Nursing License Requirements in Texas
As one of the largest states in the country, Texas employs high numbers of nursing personnel compared to many other states. These nurses may work in university hospitals, small rural clinics or a wide variety of other work settings. The US Bureau of Labor Statistics reports that in 2018, 87,750 certified nurse aides (CNAs) and 72,030 licensed vocational nurses (LVNs) were employed in Texas. Texas is one of only two states to use the term LVN – all other states except California call this group licensed practical nurses, or LPNs. In addition, Texas employed 210,350 registered nurses (RNs). The numbers on RN employment include clinical nurse specialists (CNSs), who are advanced practice registered nurses (APRNs). Other APRNs employed in Texas in 2018 included 6,040 certified registered nurse anesthetists (CRNAs) and 120,020 nurse practitioners (NPs). The BLS does not have data on certified nurse-midwives (CNMs) in Texas, but the American Midwifery Certification Board reports Texas employed 511 CNMs in 2018.
The Texas Health and Human Services department sets standards and manages the licensing process for CNAs in the state. The Texas Board of Nursing (TBON) is responsible for licensing of LVNs, RNs, and APRNs. Each group has specific requirements for education, competency validation, initial licensure, and renewals. These two organizations also handle disciplinary actions. Texas is a nursing compact state, which means nurses licensed in another nursing compact state who meet the requirements set by the TBON may also practice in Texas.
The purpose of nursing licensure is to ensure competence and to protect the public. In addition, employers in Texas have specific responsibilities in hiring – such as a criminal background check.
CNA – Texas offers a number of paths to CNA certification. In all cases, the applicant must pass the National Nurse Aide Assessment Program (NNAAP) exam and be listed in the Texas Nurse Aide Registry. These paths include the following:
Initial training in a training program approved by the Health and Human Services Commission (HHSC) (formerly known as Department of Aging and Disability Services - DADS). The applicant must complete the process within 24 months of the initial training.
- CNAs whose certificate has expired can retake the examination.
- Military veterans who have completed at least 100 hours of equivalent training can take the certification examination.
- RNs and LVNs who have completed their training in any state-accredited nursing school in Texas or another state are eligible to take the examination.
- CNAs from another state can apply for reciprocity. A criminal background check and a photocopy of the individual’s photo identification are required.
- CNAs who have completed specialized training may also become medication aides in Texas.
LVN – LVNs in Texas must complete a TBON-approved program, submit fingerprints and pass a criminal background check. In addition, the candidate must pass the NCLEX-PN examination. A fee is required for both the test and licensure. In addition, Texas requires LVN applicants to pass the Texas Nursing Jurisprudence Exam prior to taking the NCLEX-PN examination.
LVNs educated in another country must submit an original Credential Evaluation Service (CES) course-by-course report from an approved agency and pass an English proficiency examination.
LVNs licensed in another state may apply for reciprocity or endorsement in Texas.
RN – Texas licenses associate degree and baccalaureate RNs who have completed a TBON-approved program and passed the NCLEX-RN examination. Fees are required for both licensing and the examination. Requirements for foreign-educated RNs and those licensed in another state are the same as those for LVNs.
APRN – an APRN in Texas must first meet the requirements for RN practice and hold a current, valid RN license. In addition, an APRN must have completed either a master's degree or a doctorate in nursing and be nationally certified in his or her specialty.
CNAs, LVNs, RNs, and APRNs in Texas must renew licensure on a regular basis to keep practicing. Another option is to request inactive status. The nurse is still licensed but cannot practice without meeting continuing education requirements to restore active status. Texas also offers LVNs, RNs, and APRNs the option of retired volunteer nurse status. Continuing education requirements are lower for this designation and APRNs are not allowed to prescribe.
CNA – renewal is required every two years; there is no fee. The applicant must submit proof of 24 hours of in-service training approved by the DADS. Verification of employment within the past two years is also required.
LVN – LVNs in Texas are required to complete a minimum of 20 hours of continuing education to renew a license. Renewal is scheduled for the nurse’s birth month. There is a fee and the process can usually be completed online.
RN – an RN has two options for licensure renewal in Texas. The first is to complete 20 hours of continuing education within a two-year time period preceding the renewal date. The second is to maintain national certification in his or her area of practice. The TBON lists approved certifications on its website. Renewal can be completed online. A fee is required to renew.
APRN – APRN requirements are essentially the same as for RNs. However, an APRN with prescriptive authority must complete an additional five hours in pharmacotherapeutics and an additional three hours in the prescription of controlled substances. APRNs can also use Category I Continuing Medical Education (CME) to meet continuing education requirements, with the exception of the nursing jurisprudence and nursing ethics requirements.
Other Methods of Licensure
In addition to the usual method of initial licensure in Texas, nurses have other options. These include:
Licensure by Endorsement
Nurses who are licensed in another state can apply for reciprocity or licensure by endorsement. A CNA who is registered in another state must submit an application and criminal background check. LVNs, RNs, and APRNs must have graduated from an approved program and completed the NCLEX-PN or NCLEX-RN examination or worked in nursing within the previous four years. Nurses who were previously licensed in Texas cannot apply for endorsement but must reactive the previous license. Nurses who have applied for endorsement will usually be issued a temporary license good for 120 days while the application is being processed.
