(a) A nurse must meet either the requirements of this subsection or subsection (b) of this section. A nurse may choose to complete 20 contact hours of continuing nursing education (CNE) in the nurse's area of practice within licensing period, as defined in this chapter. These contact hours shall be obtained by participation in programs approved by a credentialing agency or provider recognized by the Board. A list of these agencies/providers may be obtained from the Board's office or website.     
      (b) A nurse must meet either the requirements of this subsection or subsection (a) of this section. A nurse may choose to demonstrate the achievement, maintenance, or renewal of a Board approved national nursing certification in the nurse's area of practice within the licensing period, as defined in this chapter. A list of approved national nursing certifications may be obtained from the Board's office or website.     
      (c) Requirements for the APRN. A nurse licensed by the Board as an APRN is required to complete 20 contact hours of continuing education or achieve, maintain, or renew the national nursing certification recognized by the Board as meeting the certification requirement for the APRN's role and population focus area of licensure within the licensing period, as defined in this chapter.      
        (1) The required 20 contact hours are not in addition to the requirements of subsection (a) or (b) of this section.       
        (2) The 20 contact hours of continuing education must be appropriate to the advanced practice role and population focus area recognized by the Board.       
        (3) The APRN who holds prescriptive authority must complete, in addition to the requirements of this subsection, at least five additional contact hours of continuing education in pharmacotherapeutics within the licensing period.       
        (4) The APRN who has entered into a prescriptive authority agreement authorizing the prescribing of opioids must complete not less than two (2) hours of continuing education annually regarding safe and effective pain management related to the prescription of opioids and other controlled substances, including education regarding reason-able standards of care; the identification of drug-seeking behavior in patients; and effectively communicating with patients regarding the prescription of an opioid or other controlled substance. This requirement applies to renewal of licensure on or after January 1, 2021.       
        (5) The APRN whose practice includes the prescription of opioids must attend at least one (1) hour of continuing education annually covering best practices, alternative treatment options, and multi-modal approaches to pain management that may include physical therapy, psychotherapy, and other treatments. The content of the continuing education described by this paragraph must meet the requirements set forth by the Texas Pharmacy Board. This requirement applies to renewal of licensure on or after September 1, 2019, and expires on August 31, 2023.       
        (6) The APRN who is licensed prior to September 1, 2020, and authorized to receive information from the prescription monitoring program (PMP) authorized by Chapter 481, Health and Safety Code, must complete two (2) hours of continuing education related to approved procedures of prescribing and monitoring controlled substances no later than September 1, 2021. The APRN licensed after September 1, 2020, and authorized to receive information from the PMP, must complete the continuing education required by this paragraph no later than one year after the APRN's initial licensure date. This is a one-time education requirement.       
        (7) Category I Continuing Medical Education (CME) contact hours will meet requirements as described in this chapter, unless otherwise prohibited.       
      (d) Forensic Evidence Collection.      
        (1) Pursuant to the Health and Safety Code §323.004 and §323.0045, a nurse licensed in Texas or holding a privilege to practice in Texas, including an APRN, who performs a forensic examination on a sexual assault survivor must have basic forensic evidence collection training or the equivalent education prior to performing the examination. This requirement may be met through the completion of CNE that meets the requirements of this subsection. This is a one-time requirement. An APRN may use continuing medical education in forensic evidence collection that is approved by the Texas Medical Board to satisfy this requirement.       
        (2) A nurse licensed in Texas or holding a privilege to practice in Texas, including an APRN, who is employed in an emergency room (ER) setting must complete a minimum of two contact hours of CNE relating to forensic evidence collection that meets the requirements of this subsection within two years of the initial date of the nurse's employment in an ER setting. This is a one-time requirement.                  (A) This requirement applies to nurses who work in an ER setting that is:                      (i) the nurse's home unit;                       (ii) an ER unit to which the nurse "floats" or schedules shifts; or                       (iii) a nurse employed under contractual, temporary, per diem, agency, traveling, or other employment relationship whose duties include working in an ER.                     (B) A nurse shall be considered to have met the requirements of paragraphs (1) and (2) of this subsection if the nurse:                      (i) completed CNE during the time period of February 19, 2006 through September 1, 2013; and                       (ii) the CNE met the requirements of the Board's rules related to forensic evidence collection that were in effect from February 19, 2006 through September 1, 2013.                     (C) Completion of at least two contact hours of CNE that meets the requirements of this subsection may simultaneously satisfy the requirements of paragraphs (1) and (2) of this subsection.         
        (3) A nurse who would otherwise be exempt from CNE requirements for issuance of the initial Texas license and for the immediate licensing period following initial Texas licensure under §216.8(b) or (c) of this chapter (relating to Relicensure Process) shall comply with the requirements of this section. In compliance with §216.7(b) of this chapter (relating to Responsibilities of Individual Licensee), each licensee is responsible for maintaining records of CNE completion. Record of course completion in forensic evidence collection should be retained by the nurse indefinitely, even if a nurse changes employment.       
        (4) Continuing education completed under this subsection shall include information relevant to forensic evidence collection and age or population-specific nursing interventions that may be required by other laws and/or are necessary in order to assure evidence collection that meets requirements under the Government Code §420.031 regarding use of an Attorney General-approved evidence collection kit and protocol. Content may also include, but is not limited to, documentation, history-taking skills, use of sexual assault kit, survivor symptoms, and emotional and psychological support interventions for victims.       
        (5) The hours of continuing education completed under this subsection shall count towards completion of the 20 contact hours of CNE required in subsection (a) of this section. Certification related to forensic evidence collection that is approved by the Board may be used to fulfill the requirements of this subsection.       
      (e) A nurse who holds or is seeking to hold a valid Volunteer Retired (VR) Nurse Authorization in compliance with the Occupations Code §112.051 and §301.261(e) and §217.9(e) of this title (relating to Inactive and Retired Status):      
        (1) Must, if licensed by the Board as a LVN and/or RN, have completed at least 10 contact hours of CNE in his or her area of practice within the two years immediately preceding application for, or renewal of, VR status.       
        (2) Must, if licensed by the Board as an APRN, have completed at least 20 contact hours of continuing education in his or her area of practice within the two years immediately preceding application for, or renewal of, VR status. The 20 hours of continuing education must meet the same criteria as APRN continuing education defined under subsection (c) of this section. A nurse authorized as a VR-RN/APRN may not hold prescriptive authority. This does not preclude a registered nurse from placing his or her APRN license on inactive status and applying for authorization only as a VR-RN.       
        (3) Is exempt from fulfilling targeted continuing education requirements.       
      (f) Tick-Borne Diseases. An APRN whose practice includes the treatment of tick-borne diseases is encouraged to participate in continuing education relating to the treatment of tick-borne diseases. The continuing education course(s) should contain information relevant to treatment of the disease within the APRN's role and population focus area of licensure and may represent a spectrum of relevant medical clinical treatment relating to tick-borne disease. Completion of CME in the treatment of tick-borne disease that meets the requirements of this subsection shall count towards completion of the 20 contact hours of continuing education required for APRNs in subsection (c) of this section.     
      (g) Nursing Jurisprudence and Nursing Ethics. Each nurse, including an APRN, is required to complete at least two contact hours of CNE relating to nursing jurisprudence and nursing ethics before the end of every third two-year licensing period applicable to licensing periods that began on or after January 1, 2014. The CNE course(s) shall contain information related to the Texas Nursing Practice Act, the Board's rules, including §217.11 of this title (relating to Standards of Nursing Practice), the Board's position statements, principles of nursing ethics, and professional boundaries. The hours of CNE completed under this subsection shall count towards completion of the 20 contact hours of CNE required in subsection (a) of this section. Certification and/or CME may not be used to fulfill the CNE requirements of this subsection.     
      (h) Older Adult or Geriatric Care. A nurse, including an APRN, whose practice includes older adult or geriatric populations is required to complete at least two contact hours of CNE relating to older adult or geriatric populations or maintain certification in an area of practice relating to older adult or geriatric populations before the end of every licensing period, applicable to licensing periods that began on or after January 1, 2014. The CNE course(s) may contain information related to elder abuse, age-related memory changes and disease processes, including chronic conditions, end of life issues, health maintenance, and health promotion. The hours of CNE completed under this subsection shall count towards completion of the 20 contact hours of CNE required in subsection (a) of this section. Certification related to older adult or geriatric populations that is approved by the Board may be used to fulfill the CNE requirements of this subsection.     
      (i) Human Trafficking Prevention. A nurse, including an APRN, who provides direct patient care must complete a human trafficking prevention course approved by the Health and Human Services Commission. This requirement applies to the renewal of a license on or after September 1, 2020.     
     Source Note:        The provisions of this §216.3 adopted to be effective August 16, 2009, 34 TexReg 5524; amended to be effective October 4, 2010, 35 TexReg 8917; amended to be effective July 16, 2012, 37 TexReg 5274; amended to be effective November 20, 2013, 38 TexReg 8208; amended to be effective February 23, 2014, 39 TexReg 982; amended to be effective December 5, 2018, 43 TexReg 7766; amended to be effective November 19, 2019, 44 TexReg 7051