Welcome to the Texas Board of Nursing

COVID-19 Nursing Education Information

Practice/Academic Partnerships During COVID-19 Resources

Expiration of Simulation Waiver Due to COVID-19 – September 1, 2022

Following Governor Greg Abbott’s state disaster declaration on March 13, 2020, the Governor granted a waiver on March 21, 2020, that allows students in their final year of a nursing education program to meet clinical learning objectives by exceeding the 50% limit on simulated clinical learning experiences.  The waiver has continued to be renewed until the present.

The following announcement was released to nursing programs on July 1, 2022:

Dear Program Directors,

Board Staff wish to acknowledge the ingenuity and commitment of directors and faculty to return students to valuable direct patient care experiences.  The purpose of this email is to provide notice that the current waiver to Board Rules 214.10(e)(3) and 215.10(e)(3) relating to Clinical Learning Experiences for Vocational and Professional Nursing Education Programs will expire on September 1, 2022.  This waiver, initiated on March 21, 2020, allowed programs to use up to 100% simulated clinical learning experiences for students in the final year of study. 

If you have questions or concerns, please reach out to your program's assigned education consultant.


Education Team 

Texas Board of Nursing




Questions for Post-COVID


Question:  Is it OK to just use simulation for clinicals?


Response:  No.  The definition for Clinical learning experiences in Rules 214 and 215 both require hands-on experiences in actual patient care clinical learning situations. The clinical settings for faculty-supervised hands-on patient care include acute care and rehabilitation facilities; primary care settings; extended care facilities (long-term care and nursing homes); residential care settings; respite or day care facilities; community or public health agencies; and other settings WHERE ACTUAL PATIENTS RECEIVE NURSING CARE.


Question:  How much simulation can we have in the program?


Response:  Besides hands-on patient care, Rules 214 and 215 both define clinical learning experiences as including those in clinical conferences, in nursing skills and computer laboratories, and simulated clinical settings including high-fidelity settings.  Rules 214.10(e)(3) and 215.10(e)(3) state that when a high-fidelity simulation laboratory is used to meet clinical learning objectives, the faculty shall be trained in planning and guiding the experience and in debriefing and evaluating students.  In these instances, programs may use up to 50% simulation activities in each clinical course.  This ensures that students receive adequate hands-on care in the required content areas (medical-surgical, geriatric, pediatric, maternal/child, and mental health (MH optional for VN programs).


Note: How much simulation can we use is the WRONG QUESTION.  The RIGHT QUESTION is What simulation experiences will help prepare students for safe, competent care of actual patients?


Question:   How many hours of actual hands-on patient care do we need to include?


Response:   The BON does not require a set number of hours specific to clinical learning.  The requirement is that the number of hours allotted is enough time to meet the clinical objectives.  The BON recommends that faculty evaluate the clinical learning objectives and decide which ones should be accomplished via hands-on patient care clinical experiences which include observational clinicals.  Programs should take advantage of strategies to engage students in active learning to gain the knowledge, skills, and abilities essential to safe, competent nursing practice.


You need as many as you can get!  NEPIS data indicates that the average number of hands-on clinical hours for the last three years were:


Program Type





















Besides hands-on hours, programs also document hours spent in computer activities, nursing skills lab, and simulation lab, often resulting in a total of over 800 hours in total.


Question:  What are the values of hands-on care?


Response:   Students must work with real patients to experience the unexpected changes in condition, the individual patient’s reaction to illness, and the life stressors that accompany their illness.   Without adequate hands-on clinical practice, students do not gain the experience of making clinical decisions for sudden and unexpected responses of patients.  Hands-on practice with real patients affords the students an opportunity to apply nursing knowledge and gain competence in providing care.  


Question:  What if I cannot find any pediatric or maternal/infant hands-on clinical settings?


Response:  This is a real concern and this response will give some ideas.  To carry this out, the director needs help:  a Clinical Coordinator who can spend the time searching for experiences to gain exposure to these clients.  Choice clinicals would be in hospitals, birthing centers, or clinics.   Second tier experiences may include services to help women and children, school programs for pregnant teens, after school programs where students can teach health to an available audience, school clinics, special schools, Olympics for disabled children, church nurseries, preschools, home health that may include new mothers, breast feeding classes, childbirth classes, health fairs, and children camps.  Some of these may be service learning experiences (consider adding this to your set of experiences).  Instead of offering no experiences with mothers and children, look for some valuable exposure to activities for them.  Do not forget observations – especially in health care facilities where the students can follow another health care worker to observe procedures and care.  Each student should probably be evaluated for their previous exposure to pregnancy, infancy, and children, and placed where they need more interaction.


If your nursing program is formatted for concept-based curriculum, courses are not designed for a specific population and clinical experiences may provide opportunities for interaction with mothers and children (such as ER, or public health clinics in community).



Question:   What are some alternate settings for clinical that can be counted as hands-on?


Response:   Many alternative settings are suggested the previous response.  For activities for adult and geriatric ages: home health visits accompanying a home health nurse, specialty clinics, residential care and retirement centers, telehealth, hospice, phone visits through an agency to elderly citizens, community mental health centers.


Question:  How can I know I have an adequate number of hands-on clinical hours?


Response:   The best evidence will be from the employers who hire your graduates asking if they were prepared for practice, and from the graduates asking if they found they were prepared for practice.





The Growing Importance of Academic-Practice Partnerships


The National Council of State Boards of Nursing (NCSBN) issued a Policy Brief endorsed by 10 national nursing organizations on March 27, 2020 that promoted the establishment of partnerships between health care facilities and nursing education programs to allow students to continue to practice clinical skills during the pandemic emergency.  This model served the dual purpose of providing clinical learning experiences for students while helping to alleviate the nursing shortage experienced by COVID-19.


Considering the use of a partnership model may offer several advantages including:

  • An intensive clinical experience for students
  • Nursing assistance to health care settings at time of nursing shortage
  • Better-prepared graduates to enter nursing practice
  • Opportunity for compensation when it included in the agreement
  • Possible sustainable model that may prevent crisis when emergencies arise


Partnerships may be developed that comply with Board rules – review Education Guideline 3.8.3.b



Additional Nursing Education Resources

· Texas Department of State Health Services- Coronavirus Disease 2019 (COVID-19) 

· Texas Department of State Health Services- News Updates 

· Texas Education Agency - Coronavirus (COVID-19) Support and Guidance 

· Texas Association of Community Colleges - COVID-19 Resources 

· Texas Department of State Health Services- Texas COVID-19 Data 

· The Centers for Disease Control (CDC) and Prevention – Guidance for Institutions of Higher Education (IHEs)