Veterans who have completed at least 100 hours of equivalent training can become CNAs in Texas. The US Army is the only branch of the service that has equivalent training for an LVN. There is no option for veterans to qualify as RNs or APRNs.
Paramedics: paramedics must complete additional training to become LVNs or RNs.
Nurses educated and/or licensed outside the US must pass the NCLEX-PN or NCLEX-RN examination, submit a completed criminal history report and provide proof of passing scores in an English proficiency examination. In addition, the applicant must submit an original Credential Evaluation Service (CES) Full Education Professional report from an organization such as the Commission on Graduates of Foreign Nursing Schools (CGFNS). Verification of licensure from all countries, states, provinces, and/or territories where the applicant has held a license must be submitted directly from the licensing authority and include the authority’s official seal. A criminal background check is required. The applicant must have worked as a nurse within the four years prior to submitting the application.
Criminal History Reports
Nurses who work in Texas must submit their fingerprints for a criminal background check. In fact, nursing schools in the state have the same requirement. The fingerprints are used to check criminal history records of the Federal Bureau of Investigation (FBI) and the Texas Department of Public Safety. Employers are required to check CNA eligibility by searching the Employee Misconduct Registry and the Nurse Aide Registry. LVN, RN and APRN applicants for initial licensure, as well as those requesting licensure by endorsement or examination, must also submit to a criminal background check. Applicants must also note on the application any criminal convictions. Those who were convicted of one or more felonies and have completed a sentence must wait five years after release to apply for a new license. Some convictions preclude licensure entirely. These include registerable sex offenses, robbery, and aggravated assault. Nurses who have received an order of non-disclosure or whose criminal record has been expunged are not required to report these crimes to the board. An arrest without a conviction, for example, can be expunged. Youthful indiscretions – committed prior to the age of 22 with no further offenses – may not need to be reported to the board.
It is the duty of Texas Health and Human Services and the Texas Board of Nursing to protect the public from criminal activities, incompetence, malpractice or negligence on the part of a CNA, LVN, RN or APRN. While each has specific processes for handling complaints, they are similar. Once a complaint has been filed, the agency will conduct an investigation. If the complaint is found to be unwarranted, it will be dismissed. Complaints outside of the agency’s jurisdiction will be referred. Evidence is collected and reviewed. The agency makes a decision to close the case, make an agreement offer or file formal charges. An agreement offer is most likely in cases of extenuating circumstances or substance abuse. Completion of a mandated drug rehabilitation program or prison sentence, for example, may allow the individual to retain his or her license. The kinds of offenses for which a license might be revoked include abduction, aiding a suicide, murder, assault, robbery and substance abuse, distribution or sale. The agencies consider such issues as the individual’s age, other criminal history, and extenuating circumstances. Licenses may be suspended, temporarily revoked or permanently revoked.
Scope of Practice
Scope of practice is delineated by individual states and determines exactly what a CNA or nurse can do.
CNAs are considered dependent caregivers who must work under the supervision of a physician or licensed nurse. Their tasks include assistance with activities of daily living such as bathing and walking, feeding patients, changing linens and stocking supplies. Those CNAs who are properly trained and certified may administer oral medications in certain work settings.
LVN scope of practice includes similar tasks as those of the CNA, However, LVNs can also administer injectable medications. Those who have completed additional training such as an IV validation course or LVN IV certification may insert, manage and discontinue peripheral intravenous lines. LVNs must be supervised by a physician or registered nurse.
RN and APRN scope of practice includes all tasks of a CNA or LVN. In addition, RNs and APRNs perform more complex tasks that require nursing judgment and use of the nursing process. These include inserting and managing central intravenous lines, complex wound care, administration of intravenous push medications, dispensing medications and performing independent telephone triage. In addition, APRNs can prescribe medications and medical devices, order lab and diagnostic tests, suture wounds and perform joint injections and other tasks considered to be in the domain of medical practice.
Online Services Related to Nursing Licensure in Texas
Texas Health and Human Services maintains online resources for CNAs in Texas. These include:
- Certified Nurse Aide In-Service Education
- Employee Misconduct Registry
- Find a Credentialing Training Program
- Long-term Care Licensing Renewals and Contracts
- Medication Aide Program
- Nurse Aide Registry
- Nurse Aide Training and Competency Evaluation Program
- Nursing Facility Administrators Licensing
- Referral Policies and Procedures
- Texas Unified Licensure Information Portal
The TBON maintains online resources for LVNs, RNs, and APRNs. Among these are:
- APRN Initial Licensure
- Board Position Statements
- Educational Discipline and Complaints
- Laws and Rules
- Nurse Endorsement Application
- Nurse Examination Application
- Nurse License Renewal
- Nurse Quick Confirm
- Nursing Practice Information
- Webinars, Workshops and Online CNE
Resources for more information: