Long-Term Care & Home Health
Nursing Facility Workplace Violence Prevention in Texas
How Texas Chapter 331 applies to nursing facilities that employ two or more RNs — the committee, plan, training, and annual evaluation a licensing surveyor checks.
Texas nursing facilities licensed under Chapter 242 are covered by Health & Safety Code Chapter 331 when they employ two or more registered nurses. A covered facility must operate a written workplace violence prevention program — a committee, an at-least-annual training cadence, a confidential anti-retaliation reporting policy, post-incident response, and an annual plan evaluation reported to the governing body — all required since September 1, 2024.
Long-term care presents a distinctive workplace violence profile. The most common hazard is not an intruder or a visitor — it is resident-on-staff aggression, frequently driven by dementia, delirium, or acute medical conditions. A nursing facility's program has to address that reality honestly while staying survey-defensible. This article maps what Chapter 331 requires of a nursing facility and how an HHSC licensing surveyor reviews it.
#Is your nursing facility covered?
Coverage turns on a single threshold: employing two or more registered nurses. This is the same trigger that applies to HCSSAs, and it is easy to misread in a facility with a fluctuating or contractor-heavy staffing model. The counting question — who is an "employed RN," and how contractors and PRN staff factor in — deserves careful attention. We work through it in detail in our companion guide to the two-employed-RNs coverage test.
Primary source: Texas Health & Safety Code Chapter 331 (added by SB 240, 88th Legislature, 2023); nursing facilities are licensed under Ch. 242 and covered when they employ ≥2 RNs.
If your facility meets the threshold, the full program applies. Private physician practices are excluded from Chapter 331, but a licensed nursing facility at or above the RN threshold is squarely covered.
#The committee a surveyor checks
Chapter 331 requires a standing workplace violence prevention committee. For a nursing facility, the required member categories are:
- A registered nurse who provides direct patient care — always required.
- A physician who provides direct patient care — only if the facility employs one.
- A security-services employee — only if the facility employs one.
Most nursing facilities seat the direct-care RN as the mandatory member and do not employ a physician or security-services staff. Chapter 331 lets you re-authorize an existing committee — many facilities extend an existing safety or QAPI committee — provided you document the re-authorization and seat the required member.
A surveyor will ask to see a committee charter, appointment letters, a membership roster naming the direct-care RN, and minutes for the trailing twelve months. A committee that exists on paper but cannot show minutes is one of the most common deficiencies. The WVP Foundation Package builds the charter, drafts appointment letters, and facilitates and minutes the first meeting.
#A facility-specific plan that names care-driven behaviors
The most-cited Chapter 331 deficiency is a generic template plan. For a nursing facility, "facility-specific" means the plan reflects the actual hazard profile of long-term care: a resident with advancing dementia who strikes a CNA during personal care is a different risk than an agitated visitor in an emergency department, and the controls differ.
A defensible nursing facility plan addresses:
- Resident-on-staff aggression, including behaviors driven by dementia, delirium, sundowning, and acute medical conditions.
- Care-driven incidents versus intentional violence, documented so the distinction is clear in the record.
- High-risk care moments — personal care, transfers, medication administration, and night-shift staffing.
- The statutory elements: committee, prevention measures, reporting and anti-retaliation, training, post-incident response, and annual evaluation.
The clinical and documentation approach to resident behaviors is detailed in our guide to resident-on-staff aggression in long-term care. Documenting these behaviors well protects both staff and the facility's record — it shows the hazard was recognized and controlled, not ignored.
#Training, reporting, and post-incident response
Training must occur at least annually under Chapter 331, mapped to your facility's actual risks — de-escalation for residents in distress, recognizing escalating behaviors, the reporting pathway, and post-incident steps. Rosters must reconcile against the full census, including PRN, per-diem, and contracted clinical staff. VIGILO's de-escalation and staff training is built for long-term care teams and hands over binder-ready completion records.
Reporting requires a confidential policy with anti-retaliation protection and explicit non-discouragement of contacting law enforcement. In long-term care, the policy must make it safe for a CNA or nurse to report an aggressive resident encounter without fear that doing so reflects on their care.
Post-incident response requires the facility to offer acute medical treatment to directly-involved staff and to adjust the work assignment as appropriate — for instance, reassigning a staff member away from a resident after a serious event, while still meeting the resident's care needs.
#The annual plan evaluation — the recurring obligation
Chapter 331 requires the committee to evaluate the plan at least annually and report the results to the governing body. For a nursing facility, the governing body is the licensed operator's board or its equivalent authority.
A surveyor checks two artifacts: the annual evaluation record (committee minutes) and proof it reached the governing body (board minutes or a signed report). Doing the evaluation but never reporting it upward is a distinct, commonly-cited gap. Because the obligation renews every year, most facilities carry it through an annual program review on a fixed calendar.
#Where nursing facilities most often fall short
| Common deficiency | The fix |
|---|---|
| Assumed exempt while employing ≥2 RNs | Confirm coverage; build the program |
| Generic template plan | Rewrite to name long-term-care hazards |
| Committee with no minutes | Seat the RN, meet, and minute it |
| Training roster gaps (PRN/agency) | Reconcile against the full census |
| Annual evaluation never reported to the board | Make the governing-body report a standing item |
#Survey-readiness, not fines
Chapter 331 carries no dedicated fine schedule. For a nursing facility, non-compliance surfaces as a deficiency at the HHSC licensure survey, requiring a plan of correction, and as exposure in post-incident litigation after a serious assault. The licensing agency may also take disciplinary action against the license.
A flat-fee survey-readiness audit scores your nursing facility against the full Chapter 331 requirement set in a single engagement, and our Chapter 331 compliance checklist lets you self-assess first. VIGILO serves long-term care facilities across Texas with flat-fee, subscription-based support.
VIGILO is a healthcare compliance, training, and consulting firm. It builds survey-defensible programs and documentation; it is not a security-guard, patrol, or investigations company, and it does not guarantee safety outcomes. Every compliance claim traces to a named primary source.