Q: I am a registered nurse in the State of Texas. I have accepted a job working in an orthopedic surgeon's office where my duties will include performing X-rays. I think there is a rule about RNs doing X-rays but I cannot find it. Do I need to attend a special certification course? Are there different requirements for hospitals, urgent care centers, or other types of practice settings?
A: BON Rule 217.14, Registered Nurses Performing Radiologic Procedures is the Texas Board Nursing (Board or BON) rule applicable to your question. According to this rule, if a registered nurse (RN) is employed in a practice setting that is not a Medicare-approved provider or accredited by The Joint Commission, the RN is required to submit an application for registration to the Board. The RN must print out the application for registration form http://www.bon.texas.gov/olv/pdfs/rad_appl.pdf and submit it to the Board. There is no cost for registering. The RN must notify the Board within 30 days of any changes that render the information provided on the application incorrect, such as new practitioner or director of radiologic services under whose instruction or direction the radiological procedures are performed [BON Rule 217.14 (c)]. If the RN will be performing radiological procedures in a practice setting that is a Medicare-approved provider or accredited by The Joint Commission, then the registration requirement does not apply.
BON Rule 217.14 also references other laws outside of the BON's jurisdiction. These laws require a RN to demonstrate competency in performing radiologic procedures. The Department of State Health Services (DSHS) regulates radiation control, the Medical Radiologic Technologist, and the Non-Certified Medical Radiologic Technician. The statutes that specify the requirements to perform x-rays are in the Texas Occupations Code, Chapter 601, “Medical Radiological Technologists” and may be accessed on the DSHS website, www.dshs.state.tx.us.
DSHS also has rules and regulations applicable to RNs performing X-rays in 25 Texas Administrative Code, Part 1, Chapter 140, Subchapter J. Board staff recommend checking with DSHS for interpretation of the statutes and rules relating to radiologic procedures and required training. The phone number for the department is listed as 512-834-6634.
Some radiologic procedures may be considered delegated medical acts. BON staff recommend caution when performing a task as a delegated medical act and the Board’s Position Statement 15.11, Delegated Medical Acts is a valuable resource for nurses. Delegated medical acts do not diminish the responsibility in any way of the nurse to adhere to the Board’s Standards of Nursing Practice, Rule 217.11. Included in BON Rule 217.11 are standards requiring a nurse to know and comply with the Nursing Practice Act (NPA) and Board’s Rules and Regulations as well as all federal, state, or local laws, to maintain client safety. Nurses must accept only those assignments that are within the nurse's knowledge, skills, and abilities, and seek instruction as necessary in order to maintain competency when performing tasks in any practice setting. [BON Rule 217.11(1): (A), (B), (G), (R) and (T)].
For general information on nurses practicing in the area of radiology, BON staff recommend contacting professional nursing organizations, such as the Radiological Society of North America at http://www.rsna.org or the Association for Radiologic and Imaging Nursing at https://www.arinursing.org/. Other nursing organizations related to a nurse’s specialty practice setting may provide further guidance. In addition to other nursing organizations related to a nurse’s specialty practice setting, national patient safety organizations may provide resource information and procedure guidelines for evidence-based practice. Examples include:
- Agency for Healthcare Research and Quality: http://www.ahrq.gov/
- National Quality Measures Clearinghouse: http://www.qualitymeasures.ahrq.gov/
- Institute for Safe Medication Practices: http://www.ismp.org/
- Occupational Safety and Health Administration: http://www.osha.gov/
- Institute of Medicine: http://www.iom.edu/
Q: How does BON Rule 217.14 apply to LVNs?
A: BON Rule 217.14 only addresses the RN. Chapter 601 of the Texas Occupations Code, 25 Texas Administrative Code, Part 1, Chapter 140, Subchapter J, as well as the Nursing Practice Act and Board Rules and Regulations do not address the LVN performing radiological procedures. Therefore, the LVN would be required to become a certified radiologic technologist/technician in order to perform X-rays.
Revised February 2013