Texas 2009 - 81st Regular

Texas House Bill HB3961 Latest Draft

Bill / Enrolled Version Filed 02/01/2025

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                            H.B. No. 3961


 AN ACT
 relating to the regulation of nursing.
 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 SECTION 1. Section 301.155(c), Occupations Code, is amended
 to read as follows:
 (c) The board shall assess a [$3] surcharge of not less than
 $3 or more than $5 for a registered nurse and a [$2] surcharge of not
 less than $2 or more than $3 for a vocational nurse to the fee
 established by the board under Subsection (a) for a license holder
 to renew a license under this chapter. The board may use nine cents
 of the registered nurse surcharge and six cents of the vocational
 nurse surcharge to cover the administrative costs of collecting and
 depositing the surcharge. The board quarterly shall transmit the
 remainder of each surcharge to the Department of State Health
 Services to be used only to implement the nursing resource section
 under Section 105.002, Health and Safety Code. The board is not
 required to collect the surcharge if the board determines the funds
 collected are not appropriated for the purpose of funding the
 nursing resource section.
 SECTION 2. Section 301.157, Occupations Code, is amended by
 amending Subsection (d-4) and adding Subsections (d-8), (d-9),
 (d-10), and (d-11) to read as follows:
 (d-4) The board may recognize and accept as approved under
 this section a school of nursing or educational program operated in
 another state and approved by a state board of nursing or other
 regulatory body of that [another] state. The board shall develop
 policies to ensure that the other state's [state board's] standards
 are substantially equivalent to the board's standards.
 (d-8)  For purposes of Subsection (d-4), a nursing program
 is considered to meet standards substantially equivalent to the
 board's standards if the program:
 (1)  is part of an institution of higher education
 located outside this state that is approved by the appropriate
 regulatory authorities of that state;
 (2)  holds regional accreditation by an accrediting
 body recognized by the United States secretary of education and the
 Council for Higher Education Accreditation;
 (3)  holds specialty accreditation by an accrediting
 body recognized by the United States secretary of education and the
 Council for Higher Education Accreditation, including the National
 League for Nursing Accrediting Commission;
 (4)  requires program applicants to be a licensed
 practical or vocational nurse, a military service corpsman, or a
 paramedic, or to hold a college degree in a clinically oriented
 health care field with demonstrated experience providing direct
 patient care; and
 (5) graduates students who:
 (A)  achieve faculty-determined program outcomes,
 including passing criterion-referenced examinations of nursing
 knowledge essential to beginning a registered nursing practice and
 transitioning to the role of registered nurse;
 (B)  pass a criterion-referenced summative
 performance examination developed by faculty subject matter
 experts that measures clinical competencies essential to beginning
 a registered nursing practice and that meets nationally recognized
 standards for educational testing, including the educational
 testing standards of the American Educational Research
 Association, the American Psychological Association, and the
 National Council on Measurement in Education; and
 (C)  pass the National Council Licensure
 Examination for Registered Nurses at a rate equivalent to the
 passage rate for students of approved in-state programs.
 (d-9)  A graduate of a clinical competency assessment
 program operated in another state and approved by a state board of
 nursing or other regulatory body of another state is eligible to
 apply for an initial license under this chapter if:
 (1)  the board allowed graduates of the program to
 apply for an initial license under this chapter continuously during
 the 10-year period preceding January 1, 2007;
 (2)  the program does not make any substantial changes
 in the length or content of its clinical competency assessment
 without the board's approval;
 (3)  the program remains in good standing with the
 state board of nursing or other regulatory body in the other state;
 and
 (4)  the program participates in the research study
 under Section 105.008, Health and Safety Code.
 (d-10)  In this section, the terms "clinical competency
 assessment program" and "supervised clinical learning experiences
 program" have the meanings assigned by Section 105.008, Health and
 Safety Code.
 (d-11)  Subsections (d-8), (d-9), (d-10), and (d-11) expire
 December 31, 2017. As part of the first review conducted under
 Section 301.003 after September 1, 2009, the Sunset Advisory
 Commission shall:
 (1)  recommend whether Subsections (d-8) and (d-9)
 should be extended; and
 (2)  recommend any changes to Subsections (d-8) and
 (d-9) relating to the eligibility for a license of graduates of a
 clinical competency assessment program operated in another state.
 SECTION 3. Section 301.160(a)(2), Occupations Code, is
 amended to read as follows:
 (2) "Targeted continuing nursing education" means
 continuing education focusing on a skill that would likely benefit
 a significant proportion of [registered] nurses in a particular
 practice area.
