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In the state of Texas, an advanced practice nurse is defined as a registered nurse approved by the board to practice at an advanced level following the completion of an advanced education program acceptable to the Board (22 Tex. Admin. Code § 11.221.1; Buppert, 2021). This advanced practice nurse is prepared to operate in an expanded role, such as a nurse practitioner, nurse-midwife, nurse anesthetist, or clinical nurse specialist, providing healthcare services to individuals, families, or groups in various settings. These practice settings encompass homes, hospitals, institutions, offices, industry, schools, community agencies, public and private practices. To obtain licensure, the advanced practice registered nurse (APRN) must graduate from an advanced education program with a curriculum aligned with the competencies of the specific area of practice Texas State Nursing Certification and Licensure Essay.
Each instructional track/major should include a minimum of 500 supervised clinical hours as defined by the Board. This supervised experience should be directly related to the role and population focus area of licensure and should include pharmacotherapeutic management of patients consistent with the competencies of the specific areas of practice. The APN can practice independently or in collaboration with other healthcare professionals (22 Texas Admin. Code §11.221.1; Buppert, 2021). The term “advanced practice registered nurse” encompasses both advanced nurse practitioners and advanced practice nurses, as defined by administrative code 301.152 (Buppert, 2021). A graduate APRN must pass either the American Nurse Credentialing Center (ANCC) or the American Academy of Nurse Practitioners Certification Board (AANPCB) examination (Leik, 2021). For prescriptive authority, the APRN must hold full licensure from the Board of Nursing and have successfully completed graduate-level courses in pharmacotherapeutics, advanced pathophysiology, advanced health assessment, and the diagnosis and management of diseases and conditions within their 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 work under the supervision of a physician with practice protocols and other authorization agreements, such as prescribing authority, which should be documented and signed by both the APRN and the physician. This agreement should be reviewed annually and kept on-site in the practice setting for verification purposes. While under the authority of the physician, the advanced practice nurse maintains professional accountability for their advanced practice (Bupert, 2021). The APRN is authorized to prescribe drugs and devices allowed by the supervising physician if facility-based, either through prescriptive authority or protocols. When prescribing controlled substances, the APRN must adhere to the prescription format specified by the State of Texas and include their US DEA number if applicable. The APRN is only permitted to prescribe FDA-approved drugs, and off-label use is permissible if it is evidence-based and within the current standard of care for treating specific diseases and conditions. The APRN may also authorize or prevent generic substitution on a prescription in accordance with the current rules of the Texas State Board of Pharmacy regarding generic substitution.
In their role, the APRN engages in observation, assessment, diagnosis, intervention, evaluation, rehabilitation, care and counseling, and health education for individuals who are injured, ill, or experiencing changes in their normal health. They promote and maintain health, work in disease prevention, and provide care in accordance with current healthcare standards (Buppert, 2021). The APRN is required to retain a copy of the prescriptive authority agreement until the second anniversary of the agreement’s termination date. 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 prohibit APRNs from practicing within the scope of a registered nurse Texas State Nursing Certification and Licensure Essay.
To obtain a DEA number, an APRN with full licensure and prescriptive authority must meet the following requirements before ordering or prescribing controlled substances: (a) The advanced practice registered nurse must hold a prescriptive authority number issued by the Texas Board of Nursing before submitting the controlled substance registration form, and (b) DEA applications may be obtained via the DEA’s website or by contacting the local DEA office (Texas Board of Nursing, 2013).
APRNs are required to hold periodic meetings with their supervising physician, meeting at least once a month to exchange information related to patient treatment and care, changes in the care plan, referrals, and other matters pertaining to patient management. These meetings should be documented and available for review by relevant authorities Texas State Nursing Certification and Licensure Essay.
Currently, the limitation on full practice authority (FPA) for APRNs has been a longstanding issue, with various nursing organizations, such as the American Nurse Association (ANA), advocating for change. There is a need for clarification in the State of Texas regarding specific functions of APRNs, such as diagnosing, treatment, hospital and psychiatric institution admissions, referrals, patient education, test ordering, procedure performance, surgical assistance, medical equipment and restraint ordering, medical marijuana certification, and palliative care (Buppert, 2021).
Health policies related to APRN practice have been rapidly evolving, both at the local and national levels. Legislative and regulatory progress is being made by various APRN organizations. 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, with the support of the Texas Nurses Association (National Association of Pediatric Nurse Practitioners [NAPNAP], 2021). Texas is one of the 12 states that still restrict practice. Recently, Rep. Stephanie Klick introduced a full practice authority bill, H.B. 1792, aimed at removing outdated regulatory barriers for nurse practitioners and expanding access to healthcare for Texans (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 Texan APRNs, the journey toward unrestricted practice authority is likely to be a protracted battle Texas State Nursing Certification and Licensure Essay.
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. https://www.bon.texas
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