevidence-based practice in collaborationwith patients, their families, and theinterdisciplinary health care team.

D. Provide safe, compassionate,comprehensive nursing care to patientsand their families through a broad arrayof health care services.

B. Determine the physical and mentalhealth status, needs, and preferencesof culturally, ethnically, and sociallydiverse patients, families, populations,and communities based uponinterpretation of comprehensive healthassessment findings compared withevidence-based health data and asynthesis of knowledge derived from abaccalaureate degree nursing programof study.

C. Synthesize comprehensive assessmentdata to identify problems, formulategoals/outcomes, and develop plans ofcare for patients, families, populations,and communities using informationfrom evidence-based practice andpublished research in collaborationwith the above groups and theinterdisciplinary health care team.

D. Provide safe, compassionate,comprehensive nursing care topatients, families, populations, andcommunities through a broad array ofhealth care services.

Differentiated Essential Competencies (DECs)


15

E. Implement aspects of the plan of carewithin legal, ethical, and regulatoryparameters and in consideration ofpatient factors.

F. Identify and report alterations inpatient responses to therapeuticinterventions in comparison toexpected outcomes.

G. Implement teaching plans for patientsand their families with commonhealth problems and well-definedhealth learning needs.

H. Assist in the coordination of human,information, and materiel resources inproviding care for assigned patientsand their families.

E. Implement the plan of care for patientsand their families within legal, ethical,and regulatory parameters and inconsideration of disease prevention,wellness, and promotion of healthylifestyles.

F. Evaluate and report patient outcomesand responses to therapeuticinterventions in comparison tobenchmarks from evidence-basedpractice, and plan follow-up nursingcare.

G. Develop, implement, and evaluateteaching plans for patients and theirfamilies to address health promotion,maintenance, and restoration.

H. Coordinate human, information, andmateriel resources in providing care forpatients and their families.

E. Implement the plan of care for patients,families, populations, and communitieswithin legal, ethical, and regulatoryparameters and in consideration ofdisease prevention, wellness, andpromotion of healthy lifestyles.

F. Evaluate and report patient, family,population, and community outcomesand responses to therapeuticinterventions in comparison tobenchmarks from evidence-basedpractice and research findings, andplan follow-up nursing care.

G. Develop, implement, and evaluateteaching plans for patients, families,populations, and communities toaddress health promotion,maintenance, restoration, andpopulation risk reduction.

H. Coordinate human, information, andmateriel management resources inproviding care for patients, families,populations, and communities.





A. Demonstrate knowledge of the TexasNursing Practice Act and the TexasBoard of Nursing Rules that emphasizesafety, as well as all federal, state, andlocal government and accreditationorganization safety requirements andstandards.

B. Implement measures to promote qualityand a safe environment for patients,self, and others.

C. Assist in the formulation of goals andoutcomes to reduce patient risks.

D. Obtain instruction, supervision, ortraining, as needed, when implementingnursing procedures or practices.

E. Comply with mandatory reportingrequirements of the Texas NursingPractice Act.

F. Accept and make assignments that takeinto consideration patient safety andorganizational policy.




C. Formulate goals and outcomes usingevidence-based data to reduce patientrisks.



F. Accept and make assignments anddelegate tasks that take intoconsideration patient safety andorganizational policy.





C. Formulate goals and outcomes using anevidence-based and theoretical analysisof available data to reduce patient andcommunity risks.



F. Accept and make assignments anddelegate tasks that take intoconsideration patient safety andorganizational policy.

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A. Coordinate, collaborate, andcommunicate with patients, theirfamilies, and the interdisciplinary healthcare team to plan, deliver, and evaluatepatient-centered care.

B. Serve as a health care advocate inmonitoring and promoting quality andaccess to health care for patients andtheir families.

C. Refer patients and their families toresources that facilitate continuity ofcare; health promotion, maintenance,and restoration; and ensureconfidentiality.

D. Communicate and collaborate in atimely manner with members of theinterdisciplinary health care team topromote and maintain optimal healthstatus of patients and their families.




A. Communicate and collaborate withpatients, their families, and theinterdisciplinary health care team toassist in the planning, delivery, andcoordination of patient-centered careto assigned patients.

B. Participate as an advocate in activitiesthat focus on improving the healthcare of patients and their families.

C. Participate in the identification ofpatient needs for referral to resourcesthat facilitate continuity of care, andensure confidentiality.



A. Coordinate, collaborate, andcommunicate with patients, families,populations, communities, and theinterdisciplinary health care team toplan, deliver, and evaluate care.

B. Serve as a health care advocate inmonitoring and promoting quality andaccess to health care for patients,families, populations, andcommunities.

C. Use multiple referral resources forpatients, families, populations, andcommunities, considering cost;confidentiality; effectiveness andefficiency of care; continuity andcontinuum of care; and healthpromotion, maintenance, andrestoration.

D. Communicate and collaborate in atimely manner with members of theinterdisciplinary health care team topromote and maintain optimal healthstatus of patients, families,populations, and communities.

E. Communicate patient data usingtechnology to support decision-making to improve patient care.

F. Assign nursing care to LVNs orunlicensed personnel based upon ananalysis of patient or unit need.

G. Supervise nursing care provided byothers for whom the nurse isresponsible.

E. Communicate and manage informationusing technology to support decision-making to improve patient care.

F. Assign and/or delegate nursing care toother members of the health care teambased upon an analysis of patient orunit need.

G. Supervise nursing care provided byothers for whom the nurse isresponsible by using evidence-basednursing practice.

E. Communicate and manageinformation using technology tosupport decision-making to improvepatient care and delivery systems.

F. Assign and/or delegate nursing care toother members of the health careteam based upon an analysis ofpatient or organizational need.

G. Supervise nursing care provided byothers for whom the nurse isresponsible by using best practices ofmanagement, leadership, andevaluation.




A licensed nurse (LVN or RN) who exhibits behaviors that reflect commitment to the growth and development of the role and function ofnursing consistent with state and federal regulations and with ethical and professional standards; aspires to improve the discipline ofnursing and its contribution to society; and values self-assessment and the need for lifelong learning.


Knowledge1. a. Texas Nursing Practice Act.

b. Texas Board of Nursing Rules,Position Statements, andGuidelines.

c. Federal, state, or local laws, rules,and regulations affecting nursingpractice.

2. Nursing scope of practice in relation todelegated medical acts and facilitypolicies.

3. Standards and guidelines fromprofessional organizations.

4. Facility policies and procedures.

1. a. Texas Nursing Practice Act.b. Texas Board of Nursing Rules,

Position Statements, andGuidelines.





1. a. Texas Nursing Practice Act.b. Texas Board of Nursing Rules,










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Clinical Judgments and Behaviors

1. Function within the directed scope ofpractice of the vocational nurse withappropriate supervision.

2. Assist in determination of predictablehealth care needs of patients toprovide individualized, goal-directednursing care.

3. a. Practice according to facilitypolicies and procedures andprovide input in the developmentof facility policies and procedures.

b. Question orders, policies, andprocedures that may not be in thepatient’s best interest.

1. Function within the scope of practice ofthe registered nurse.

2. Use a systematic approach to provideindividualized, goal-directed nursing careto meet health care needs of patientsand their families.

3. a. Practice according to facilitypolicies and procedures andparticipate in the development offacility policies and procedures.


1. Function within the scope of practiceof the registered nurse.

2. Use a systematic approach to provideindividualized, goal-directed nursingcare to meet health care needs ofpatients, families, populations, andcommunities.

3. a. Practice according to facilitypolicies and procedures andparticipate in the development offacility policies and procedures.




B. Assume responsibility andaccountability for the quality ofnursing care provided to patients andtheir families.

1. a. Texas Board of Nursing Standardsof Practice.

b. National standards of vocationalnursing practice and care.

c. National Federation of LicensedPractical Nurses Code of Ethics.

d. Advocacy process.

2. Legal parameters of vocationalnursing practice and the TexasNursing Practice Act, includingSafe Harbor.

B. Assume responsibility andaccountability for the quality of nursingcare provided to patients and theirfamilies.

1. a. Texas Board of Nursing Standards ofPractice.

b. National standards of nursingpractice and care.

c. American Nurses Association Codeof Ethics.

d. Models of ethical decision-making.

e. Advocacy process.

2. a. Legal parameters of nursingpractice and the Texas NursingPractice Act, including SafeHarbor.

b. Legal principles relative to healthcare.

B. Assume responsibility andaccountability for the quality ofnursing care provided to patients,families, populations, andcommunities.

1. a. Texas Board of Nursing Standardsof Practice.

b. National standards of nursingpractice and care; process for thedevelopment of standards ofnursing practice and care.

c. American Nurses AssociationCode of Ethics.

d. Models of ethical decision-making.

e. Legislative advocacy process.f. Resources and strategies for

access to standards of practice.

2. a. Legal parameters of nursingpractice and the Texas NursingPractice Act, including SafeHarbor.

b. Legal principles and practicetheories, and principles relativeto health care.

Knowledge

21



3. Issues affecting the vocational nurserole and the delivery of culturally-sensitive care to patients and theirfamilies.

4. Continuing competency andprofessional development.

5. Self-evaluation, staff evaluation, andpeer evaluation processes.

6. Employment setting policies andprocedures.

3. Issues affecting the registered nurse roleand the delivery of culturally-sensitivecare to patients and their families.

4. Continuing competency andprofessional development.

5. Self-evaluation, staff evaluation, andpeer evaluation processes.

6. a. Employment setting policies andprocedures.

b. Methods for the development ofpolicies and procedures.

3. Issues affecting the registered nurserole, the BSN role, and the delivery ofculturally-sensitive care to patients,families, populations, andcommunities.

4. a. Continuing competency andprofessional development.

b. Principles of staff developmentand learner behaviors.

5. a. Self-evaluation, staff evaluation,and peer evaluation processes.

b. Human resource managementand performance evaluationprocesses.

6. a. Employment setting policies andprocedures.

b. Methods for the development ofpolicies and procedures.

c. Roles of committees in thedevelopment of health carepolicies and procedures.

d. Communication skills in the areasof writing, speaking, andpresenting as required to functionin leadership positions.



7. a. Professional characteristics andvalues such as altruism, humandignity, truth, justice, freedom,equality, and esthetics.

b. Aspects of professionalismincluding attention to appearanceand demeanor.

c. Communication techniques tomaintain professionalboundaries.

8. Principles of quality improvement.

1. Pass the Nursing JurisprudenceExamination before licensure.

2. a. Provide nursing care within theparameters of vocational nursingknowledge, scope of practice,education, experience, andethical/legal standards of care.

b. Participate in evaluation of careadministered by theinterdisciplinary health careteam.



c. Communication techniques andmanagement skills to maintainprofessional boundaries.

8. Principles of quality improvement andbasic outcome measurement in healthcare organizations.


2. a. Provide nursing care within theparameters of professional nursingknowledge, scope of practice,education, experience, and ethical/legal standards of care.

b. Evaluate care administered by theinterdisciplinary health care team.

c. Advocate for standards of practicethrough professional memberships.



c. Communication techniques,management and leadership skills,and role modeling to maintainprofessional boundaries.

8. Principles and tools of qualityimprovement and outcomemeasurement in systems of caredelivery.


2. a. Provide nursing care within theparameters of professional nursingknowledge, scope of practice,education, experience, and ethical/legal standards of care.

b. Evaluate care administered by theinterdisciplinary health care team.

c. Advocate for standards of practiceusing professional and legislativeprocesses.


23



3. a. Practice nursing in a caring,nonjudgmental,nondiscriminatory manner.

b. Provide culturally sensitive healthcare to patients and theirfamilies.

c. Provide holistic care thataddresses the needs of diverseindividuals across the lifespan.

4. Use performance and self-evaluationprocesses to improve individualnursing practice and professionalgrowth.

5. a. Assume accountability forindividual nursing practice.

b. Follow established evidence-based clinical practice guidelines.

3. a. Practice nursing in a caring,nonjudgmental, nondiscriminatorymanner.

b. Provide culturally sensitive healthcare to patients and theirfamilies.

c. Provide holistic care that addressesthe needs of diverse individualsacross the lifespan.

4. a. Use performance and self-evaluation processes to improveindividual nursing practice andprofessional growth.

b. Evaluate the learning needs of self,peers, and others and intervene toassure quality of care.

c. Apply management skills incollaboration with theinterdisciplinary health care teamto implement quality patient care.


b. Promote accountability for qualitynursing practice throughparticipation on policy andprocedure committees.

3. a. Practice nursing in a caring,nonjudgmental,nondiscriminatory manner.

b. Provide culturally sensitive healthcare to patients, families,populations, and communities.

c. Provide holistic care thataddresses the needs of diverseindividuals and populationsacross the lifespan.

d. Advocate for policy developmentto support care of vulnerablepopulations and communities.

4. a. Use performance and self-evaluation processes to improveindividual nursing practice andprofessional growth.

b. Evaluate the learning needs ofself, peers, and others andintervene to assure quality ofcare.

c. Apply leadership andmanagement concepts and skillsin collaboration with theinterdisciplinary health care teamto implement quality patient care.


b. Promote accountability for qualitynursing practice throughparticipation on policy andprocedure committees.



c. Implement established evidence-based clinical practice guidelines.

6. a. Follow established policies andprocedures.


c. Use nursing judgment to anticipateand prevent patient harm, includinginvoking Safe Harbor.

7. Use communication techniques andmanagement skills to maintainprofessional boundaries betweenpatients and individual health care teammembers.

8. Comply with professional appearancerequirements according toorganizational standards and policies.

c. Implement established evidence-based clinical practice guidelines.

d. Participate in designing systemsthat support quality nursingpractice.

e. Apply research findings andprinciples of research to enhanceevidence-based practice.



c. Use nursing judgment to anticipateand prevent patient harm, includinginvoking Safe Harbor.

7. a. Use communication techniques andmanagement skills to maintainprofessional boundaries betweenpatients and individual health careteam members.

b. Use leadership and role modelingskills to promote professionalboundaries among the members ofthe interdisciplinary team.




c. Use nursing judgment to anticipateand prevent patient harm,including invoking Safe Harbor.

7. Use communication techniques tomaintain professional boundaries inthe nurse/patient relationship.


25



9. Implement principles of qualityimprovement in collaboration with thehealth care team.

C. Contribute to activities that promotethe development and practice ofvocational nursing.

1. Historical evolution of nursingpractice.

2. Issues affecting the development andpractice of vocational nursing.

3. The role of vocational nursingorganizations, regulatory agencies, andhealth care organizations.

4. Factors affecting the public image ofnursing.

9. Collaborate with the interdisciplinaryteam on basic principles of qualityimprovement and outcomemeasurement.

C. Participate in activities that promotethe development and practice ofprofessional nursing.

1. Historical evolution of professionalnursing.

2. Issues and trends affecting nursingpractice, the nursing profession, andhealth care delivery.

3. The role of professional nursingorganizations, regulatory agencies, andhealth care organizations.

4. Strategies to influence the publicperception of nursing.

9. Collaborate with the interdisciplinaryteam on principles and tools of qualityimprovement and outcomemeasurement in systems of care delivery.