 SECTION 4. Sections 301.160(b) and (j) are amended to read
 as follows:
 (b) The board may develop pilot programs to evaluate the
 effectiveness of mechanisms, including proactive nursing peer
 review and targeted continuing nursing education, for maintenance
 of the clinical competency of a [registered] nurse in the nurse's
 area of practice and the understanding by [registered] nurses of
 the laws, including regulations, governing the practice of
 [professional] nursing.
 (j) The board shall issue an annual report regarding any
 pilot programs developed or approved and a status report on those
 programs, including preliminary or final findings concerning their
 effectiveness. The board shall mail the report to statewide
 associations of [registered] nurses and[, registered nurse]
 educators[,] and employers of [registered] nurses that request a
 copy. [The board shall issue a final report not later than
 September 1, 2000.]
 SECTION 5. Sections 301.1605(a) and (c), Occupations Code,
 are amended to read as follows:
 (a) The board may approve and adopt rules regarding pilot
 programs for innovative applications in the practice and regulation
 of [professional] nursing.
 (c) In approving a pilot program, the board may grant the
 program an exception to the mandatory reporting requirements of
 Sections 301.401-301.409 or to a rule adopted under this chapter or
 Chapter 303 that relates to the practice of [professional] nursing,
 including education and reporting requirements for [registered]
 nurses. The board may not grant an exception to:
 (1) the education requirements of this chapter unless
 the program includes alternate but substantially equivalent
 requirements; or
 (2) the mandatory reporting requirements unless the
 program:
 (A) is designed to evaluate the efficiency of
 alternative reporting methods; and
 (B) provides consumers adequate protection from
 [registered] nurses whose continued practice is a threat to public
 safety.
 SECTION 6. Sections 301.1606(a) and (b), Occupations Code,
 are amended to read as follows:
 (a) The [Before January 1, 2004, the] board may [shall]
 solicit proposals for pilot programs designed to evaluate the
 efficacy and effect on protection of the public of reporting
 systems designed to encourage identification of system errors.
 (b) The board may grant a pilot program approved under this
 section an exception to the mandatory reporting requirements of
 Sections 301.401-301.409 or to a rule adopted under this chapter or
 Chapter 303 that relates to the practice of [professional] nursing,
 including education and reporting requirements for [registered]
 nurses. If the board grants an exception, the board may require
 that the program:
 (1) provide for the remediation of the deficiencies of
 a [registered] nurse who has knowledge or skill deficiencies that
 unless corrected may result in an unreasonable risk to public
 safety;
 (2) provide for supervision of the nurse during
 remediation of deficiencies under Subdivision (1);
 (3) require reporting to the board of a [registered]
 nurse:
 (A) who fails to satisfactorily complete
 remediation, or who does not make satisfactory progress in
 remediation, under Subdivision (1);
 (B) whose incompetence in the practice of
 [professional] nursing would pose a continued risk of harm to the
 public; or
 (C) whose error contributed to a patient death or
 serious patient injury; or
 (4) provide for a nursing peer review committee to
 review whether a [registered] nurse is appropriate for remediation
 under Subdivision (1).
 SECTION 7. Subchapter E, Chapter 301, Occupations Code, is
 amended by adding Sections 301.206 and 301.207 to read as follows:
 Sec. 301.206.  CONFIDENTIALITY OF INFORMATION COLLECTED FOR
 EMERGENCY RELIEF PROGRAMS. (a) In this section, "emergency relief
 program" means a program operated or sponsored by the federal
 government, the state, or a nonprofit organization to provide
 nurses to assist in providing health care to victims or potential
 victims of a disaster or state or local emergency.
 (b)  A nurse's personal contact information, including
 e-mail addresses, telephone numbers, and fax numbers, collected by
 the board for use by an emergency relief program is:
 (1)  confidential and not subject to disclosure under
 Chapter 552, Government Code; and
 (2)  not subject to disclosure, discovery, subpoena, or
 other means of legal compulsion for release to anyone other than for
 the purpose of contacting the nurse to assist in an emergency relief
 program.
 Sec. 301.207.  CONFIDENTIALITY OF HEALTH INFORMATION
 PROVIDED FOR LICENSURE. Information regarding a person's diagnosis
 or treatment for a physical condition, mental condition, or
 chemical dependency that the person submits to the board for a
 petition for a declaratory order of eligibility for a license or for
 an application for an initial license or a license renewal under
 this chapter is confidential to the same extent information
 collected on a nurse as part of an investigation of a complaint is
 confidential under Section 301.466.
