AUSTIN-Texas legislators are entertaining a bill that for the first time would legally define the scope of practice for licensed vocational nurses in the state, a measure garnering support from LVN regulators and educators but raising concerns with the Texas Nurses Association.

The Licensed Vocational Nursing Practice Act, authored by state Rep. Mike Villarreal, D-San Antonio, as House Bill 311, is intended to coordinate differing standards of LVN practice that have evolved in various regional and vocational settings in the state, according to supporters.

At present, Texas LVNs work under an occupational title act that provides no clear distinctions on either proper or disallowed practices, which may cause confusion for nurses, health care employers and the general public.

Many LVNs, primarily those in areas with acute shortages of registered nurses, are assigned duties and responsibilities that may be beyond their training and expertise, "and in most cases, without the needed compensation" commanded by RNs, said Terrie Hairston, executive director of the Texas Board of Vocational Nurse Examiners.

"Right now, LVNs in Texas are the only professionals remaining without a practice act for nursing. And that's out of 61 other boards in the country," Hairston said.

Without a practice act, Hairston said, LVNs are without legal protection to advocate for patient safety and the public is unable to distinguish the professional credentials of LVNs from unlicensed aides who may be assigned LVN-type roles in hospitals and nursing homes.

The Texas LVN board oversees the licensure, examination and education of 75,000 licensed vocational nurses in Texas. That board is independent of the Texas Board of Nurse Examiners, which oversees 170,000 registered and advanced practice nurses.

RNs in Texas already are covered by their own practice act.

Without an occupational practice act, according to an LVN educator, vocational nursing is akin to an "unregulated kind of regulated practice" in Texas, in which LVNs are asked to perform a wider range of tasks by doctors, RNs, hospitals, nursing homes and home health care operators.

"It's kind of gotten out of hand," said Linda Bland, a nursing instructor and president of the Texas Association of Vocational Nurse Educators. "Some nurses call the [Texas LVN board] and ask, 'Can I do botox injections?' I'm a registered nurse, and I caneven do that."

The act would provide LVNs the ability to delegate assignments to nonlicensed aides and personnel, which some believe may create conflict with existing authority from physicians and registered nurses. Differences in LVN practice authority also could arise between separate rules made by the dual nurse examiner boards in Texas.

"RNs and LVNs are both generalist-type practitioners with overlap of practice," said Jim Willmann, general counsel and director of governmental affairs for the Texas Nurses Association, the state affiliate for the American Nurses Association.

"There is not a hard-and-fast line where vocational nursing ends and professional nursing begins, but rather a continuum of nursing care ...
and defining job duties under the [Texas LVN board] has the potential for creating conflict of where the line should be drawn."

Hairston said the act eventually will help in making that distinction.

"LVNs, RNs and advanced practice nurses provide a lot of the same care but at different levels," she said.

By creating defined rules for LVN practice, "it helps to define those lines even clearer, as to who can provide what [practice]."

The bill itself does not instill prohibited procedures and applications for LVNs, but instead would leave the authority to define allowable functions to the Texas LVN board, said Doug Smith, a spokesman for Villarreal.

"I cannot come up with a single example of something that an LVN is doing right now that they are going to be restricted from doing."

Contact Glen Fest at glenf@nurseweek.com