C. Promote the practice of professionalnursing through leadership activitiesand advocacy.

1. Links between nursing history andmedical, social, political, religious, andcultural influences.

2. a. Issues and trends affectingnursing practice, the nursingprofession, and health caredelivery systems.

b. Inquiry, analysis, and informationapproaches in addressing practiceissues.

3. a. The role of professional nursingorganizations, regulatoryagencies, and health careorganizations.

b. Research related to organizationaland societal change.

4. Strategies to influence the publicperception of nursing.

Knowledge



27

5. Distinctions between the evolvingvocational and professional nursingroles.

1. Identify historical evolution of nursingpractice and issues affecting thedevelopment and practice ofvocational nursing.

2. Work collegially with members of theinterdisciplinary health care team.

3. Participate in activities individually orin groups through organizations thatpromote a positive image of thevocational nursing role.

5. a. The evolving practice roles ofprofessional nurses and theircontributions to the profession.

b. Types of leadership.c. Political processes to promote

professional nursing practice.

1. Analyze the historical evolution ofprofessional nursing and the applicationto current issues and trends.

2. Promote collegiality amonginterdisciplinary health care teammembers.

3. a. Participate in activities individuallyor in groups through organizationsthat promote a positive image ofthe profession of nursing.

b. Collaborate with nursing colleaguesand health care organizations topromote the profession ofnursing.

c. Articulate the values and roles ofnursing to the public.

5. a. Evolving leadership roles in theadvancement of the nursingprofession; distinction of rolesand scopes of practice amongnursing and other health careprofessions.

b. Theories of leadership.c. Strategies to influence legislative

action processes and publicpolicy.

1. Synthesize the links between nursinghistory and medical, social, political,religious, and cultural influences topromote professional nursing practice.

2. Provide leadership in collaborationwith the interdisciplinary health careteam.

3. a. Participate in activities individuallyor in groups through organizationsthat promote a positive image ofthe profession of nursing.

b. Collaborate with nursingcolleagues and health careorganizations and with othersoutside the health care industry topromote the profession of nursing.




4. Recognize roles of vocational nursingorganizations, regulatory agencies,and organizational committees.

5. Practice within the vocational nursingrole and Scope of Practice.

6. Serve as a positive role model forstudents, peers, and members of theinterdisciplinary health care team.

4. Recognize roles of professional nursingorganizations, regulatory agencies, andorganizational committees.

5. Practice within the professional nursingrole and Scope of Practice.

6. a. Serve as a positive role model forstudents, peers, and members ofthe interdisciplinary health careteam.

b. Participate in activities thatpromote consumer awareness ofnursing’s contribution to society.

c. Articulate the values and roles ofnursing to the public.

d. Communicate with statelegislators and representatives ofother regulatory bodies topromote a competent nursingworkforce and protection of thepublic’s safety and welfare.

4. Recognize and analyze the impact ofprofessional nursing organizations,regulatory agencies, and organiza-tional committees upon the nursingprofession and the roles of nurses.

5. Practice within the professionalnursing role and Scope of Practice.

6. a. Serve as a positive role model forstudents, peers, and members ofthe interdisciplinary health careteam.

b. Participate in activities thatpromote consumer awareness ofnursing’s contribution to society.




1. Texas Board of Nursing Rules forcontinuing competence.

2. Resources, tools, and processes toassess vocational learning needs.

3. Lifelong learning opportunities tofacilitate continuing competence (e.g.,certifications and educationalarticulation/mobility).

4. Changing roles and competencies invocational nursing.

1. Participate in educational activities tomaintain/improve competence,knowledge, and skills.

*2. Participate in nursing continuingcompetency activities to maintainlicensure.



2. Resources, tools, and processes toassess professional learning needs.

3. Lifelong learning opportunities tofacilitate continuing competence (e.g.,certifications and educationalarticulation/mobility).

4. Changing roles and competencies inprofessional nursing.





2. Resources, tools, and processes toassess professional learning needs.

3. Lifelong learning opportunities tofacilitate continuing competence (e.g.,certifications and graduate education).

4. Changing roles and competencies inprofessional nursing.



Knowledge


29



3. Use self-evaluation, reflection, peerevaluation, and feedback to modifyand improve practice.

4. Demonstrate accountability toreassess and establish newcompetency when changing practiceareas.

5. Demonstrate commitment to thevalue of lifelong learning.

3. Use self-evaluation, reflection, peerevaluation, and feedback to modify andimprove practice.

4. Demonstrate accountability to reassessand establish new competency whenchanging practice areas.

5. Demonstrate commitment to the valueof lifelong learning.

3. Use self-evaluation, reflection, peerevaluation, and feedback to modifyand improve practice.

4. Demonstrate accountability toreassess and establish newcompetency when changing practiceareas.

5. Demonstrate commitment to the valueof lifelong learning.




A licensed nurse (LVN or RN) who, based on educational preparation and scope of practice, accepts responsibility for the quality ofnursing care and provides safe, compassionate nursing care using a systematic process of assessment, analysis, planning, intervention,and evaluation that focuses on the needs and preferences of patients and their families. The nurse incorporates professional values andethical principles into nursing practice. The patients for LVNs and for Diploma and ADN educated RNs include individual patients andtheir families; the BSN-educated RN is also prepared to provide care to populations and communities.


A. Use clinical reasoning and knowledgebased on the diploma or associatedegree nursing program of study andevidence-based practice outcomes asthe basis for decision-making in nursingpractice.

1. a. A systematic problem-solvingprocess in the care of patients andtheir families based on selectedliberal arts and sciences, andevidence-based practice outcomes.

b. Conceptual frameworks of nursingpractice as a means of planningcare and solving clinical problemsin the care of patients and theirfamilies.

A. Use clinical reasoning and knowledgebased on the vocational nursingprogram of study and establishedevidence-based practice as the basisfor decision-making in nursingpractice.

1. A systematic problem-solving processin the care of patients and theirfamilies.

A. Use clinical reasoning and knowledgebased on the baccalaureate degreenursing program of study, evidence-based practice outcomes, and researchstudies as the basis for decision-makingand comprehensive patient care.

1. a. A systematic problem-solvingprocess in the care of patients andfamilies based on the liberal arts,sciences, and evidence-basedpractice outcomes and researchstudies.

b. Conceptual frameworks of nursingpractice as a means of planningcare and solving clinical problemsin the care of patients and families.

c. Nursing frameworks, theories, andmodels that relate to managingand evaluating health caredelivery with consideration ofrelated costs in care of patients,families, populations, andcommunities.

Knowledge

31


2. a. Priority setting based on patienthealth status and individualcharacteristics.

b. Clinical reasoning processes.

3. Application of current literature,available work setting resources, andevidence-based practice to assist indecision-making.

4. Resources from scientifically validsources.

1. Use problem-solving approach tomake decisions regarding care ofassigned patients.

2. a. Organize care for assignedpatients based upon problem-solving and identified priorities.


b. Clinical reasoning processes,systematic clinical judgment,and best practices.

3. Application of current literature and/orresearch findings and evidence-basedpractice in improving patient care.

4. Resources for accurate and scientificallyvalid current information.

1. Use clinical reasoning and nursingscience as a basis for decision-making innursing practice.

2. a. Organize care based upon problem-solving and identified priorities.


b. Clinical reasoning models,systematic clinical judgment,research process, and bestpractices.

3. a. Research utilization and evi-dence-based practice.

b. Analysis of reliability, validity, andlimitations of quality of evidence.

c. Informed consent forparticipation in research.

4. a. Resources for accurate andscientifically valid currentinformation.

b. Research and evaluationmethodologies.

1. Use systematic approaches for clinicaldecision-making, including nursingresearch, epidemiology, and political,social, ethical, and legal processes.

2. a. Organize care based uponproblem-solving and identifiedpriorities.




b. Proactively manage priorities inpatient care and follow-up onclinical problems that warrantinvestigation with considerationof anticipated risks.

3. Identify and communicate patientphysical and mental health careproblems encountered in practice.

4. Apply relevant, current nursingpractice journal articles to practiceand clinical decisions.

b. Proactively manage priorities inpatient care and follow-up onclinical problems that warrantinvestigation with consideration ofanticipated risks.

3. Use knowledge of societal and healthcare trends and evidence-basedoutcomes to identify and communicatepatient physical and mental health careproblems.

4. Apply relevant, current nursing practicejournal articles and evidence-basedoutcomes from research findings topractice and clinical decisions.

b. Proactively manage priorities inpatient care and follow-up onclinical problems that warrantinvestigation with considerationof anticipated risks.

c. Apply knowledge from genomics,epidemiology, bioterrorism, andcurrent population demographicsin decision-making to reducehealth risks in communities andvulnerable populations.

3. Use knowledge of societal and healthcare trends and current researchfindings to identify and communicatepatient physical and mental healthcare problems.

4. Analyze and incorporate researchfindings/studies and evidence-baseddata into nursing practice and clinicaldecisions.

33



Knowledge

B. Assist in determining the physical andmental health status, needs, andpreferences of culturally, ethnically,and socially diverse patients and theirfamilies based on interpretation ofhealth-related data derived from thevocational nursing program of study.

1. Steps of a systematic process inclinical decision-making that includesvocational nursing scope of practice infocused assessment, planning,implementation, and evaluation.

2. Components of focused nursingassessment.

B. Determine the physical and mentalhealth status, needs, and preferencesof culturally, ethnically, and sociallydiverse patients and their familiesbased upon interpretation ofcomprehensive health assessmentfindings compared with evidence-basedhealth data derived from the diplomaor associate degree nursing program ofstudy.

1. Steps of a systematic process, whichincludes assessment, analysis, planning,implementation, and evaluation.

2. Comprehensive nursing assessment ofpatients and their families.

B. Determine the physical and mentalhealth status, needs, and preferencesof culturally, ethnically, and sociallydiverse patients, families, populations,and communities based uponinterpretation of comprehensivehealth assessment findings comparedwith evidence-based health data and asynthesis of knowledge derived fromthe baccalaureate degree nursingprogram of study.

1. a. Steps of a systematic process,including assessment, analysis,planning, implementation,and evaluation.

b. Systematic processes, includingnursing research, epidemiological,psychosocial, and management.

c. Systematic approach to performinga community assessment.

2. Comprehensive nursing assessment ofpatients, families, populations, andcommunities. Analysis of nursingresearch, epidemiological, and socialdata to draw inferences andconclusions.



35

3. Structured data collection tools andtechniques of assessment of patientsincluding interviewing.

4. Characteristics, concepts, andprocesses related to patients,including: gross anatomy; basicphysiology and pathophysiology;psychosocial growth anddevelopment; basic psychopathology;ethical reasoning; and major culturaland spiritual belief and practicesrelated to health, illness, birth, death,and dying.

5. Cultural differences of patients acrossthe lifespan.

3. Structured and unstructured datacollection tools and techniques ofassessment of patients and theirfamilies including interviewing.

4. Characteristics, concepts, and processesrelated to patients, including: anatomyand physiology; physical andpsychosocial growth and development;pathophysiology and psychopathology;ethical reasoning; and cultural andspiritual beliefs and practices related tohealth, illness, birth, death, and dying.

5. Cultural differences of patients acrossthe lifespan and major needs ofvulnerable patients.

3. a. Structured data collection toolsand techniques of assessment ofpatients including interviewing.

b. Unstructured data collection toolsand techniques for assessment ofpatients, families, populations,and communities.

c. Components of comprehensivedatabases and methods for datacollection, health screening andcase finding.

4. Characteristics, concepts, processes,and theories related to patientsincluding: anatomy and physiology;physical and psychosocial growth anddevelopment; pathophysiology andpsychopathology; cultural and spiritualbeliefs and practices related to health,illness, birth, death, and dying; history;research; statistics; humanities;genomics; global health; ethics; andlogical and ethical reasoning.

5. Cultural differences and integration ofpatient needs across the lifespan intothe health care system includingcomprehensive needs of vulnerablepatients, families, populations, andcommunities.



6. Characteristics, concepts, andprocesses related to transmission ofcommon communicable diseases,including individual risk factors andpreventive health practices.

7. Common disease processes,medication administration, and othertherapies and treatments.

8. Introduction to establishedapproaches that guide nursingpractice.

9. Family processes that impact health.

10. Application of clinical technology inthe delivery of safe patient care anddocumentation.

6. Characteristics, concepts, and processesrelated to disease transmission, riskfactors, preventive health practices, andtheir implications for selected popula-tions and community resources.

7. Disease processes,pharmacotherapeutics, and othertherapies and treatments.

8. Introduction to established theories,models, and approaches that guidenursing practice.

9. Characteristics, concepts, and processesrelated to families, including familydevelopment, risk factors, familycommunication patterns, and decision-making structures. Functional anddysfunctional characteristics of familiesthat impact health.

10. Application of clinical technology anduse of nursing informatics in thedelivery of safe patient care.

6. Characteristics, concepts, andprocesses related to communities,including epidemiology, risk factors,and preventive health practices andtheir implications for vulnerablepopulations, resources and resourceassessment techniques, environmentalfactors, and social organizations.

7. Disease processes,pharmacotherapeutics, and othertherapies and treatments.

8. Nursing theories, research findings,and interdisciplinary roles to guidenursing practice.

9. Characteristics, concepts, andprocesses related to families, includingfamily development, risk factors,family communication patterns, anddecision-making structures. Functionaland dysfunctional characteristics offamilies that impact health.

10. Application of clinical technology,information management, and use ofnursing informatics in the delivery ofsafe patient care.




11. Complex and multiple health careproblems and issues, integratingevidence-based traditional andcomplementary health care practices,and population interventions andsolutions.

12. Political, economic, and societal forcesaffecting health care for patients,families, populations, and globalcommunities.

1. a. Use structured and unstructureddata collection tools to obtainpatient and family history in areasof physical, psychiatric/mentalhealth, spiritual, cultural, familial,occupational, environmentalinformation, risk factors, andpatient resources.

b. Expand and modify datacollection tools usingevidence-based practice.

2. Perform comprehensive assessmentsand monitor changes to include factorsimpacting health status and healthneeds of patients, families,populations, and communities.

11. Introduction to complex and multiplehealth care problems and issues,including evidence-basedcomplementary health care practices.

12. Political, economic, and societal forcesaffecting the health care of individualsand their families.

1. Use structured and unstructured datacollection tools to obtain patient andfamily history in areas of physical,psychiatric/mental health, spiritual,cultural, familial, occupational, andenvironmental information, risk factors,and patient resources.

2. Perform comprehensive assessments toidentify health needs and monitorchanges in health status of patients andfamilies.

11. Introduction to patients with multiplehealth care problems.

12. Political, economic, and societal forcesaffecting health care of individuals.

1. Use structured assessment tools toobtain patient history.

2. Perform focused assessments to assistin identifying health status andmonitoring changes in patients.


37

3. Report and document focused patientassessment data.

4. Identify predictable and multiplehealth care needs of patients andrecognize signs of decompensation.

5. Share observations that assistmembers of the health care team inmeeting patient needs.

6. Assist with health screening.

3. a. Validate, report, and documentcomprehensive assessment data forpatients and families, includingphysical and mental health statusand needs for patients and theirfamilies.

b. Evaluate the use of safe comple-mentary health care practices.

4. Identify complex multiple health careneeds of patients, with consideration ofsigns and symptoms of decompensationof patients and families.