 SECTION 8. Section 301.257(a), Occupations Code, is amended
 to read as follows:
 (a) A person may petition the board for a declaratory order
 as to the person's eligibility for a license under this chapter if
 the person has reason to believe that the person is ineligible for
 the license and:
 (1) is enrolled or planning to enroll in an
 educational program that prepares a person for an initial license
 as a registered nurse or vocational nurse; or [and]
 (2) is an applicant for a [has reason to believe that
 the person is ineligible for the] license.
 SECTION 9. Section 301.401(2), Occupations Code, is amended
 to read as follows:
 (2) "Minor incident" means conduct by a nurse that
 does not indicate that the nurse's continued practice poses a risk
 of harm to a patient or another person. This term is synonymous
 with "minor error" or "minor violation of this chapter or board
 rule."
 SECTION 10. Subchapter J, Chapter 301, Occupations Code, is
 amended by adding Section 301.4521 to read as follows:
 Sec. 301.4521.  PHYSICAL AND PSYCHOLOGICAL EVALUATION. (a)
 In this section:
 (1) "Applicant" means:
 (A)  a petitioner for a declaratory order of
 eligibility for a license; or
 (B)  an applicant for an initial license or
 renewal of a license.
 (2)  "Evaluation" means a physical or psychological
 evaluation conducted to determine a person's fitness to practice
 nursing.
 (b)  The board may require a nurse or applicant to submit to
 an evaluation only if the board has probable cause to believe that
 the nurse or applicant is unable to practice nursing with
 reasonable skill and safety to patients because of:
 (1) physical impairment;
 (2) mental impairment; or
 (3) chemical dependency or abuse of drugs or alcohol.
 (c)  A demand for an evaluation under Subsection (b) must be
 in writing and state:
 (1)  the reasons probable cause exists to require the
 evaluation; and
 (2)  that refusal by the nurse or applicant to submit to
 the evaluation will result in an administrative hearing to be held
 to make a final determination of whether probable cause for the
 evaluation exists.
 (d)  If the nurse or applicant refuses to submit to the
 evaluation, the board shall schedule a hearing on the issue of
 probable cause to be conducted by the State Office of
 Administrative Hearings. The nurse or applicant must be notified
 of the hearing by personal service or certified mail. The hearing
 is limited to the issue of whether the board had probable cause to
 require an evaluation. The nurse or applicant may present testimony
 and other evidence at the hearing to show why the nurse or applicant
 should not be required to submit to the evaluation. The board has
 the burden of proving that probable cause exists.  At the conclusion
 of the hearing, the hearing officer shall enter an order requiring
 the nurse or applicant to submit to the evaluation or an order
 rescinding the board's demand for an evaluation.  The order may not
 be vacated or modified under Section 2001.058, Government Code.
 (e)  If a nurse or applicant refuses to submit to an
 evaluation after an order requiring the evaluation is entered under
 Subsection (d), the board may:
 (1) refuse to issue or renew a license;
 (2) suspend a license; or
 (3) issue an order limiting the license.
 (f)  The board may request a nurse or applicant to consent to
 an evaluation by a practitioner approved by the board for a reason
 other than a reason listed in Subsection (b). A request for an
 evaluation under this subsection must be in writing and state:
 (1) the reasons for the request;
 (2) the type of evaluation requested;
 (3) how the board may use the evaluation;
 (4)  that the nurse or applicant may refuse to submit to
 an evaluation; and
 (5)  the procedures for submitting an evaluation as
 evidence in any hearing regarding the issuance or renewal of the
 nurse's or applicant's license.
 (g)  If a nurse or applicant refuses to consent to an
 evaluation under Subsection (f), the nurse or applicant may not
 introduce an evaluation into evidence at a hearing to determine the
 nurse's or applicant's right to be issued or retain a nursing
 license unless the nurse or applicant:
 (1)  not later than the 30th day before the date of the
 hearing, notifies the board that an evaluation will be introduced
 into evidence at the hearing;
 (2) provides the board the results of that evaluation;
 (3)  informs the board of any other evaluations by any
 other practitioners; and
 (4)  consents to an evaluation by a practitioner that
 meets board standards established under Subsection (h).
 (h)  The board shall establish by rule the qualifications for
 a licensed practitioner to conduct an evaluation under this
 section. The board shall maintain a list of qualified
 practitioners. The board may solicit qualified practitioners
 located throughout the state to be on the list.
