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In the state of Texas, an advanced practice nurse is described as a registered nurse authorized by the board to practice at an advanced level following the completion of an approved advanced education program as recognized by the Board (22 Tex. Admin. Code § 11.221.1[3]; Buppert, 2021). These advanced practice nurses are prepared to function in expanded roles such as nurse practitioners, nurse-midwives, nurse anesthetists, and clinical nurse specialists, delivering healthcare to individuals, families, or groups across diverse settings. These practice settings encompass homes, hospitals, institutions, offices, industry, schools, community agencies, and public and private practices. To secure licensure, an advanced practice registered nurse (APRN) must graduate from an advanced education program with a curriculum aligned with the competencies required for their specific practice areas Texas State Nursing Certification and Licensure Essay.
Nursing Classes and Assignments
Each instructional track or major must include a minimum of 500 supervised clinical hours as outlined by the Board. This supervised experience must be directly relevant to the role and population focus area specified for licensure and should encompass the pharmacotherapeutic management of patients, aligning with the competencies associated with the particular practice area. An APRN may function independently or collaborate with other healthcare professionals (22 Texas Admin. Code §11.221.1[3]; Buppert, 2021). Advanced practice registered nurse encompasses both advanced nurse practitioners and advanced practice nurses as defined by administrative code 301.152 (Buppert, 2021). Graduates of APRN programs are required to successfully pass either the American Nurse Credentialing Center (ANCC) or the American Academy of Nurse Practitioners Certification Board (AANPCB) examination (Leik, 2021). For prescriptive authority, APRNs must possess full licensure from the Board of Nursing and have completed graduate-level courses in pharmacotherapeutics, advanced pathophysiology, advanced health assessment, and the diagnosis and management of diseases and conditions within their designated role and population focus area (Buppert, 2021) Texas State Nursing Certification and Licensure Essay.
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The scope of practice for APRNs extends beyond that of registered nurses (RNs). Texas law mandates that APRNs operate under the supervision of a physician, with practice protocols and other authorization agreements, such as prescribing authority, documented in writing and signed by both the APRN and the physician. This agreement must be reviewed annually and remain readily available in the practice setting for verification purposes. The advanced practice nurse retains authority and professional accountability for advanced practice (Buppert, 2021). APRNs are authorized to prescribe drugs and devices as permitted by the supervising physician, whether facility-based authorization or protocol-based. When prescribing controlled substances, APRNs must adhere to the prescription format specified by the State of Texas and include their US DEA number, if applicable.
APRNs are allowed to prescribe only FDA-approved drugs and may do so for off-label purposes if such practice is evidence-based and aligns with the current standard of care for the treatment of specific diseases and conditions. APRNs can also authorize or prevent generic substitution on prescriptions in accordance with the current rules of the Texas State Board of Pharmacy regarding generic substitution. APRNs engage in observation, assessment, diagnosis, intervention, evaluation, rehabilitation, care and counsel, and health education for individuals who are injured, ill, or experiencing deviations from normal health. They work to promote and maintain health and participate in disease prevention (Buppert, 2021). APRNs are required to retain copies of prescriptive authority agreements until the second anniversary of the agreement’s termination. According to the Texas Administrative Code (22 Tex. Admin. Code §221.12; Buppert, 2021), the scope of practice for specialty areas is defined by national professional specialty organizations or advanced practice nursing organizations recognized by the Board. The Board does not restrict APRNs from practicing within the scope of a registered nurse Texas State Nursing Certification and Licensure Essay.
To acquire a DEA number, an APRN with full licensure and prescriptive authority must meet the following prerequisites before ordering or prescribing controlled substances: (a) Possess a prescriptive authority number issued by the Texas Board of Nursing before submitting the controlled substance registration form, and (b) Access DEA applications via the DEA’s website or contact the local DEA office (Texas Board of Nursing, 2013).
APRNs are required to hold periodic meetings with the supervising physician, occurring at least once a month, to exchange information pertaining to patient treatment and care, modifications to the care plan, referrals, and other issues relating to patient management. Documentation of these meetings must be maintained and available for review by the relevant authorities Texas State Nursing Certification and Licensure Essay.
Currently, the limitations on APRNs’ full practice authority (FPA) have sparked ongoing debates and advocacy efforts by various nursing organizations, including the American Nurse Association (ANA). Some aspects of APRN practice in Texas, such as diagnosis, treatment, hospital and psychiatric institution admissions, referrals, education, test ordering, procedure performance, surgical assistance, medical equipment and restraint ordering, medical marijuana certification, and palliative care, require clarification (Buppert, 2021).
Health policies related to APRN practice are evolving rapidly, both at the local and national levels. Various APRN organizations are actively advancing legislative and regulatory changes. In Texas, the primary APRN legislative advocacy group is the APRN Alliance, comprising four APRN groups: Texas Nurse Practitioners, Texas Association of Nurse Anesthetists, Consortium of Texas Certified Nurse-Midwives, and Texas Clinical Nurse Specialists. The Texas Nurses Association (TNA) also lends support to these efforts (National Association of Pediatric Nurse Practitioners [NAPNAP], 2021). Texas is one of the 12 states that still restricts APRN practice. Recently, Representative Stephanie Klick introduced House Bill 1792, aimed at eliminating outdated regulatory barriers for nurse practitioners and expanding Texans’ access to healthcare (NAPNAP, 2021; Texas Nurse Association [TNA], 2019). Since the bill’s introduction, members of the Texas Medical Association and other physician groups have been actively engaging legislative offices through calls, personalized emails, and in-person visits (NAPNAP, 2021). For Texas APRNs, the journey towards unrestricted practice authority promises to be a protracted battle Texas State Nursing Certification and Licensure Essay.
References:
Buppert, C. (2021). Nurse practitioner scope of practice. Nurse Practitioners Business Practice and Legal Guide, 7th ed. Jones & Bartlett Learning.
Leik, M. T. C. (2021). Certification exam information. Adult-Gerontology Nurse Practitioner Certification: Intensive Review 4th ed. Springer Publishing.
NAPNAP. (2021). APRN Legislative review-greater Texas NAPNAP. https://community.napnap.org/txgreater/advocate#22 Tex. Admin. Code § 11.221.3 (2019): https://www.bon.texas.gov/rr_current/221-3.asp
Texas Board of Nursing. (2013). Obtaining a DEA number.
TNA. (2019). In the trenches at the Texas legislature. https://www.texasnurses.org/news/news.asp?id=445224 Texas State Nursing Certification and Licensure Essay.
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