5. Use clinical reasoning to identify patientneeds based upon analysis of healthdata and evidence-based practiceoutcomes and communicateobservations.

6. Perform health screening and identifyanticipated physical and mental healthrisks related to lifestyle and activities forprevention.

3. a. Validate, report, and documentcomprehensive assessment data,including physical and mentalhealth status and needs forpatients, families, populations,and communities.

b. Evaluate evidence supportingtraditional and complementaryhealth care practices being usedby patients, families, populations,and communities.

4. Identify complex multiple health careneeds of patients, with considerationof signs and symptoms of decom-pensation of patients and families.

5. Use clinical reasoning to identifypatient needs based upon analysis ofhealth data, evidence-based practiceoutcomes, and research findings andcommunicate observations.

6. Perform health screening and casefinding, and identify links betweenphysical and mental health, lifestyle,prevention, and cost; and access tohealth care.



39

7. Differentiate abnormal from normalhealth data of patients.

8. Recognize healthcare outcomes andreport status of patients.

9. Recognize that economic and familyprocesses affect the health ofpatients.

7. Interpret and analyze health data forunderlying pathophysiological changesin the patients’ status.

8. Incorporate multiple determinants ofhealth when providing nursing care forpatients and families.

9. Recognize that political, economic, andsocietal forces affect the health ofpatients and their families.

7. Interpret and analyze health data ofpatients, families, populations, andcommunities, including pathophysiol-ogy, genomics, and epidemiologicalconsiderations.

8. Incorporate multiple determinantsof health when providing nursing carefor patients, families, populations, andcommunities.

9. a. Recognize that political, economic,and societal forces affect thehealth of patients, families,populations, and communities.

b. Examine populations at risk fromepidemiological, social, andenvironmental perspectives.

10. Use epidemiological, social, andenvironmental data to draw inferencesabout the health status of populationsand communities.



C. Report data to assist in the identifica-tion of problems and formulation ofgoals/outcomes and patient-centeredplans of care in collaboration withpatients, their families, and theinterdisciplinary health care team.

1. Process to establish the nurse-patient/family relationship includingcultural aspects of care.

2. Written, verbal, and non-verbalmodes of communication includinginformation technologies.

3. Fundamental principles of diseaseprevention and health promotion/restoration for patients.

C. Analyze assessment data to identifyproblems, formulate goals/outcomes,and develop plans of care for patientsand their families using informationfrom evidence-based practice incollaboration with patients, theirfamilies, and the interdisciplinaryhealth care team.

1. a. Principles of establishing nurse-patient/family relationshipincluding cultural aspects of care.

b. Principles for recognizing functionaland dysfunctional relationships.

2. a. Techniques of written, verbal, andnonverbal communication includingelectronic information technologies.

b. Principles of effective communicationand the impact on nursing practice.

3. Principles of disease prevention, healthpromotion, education, and rehabilitationfor patients.

C. Synthesize comprehensive assessmentdata to identify problems, formulategoals/outcomes, and develop plans ofcare for patients, families, populations,and communities usinginformation from evidence-basedpractice and published research incollaboration with the above groupsand the interdisciplinary health careteam.

1. a. Principles of establishing nurse-patient/family relationshipincluding cultural aspects of care.

b. Models for understanding thedynamics of functional anddysfunctional relationships.

2. a. Techniques of written, verbal, andnonverbal communicationincluding electronic informationtechnologies.

b. Communication theories and theirimpact on nursing practice.

3. a. Principles and theories of diseaseprevention, health promotion,education, and rehabilitation forpatients.

b. Principles of epidemiology andgenomics.

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41



4. Interventions to support patients andtheir families during life stages,including end-of-life care.

5. Relationships among the nursing planof care, the therapeutic regimen, theplan of care of other interdisciplinaryhealth care team members, and basiccost factors.

6. Criteria for setting priorities inplanning and evaluating care.

7. Steps and procedures in dischargeplanning process.

8. Concepts from basic sciences andsupport courses.

4. a. Evidence-based clinical practiceguidelines as a basis of interventionsto support patients and theirfamilies throughout the lifespan,including end-of-life care.

b. Interdisciplinary collaboration.

5. Congruence of the relationships amongthe nursing plan of care, the therapeuticregimen, the plan of care of otherinterdisciplinary health care teammembers, and basic cost factors.

6. A systematic approach for problem-solving and decision-making forprioritizing and evaluating the plan ofcare.

7. Strategies for collaborative dischargeplanning.

8. Concepts from humanities and natural,social, and behavioral sciences appliedto care planning for patients and theirfamilies.

4. a. Evidence-based clinical practiceguidelines as a basis ofinterventions to support patientsand families throughout thelifespan, including end-of-life care.

b. Interdisciplinary interventions,including nursing care across allsettings.

5. Congruence of the relationshipsamong the nursing plan of care, thetherapeutic regimen, the plan of careof other interdisciplinary health careteam members, and cost factors inmultiple settings.

6. A variety of systematic approaches forproblem-solving and decision-makingfor prioritizing and evaluating the planof care.

7. a. Strategies for collaborativedischarge planning.

b. Research findings related tonursing care and dischargeplanning.

8. Concepts and principles of arts,humanities, and natural, social, andbehavioral sciences as applied to careplanning for patients, families,populations, and communities.


1. Integrate concepts from basic sciencesand humanities to deliver safe andcompassionate care in delivery ofpatient care.

2. Identify short-term goals andoutcomes, select interventionsconsidering cultural aspects, andestablish priorities for care incollaboration with patients, theirfamilies, and the interdisciplinaryteam.

3. Participate in the development andmodification of the nursing plan ofcare across the lifespan, includingend-of-life care.

4. Contribute to the plan of care bycollaborating with interdisciplinaryteam members.

1. Integrate knowledge from generaleducation and sciences for the directand indirect delivery of safe andcompassionate care for patients andtheir families.

2. Establish short-term and long-termgoals and outcomes, selectinterventions considering culturalaspects, and establish priorities forcare in collaboration with patients, theirfamilies, and the interdisciplinary team.

3. a. Use current technology andevidence-based information toformulate and modify the nursingplan of care across the lifespan,including end-of-life care.

b. Assist with collection of data fromdirect patient care to redefinepractice guidelines.

4. Collaborate with interdisciplinary teammembers to plan for comprehensiveservices for patients and their families.

1. Synthesize theory and research-basedknowledge from arts, humanities, andsciences for the direct and indirectdelivery of safe and compassionate carefor patients, families, populations, andcommunities.

2. Establish short-term and long-termgoals and outcomes, select interventionsconsidering cultural aspects, andestablish priorities for care ofpatients, families, populations,communities, and the interdisciplinaryteam.

3. a. Use current technology andevidence-based information toformulate and modify the nursingplan of care across the lifespan,including end-of-life care.

b. Assist in the development ofclinical practice guidelines usingevidence-based practice andresearch findings.

4. Collaborate with interdisciplinary teammembers to plan for comprehensiveservices for patients, families,populations, and communities.



43

5. Assist in the discharge planning ofselected patients.

6. Demonstrate fiscal accountability inproviding patient care.

7. Demonstrate basic knowledge ofdisease prevention and healthpromotion in delivery of care topatients and their families.

D. Provide safe, compassionate, basicnursing care to assigned patients withpredictable health care needs througha supervised, directed scope ofpractice.

1. a. Components of compassionate,patient-centered care.

b. Standards of Care, Standards ofPractice, institutional policies andprocedures for delivery of nursingcare.

c. Professional ethics.

5. Plan, implement, and evaluate dischargeplanning using evidence-basedguidelines in collaboration with theinterdisciplinary health care team.

6. Demonstrate fiscal accountability inproviding care for patients and theirfamilies.

7. Demonstrate knowledge of diseaseprevention and health promotion indelivery of care to patients and theirfamilies.

D. Provide safe, compassionate, compre-hensive nursing care to patients andtheir families through a broad array ofhealth care services.




5. Use research findings and evidence-based guidelines to plan, implement,and evaluate discharge plans incollaboration with the interdisciplinaryhealth care team.

6. In collaboration with theinterdisciplinary team, use knowledgeof financial resources to demonstratefiscal accountability for health care ofpatients, families, populations, andcommunities.

7. Demonstrate knowledge of diseaseprevention and health promotion indelivery of care to patients, families,populations, and communities.

D. Provide safe, compassionate,comprehensive nursing care topatients, families, populations, andcommunities through a broad array ofhealth care services.




Knowledge



d. Professional characteristics andvalues such as altruism, humandignity, truth, justice, freedom,equality, and esthetics.

2. Characteristics, trends, and issues ofhealth care delivery.

3. a. Basis for determining nursing carepriorities in patient care.

b. Principles of decision-making.

4. Scope of responsibilities andaccountability for supervision andcollaboration.


e. Nursing unit staffmanagement.

2. Characteristics, trends, and issues ofhealth care delivery.


b. Principles for determining prioritiesand organization of nursing care.

4. a. Scope of responsibilities andaccountability for supervision andcollaboration.

b. Principles of delegation,supervision, and collaborationincluding Texas Board of NursingDelegation Rules.

c. Models and patterns of nursingcare delivery.


e. Nursing unit staff management.f. Resource management and

organizational behavior.

2. a. Characteristics, trends, and issuesof health care delivery.

b. Models for health care delivery inorganizations and communities.


b. Principles for determiningpriorities and organization ofnursing care.

c. Models of priority setting andorganizational management.

4. a. Scope of responsibilities andaccountability for supervision andcollaboration.

b. Principles of delegation,supervision, and collaborationincluding Texas Board of NursingDelegation Rules.

c. Systems of nursing care delivery.



45

5. Channels of communication fordecision-making processes withinwork settings.

1. Assume accountability andresponsibility for nursing care througha directed scope of practice under thesupervision of a registered nurse,advanced practice registered nurse,physician assistant, physician,podiatrist, or dentist using standardsof care and professional values.

2. a. Identify priorities and makejudgments concerning basicneeds of multiple patients withpredictable health care needs inorder to organize care.

b. Manage multiple responsibilities.c. Recognize changes in patient

status.d. Communicate changes in patient

status to other providers.

5. a. Channels of communication fordecision-making processes withinwork settings.

b. Principles of decision-making.

1. Assume accountability and responsibilityfor nursing care provided within theprofessional scope of practice, standardsof care, and professional values.

2. a. Identify priorities and makejudgments concerning the needs ofmultiple patients in order toorganize care.

b. Anticipate and interpret changes inpatient status and relatedoutcomes.

c. Communicate changes in patientstatus to other providers.

d. Manage priorities and multipleresponsibilities to provide care formultiple patients.

5. a. Channels of communication anddecision-making processes withinwork settings, organizations, andcommunities.

b. Decision-making principles andmodels.

1. Assume accountability andresponsibility for nursing care providedwithin the professional scope ofpractice, standards of care, andprofessional values.

2. a. Identify priorities and makejudgments concerning the needsof multiple patients, families,populations, and communities inorder to organize care.

b. Anticipate and interpret changesin patient and group status andrelated outcomes.

c. Communicate changes in patientstatus to other providers.

d. Manage priorities and multipleresponsibilities to provide care forpatients and groups.




3. a. Implement plans of care formultiple patients.

b. Collaborate with others to ensurethat health care needs are met.

4. Participate in management activities.

E. Implement aspects of the plan of carewithin legal, ethical, and regulatoryparameters and in consideration ofpatient factors.

1. Common health practices andbehaviors of patients and their familiesrelated to developmental level,gender, culture, belief system, and theenvironment.


b. Collaborate within and acrosshealth care settings to ensure thathealth care needs are met,including primary and preventivehealth care.

c. Manage care for multiple patientsand their families.

4. Apply management skills to assign and/or delegate nursing care to othermembers of the nursing team.

E. Implement the plan of care for patientsand their families within legal, ethical,and regulatory parameters and inconsideration of disease prevention,wellness, and promotion of healthylifestyles.

1. a. Health practices and behaviors andearly manifestations of disease inpatients and their families relatedto developmental level, gender,culture, belief system, and theenvironment.


b. Collaborate within and across abroad array of settings to ensurethat health care needs are met,including primary and preventivehealth care.

c. Manage care for multiple patients,families, populations, andcommunities.

4. Apply concepts and skills frommanagement theory to assign and/ordelegate nursing care to othermembers of the nursing team in avariety of settings.

E. Implement the plan of care forpatients, families, populations, andcommunities within legal, ethical, andregulatory parameters and in consider-ation of disease prevention, wellness,and promotion of healthy lifestyles.

1. a. Health practices and behaviorsand early manifestations ofdisease in patients, families,populations, and communities,related to developmental level,gender, culture, belief system,and the environment.

Knowledge



47

b. Healthy lifestyles and earlymanifestations of disease inpatients and their families.

2. Patterns and modes of therapeutic andnon-therapeutic communication,delegation, and collaboration.

3. a. Rights and responsibilities ofpatients related to health care andadvocacy.

b. Advocacy for health promotion forpatients and their families.

4. a. Physiological, psychiatric, andmental health aspects of nursinginterventions.

b. Approaches to comprehensivehealth care, including healthpromotion and preventive practicesfor patients and their families.

5. Principles and factors that contribute tothe maintenance or restoration ofhealth and prevention of illness.

b. Healthy lifestyles, earlymanifestations of disease, andepidemiology in populations.

c. Health behavior change strategiesto promote health and manageillness.

2. Theories, models, patterns, and modesof therapeutic and non-therapeuticcommunication, delegation, andcollaboration.

3. a. Rights and responsibilities ofpatients related to health care andadvocacy.

b. Public policy advocacy.

4. a. Physiological, psychiatric, andmental health aspects of nursinginterventions.

b. Approaches to comprehensivehealth care, including healthpromotion and preventive practicesfor patients, families, populations,and communities.

5. Principles and research findings offactors that contribute to themaintenance or restoration of healthand prevention of illness.

2. Methods of therapeuticcommunication.

3. Rights and responsibilities of patientsrelated to health care and basicadvocacy.

4. Basic physiological and mental healthaspects of nursing interventions.

5. Principles and factors that contributeto the maintenance or restoration ofhealth and prevention of illness.



6. a. Properties, effects, and basicprinciples underlying the use andadministration ofpharmacotherapeutic agents,including patients’ responses.

b. Effects of misuse of prescriptionand nonprescription medicationsand other substances.

7. Coping mechanisms for managingstress and identifying resources forcrisis management.

8. Code of vocational nurse ethics andpatient’s rights.

9. Legal parameters of vocational nursingpractice and health care.

10. Available intradisciplinary andinterdisciplinary resources within theemployment setting.

6. a. Principles and rationale underlyingthe use, administration, andinteraction of pharmacotherapeuticand psychopharmacotherapeuticagents using evidence-basedoutcomes which impact patients’responses.


7. Principles and strategies of stressmanagement, crisis intervention, andconflict management.

8. Code of ethics, ethical practices, andpatient’s rights; and framework forethical decision-making.

9. Legal parameters of professional nursingpractice and health care.

10. Intradisciplinary and interdisciplinaryresources and organizationalrelationships including structure,function, and utilization of resources.

6. a. Principles and rationale underlyingthe use, administration, andinteraction of pharmacotherapeuticand psychopharmacotherapeuticagents, and research studiesimpacting patients’ responses tothese agents.


7. Principles, strategies, theories, andmodels of stress, crisis responses, andconflict management.

8. Code of ethics, ethical practices, currentissues, and patient’s rights in the healthcare delivery system.

9. Legal standards and implications forprofessional nursing care in multiplehealth care delivery settings.

10. Intradisciplinary and interdisciplinaryresources and organizationalrelationships including structure,function, and utilization of health caredelivery system resources.



49

11. Key federal and state statutes andinstitutional policies regarding patientconfidentiality.

12. Nursing interventions to implementplan of care.

13. Clinical reasoning in the delivery ofcare to patients with predictablehealth care needs using knowledgefrom the vocational nursing programof study.

1. Implement individualized plans of careto assist patients to meet basicphysical and psychosocial needs.

11. a. Key federal and state statutes andinstitutional policies regardingpatient confidentiality.

b. Issues and factors impactingconfidentiality.

c. Management of nursing informaticsusing principles of confidentiality.

12. Nursing interventions to implement planof care, reduce risks, and promotehealth for patients and their families.

13. Clinical reasoning for patients and theirfamilies with complex health care needsusing a framework of knowledge derivedfrom the diploma or associate degreenursing program of study.

1. Implement individualized plans of careto assist patients and their families tomeet physical and mental health needs.

11. a. Key federal and state statutes andinstitutional policies regardingpatient confidentiality.

b. Issues and factors impactingconfidentiality.

c. Information systems managementconsistent with principles ofconfidentiality.

12. Nursing interventions to implementplan of care, reduce risks, and promotehealth for individuals, families,populations, and communities.

13. Clinical reasoning for complex healthcare needs of patients, families,populations, and communities using abroad framework of knowledge fromthe baccalaureate nursing program ofstudy.

1. Implement individualized plans of careto assist patients, families, communities,and vulnerable populations to meetcomprehensive physical and mentalhealth care needs in multiple settings.




2. Implement nursing interventions topromote health, rehabilitation, andimplement nursing care for clientswith chronic physical and mentalhealth problems and disabilities.

3. Initiate interventions in rapidly-changing and emergency patientsituations.

4. Communicate accurately andcompletely and document responsesof patients to prescription andnonprescription medications,treatments, and procedures to otherhealth care professionals clearly and ina timely manner.

5. Foster coping mechanisms of patientsand their families during alterations inhealth status and end of life.

2. a. Implement nursing interventions topromote health and rehabilitation.

b. Implement nursing care to promotehealth and manage acute andchronic physical and mental healthproblems and disabilities.

c. Assist patients and their families tolearn skills and strategies to protectand promote health.

3. a. Adjust priorities and implementnursing interventions in rapidly-changing and emergency patientsituations.

b. Participate with theinterdisciplinary team to managehealth care needs of patients andtheir families.

4. Communicate accurately and completelyand document responses of patients toprescription and nonprescriptionmedications, treatments, andprocedures to other health careprofessionals clearly and in a timelymanner.

5. a. Facilitate coping mechanisms ofpatients and their families duringalterations in health status and endof life.

2. a. Implement nursing interventions topromote health and rehabilitation.

b. Implement nursing care to promotehealth and manage acute andchronic physical and mental healthproblems and disabilities.

c. Assist patients and families to learnskills that promote and protecthealth in multiple settings.

3. a. Adjust priorities and implementnursing interventions in rapidly-changing and emergency patientsituations.

b. Participate with the interdisciplin-ary team to manage health careneeds of patients, families,populations, and communities.

4. Communicate accurately and completelyand document responses of patients toprescription and nonprescriptionmedications, treatments, andprocedures to other health careprofessionals clearly and in a timelymanner.

5. a. Facilitate patient and family copingduring alterations in health statusand end of life.



51

b. Apply evidence-based practiceoutcomes to support patient andfamily adaptation during healthcrises.

6. a. Collaborate with other health careproviders regarding treatments andprocedures.

b. Promote interdisciplinary teamcollaboration in carrying out theplan of care.

c. Seek clarification as needed.d. Provide accurate and pertinent

communication when transferringpatient care to another provider.

7. a. Inform patient of Patient’s Bill ofRights.

b. Evaluate and clarify patient’sunderstanding of health care rights.

c. Encourage active engagement ofpatients and their families in care.

8. Use interdisciplinary resources withinthe institution to address ethical andlegal concerns.

b. Apply evidenced-based practiceoutcomes and research findings tosupport patient, family, population,and community coping andadaptation during health crises.

6. a. Collaborate with other health careproviders regarding treatments andprocedures.

b. Promote interdisciplinary teamcollaboration in carrying out theplan of care.

c. Seek clarification as needed.d. Provide accurate and pertinent



b. Evaluate and clarify patient’sunderstanding of health care rights.

c. Encourage active engagement ofpatient, family, population, andcommunity in care.

8. Use interdisciplinary, institutional,community, and scholarly resources toaddress ethical and legal concerns.

6. a. Assist interdisciplinary healthcare team members withexaminations and procedures.

b. Seek clarification as needed.c. Provide accurate and pertinent



b. Encourage active engagement ofpatients and their families incare.

8. Communicate ethical and legalconcerns through establishedchannels of communication.



9. Use basic therapeutic communicationskills when interacting with patients,their families, and other professionals.

10. Apply current technology andinformatics to enhance direct patientcare while maintaining patientconfidentiality and promoting safety.

11. Facilitate maintenance of patientconfidentiality.

12. a. Demonstrate accountability byproviding nursing interventionssafely and effectively using adirected scope of practice.

b. Provide nursing interventionssafely and effectively usingestablished evidence-basedpractice guidelines.

9. Use therapeutic communication skillswhen interacting with and maintainingrelationships with patients and theirfamilies, and other professionals.

10. Apply current technology andinformatics to enhance patient carewhile maintaining confidentiality andpromoting safety.


12. a. Demonstrate accountability byusing independent clinicaljudgment and established clinicalguidelines to reduce risks andpromote health.

b. Provide nursing interventions safelyand effectively using evidence-based outcomes.

9. a. Use therapeutic communicationskills when interacting with andmaintaining relationships withpatients and families, and otherprofessionals.

b. Apply communication theory andtechniques in maintainingprofessional relationships withpatients, families, populations,and communities.

10. a. Apply current technology andinformatics to enhance patientcare while maintainingconfidentiality and promotingsafety.

b. Use informatics to promotehealth and reduce risk in thecommunity.


12. a. Demonstrate accountability byusing independent clinicaljudgment and established clinicalguidelines to reduce risks andpromote health.

b. Provide nursing interventionssafely and effectively usingcurrent research findings andevidence-based outcomes.



53

13. Provide direct patient care in diseaseprevention and health promotionand/or restoration.

F. Identify and report alterations inpatient responses to therapeuticinterventions in comparison toexpected outcomes.

1. Mechanisms to evaluate specificnursing interventions and patientoutcomes.

2. Factors indicating changes that havepotential for life-threateningconsequences based on knowledge oflife sciences.

13. Provide direct and indirect patient andfamily care in disease prevention andhealth promotion and/or restoration.

F. Evaluate and report patient outcomesand responses to therapeuticinterventions in comparison tobenchmarks from evidence-basedpractice, and plan follow-up nursingcare.

1. Methods to evaluate health careprocesses and patient outcomes.

2. Factors indicating changes that havepotential for life-threateningconsequences based on knowledgeof physiology, pathophysiology,and pharmacology.

Knowledge



13. a. Provide direct and indirect patientand family care in diseaseprevention and health promotionand/or restoration.

b. Provide direct and indirect care incommunity-based programs whoseprimary goals are diseaseprevention and health promotionand/or restoration.

F. Evaluate and report patient, family,population, and community outcomesand responses to therapeuticinterventions in comparison tobenchmarks from evidence-basedpractice and research findings, and planfollow-up nursing care.

1. Systematic processes to assess methodsfor evaluating patient outcomes,including reliability and validity ofevaluation tools.

2. Factors indicating changes that havepotential for life-threateningconsequences based on knowledgeof advanced pathophysiology,neurobiology, pharmacology, genomics,chemistry, humanities, and liberal artseducation.

3. Basic performance improvementactivities in patient care delivery.

1. Report changes in assessment data.

2. Use standard references to compareexpected and achieved outcomes ofnursing care.

3. Communicate reasons for deviationsfrom plan of care to supervisoryhealth care team member.

3. Introduction to performance improve-ment concepts in patient care delivery.

1. a. Report changes in assessment data.b. Evaluate need to intervene to

stabilize and prevent negativepatient outcomes and/or tosupport end-of-life care.

c. Evaluate patterns of behavior andchanges that warrant immediateintervention.

2. a. Use standard references tocompare expected and achievedoutcomes of nursing care.

b. Analyze patient data to compareexpected and achieved outcomesfor patient using evidence-basedpractice guidelines.

3. a. Communicate reasons and rationalefor deviation from plan of care tointerdisciplinary health care team.

b. Use nursing knowledge torecommend revisions of plan ofcare with interdisciplinary team.

3. Performance improvement concepts,motivation theory, and research/evaluation outcome measures toevaluate efficacy and effectiveness ofcare.

1. a. Report changes in assessment data.b. Evaluate need to intervene to

stabilize and prevent negativepatient outcomes and/or tosupport end-of-life care.

c. Evaluate patterns of behavior andchanges that warrant immediateintervention.

2. a. Use standard references tocompare expected and achievedoutcomes of nursing care.

b. Analyze patient data and useresearch findings, evidence-basedpractice guidelines, and a variety ofsystematic processes to compareexpected and achieved outcomesfor patient.

3. a. Communicate reasons and rationalefor deviation from plan of care tointerdisciplinary health care team.

b. Use research findings to helpexplain deviations from plan of careand revise plan of care withinterdisciplinary health care team.




55

4. Modify plan of care based on overt orsubtle shifts in patient status andoutcomes.

5. a. Report and document patient’sresponses to nursing interventions.

b. Evaluate and communicate qualityand effectiveness of therapeuticinterventions.

c. Collaborate with interdisciplinaryhealth care team to evaluate planof care and to promote quality andeffectiveness of care.

6. Evaluate the effectiveness of nursinginterventions based on expected patientoutcomes, modify interventions to meetthe changing needs of patients, andrevise plan of care as a result ofevaluation.

4. Modify plan of care based on overt orsubtle shifts in patient status, researchfindings, and evaluation data.

5. a. Report and document patient’sresponses to nursing interventions.

b. Evaluate and communicatequality and effectiveness oftherapeutic interventions.

c. Collaborate with interdisciplinaryhealth care team to evaluate planof care and to promote qualityand effectiveness of care.

6. a. Evaluate the effectiveness ofnursing interventions based onexpected patient outcomes,modify interventions to meet thechanging needs of patients, andrevise plan of care as a result ofevaluation.

b. Evaluate evidence-based data foruse in providing comprehensive,efficient, cost-effective care todiverse patients, families,populations, and communities.

4. Assist in modifying plan of care.

5. Report and document patient’sresponses to nursing interventions.

6. Assist in evaluating patient caredelivery based on expected outcomesin plan of care and participate inrevision of plan of care.



G. Implement teaching plans for patientsand their families with commonhealth problems and well-definedhealth learning needs.

1. Lifespan development and commonsituational variables affecting learning,such as stress, pain, and fear.

2. Basic principles of the teaching/learning process.

3. Resources that support patient healthcare knowledge, decision-making, andself-advocacy.

G. Develop, implement, and evaluateteaching plans for patients and theirfamilies to address health promotion,maintenance, and restoration.

1. a. Lifespan development and sociocul-tural variables affecting theteaching/learning process.

b. Techniques for assessment oflearning needs and factors affectinglearning.

2. a. Principles, methods, strategies, andoutcomes of learning andteaching.

b. Methods and strategies to evaluatelearning and teaching.

3. a. Resources that support patienthealth care knowledge,decision-making, andself-advocacy.

b. Methods for advocating for patientand family health.

G. Develop, implement, and evaluateteaching plans for patients, families,populations, and communities toaddress health promotion, maintenance,restoration, and population riskreduction.

1. a. Lifespan development andsociocultural variables affecting theteaching/learning process.

b. Techniques for assessment oflearning needs and factors affectinglearning.

c. Techniques for assessment ofcommunity health literacy, learningneeds, and factors affecting qualityof life and health care.

2. a. Principles, methods, strategies, andoutcomes of learning and teaching.

b. Learning theories and bestpractices for evaluating methods,strategies, and outcomes oflearning and teaching.

3. a. Resources that support patienthealth care knowledge,decision-making, and self-advocacy.

b. Methods for advocating for patient,family, population, and communityhealth.

Knowledge



57

1. Assess learning needs of patients andtheir families related to risk reductionand health promotion, maintenance,and restoration.

2. a. Collaborate with the patient andinterdisciplinary health care teamto develop individualized teachingplans based upon developmentaland health care learning needs.

b. Use best practice standards andother evidence-based findings indeveloping and modifying teachingplans for patients and theirfamilies.

3. Develop and implement comprehensiveteaching plans for health promotion,maintenance, and restoration and riskreduction for patients and their familieswith consideration of support systems.

1. a. Assess learning needs of patients,families, populations, andcommunities related to healthpromotion, maintenance, andrestoration.

b. Assess genetic, protective, andpredictive factors that influencethe learning needs of patients,families, populations, andcommunities, related to riskreduction and health promotion,maintenance, and restoration.

2. a. Collaborate with the patient andinterdisciplinary health care teamto develop individualized teachingplans based upon developmentaland health care learning needs.

b. Use best practice standards andother evidence-based findings indeveloping and modifying teachingplans and strategies for patients,families, populations, andcommunities.

3. Develop and implement comprehensiveteaching plans for health promotion,maintenance, and restoration, and riskreduction of patients, families,populations, and communities.


1. Identify health-related learning needsof patients and their families.

2. Contribute to the development of anindividualized teaching plan.

3. Implement aspects of an establishedteaching plan for patients and theirfamilies.



4. Assist in evaluation of learningoutcomes using structured evaluationtools.

5. Teach health promotion andmaintenance and self-care toindividuals from a designated teachingplan.

6. Provide patients with theinformation needed to make choicesregarding health.

7. Provide patients and their familieswith basic sources of healthinformation.

4. Evaluate learning outcomes ofpatients and their families receivinginstruction.

5. a. Modify teaching plans for healthpromotion and maintenance andself-care to accommodate patientand family differences.

b. Teach health promotion andmaintenance and self-care toindividuals and their families basedupon teaching goals.

6. Provide patients and their families withthe information needed to make choicesregarding health.

7. Serve as an advocate and resource forhealth education and information forpatients and their families.

4. Evaluate learning outcomes ofcomprehensive teaching plans forpatients, families, populations, andcommunities.

5. a. Modify teaching plans for healthpromotion and maintenance andself-care to accommodate patientand family differences.

b. Develop teaching plans with specialconsiderations for vulnerablepopulations.

c. Teach health promotion andmaintenance and self-care toindividuals, families, and groupsbased upon teaching goals.

6. a. Provide patients, families,populations, and communities withthe information needed to makechoices regarding health.

b. Implement risk reduction strategiesto address social and public healthissues.

7. Advocate for health education, healthylifestyles, and early detection andtreatment of disease, targetingvulnerable populations.