 (i)  A nurse or applicant shall pay the costs of an
 evaluation conducted under this section.
 (j) The results of an evaluation under this section are:
 (1)  confidential and not subject to disclosure under
 Chapter 552, Government Code; and
 (2)  not subject to disclosure by discovery, subpoena,
 or other means of legal compulsion for release to anyone, except
 that the results may be:
 (A)  introduced as evidence in a proceeding before
 the board or a hearing conducted by the State Office of
 Administrative Hearings under this chapter; or
 (B)  included in the findings of fact and
 conclusions of law in a final board order.
 (k)  If the board determines there is insufficient evidence
 to bring action against a person based on the results of any
 evaluation under this section, the evaluation must be expunged from
 the board's records.
 (l)  The board shall adopt guidelines for requiring or
 requesting a nurse or applicant to submit to an evaluation under
 this section.
 (m)  The authority granted to the board under this section is
 in addition to the board's authority to make licensing decisions
 under this chapter.
 SECTION 11. Sections 301.453(a) and (b), Occupations Code,
 are amended to read as follows:
 (a) If the board determines that a person has committed an
 act listed in Section 301.452(b), the board shall enter an order
 imposing one or more of the following:
 (1) denial of the person's application for a license,
 license renewal, or temporary permit;
 (2) issuance of a written warning;
 (3) administration of a public reprimand;
 (4) limitation or restriction of the person's license,
 including:
 (A) limiting to or excluding from the person's
 practice one or more specified activities of nursing; or
 (B) stipulating periodic board review;
 (5) suspension of the person's license [for a period
 not to exceed five years];
 (6) revocation of the person's license; or
 (7) assessment of a fine.
 (b) In addition to or instead of an action under Subsection
 (a), the board, by order, may require the person to:
 (1) submit to care, counseling, or treatment by a
 health provider designated by the board as a condition for the
 issuance or renewal of a license;
 (2) participate in a program of education or
 counseling prescribed by the board, including a program of remedial
 education;
 (3) practice for a specified period under the
 direction of a registered nurse or vocational nurse designated by
 the board; or
 (4) perform public service the board considers
 appropriate.
 SECTION 12. Section 301.4535, Occupations Code, is amended
 by adding Subsection (a-1) and amending Subsection (b) to read as
 follows:
 (a-1)  An applicant or nurse who is refused an initial
 license or renewal of a license or whose license is suspended under
 Subsection (a) is not eligible for a probationary, stipulated, or
 otherwise encumbered license unless the board establishes by rule
 criteria that would permit the issuance or renewal of the license.
 (b) On final conviction or a plea of guilty or nolo
 contendere for an offense listed in Subsection (a), the board, as
 appropriate, may not issue a license to an applicant, shall refuse
 to renew a license, or shall revoke a license [if the applicant or
 license holder did not previously disclose the conviction or plea
 and the fifth anniversary of the date the person successfully
 completed community supervision or parole has not occurred].
 SECTION 13. Subchapter J, Chapter 301, Occupations Code, is
 amended by adding Section 301.4551 to read as follows:
 Sec. 301.4551.  TEMPORARY LICENSE SUSPENSION FOR DRUG OR
 ALCOHOL USE. The board shall temporarily suspend the license of a
 nurse as provided by Section 301.455 if the nurse is under a board
 order prohibiting the use of alcohol or a drug or requiring the
 nurse to participate in a peer assistance program, and the nurse:
 (1) tests positive for alcohol or a prohibited drug;
 (2)  refuses to comply with a board order to submit to a
 drug or alcohol test; or
 (3)  fails to participate in the peer assistance
 program and the program issues a letter of dismissal and referral to
 the board for noncompliance.
 SECTION 14. Section 301.468, Occupations Code, is amended
 by amending Subsection (a) and adding Subsections (e) and (f) to
 read as follows:
 (a) The board may determine that an order denying a license
 application or suspending a license be probated. A person subject
 to a probation order shall conform to each condition the board sets
 as the terms of probation, including a condition:
 (1) limiting the practice of the person to, or
 excluding, one or more specified activities of professional nursing
 or vocational nursing; [or]
 (2) requiring the person to submit to supervision,
 care, counseling, or treatment by a practitioner designated by the
 board; or
 (3)  requiring the person to submit to random drug or
 alcohol tests in the manner prescribed by the board.
 (e)  A hearing under this section is limited to a
 determination of whether the person violated the terms of the
 probation order under Subsection (a) and whether the board should:
 (1)  continue, rescind, or modify the terms of
 probation, including imposing an administrative penalty; or
 (2)  enter an order denying, suspending, or revoking
 the person's license.