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H. Assist in the coordination of human,information, and materiel resources inproviding care for assigned patientsand their families.

1. Organizational mission, vision, andvalues as a framework for care.

2. Lines of authority and accountabilitywithin structured health care settings.

3. Workplace safety consistent withcurrent federal, state, and localregulations and guidelines.

4. Vocational nursing role inimplementing establishedcost containment measures.

5. Communication within organizationalframework.

6. Roles and responsibilities of membersof the interdisciplinary health care team.

H. Coordinate human, information, andmateriel resources in providing care forpatients and their families.

1. Organizational mission, vision, andvalues as a framework for care andmanagement.

2. Types of organizational frameworks ofvarious health care settings.

3. a. Workplace safety consistent withcurrent federal, state, and localregulations and guidelines.

b. Promoting a safe environment.

4. a. Key issues related to budgetaryconstraints impacting the use ofresources.

b. Basic models of reimbursement.

5. Basic principles of management andcommunication within an organization.

6. Roles and responsibilities of members ofthe interdisciplinary health care team.

H. Coordinate human, information, andmateriel management resources inproviding care for patients, families,populations, and communities.

1. Organizational mission, vision, andvalues as a framework for care,management, and leadership.

2. Organizational theories/principles oforganizational behavior.

3. a. Workplace safety consistent withcurrent federal, state, and localregulations and guidelines.

b. Safe environmental managementand promoting a culture of safety.

4. a. Workplace unit budgeting andworkforce resource management.

b. Basic models of reimbursement.

5. a. Management and communicationwithin an organization.

b. Leadership and managementtheory, practice, and skills.

6. Roles and responsibilities of members ofthe interdisciplinary health care team.

Knowledge



7. Individual response to organizationalchange.

1. Participate in implementing changesthat lead to improvement in the worksetting.

2. Report unsafe patient careenvironment and equipment.

3. Implement established costcontainment measures in directpatient care.

7. Change process and strategies forinitiating and evaluating effectivenessof change.

1. Identify and participate in activities toimprove health care delivery within thework setting.

2. Report the need for corrective actionwithin the organization for safe patientcare.

3. Collaborate with the interdisciplinaryhealth care team to select human andmateriel resources that are optimal,legal, and cost-effective to achievepatient-centered outcomes and meetorganizational goals.

7. Change theory, processes, andstrategies and change agent role,including methods for evaluatingeffectiveness of change.

1. a. Identify and participate inactivities to improve health caredelivery within the work setting.

b. Assess the management structureand nursing care delivery systemwithin a health care organizationand recommend changes forimprovement.

2. a. Report the need for correctiveaction within the organization forsafe patient care.

b. Design and implement strategies(e.g., coaching to increase theeffectiveness of teamwork) torespond to the need for correctiveaction to promote a safe workenvironment.

3. Collaborate with the interdisciplinaryhealth care team to use human andmateriel resources that are optimal,legal, and cost-efficient to achievepatient-centered outcomes, meetorganizational goals, and promotehealth in the community.




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4. Assign patient care activities takingpatient safety into considerationaccording to Texas Board of NursingRules (217.11).

5. Use management skills to assign tolicensed and unlicensed personnel.

6. Assist with maintenance of standardsof care.

4. Use basic management and leadershipskills, act as a team leader, superviseand delegate care, and contribute toshared goals.

5. a. Use management skills to delegateto licensed and unlicensedpersonnel.

b. Demonstrate leadership role inachieving patient goals.

6. Implement established standards ofcare.

4. a. Supervise and delegate care andcontribute to shared goals.

b. Use management, leadership,team building, and administrativeskills; organize, manage, andevaluate the functioning ofgroups of individuals and staff.

5. a. Use management skills todelegate to licensed andunlicensed personnel.

b. Demonstrate a leadership role inachieving patient/family/population/community goals andmanagement goals.

6. a. Implement established standardsof care.

b. Collaborate in the development ofstandards of care based onevidence-based practicecongruent with organizationalstructure and goals.






A licensed nurse (LVN or RN) who promotes safety in the patient and family environment by: following scope and standards of nursingpractice; practicing within the parameters of individual knowledge, skills, and abilities; identifying and reporting actual and potentialunsafe practices; and implementing measures to prevent harm. The BSN-educated RN is also prepared to be a patient safety advocatefor populations and communities.

Knowledge


1. Texas Nursing Practice Act and TexasBoard of Nursing Rules.

2. National Standards of Nursing Practice.

3. Federal, state, and local governmentand accreditation organizations’ safetyrequirements and standards.


5. Facility licensing agency or authoritystandards.




3. Federal, state, and local government andaccreditation organizations’ safetyrequirements and standards.






3. Federal, state, and local governmentand accreditation organizations’ safetyrequirements and standards.



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6. Principles of quality improvement.

1. Attain licensure.

2. Practice according to the TexasNursing Practice Act and Texas Boardof Nursing Rules.

3. Seek assistance if practice requiresbehaviors or judgments outside ofindividual knowledge and expertise.

4. Use standards of nursing practice toprovide and evaluate patient care.

5. Recognize and report unsafe practicesand contribute to qualityimprovement processes.

6. Participate in peer review.

6. Principles of quality improvement andoutcome measurement in health careorganizations.


2. Practice according to the Texas NursingPractice Act and Texas Board of NursingRules.



5. a. Recognize and report unsafepractices.

b. Manage personnel to maintain safepractice including participation inquality improvement processes forsafe patient care.


6. Principles and tools of quality improve-ment and outcome measurement insystems of care delivery.


2. Practice according to the Texas NursingPractice Act and Texas Board of NursingRules.



5. a. Recognize and report unsafepractices.

b. Manage personnel to maintain safepractice and manage qualityimprovement processes for safepatient care.





B. Implement measures to promotequality and a safe environment forpatients, self, and others.

1. Principles of patient safety includingsafe patient handling.

2. Methods for promoting safety in thepatient care environment consistentwith current standards and guidelines.

3. Role in safety and risk managementfor patients and others.

4. Principles of a culture of safetyincluding safe disposal of medicationsand hazardous materials.

5. Texas Board of Nursing Rules relatedto mandatory reporting, Safe Harbor,and “Whistleblower” protection.


1. a. Principles of patient safetyincluding safe patient handling.

b. Management of the patientenvironment for safety.


3. Role in safety and risk management forpatients and others.

4. Principles of a culture of safety includingsafe disposal of medications andhazardous materials.

5. Texas Board of Nursing Rules related tomandatory reporting, Safe Harbor, and“Whistleblower” protection.

B. Implement measures to promotequality and a safe environment forpatients, self, and others.

1. a. Principles of patient safetyincluding safe patient handling.

b. Quality improvement,environmental management, andrisk management with a focus onpatient safety.


3. Leadership role in quality, safety, andpatient risk management andmanagement of the environment forpatient and others’ safety.

4. Principles of a culture of safety includingsafe disposal of medications andhazardous materials.

5. Texas Board of Nursing Rules related tomandatory reporting, Safe Harbor, and“Whistleblower” protection.

Knowledge



65


1. Promote a safe, effective careenvironment conducive to the optimalhealth and dignity of patients andtheir families.

2. Accurately identify patients.

3. a. Safely perform preventive andtherapeutic procedures andnursing measures including safepatient handling.

b. Safely administer medicationsand treatments.

4. Clarify any order or treatment regimenbelieved to be inaccurate, non-efficacious, contraindicated, orotherwise harmful to the patient.

5. Document and report reactions anduntoward effects to medications,treatments, and procedures andclearly and accurately communicatethe same to other health careprofessionals.

1. Promote a safe, effective environmentconducive to the optimal health anddignity of patients and theirfamilies.


3. a. Safely perform preventive andtherapeutic procedures andnursing measures including safepatient handling.

b. Safely administer medicationsand treatments.

c. Reduce patient risk related tomedication and treatmentadministration based onevidence-based data.


5. Document and report reactions anduntoward effects to medications,treatments, and procedures andclearly and accurately communicatethe same to other health careprofessionals.

1. Promote and manage a safe, effectiveenvironment conducive to the optimalhealth and dignity of patients, families,populations, and communities.


3. a. Safely perform preventive andtherapeutic procedures and nursingmeasures including safe patienthandling.

b. Safely administer medications andtreatments.

c. Use epidemiological process tomanage and reduce risks related tomedication and treatmentadministration and modifytechniques in a variety of settings.


5. Document and report reactions anduntoward effects to medications,treatments, and procedures and clearlyand accurately communicate the sameto other health care professionals.



6. Report environmental and systemsincidents and issues that affect safety.

7. Use evidence-based information tocontribute to development ofinterdisciplinary policies andprocedures related to a safeenvironment including safe disposal ofmedications and hazardous materials.

8. Implement measures to prevent risk ofpatient harm resulting from errors andpreventable occurrences.

9. Inform patients regarding their plansof care and encourage participation toensure consistency and accuracy intheir care.

6. Report environmental and systemsincidents and issues that affect qualityand safety, promote a culture of safety,and participate in organizationalinitiatives that enhance a culture ofsafety.

7. Use evidence-based information toparticipate in development ofinterdisciplinary policies and proceduresrelated to a safe environment includingsafe disposal of medications andhazardous materials.

8. Assess potential risk for patient harmrelated to accidents and implementmeasures to prevent risk of patientharm resulting from errors andpreventable occurrences.

9. Inform patients regarding their plans ofcare and encourage participation toensure consistency and accuracy in theircare.

6. a. Report environmental and systemsincidents and issues that affectquality and safety, and promote aculture of safety.

b. Participate in organizationalinitiatives that enhance a culture ofsafety for patients, families,populations, and communities.

7. Use evidence-based findings to developinterdisciplinary policies and proceduresrelated to a safe environment includingsafe disposal of medications andhazardous materials.

8. Use evidence-based findings to initiateaccident prevention measures forpatients and implement measures toprevent risk of patient harm resultingfrom errors and preventableoccurrences.

9. Inform patients regarding their plans ofcare and encourage participation toensure consistency and accuracy in theircare.



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C. Assist in the formulation of goals andoutcomes to reduce patient risks.

1. Principles of disaster preparednessand fundamental principles ofcommunicable disease prevention forpatients and their families.

2. Current national and state standardsand guidelines and local proceduresfor infection control.

1. Assist in the formulation of goals andoutcomes to reduce patient risk ofhealth care-associated infections.

2. a. Implement measures to preventexposure to infectious pathogensand communicable conditions.

b. Anticipate risk for the patient.

C. Formulate goals and outcomes usingevidence-based data to reduce patientrisks.

1. Principles of disaster preparedness andcommunicable disease prevention andcontrol for patients and their families.

2. Current national and state standardsand guidelines and local procedures forinfection control.

1. Formulate goals and outcomes usingevidence-based data to reduce the riskof health care-associated infections.


b. Anticipate risk for the patient.

C. Formulate goals and outcomes using anevidence-based and theoretical analysisof available data to reduce patient andcommunity risks.

1. a. Principles and theoretical modelsof epidemiology and communicabledisease prevention andcontrol for patients, families,populations, and communities.

b. Evidence-based risk reduction.c. Epidemic and pandemic

prevention and control.d. Disaster preparedness, response,

and recovery.

2. Current international, national, andstate standards and guidelines and localprocedures for infection control.

1. Formulate goals and outcomes using anevidence-based and theoretical analysisof available data to reduce the risk ofhealth care-associated infections.


b. Anticipate risk for the patient,family, population, and community.

Knowledge




3. Implement established policies relatedto disease prevention and control.

D. Obtain instruction, supervision, ortraining as needed when implementingnursing procedures or practices.

1. a. Standards of Practice.b. Texas Board of Nursing Rules

(including Scope of Practice),Texas Board of Nursing PositionStatements, and Guidelines.

c. Facility policies and procedures.

1. Evaluate individual scope of practiceand competency related to assignedtask.

2. Seek orientation/training forcompetency when encounteringunfamiliar patient care situations.

3. Participate in development of policies toprevent exposure to infectious patho-gens, communicable conditions, andoccupational hazards.







3. a. Assist in developing policies andprocedures to prevent exposure toinfectious pathogens,communicable conditions, andother occupational hazards.

b. Participate in programs and systemsto address safety of patients,families, populations, andcommunities in the event ofemergency or disaster.







Knowledge




69

3. Seek orientation/training for compe-tency when encountering newequipment and technology.


1. a. Standards of Practice.b. Texas Board of Nursing Rules,


c. Scope of Practice.


1. Report unsafe practices of health careproviders using appropriate channelsof communication.

2. Understand Safe Harbor Rules andimplement when appropriate.

3. Report safety incidents and issuesthrough the appropriate channels.







1. Report unsafe practices of health careproviders using appropriate channels ofcommunication.


3. Report safety incidents and issues to theappropriate internal or externalindividual or committee.







1. Report unsafe practices of health careproviders using appropriate channels ofcommunication.


3. Report safety incidents and issues tothe appropriate internal or externalindividual or committee.

Knowledge




4. Implement established safety and riskmanagement measures.

* F. Accept and make assignments thattake into consideration patient safetyand organizational policy.


(including awareness of RNDelegation Rules), PositionStatements, and Guidelines.



1. Accept only those assignments thatfall within individual scope of practicebased on experience and educationalpreparation.

4. Participate in committees that promotesafety and risk management.

* F. Accept and make assignments anddelegate tasks that take intoconsideration patient safety andorganizational policy.


(including RN Delegation Rules),Position Statements, andGuidelines.



1. Accept only those assignments that fallwithin individual scope of practicebased on experience and educationalpreparation.

4. a. Participate in committees thatpromote quality, safety, and riskmanagement.

b. Interpret and guide others towardsafe and legal clinical practice.

c. Identify systems issues that impactnursing practice.

* F. Accept and make assignments anddelegate tasks that take intoconsideration patient safety andorganizational policy.


(including RN Delegation Rules),Position Statements, andGuidelines.



1. Accept only those assignments that fallwithin individual scope of practicebased on experience and educationalpreparation.

Knowledge




71

* 2. When making assignments, ensureclear communication regarding othercaregivers’ levels of knowledge, skills,and abilities.

* 3. When assigning nursing care, retainaccountability and supervisepersonnel based on Texas Board ofNursing Rules according to the settingto ensure patient safety.

* 2. When making assignments anddelegating tasks, ensure clearcommunication regarding othercaregivers’ levels of knowledge, skills,and abilities.

* 3. a. When assigning and delegatingnursing care, retain accountabilityand supervise personnel accordingto Texas Board of Nursing Rulesbased on the setting to ensurepatient safety.

b. Implement and participate indevelopment of organizationalpolicies and procedures regardingassignments and delegated tasks.

* 2. When making assignments anddelegating tasks, ensure clearcommunication regarding othercaregivers’ levels of knowledge, skills,and abilities.

* 3. a. When assigning and delegatingnursing care, retain accountabilityand supervise personnel accordingto Texas Board of Nursing Rulesbased on the setting to ensurepatient safety.

b. Implement and developorganizational policies andprocedures regarding assignmentsand delegated tasks.





A licensed nurse (LVN or RN) who provides patient-centered care by collaborating, coordinating, and/or facilitating comprehensive carewith an interdisciplinary/multidisciplinary health care team to determine and implement best practices for the patients and theirfamilies. The BSN-educated RN is also prepared to become a leader of the health care team as well as to provide care to populations andcommunities.


A. Communicate and collaborate withpatients, their families, and theinterdisciplinary health care team toassist in the planning, delivery, andcoordination of patient-centered careto assigned patients.

1. a. Structure and function of thehealth care delivery system.

b. Roles of interdisciplinary healthcare team members.

2. Methods of effective communicationand cooperation.

A. Coordinate, collaborate, andcommunicate with patients, theirfamilies, and the interdisciplinary healthcare team to plan, deliver, and evaluatepatient-centered care.

1. a. Structure, function, andinterdisciplinary relationshipswithin the health care deliverysystem.

b. Models of care delivery and roles ofinterdisciplinary health care teammembers.

2. Patterns and processes of effectivecommunication and collaboration,including assertiveness, negotiation,conflict resolution, and delegation.

A. Coordinate, collaborate, andcommunicate with patients, families,populations, communities, and theinterdisciplinary health care team toplan, deliver, and evaluate care.

1. a. Structure, function, andinterdisciplinary relationshipswithin the health care deliverysystem.

b. Social, economic, and politicalprocesses impacting the access toand delivery of health care incommunities.

c. Models of care delivery includingintegrated care.

2. Theories and strategies of effectivecommunication and collaboration,including assertiveness, negotiation,conflict resolution, and delegation.

Knowledge

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3. a. Strategies to deal with situationalchange.

b. Roles of all levels of nursing andother health care professionals.

4. a. Patient advocacy and consumerrights and responsibilities.

b. Legal and ethical processesrelated to health care.

5. Contribution of evidence-basedpractice in development of health careand quality improvement.

1. Involve patients and their familieswith other interdisciplinary healthcare team members in patient careacross the lifespan.

3. a. Principles of change, teammanagement, and leadership.



b. Legal and ethical processes relatedto health care.

5. a. Principles of evidence-basedpractice and application ofevidence-based outcomes relatedto health care.

b. Methods of evaluation forcontinuous quality improvement.

1. Involve patients and their families incollaboration with other interdisciplinaryhealth care team members for planninghealth care delivery to improve thequality of care across the lifespan.

3. a. Role theory, change theory,management and leadership theory.


c. Theories of leadership,organization, and group dynamics.


b. Legislative, legal, and ethicalprocesses related to health care.

5. a. Evidence-based practice andresearch findings related to healthcare.

b. Process of translating currentevidence into practice.

c. Methods of evaluation forcontinuous quality improvement.

d. Processes of continuous qualityimprovement and application ofquality improvement data.

1. a. Involve patients, families,populations, and communities incollaboration with interdisciplinaryhealth care team members forplanning health care delivery toimprove the quality of care acrossthe lifespan.




b. Use models of health caredelivery to plan and improvehealth care for patients, families,populations, and communities.

2. a. Use strategies of cooperation,collaboration, and communicationto plan, deliver, and evaluateinterdisciplinary health care.

b. Promote and provide leadershipin the effective coordination ofservices to patients, families,populations, and communities.

3. Synthesize evidence-based practices,research findings, and methods ofevaluation with the interdisciplinaryteam by translating current evidenceinto practice for patients, families,populations, and communities.

B. Serve as a health care advocate inmonitoring and promoting quality andaccess to health care for patients,families, populations, andcommunities.

1. a. Rights and responsibilities ofpatients regarding health care,including self-determinationand right of refusal.

2. Cooperate and communicate to assistin planning and deliveringinterdisciplinary health care.

3. Participate in evidence-based practicein development of patient care policywith the interdisciplinary team topromote care of patients and theirfamilies.

B. Participate as an advocate in activitiesthat focus on improving the healthcare of patients and their families.

1. a. Rights and responsibilities ofpatients regarding health care,including self-determinationand right of refusal.

2. a. Use strategies of cooperation,collaboration, and communicationto plan, deliver, and evaluateinterdisciplinary health care.

b. Promote the effective coordinationof services to patients and theirfamilies in patient-centered healthcare.

3. Apply principles of evidence-basedpractice and methods of evaluation withthe interdisciplinary team to providequality care to patients and theirfamilies.

B. Serve as a health care advocate inmonitoring and promoting quality andaccess to health care for patients andtheir families.

1. a. Rights and responsibilities ofpatients regarding health care,including self-determination andright of refusal.



Knowledge

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b. Current economic, legal, andpolitical factors that influenceaccess to health care delivery forpatients, families, populations,and communities.

2. a. Individual responsibility forquality of nursing care.

b. Role of the nurse as advocate forpatients, families, populations,and communities.

c. Research and theories related toadvocacy for access to health carefor patients, families,populations, and communities.

3. a. Leadership role in organizationalcommittees, peer reviewcommittees, nursing organizations,and community groups involvedwith improving the quality ofhealth care for patients, families,populations, and communities.

b. Formal and informal sources ofpower and negotiation processes.

c. Historical development ofprofessional advocacy groups andthe growth of consumer advocacy.

d. Knowledge of reliable online sitesand other resources that providequality health care data.

b. Current legal factors relating tosafeguarding patient rights.

2. a. Individual responsibility forquality of nursing care.

b. Role of the nurse as patientadvocate for patients and theirfamilies.

3. a. Role of the nurse in qualityimprovement process.

b. Peer review committee.c. Knowledge of reliable online

sites for quality health care data.

b. Current legal and societal factorsthat influence access to health carefor patients and their familiesrelating to safeguardingpatient rights.

2. a. Individual responsibility for qualityof nursing care.

b. Role of the nurse as advocate forpatients and their families.

3. a. Role of organizational committees,peer review committees, nursingorganizations, and communitygroups involved with improving thequality of health care for patientsand their families.

b. Knowledge of reliable online sitesand other resources that providequality health care data.



4. Responsibility for reporting to licensingand public protective agencies, whichmay involve mandatory reporting.

1. Respect the privacy and dignity of thepatient.

2. Identify unmet health needs ofpatients.

3. Act as an advocate for patient’s basicneeds, including following establishedprocedures for reporting and solvinginstitutional care problems and chainof command.

4. Role and responsibility for public safetyand welfare, which may involvemandatory reporting.

1. a. Support the patient’s right of self-determination and choice evenwhen these choices conflict withvalues of the individualprofessional.

b. Apply legal and ethical principles toadvocate for patient well-being andpreference.

2. Identify unmet needs of patients andtheir families from a holisticperspective.

3. a. Act as an advocate for patient’sbasic needs, including followingestablished procedures forreporting and solving institutionalcare problems and chain ofcommand.

4. Health care policies and regulationsrelated to public safety and welfare,mandatory reporting, and developmentof the future workforce.

1. a. Support the patient’s right ofself- determination and choiceeven when these choices conflictwith values of the individualprofessional.

b. Apply legal and ethical principles toadvocate for human and societalwell-being and preferences.

2. a. Identify the unmet needs ofpatients, families, populations, andcommunities from a holisticperspective.

b. Identify problems that patients andvulnerable populations have inaccessing health care anddisparities in health care.

3. a. Act as an advocate for patient’sbasic needs, including followingestablished procedures forreporting and solving institutionalcare problems and chain ofcommand.




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b. Advocate on behalf of patients andtheir families with other membersof the interdisciplinary healthcare team.

c. Teach patients and families aboutaccess to reliable and valid sourcesof information and resourcesincluding health information.

4. a. Participate in quality improvementactivities.

b. Participate in professional organiza-tions and community groups toimprove the quality of health care.

5. a. Refer patients and their families tocommunity resources.

b. Serve as a member of health careand community teams to provideservices to individuals and theirfamilies who experience unmetneeds.

b. Advocate on behalf of patients,families, populations, andcommunities with other membersof the interdisciplinary health careteam by implementing strategiesfor improving health care deliverysystems.

c. Teach patients, families,populations, and communitiesabout access to reliable and validsources of information andresources including healthinformation.

4. a. Participate in quality improvementactivities.

b. Participate in professionalorganizations and communitygroups to improve the quality ofhealth care.

5. a. Refer patients, families,populations, and communities toresources.

b. Serve as a member of health careand community teams to provideservices to individuals andcommunities with unmet needs.

c. Initiate and participate incommunity partnerships andcoalitions to provide health care totargeted, diverse populations.

4. Participate in quality improvementactivities.

5. Refer patients and their families tocommunity resources.




C. Participate in the identification ofpatient needs for referral to resourcesthat facilitate continuity of care, andensure confidentiality.

1. Work setting and major communityresources.

2. Role of the case manager.

3. Roles of family and significant othersin providing support to the patient.

4. a. Functions of members of theinterdisciplinary health careteam.

b. Confidentiality regulations (e.g.,HIPAA).

C. Refer patients and their families toresources that facilitate continuity ofcare; health promotion, maintenance,and restoration; and ensureconfidentiality.

1. Institutional and community resourcesincluding agencies/services and healthcare providers.

2. Principles of case management.

3. Roles of family and significant others inproviding support to the patient.

4. a. Roles and functions of members ofthe interdisciplinary health careteam.


C. Use multiple referral resources forpatients, families, populations, andcommunities, considering cost;confidentiality; effectiveness andefficiency of care; continuity andcontinuum of care; and healthpromotion, maintenance, andrestoration.

1. Institutional, community, state, andfederal resources including agencies/services and health care providers.

2. Theory and principles of casemanagement, population characteristics,and epidemiology.

3. a. Roles of family and significantothers in providing support to thepatient.

b. Family systems theory.

4. a. Roles and functions of members ofthe interdisciplinary health careteam.


Knowledge



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5. Need for patient referrals to promotecontinuity of care.

6. Issues in current treatmentmodalities.

7. Cost of health care services.

8. Organizational and local resources forhealth promotion, maintenance, andrestoration.

1. a. Identify support systems ofpatients and their families.

b. Identify major communityresources that can assist inmeeting needs.

5. Referral processes for patients and theirfamilies to promote continuity of care.

6. Issues and trends in health care delivery.

7. Major current issues affecting public/government/private health careservices, programs, and costs.

8. Organizational, local, and stateresources for risk reduction, and healthpromotion, maintenance, andrestoration.

1. a. Assess the adequacy of the supportsystems of patients and theirfamilies.

b. Work with families to use resourcesto strengthen support systems.

c. Identify providers and national andcommunity resources to meet theneeds of patients and their families.

5. Referral processes and methods forpromoting continuity of care andimproving access to health care forpatients, families, populations, andcommunities.

6. a. Issues and trends in health caredelivery.

b. Implications of demographic,epidemiological, and geneticsdata on the changing needs forhealth care resources and services.

7. Past, present, and future issuesaffecting public/government/privatehealth care services, programs,policies and costs.

8. Organizational, local, state, federal,and global resources for risk reductionand health promotion, maintenance,and restoration.

1. a. Assess the adequacy of thesupport systems of patients,families, populations, andcommunities.

b. Work with family and communityresources to develop andstrengthen support systems forpatients, families, populations,and communities.




c. Identify providers and nationaland community resources tomeet the needs of patients,families, populations, andcommunities.

2. a. Facilitate communication amongpatients, families, and theinterdisciplinary team to useinstitutional or communityresources to meet health careneeds.

b. Maintain confidentialityaccording to HIPAA guidelines.

c. Promote system-wide verbal,written, and electronicconfidentiality.

3. a. Advocate with members of theinterdisciplinary health care teamand community resources onbehalf of patients, families, andvulnerable populations to procureresources for care.

b. Assist patients, families, andvulnerable populations tocommunicate needs to theirsupport systems and to otherhealth care professionals.

c. Advocate for public policies tosupport health care access forvulnerable populations.

2. a. Communicate patient needs tothe family and members of thehealth care team.

b. Maintain confidentiality accordingto HIPAA guidelines.


3. a. Advocate with other members ofthe interdisciplinary health careteam on behalf of patients andfamilies to procure resources forcare.

b. Assist patients to communicateneeds to their support systemsand to other health careprofessionals.

2. a. Facilitate communication amongpatients, their families, andmembers of the health care teamto use institutional or communityresources to meet health careneeds.

b. Maintain confidentiality accordingto HIPAA guidelines.


3. a. Advocate with other members ofthe interdisciplinary health careteam on behalf of patients andfamilies to procure resources forcare.

b. Assist patients and their families tocommunicate needs to theirsupport systems and to otherhealth care professionals.



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4. Identify treatment modalities and costof health care services for patients andtheir families.


1. Principles of communication withpatients, their families, and theinterdisciplinary health care team.

4. Collaborate with the interdisciplinaryteam concerning issues and trends inhealth care delivery affecting public/government/private health careservices, programs, and cost to patientsand their families.


1. Principles of communication theory withpatients, families, and theinterdisciplinary health care team.

4. a. Collaborate with theinterdisciplinary team concerningissues and trends in health caredelivery.

b. Analyze demographic andepidemiological data on thechanging needs for health careresources and services.

c. Participate in meetings/organizations addressing past,present, and future issuesaffecting public/government/private health care services,programs, and cost to patients,families, populations, andcommunities.

D. Communicate and collaborate in atimely manner with members of theinterdisciplinary health care team topromote and maintain optimal healthstatus of patients, families,populations, and communities.

1. Communication theories as applied topatients, families, populations, andcommunities, and to theinterdisciplinary health care team.



Knowledge

2. Principles of interpersonal conflictmanagement, problem solving, datacollection, and basic timemanagement skills.

3. Functions of the interdisciplinaryhealth care team members.

4. Principles and strategies of situationalchanges.

1. a. Communicate changes in patientstatus and/or negative outcomesin patient responses to care withmembers of the interdisciplinaryhealth care team.

b. Follow legal guidelines incommunicating changes inpatient status, including chain ofcommand and the Texas NursingPractice Act.

2. Principles of management,decision-making, assertiveness, conflictmanagement, communication,motivation, time management,delegation, and principlesof change.

3. a. Functions of the interdisciplinaryhealth care team members.

b. Group process as a means ofachieving and evaluating goals.

4. Principles of change and conflictresolution and strategies for effectivemanagement and improvement ofpatient care.

1. a. Communicate changes in patientstatus and/or negative outcomes inpatient responses to care withmembers of the interdisciplinaryhealth care team.

b. Follow legal guidelines incommunicating changes in patientstatus, including chain of commandand the Texas Nursing Practice Act.

c. Facilitate joint decision-makingwith the interdisciplinary healthcare team.

2. Theories of leadership andmanagement, including criticalthinking, change theory, systemstheory, assertiveness, conflictmanagement, budgeting, principles ofdelegation, supervision, collaboration,and performance appraisal.

3. a. Functions of the interdisciplinaryhealth care team members.

b. Management of group processesto facilitate meeting patient goals.

4. Change theory and conflict resolutionstrategies for effective and efficientresource management andimprovement of patient care.

1. a. Communicate changes in patientstatus and/or negative outcomesin patient responses to care withmembers of the interdisciplinaryhealth care team.

b. Follow legal guidelines incommunicating changes in patientstatus, including chain of commandand the Texas Nursing Practice Act.

c. Use leadership skills in creatingprocesses that facilitate jointdecision-making with theinterdisciplinary health care team.




2. a. Refer to community agencies andhealth care resources to providecontinuity of care for patients andfamilies.

b. Apply case management andpopulation-based service modelsfor coordinating delivery of healthcare services across levels of carein the community.

3. a. Apply leadership andmanagement concepts in assistingthe interdisciplinary health careteam to implement quality,goal-directed patient care.

b. Facilitate positive professionalworking relationships.

*4. Develop and use evidence-basedclinical practice guidelines to guidecritical team communications duringtransitions in care between providers.

5. Recognize and manage conflictthrough the chain of command.

6. a. Initiate and participate in nursingor interdisciplinary teammeetings.

b. Use leadership skills ininterdisciplinary team meetings.

c. Provide evidence-basedinformation duringinterdisciplinary meetings.

83

2. Identify health care providers andothers who can assist in patient care.

3. Contribute to positive professionalworking relationships.

4. Use evidence-based clinical practiceguidelines to guide critical teamcommunications during transitions incare between providers.

5. Recognize and manage conflictthrough the chain of command.

6. a. Identify and report need fornursing or interdisciplinary teammeetings.

b. Participate in interdisciplinaryteam meetings.

2. Refer to community agencies and healthcare resources to provide continuity ofcare for patients and their families.

3. a. Assist the interdisciplinary healthcare team to implement quality,goal-directed patient care.

b. Facilitate positive professionalworking relationships.

4. Use evidence-based clinical practiceguidelines to guide critical teamcommunications during transitions incare between providers.

5. Recognize and manage conflict throughthe chain of command.

6. a. Initiate and participate in nursing orinterdisciplinary team meetings.

b. Provide evidence-basedinformation during interdisciplinarymeetings.



7. Respond to situational changes in thework environment to facilitateoptimum patient care.

E. Communicate patient data usingtechnology to support decision-making to improve patient care.

1. a. Current information andcommunication systems formanaging patient care, data, andthe medical record.

b. Current technology-basedinformation and communicationsystems.

2. Regulatory and ethical considerationsprotecting confidentiality when usingtechnology.

3. Technology skills includingword-processing, e-mailing, andaccessing multiple online resources.

7. Use change strategies in the workenvironment to achieve stated patientoutcomes to facilitate optimum patientcare.

E. Communicate and manage informationusing technology to support decision-making to improve patient care.

1. a. Current information andcommunication systems formanaging patient care, data, andthe medical record.



3. Technology skills includingword-processing, e-mailing, accessingdatabases, bibliographic retrieval, andaccessing multiple online resources.

7. Use change theory and strategies in thework environment for effective andefficient resource management andimprovement of patient care.

E. Communicate and manage informationusing technology to support decision-making to improve patient care anddelivery systems.

1. a. Current information andcommunication systems formanaging patient care, data, themedical record, andpopulation-based data.


c. Information management forhealth care systems.


3. Technology skills includingword-processing, e-mailing, accessingdatabases, bibliographic retrieval, andaccessing multiple online resources.



Knowledge

85


1. a. Identify, collect, process, andmanage data in the delivery ofpatient care and in support ofnursing practice and education.

b. Use recognized, credible sourcesof information, including internetsites.

c. Access, review, and use electronicdata to support decision-making.

2. a. Apply knowledge of facilityregulations when accessing clientrecords.

b. Protect confidentiality whenusing technology.

c. Intervene to protect patientconfidentiality when violationsoccur.

3. a. Use current technology andinformatics to enhancecommunication, supportdecision-making, and promoteimprovement of patient care.

b. Advocate for availability ofcurrent technology.

1. a. Identify, collect, process, andmanage data in the delivery ofpatient care and in support ofnursing practice and education.

b. Evaluate credibility of sources ofinformation, including internet sites.


d. Participate in quality improvementstudies.


b. Protect confidentiality when usingtechnology.


3. a. Use current technology andinformatics to enhancecommunication, support decision-making, and promote improvementof patient care.

1. a. Identify, collect, process, andmanage data in the delivery ofpatient care and in support ofnursing practice, administration,education, and research.

b. Evaluate credibility of sources ofinformation, including internetsites.


d. Participate in designing, conduct-ing, and evaluating qualityimprovement studies.


b. Protect confidentiality whenusing technology.


3. a. Use current technology andinformatics to enhancecommunication, support decision-making, and promoteimprovement of patient care anddelivery systems.



b. Advocate for availability of currenttechnology.

c. Use informatics to promote healthcare delivery and reduce risk inpatients and their families.

4. Document electronic informationaccurately, completely, and in a timelymanner.

*F. Assign and/or delegate nursing care toother members of the health care teambased upon an analysis of patient orunit need.

1. Texas Board of Nursing RN DelegationRules.

2. a. Principles of supervision andmanagement, team work/groupdynamics, and nursing care deliverysystems.

b. Competencies of assistivepersonnel and other licensed teammembers.

c. Structure and function of theinterdisciplinary team.

d. Patient care requirements andassessment techniques.

e. Evaluation processes and methodsto assess competencies.

b. Advocate for availability ofcurrent technology.

c. Use informatics to promotehealth care delivery and reducerisk in patients, families,populations, and communities.


*F. Assign and or delegate nursing care toother members of the health careteam based upon an analysis ofpatient or organizational need.

1. Texas Board of Nursing RN DelegationRules.

2. a. Principles of supervision, teamwork/group dynamics, nursingcare delivery systems, and healthpolicy.

b. Competencies of assistivepersonnel and other licensedteam members.


d. Patient care requirements andassessment techniques.

e. Evaluation processes and methodsto assess competencies.


*F. Assign nursing care to LVNs orunlicensed personnel based upon ananalysis of patient or unit need.

1. Awareness of Texas Board of NursingRN Delegation Rules.

2. a. Principles of supervision andteam work/group dynamics.

b. Competencies of assistivepersonnel and other licensedteam members.


d. Patient care requirements andfocused assessments.

Knowledge



87

3. Time management.

4. a. Principles of communication.b. Regulatory laws and facility

policies.

*1. Compare needs of patient withknowledge, skills, and abilities ofassistive and licensed personnel priorto making assignments.

*2. a. Assign and monitor tasks ofunlicensed and licensed personnelin compliance with Texas Boardof Nursing Rules.

b. Reassess adequacy of careprovided.

3. Time management.


policies.

*1. a. Compare needs of patient withknowledge, skills, and abilities ofassistive and licensed personnelprior to making assignments ordelegating tasks.

b. Assess competency level andspecial needs of nursing teammembers.

c. Participate in decision-makingrelated to delegation and assignedtasks.

*2. a. Assign, delegate, and monitorperformance of unlicensed andlicensed personnel in compliancewith Texas Board of NursingRules.

b. Assign patient care based onanalysis of patient ororganizational need.

c. Reassess competency and learningneeds of team members.

f. Management and systems theory.

3. Time management.


policies.c. Motivational theories.

*1. a. Compare needs of patient withknowledge, skills, and abilities ofassistive and licensed personnelprior to making assignments ordelegating tasks.

b. Assess competency level andspecial needs of nursing teammembers.

c. Participate in decision-making andestablishing facility policy relatedto delegated and assigned tasks.

*2. a. Assign, delegate, and monitorperformance of unlicensed andlicensed personnel in compliancewith Texas Board of Nursing Rules.

b. Use leadership skills to promoteteam building and team work.

c. Assign patient care based onanalysis of patient ororganizational need.

d. Reassess competency and learningneeds of team members.




*3. a. Document and/or reportresponses to care or untowardeffects.

b. Provide feedback on competencylevels of team members.

*G. Supervise nursing care provided byothers for whom the nurse isresponsible.

1. Principles of supervision and groupdynamics.

2. Principles of communication ingroups.

3. Principles of teaching and learning.

4. a. Facility policies and procedures.b. Organizational structure including

chain of command.

*3. a. Evaluate responses to delegatedand assigned tasks and makerevisions based on assessment.

b. Plan activities to develop compe-tency levels of team members.

*G. Supervise nursing care provided byothers for whom the nurse isresponsible by using evidence-basednursing practice.

1. Principles of management andorganizational behavior.

2. Principles of communication andgroup process.

3. a. Assessment of learning needs.b. Instructional methods.c. Evaluation of teaching

effectiveness.

4. a. Facility policies and procedures.b. Organizational structure

including chain of command.

*3. a. Evaluate responses to delegatedand assigned tasks and makerevisions based on assessment.

b. Plan and manage activities todevelop competency levels ofteam members.

*G. Supervise nursing care provided byothers for whom the nurse isresponsible by using best practicesof management, leadership, andevaluation.

1. Theories of management andleadership, and evaluation oforganizational behavior.

2. Communication theory and groupprocess.

3. a. Assessment of learning needs.b. Instructional methods.c. Evaluation of teaching

effectiveness.

4. a. Facility policies andprocedures.

b. Organizational structureincluding chain of commandand various health caredelivery systems.

Knowledge



89


*1. Provide instruction where needed tomembers of the health care team topromote safe care.

*2. Seek direction and clarification fromsupervisors when questions arise topromote safe care by the health careteam.

*3. a. Oversee and monitor patient careprovided by unlicensed assistivepersonnel and vocationallicensed personnel as assigned.

b. Base assignments on individualteam member competencies.

*4. Ensure timely documentation byassigned health care team members.

*1. Provide staff education to members ofthe health care team to promote safecare.

*2. Provide direction and clarification tohealth care team members or seekadditional direction and clarification topromote safe care by the health careteam.

*3. a. Oversee and follow through onpatient care provided by the healthcare team members.

b. Base assignments and delegationon team member competencies.

*4. a. Ensure timely documentation byassigned health care teammembers.

b. Ensure documentation of patientcare follow-up.

*1. a. Use leadership skills to providestaff education to members of thehealth care team to promote safecare.

b. Evaluate the effectiveness of theprocess for staff education.

c. Develop new policies andprocedures.

*2. Provide direction and clarification tohealth care team members or seekadditional direction and clarification topromote safe care by the health careteam.

*3. a. Oversee and follow through onpatient care provided by healthcare team members.

b. Base assignments and delegationon team member competencies.

*4. a. Ensure timely documentation byassigned health care teammembers.

b. Ensure documentation of patientcare follow-up.



91

Glossary

1. Best Practice: nursing practices that are based on the “bestevidence” available from nursing research, the goal being to applythe most recent, relevant, and helpful nursing interventions basedon research in real-life practice (University of Iowa, 2009).

2. Case Management: a dynamic and systemic collaborative approachto providing and coordinating health care services to a definedpopulation; a participative process to identify and facilitate optionsand services for meeting individual health care needs, whiledecreasing fragmentation and duplication of care and enhancingquality, cost-effective, clinical outcomes (American NursesAssociation, 2003).

3. Clinical Reasoning: the ability to reason as a clinical situationchanges, taking into account the context and concerns of the patientand family (Benner, Sutphen, Leonard-Kahn, & Day, 2008).

4. Clinical Practice Guidelines: systematically developed statementsthat are designed to assist nurses toward decisions on appropriatehealth care for specific conditions and provide various diagnosticcriteria and therapeutic interventions from national health advisoryboards and authoritative sources with which to carefully judgepatient care (Broughton & Rathbone, 1999).

5. Competency: an expected level of performance that integratesknowledge, skills, abilities, and judgment (American NursesAssociation, 2008).

6. Complementary Health Care Practices: please referencehttp://www.bon.texas.gov/practice/position.html#15.23

7. Comprehensive Nursing Assessment: please referencehttp://www.bon.texas.gov/practice/pdfs/position15-27.pdf

8. Culture of Safety: an organizational commitment to safety thatpermeates all levels of the organization and is characterized by thefollowing features: an acknowledgment of the high-risk, error pronenature of health care activities; promotion of a blame-freeenvironment where staff are able to report errors or close callswithout fear of reprisal; an expectation of collaboration acrossdisciplines; and a willingness on the part of the organization todirect resources for addressing safety concerns (Marquis &Huston, 2009).

9. Directed Scope of Practice: please referencehttp://www.bon.texas.gov/practice/pdfs/position15-27.pdf

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10. Evidence-Based Practice: a problem-solving approach to clinicaldecision-making within a health care organization that integratesthe best available scientific evidence with the best availableexperiential (patient and practitioner) evidence (Newhouse,Dearholt, Poe, Pugh, & White, 2007).

11. Focused Nursing Assessment: please referencehttp://www.bon.texas.gov/practice/pdfs/position15-27.pdf

12. Interdisciplinary Health Care Team (IHCT): a group of individualswith diverse training and backgrounds who work together as anidentified unit or system. Team members consistently collaborateto solve patient problems that are too complex to be solved by onediscipline or many disciplines in sequence. Team membersdetermine the team’s mission and common goals, work interdepen-dently through shared leadership to define and treat patientproblems, work through formal and informal structures, accept andcapitalize on disciplinary differences and overlapping roles (Drinka& Clark, 2000).

13. Materiel: equipment, apparatus, and supplies used by anorganization or an institution (Merriam-Webster Dictionary, 2010).

14. Scope of Practice: please referencehttp://www.bon.texas.gov/practice/gen_practice.html#Scope_of_Practice

93

References

American Association of Colleges of Nursing (1998). Essentials ofbaccalaureate education for professional nursing practice.Washington, DC: Author.

American Association of Colleges of Nursing (2008). The essentials ofbaccalaureate education for professional nursing practice.Retrieved from http://www.aacn.nche.edu/Education/pdf/BaccEssentials08.pdf

American Nurses Association (2000). Public health nursing: A partnerfor healthy populations. Washington, DC: American NursesPublishing.

American Nurses Association (2003). Nursing’s social policy statement(2nd ed.). Silver Spring, MD: Nursesbooks.org.

American Nurses Association (2008). Position statement on professionalrole competence. Washington, DC: American Nurses Publishing.

Benner, P. (1984). From novice to expert: Excellence and power inclinical nursing practice. Menlo Park, CA: Addison Wesley.

Benner, P., Sutphen, M., Leonard-Kahn, V., & Day, L. (2008). Formationand everyday ethical comportment. American Journal of CriticalCare, 17(5), 473-476.

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses:A call for radical transformation. San Francisco, CA: Jossey-Bass.

Berkow, S., Virkstis, K., Stewart, J., & Conway, L. (2008). Assessing newgraduate nurse performance. Journal of Nursing Administration,38(11), 468-474.

Broughton, R., & Rathbone, B. (2001). What makes a good clinicalguideline? Retrieved from http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/WhatareClinGuide.pdf

Commission on Collegiate Nursing Education (2009). Standards foraccreditation of baccalaureate and graduate degree nursingprograms. Retrieved from http://www.aacn.nche.edu/ccne-accreditation/standards-procedures-resources/baccalaureate-graduate

Day, L., & Smith, E. L. (2007). Integrating quality and safety content intoclinical teaching in the acute care setting. Nursing Outlook, 55(3),138-143.

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Drinka, T. J. K., & Clark, P. G. (2000). Health care teamwork: Interdisci-plinary practice and teaching. Westport, CT: Auburn House/Greenwood.

Finkelman, A., & Kenner, C. (2009). Teaching IOM: Implications of theinstitute of medicine reports for nursing education (2nd ed.).Silver Spring, MD: American Nurses Association.

Joint Commission (2009). National patient safety goals. Retrieved fromhttp://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/

Marquis, B. L., & Huston, C. J. (2009). Leadership roles and managementfunctions in nursing (6th ed.). Philadelphia, PA: WoltersKluwer/Lippincott Williams & Wilkins.