 (f)  If one of the conditions of probation is the
 prohibition of using alcohol or a drug or participation in a peer
 assistance program, violation of that condition is established by:
 (1) a positive drug or alcohol test result;
 (2)  refusal to submit to a drug or alcohol test as
 required by the board; or
 (3)  a letter of noncompliance from the peer assistance
 program.
 SECTION 15. Section 63.202(f), Education Code, is amended
 to read as follows:
 (f) Notwithstanding the limitation provided by Subsection
 (b), grants awarded under Subsection (c) for the state fiscal
 biennium ending on August 31, 2009, and the fiscal biennium ending
 on August 31, 2011, by the Texas Higher Education Coordinating
 Board shall be awarded to programs preparing students for initial
 licensure as registered nurses or programs preparing qualified
 faculty members with a master's or doctoral degree for the program,
 including programs at two-year institutions of higher education,
 four-year general academic teaching institutions, health science
 centers, and independent or private institutions of higher
 education, or to the nursing resource section established under
 Section 105.002(b), Health and Safety Code. In awarding grants
 under this subsection, the coordinating board may:
 (1) give priority to institutions proposing to address
 the shortage of registered nurses by promoting innovation in
 education, recruitment, and retention of nursing students and
 qualified faculty;
 (2) award grants on a competitive basis; [and]
 (3) consider the availability of matching funds; and
 (4)  fund a study by the nursing resource section to
 evaluate the competencies of clinical judgment and behaviors that
 professional nursing students should possess at the time of
 graduation.
 SECTION 16. Chapter 105, Health and Safety Code, is amended
 by adding Section 105.008 to read as follows:
 Sec. 105.008.  STUDY OF ALTERNATE WAYS TO ASSURE CLINICAL
 COMPETENCY OF GRADUATES OF NURSING EDUCATIONAL PROGRAMS. (a) In
 this section:
 (1)  "Clinical competency assessment program" means a
 professional nursing prelicensure program that employs a
 criterion-referenced summative performance examination, developed
 by subject matter experts, to verify its graduates' attainment of
 the clinical competency necessary for initial licensure as a
 registered nurse.
 (2)  "Professional nursing prelicensure program" means
 a professional nursing educational program that prepares students
 to obtain an initial license as a registered nurse.
 (3)  "Research study" means the study described by
 Subsection (b).
 (4)  "Supervised clinical learning experiences
 program" means a professional nursing prelicensure program that
 requires students to complete a required number of supervised
 clinical learning experiences provided by qualified clinical
 faculty involving multiple, ongoing assessments and feedback.
 (b)  To the extent funding is available, the nursing resource
 section established under Section 105.002(b) shall conduct a
 research study to identify:
 (1)  a set of expected student outcomes in terms of
 clinical judgment and behaviors that professional nursing students
 should possess at the time of graduation from a professional
 nursing prelicensure program;
 (2)  standardized, reliable, and valid clinical exit
 evaluation tools that could be used to evaluate the competencies in
 clinical judgment and behaviors that professional nursing students
 possess at the time of graduation from a professional nursing
 prelicensure program;
 (3)  any correlation between the success rate of
 graduates of professional nursing prelicensure programs on
 standardized clinical exit evaluation tools and their educational
 and experiential background, including:
 (A)  length and type of health care work
 experience before entering the professional nursing prelicensure
 programs;
 (B)  health care work experience during the
 professional nursing prelicensure programs; and
 (C)  alternative methods of teaching clinical
 judgment and behaviors, including supervised clinicals and
 simulation laboratories; and
 (4)  any correlation between the required number of
 hours in supervised clinical learning experiences and expected
 student outcomes in terms of clinical judgment and behaviors.
 (c)  In addition to any other objective, the research study
 must be designed to determine if the graduates of a clinical
 competency assessment program are substantially equivalent to the
 graduates of supervised clinical learning experiences programs in
 terms of clinical judgments and behaviors. For purposes of this
 subsection, the clinical competency assessment program must be one
 that:
 (1)  has been requiring a clinical competency
 assessment for at least 10 years;
 (2) has students who reside in this state;
 (3)  has graduates who have been considered by the
 Texas Board of Nursing to be eligible to apply for a registered
 nurse license as a result of graduating from the program on or
 before January 1, 2007; and
 (4)  conducts the clinical competency assessment at a
 facility or facilities located in this state under the supervision
 of a qualified clinical faculty member who is a registered nurse and
 who holds a master's or doctoral degree in nursing.