Merriam-Webster Online Dictionary (2010). Materiel. Retrieved fromhttp://www.merriam-webster.com/dictionary/materiel

National Association for Practical Nurse Education and Service, Inc.(2007). Standards of practice and educational competencies ofgraduates of practical/vocational nursing programs. Retrieved fromhttp://www.napnes.org/about/standards_read_only.pdf

National Council of State Boards of Nursing (2006). Transition topractice: Newly licensed Registered Nurse (RN) and LicensedPractical/Vocational Nurse (LPN/VN) activities. NCSBN ResearchBrief, 22. Retrieved from http://www.ncsbn.org

National Council of State Boards of Nursing (2010). NCLEX-RN7 testplan. Retrieved from https://www.ncsbn.org/2010_NCLEX_RN_TestPlan.pdf

National Council of State Boards of Nursing (2011). NCLEX-PN7 testplan. Retrieved from https://www.ncsbn.org/2011_PN_TestPlan.pdf

National League for Nursing (2000). Educational competencies forgraduates of associate degree nursing programs. New York, NY:NLN Press.

National League for Nursing Accrediting Commission (2008).Accreditation manual. Retrieved from http://www.nlnac.org

Newhouse, R. P., Dearholt, S. L., Poe, S. S., Pugh, L. C., & White, K.(2007). Johns Hopkins nursing evidence-based practice model andguidelines. Indianapolis, IN: Sigma Theta Tau International.

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Oregon Consortium for Nursing Education (2007). Competency rubricsand benchmarks. Retrieved from http://ocne.org/about.html

Poster, E., Adams, P., Clay, C., Garcia, B. R., Hallman, A., Jackson, B.,Klotz, L., Lumpkins, R., Reid, H., Sanford, P., Slatton, K., & Yuill, N.(2005). The Texas model of differentiated entry-level competenciesof graduates of nursing programs. Nursing Education Perspectives,26(1), 18-23.

Quality and safety education for nurses (2010). Retrieved from http://www.qsen.org/about_qsen.php

Roberts, K., Lockhart, R., & Sportsman, S. (2009). A competencytranscript to assess and personalize new graduate competency.Journal of Nursing Administration, 39(1), 19-25.

Sherwood, G., & Drenkard, K. (2007). Quality and safety curricula innursing education: Matching practice realities. Nursing Outlook,55(3), 151-155.

Texas Board of Nursing (2009). Texas nursing practice act. Retrievedfrom http://www.bon.texas.gov/nursinglaw/pdfs/npa2009.pdf

Texas Board of Nursing (2010). BON rules and regulations. Retrievedfrom http://www.bon.texas.gov/nursinglaw/pdfs/bon-rr.pdf

Texas Board of Nursing (2010). Scope of practice for nurses. Retrievedfrom http://www.bon.texas.gov/practice/gen_practice.html#Scope_of_Practice

Texas Board of Nursing (2010). The use of complementary modalities bythe LVN or RN. Retrieved from http://www.bon.texas.gov/practice/gen_practice.html#Scope_of_Practice

Texas Board of Nursing (2011). The licensed vocational nurse scope ofpractice. Retrieved from http://www.bon.texas.gov/practice/pdfs/position15-27.pdf

U. S. Department of Health and Human Services, Health Resources andServices Administration, Bureau of Health Professions, Division ofNursing (2008). Meeting the challenges of the new millennium:Challenges facing the nurse workforce in a changing health careenvironment. Retrieved from www.hrsa.gov/advisorycommittees/bhpadvisory/nacnep/Reports/sixthreport.pdf

University of Iowa (2009). Hartford center of geriatric nursingexcellence. Retrieved from http://www.nursing.uiowa.edu/hartford

Implementing the DECs

Implementing the DECs in Nursing Education Programs:

The competencies in the DECs describe the outcomes of prelicensuregraduates of Texas nursing education programs ensuring that graduatesare safe, competent entry-level nurses. The question is: How does theprogram’s curriculum guide students to achieve these outcomes?

Critical steps:

First, make sure the philosophy of the nursing program supports a cur-riculum based upon the DECs. Secondly, the program objectives shoulddescribe outcomes that are consistent with the DECs. Thirdly, coursedescriptions and content should include the knowledge base seen asnecessary for development of the competencies. Additionally, thecourse and clinical objectives should indicate that students have oppor-tunities to develop and demonstrate the competencies. A process toensure that the DECs are integrated into the curriculum includes that:

faculty should review each competency in the DECs and findwhere it is covered in the curriculum plan,

faculty may develop a matrix matching the DECs to curriculumobjectives,

faculty should review the knowledge areas in the DECs toensure inclusion in the program,

it may be necessary to rewrite the philosophy or programobjectives, and

faculty may find it necessary to add or delete didactic content.

This exercise in curriculum review updates and improves thecurriculum, and familiarizes the faculty with the entire program ofstudy.

Implementing the DECs in the Employment Setting:

The DECs may be used in the practice area to assist employers in:

Developing orientation and internship programs.The DECs provide a starting point for the orientation of newnursing graduates since the DECs describe the basiceducational preparation of graduates of Board approvednursing programs, including the knowledge base to guide

96

students in developing clinical judgments and behaviors forentry-level practice.

Establishing career ladders for the employment setting.The DECs provide descriptions of entry-level expectations ofnew graduates as well as offer potential for individualgrowth based upon educational background andpreparation.

Determining entry-level competencies.The DECs outline the basic competencies for each level ofeducation and the educational preparation for eachcompetency. The graduate may or may not havedemonstrated higher level competencies in the hands-onclinical area but the graduate has been educated andprepared to perform the competencies.

Determining job descriptions.The competencies in the DECs will provide descriptors forjob descriptions and will assist the employer in findingappropriate candidates for positions based uponcandidates’ educational preparation and clinicalopportunities.

Reviewing and revising policies and procedures.The DECs offer a baseline for developing and revisingpolicies and procedures. Policies can be written with anunderstanding of the knowledge base of nurses at differentlevels of entry.

Making appropriate assignments to new nursing graduates.The DECs provide an understanding of the beginningpractice level of nurses who have completed vocational,diploma, associate degree, or baccalaureate degreeprograms.

Planning in-services and staff development programs.The DECs outline the level of educational preparation fornew graduates and allows employers to develop programspromoting professional growth for the nurse’s full potential.

Differentiating scope of practice between vocational, diploma,associate degree, and baccalaureate degree entry-level nurses.

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Appendix ACommittee Members

The Texas Board of Nursing acknowledges the commitment and effort of thefollowing committee members in the revision process of the DECs:

Advisory Committee on Education:Eileen Deges Curl, PhD, RN, Chair, representing Texas Association of Deans and

Directors of Professional Nursing ProgramsAlicia Anger, MSN, RN, representing Diploma Programs (2009-2010)Frances Chatman, LVN, representing Licensed Vocational Nurses Association

of TexasBonnie Higgins, EdD, MSN, RN, representing Texas Organization for Associate

Degree NursingNancy Maebius, PhD, RN, representing Career Schools and CollegesBetty Sims, MSN, RN, representing Texas Association of Vocational

Nurse EducatorsBeverly Skloss, MSN, RN, representing Hospital-Based VN ProgramsKendra Slatton, MSN, RN, CDE, representing Texas Organization of

Nurse ExecutivesSusan Sportsman, PhD, RN, representing Texas Nurses AssociationVicki Thornley, MSN, RN, representing Diploma Programs (2008)

Board of Nursing Liaisons:Kristin K. Benton, MSN, RNBlanca Rosa Garcia, PhD, RNBrenda S. Jackson, PhD, RNJosefina Lujan, PhD, RN

DELC Work Group:Elizabeth Poster, PhD, RN, Work Group LeaderAlicia Anger, MSN, RN, representing Diploma EducationFrances Chatman, LVN, representing Licensed Vocational Nurses Association

of TexasEileen Deges Curl, PhD, RN, representing Texas Organization of Baccalaureate

and Graduate Nursing EducatorsApril Ernst, MSN, RN, representing Vocational Nursing EducationCathy Harris, BSN, RN, representing Texas School Nurses OrganizationBonnie Higgins, EdD, MSN, RN, representing Texas Organization for Associate

Degree NursingBrenda Jackson, PHD, RN, Board Liaison (2008-2009)Kim Judd, MSN, RN, NEA-BC, representing Texas Organization of

Nurse ExecutivesDianna Miller, EdD, MSN, RN, representing Associate Degree EducationDiane Moy, MSN, RN, representing Texas Department of State Health ServicesGail Roberts, MSN, RN, representing St. David’s HealthCare Clinical

Nurse CoordinatorBetty Sims, MSN, RN, representing Texas Association of Vocational

Nurse EducatorsBeth Skeleton, BSN, RN, representing Texas Department of Aging and DisabilitySusan Sportsman, PhD, RN, representing Texas Nurses Association

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Appendix B

Survey Respondents – Nursing Education Programs

(List of nursing education programs who provided feedbackon the draft of the DECs.)

The Texas Board of Nursing recognizes the following nursing educationprograms that contributed to the development of the DECs by offeringfeedback to the first draft:

VN ProgramsAlvin Community CollegeAmarillo CollegeAnamarc CollegeAustin Community CollegeBlinn CollegeBrazosport CollegeCentral Texas CollegeChildress Regional Medical Center School of Vocational NursingCisco CollegeClarendon CollegeComputer Career Center/Vista CollegeConcorde Career InstituteEl Centro CollegeGrayson County CollegeHouston Community CollegeHoward CollegeJoe G. Davis School of Vocational NursingKilgore CollegeLee CollegeLone Star College – CyFairNavarro CollegleOdessa CollegeSan Jacinto CollegeSouth Plains CollegeSouth Texas CollegeSouthwest Texas Junior CollegeSul Ross State UniversityTemple CollegeTexarkana CollegeTyler County Hospital School of Vocational NursingUniversal Health Services School of Vocational EducationVernon CollegeWeatherford CollegeWharton County Junior College

ADN ProgramsAmarillo CollegeAngelina CollegeAngelo State UniversityAustin Community College

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Blinn CollegeCentral Texas CollegeCisco CollegeDel Mar CollegeGrayson County CollegeKilgore CollegeLamar State College - OrangeLamar UniversityLone Star College – CyFairMcLennan Community CollegeMidland CollegeNavarro CollegeNortheast Texas Community CollegeSan Antonio CollegeSouth Texas CollegeTarrant County CollegeTemple CollegeTexarkana CollegeTrinity Valley Community CollegeUniversity of Texas at Brownsville & Texas Southmost CollegeVictoria CollegeWeatherford College

BSN ProgramsBaylor UniversityLamar University at BeaumontPatty Hanks Shelton School of NursingPrairie View A&M UniversityTarleton State UniversityTexas A&M Health Science CenterTexas Christian UniversityTexas State UniversityTexas Tech University Health Sciences CenterTexas Woman’s UniversityUniversity of Houston-VictoriaUniversity of Mary Hardin-Baylor UniversityUniversity of Texas at ArlingtonUniversity of Texas at AustinUniversity of Texas at El PasoUniversity of Texas at TylerUniversity of Texas Health Science Center at HoustonUniversity of the Incarnate WordWestern Governors University

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Appendix C

Survey Respondents – Clinical Affiliating Agencies

The Texas Board of Nursing recognizes the following clinical affiliatingagencies who provided feedback on the final draft of the DECs:

Allegiance Behavioral Health Center of PlainviewAllegiance Specialty Hospital of KilgoreAustin State HospitalBay City Independent School DistrictBig Bend Regional Medical CenterBrownwood Regional Medical CenterCatholic School Office, Archdiocese of Galveston-HoustonCitizens Medical CenterCleveland Regional Medical CenterCogdell Home HealthCollege Station Medical CenterCovenant Health SystemCuero Community HospitalCuero Nursing and Rehabilitation CenterDallas County Health and Human ServicesDeTar Healthcare SystemDevereux Texas Treatment NetworkDriscoll Children’s HospitalEnnis Care CenterExceptional Home CareFort Duncan Regional Medical CenterGood Shepherd Medical CenterHarlingen Medical CenterHealthSouth City View Rehabilitation HospitalHealthSouth Rehabilitation Hospital of HumbleHighlands Regional Rehabilitation HospitalHospice of the Heart, Inc.Kingwood Medical CenterKlein Independent School DistrictLas Palmas Medical CenterLaurel Ridge Treatment CenterLee HealthCare, Inc.Leon Independent School DistrictLifeCare Hospital of Fort WorthLifeCare Hospitals of San AntonioLongview Regional Medical CenterMatagorda Regional Medical CenterMedical Center HospitalMedWay Home HealthcareMemorial HomecareMemorial Medical Center – LivingstonMidland Independent School DistrictNewton Family ClinicNorth Texas Medical CenterNortheast Baptist HospitalProvidence Health Center

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Reunion Plaza Senior Care CenterSan Marcos Treatment CenterSouth Texas Rehabilitation HospitalSouthwest General HospitalSt. Luke’s The Woodlands HospitalStone Oak Care CenterStonewall Head Start, Inc.Texas Children’s HospitalTexas Health CleburneTexas Health Harris Methodist Fort Worth HospitalTexas Health Harris Methodist Hospital Southwest Fort WorthTexas Health Harris Methodist Hospital StephenvilleTexas Health Harris Methodist Southwest HospitalTexas Health Presbyterian HospitalThe ArborsThe Forum at Lincoln HeightsThe Methodist Hospital, The Texas Medical CenterTri County ServicesTrinity Mother Frances Hospitals and ClinicsTwilight HomeTwin Creeks HospitalTyler County HospitalUniversal Health ServicesUTMB Correctional Managed CareUvalde Memorial HospitalWarm Springs Specialty HospitalWeatherford Regional Medical CenterWhispering Oaks ManorWinkler County Memorial HospitalWise Regional Health SystemsWoodland Heights Medical Center

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Appendix D

Employer Focus Groups for DECs

The Texas Board of Nursing recognizes the following employer groups for theirparticipation in focus groups providing feedback regarding the DECs:

Baylor College of MedicineBrookhaven CollegeChristus Health SystemHarris County Hospital DistrictHouston Northwest Medical CenterJPS Health NetworkMemorial Hermann Healthcare SystemMethodist Hospital SystemMethodist Richardson Medical CenterMother Francis HospitalNorth Central Texas CollegePalo Pinto General HospitalParkland HospitalPlaza Medical CenterShriners Hospital for ChildrenSt. Luke’s Episcopal Health SystemTexas Children’s HospitalTexas Christian UniversityTexas Health Arlington MemorialTexas Health Care AssociationTexas Scottish Rite HospitalTexas Woman’s UniversityUnited RegionalUniversity of Texas at ArlingtonUniversity of Texas at Brownsville & Texas Southmost CollegeUniversity of Texas MD Anderson Cancer CenterUniversity of Texas Medical BranchValley Baptist Medical CenterWorkforce Solutions

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Published by Texas Board of Nursing333 Guadalupe, Suite 3-460Austin, Texas 78701www.bon.texas.gov

Publication Date: 12/11

BON Differentiated Essential · PDF fileDifferentiated Essential Competencies (DECs) of...

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