 (d)  Considerations to be used in determining substantial
 equivalence under Subsection (c) must include the differences
 between the clinical competency assessment program and the
 supervised clinical learning experiences program in:
 (1)  the methods of evaluating students' clinical
 judgment and behaviors;
 (2)  performance on standardized clinical exit
 evaluation tools;
 (3)  the ability of graduates to transition to and
 assimilate in the registered nurse's role; and
 (4)  passage rates on the National Council Licensure
 Examination.
 (e)  The nursing resource section shall contract with an
 independent researcher to develop the research design and conduct
 the research. The independent researcher must be selected by a
 selection committee composed of:
 (1)  one representative elected by a majority of the
 nursing advisory committee under Section 104.0155, who is the chair
 of the selection committee;
 (2)  one representative designated by the Texas Health
 Care Policy Council;
 (3)  the presiding officer of the Texas Board of
 Nursing;
 (4)  one representative of the Texas Higher Education
 Coordinating Board, designated by the governor;
 (5)  one representative designated by the Texas
 Hospital Association;
 (6)  one representative designated by the Texas
 Association of Business;
 (7)  one representative designated by a clinical
 competency assessment program that meets the requirements of
 Section 301.157(d-8), Occupations Code; and
 (8)  the nurse researcher member of the nursing
 advisory committee under Section 104.0155.
 (f)  The nursing resource section shall complete the study
 not later than June 30, 2014, and shall submit a report to the
 office of the governor, the Senate Committee on Health and Human
 Services, and the House Committee on Public Health. The report must
 include a research abstract prepared by the independent researcher.
 (g)  The nursing resource section may cooperate with the
 Texas Board of Nursing and the Texas Higher Education Coordinating
 Board in conducting the study.
 (h)  The nursing advisory committee formed under Section
 104.0155 shall serve as the oversight committee for the study.
 (i)  Any data collected as part of the study that contains
 information identifying specific students, patients, or health
 care facilities is confidential, is not subject to disclosure under
 Chapter 552, Government Code, and may not be released unless all
 identifying information is removed.
 (j)  In addition to funds appropriated by the legislature,
 the nursing resource section may solicit, receive, and spend
 grants, gifts, and donations from public or private sources for the
 purpose of conducting the study.
 (k)  If grants or other funds are available through the
 National Council of State Boards of Nursing that could be used to
 fund the study, the nursing resource section shall apply for the
 funds to the maximum amount available up to the estimated cost of
 the study. In making the application or accepting the funding, the
 nursing resource section may not relinquish any oversight
 responsibility for the study, including responsibility for
 designing and conducting the research or developing the findings.
 SECTION 17. Section 301.202(b), Occupations Code, is
 repealed.
 SECTION 18. (a) The change in law made by Section 301.4521,
 Occupations Code, as added by this Act, applies only to an
 application filed with the Texas Board of Nursing on or after the
 effective date of this Act. An application filed before the
 effective date of this Act is covered by the law in effect when the
 application was filed, and the former law is continued in effect for
 that purpose.
 (b) The changes in law made by Section 301.4551, Occupations
 Code, as added by this Act, and Section 301.468, Occupations Code,
 as amended by this Act, apply only to a violation of an order issued
 by the Texas Board of Nursing on or after the effective date of this
 Act. A violation of an order issued by the Texas Board of Nursing
 before the effective date of this Act is covered by the law in
 effect when the order was issued, and the former law is continued in
 effect for that purpose.
 SECTION 19. This Act takes effect immediately if it
 receives a vote of two-thirds of all the members elected to each
 house, as provided by Section 39, Article III, Texas Constitution.
 If this Act does not receive the vote necessary for immediate
 effect, this Act takes effect September 1, 2009.
 ______________________________ ______________________________
 President of the Senate Speaker of the House
 I certify that H.B. No. 3961 was passed by the House on April
 28, 2009, by the following vote: Yeas 147, Nays 0, 1 present, not
 voting; and that the House concurred in Senate amendments to H.B.
 No. 3961 on May 23, 2009, by the following vote: Yeas 130, Nays 1,
 1 present, not voting.
 ______________________________
 Chief Clerk of the House
 I certify that H.B. No. 3961 was passed by the Senate, with
 amendments, on May 21, 2009, by the following vote: Yeas 31, Nays
 0.
 ______________________________
 Secretary of the Senate
 APPROVED: __________________
 Date
 __________________
 Governor