Assignment: State Regulations for Advanced Practice Nurses
Although your roles and responsibilities may differ based on your practice setting (think emergency department versus inpatient hospital setting or outpatient specialty medicine clinic), they may also vary depending on the state in which you practice. Because each state has its own laws and regulations that determine the scope of practice for advanced practice nurses, it is your responsibility to understand your own state’s guidelines. This Assignment involves locating the Nurse Practice Act for your state and reviewing practice guidelines, licensing requirements, and the certification process.
· Locate the Nurse Practice Act for your state, as well as any other state legislation that outlines practice for Advanced Practice Registered Nurses (APRNs). Reflect on the definition and scope of practice of the APRN according to your state.
· Consider which state board is responsible for licensure of APRNs. Determine whether your state requires nursing board approval, board of medicine approval, or joint board approval for APRN practice.
· Consider the DEA (Drug Enforcement Administration) Drug Schedule categories approved for APRN prescribing. Think about how this might impact your clinical practice.
· Research the national certifying board options and application processes for the Adult Geriatric Acute Care Nurse Practitioner. Think about which exams are recognized by your state board and which board options best suit your professional needs.
Address the following in a 1- to 2-page paper:
· Explain the definition and scope of practice for APRNs according to the Nurse Practice Act in your state.
· Identify the state board that is responsible for licensure of APRNs. (please choose Texas Board of Nursing as I’m currently residing in Texas)
· Identify the DEA Drug Schedule categories approved for APRN prescribing in your state. Explain whether this might impact your clinical practice, and if so, explain how.
· Identify which national certifying board options are recognized by your state board. Explain which options best suit your professional needs and why. Describe the application processes for these options.
Nurse Practitioners, just like other health care providers are prone to professional liability claims. Whether it is intentional or unintentional, there are legal implications in every act or decisions that we make. Patients have the right to sue or file a case against us if for any reason, nurse practitioners failed to perform his/her duty in accordance with the state nurse practice laws. That is why, every state has its specific laws and regulations to ensure public’s safety (Burroughs et al., 2007). So, the purpose of this paper is to discuss about scope of practice of Advanced Practice Registered Nurses (APRN) in the state of Texas according to the Nurse Practice Act. I will also explain about the licensure of APRN’s and the DEA Drug Schedule categories approved for APRN’s in the state of Texas. And lastly, I will explain the best national certifying board option that suits my professional needs.
Scope of Practice for APRNs According to the Texas Nurse Practice Act
The Nurse Practice Act in Texas was initially signed into law by the Texas Legislature on March 2008. Since then, the Texas Board of Nursing continued to govern the nursing profession by enforcing the laws and regulations of the Nurse Practice Act (NPA). Nevertheless, the Texas NPA is considered as a nursing law that promotes the safety of patients and public welfare. The scope of practice of APRNs includes advanced practice education in a role and specialty, legal implications such as compliance with the NPA and Board rules, and scope of practice statements as published by national specialty and advanced practice nursing organizations. Therefore, APRNs need to practice in new settings, perform new procedures, and develop new skills in their professional careers. The APRN should maintain documentation of additional education and competency when adding a new procedure or patient care activity. Nurse practitioners usually collaborate with the physicians, obtain health histories, conduct physical exams, perform and interpret laboratory values, counsel patients, prescribe medications, and treat patient’s acute or chronic conditions (Texas Board of Nursing, 2005).
In state of Texas, both professional and individual scopes of practice exist. The professional scopes of practice are derived from professional specialty and advanced practice registered nursing organizations while an individual advanced practice registered nurse may or may not practice the full scope of the professional role and specialty. Decisions regarding individual scope of practice are complex and related to an advanced practice registered nurse’s knowledge, skills and competencies. Each advanced practice registered nurse must practice within his/her individual scope. The Texas Board of Nursing recognizes that individual scopes of practice will vary and that what is within the individual scope of practice for one advanced practice registered nurse may not be within the individual scope of practice for another advanced practice registered nurse authorized to practice in the same role and specialty. However, it is important to keep in mind that the Board holds each advanced practice registered nurse accountable for knowing and practicing within his/her professional and individual scope of practice (Texas Board of Nursing, 2005).
Identify the State Board Responsible for Licensure of APRNs
The Texas Board of Nursing approves qualified registered nurses to enter practice as advanced practice registered nurses (APRNs), including nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists. An individual may not practice or offer to practice in the state unless he or she is licensed in the State of Texas. A nurse who wishes to be licensed to practice as an APRN in the state of Texas must be licensed as a Registered Nurse in Texas or have a current, valid RN license with multistate privilege from a state that is party to the Nurse Licensure Compact for RNs and LVNs/LPNs before any level of APRN licensure can be granted. To obtain APRN licensure in Texas, an applicant has to complete a satisfactory criminal history record in which fingerprinting is required and submit it to the Board of Nursing in Texas. Failure to complete the needed requirements may result in a denial of licensure. Following the clearance of the applicant’s criminal record, a sworn license application is submitted and the applicant must demonstrate certain qualifications that includes evidence of professionalism, completion of an approved MSN nursing program, and have passed the licensure examination. The licensure examination in the Texas is regulated by the Texas Board of Nursing and the Board will issue a license to practice once the APRN applicant successfully completed the licensure examination.
DEA Drug Schedule Categories Approved for APRN Prescribing in Texas
The FDA’s Controlled Substances Act of 1970 has categorized class of medication based on their potential for abuse or addiction to promote safety and prevent harm to patients. Schedule drugs can be prescribed only by a practitioner who is registered and approved by the U.S. Drug Enforcement Agency (DEA) (Arcangelo & Peterson, 2013). In state of Texas, there are two primary limitations on prescriptive authority for APRNs. First, the prescriptive authority must be delegated by a physician through a written document prescribed by law; and secondly, certain limitations apply to prescribing Controlled Substances (CSs). The physician may only delegate authority to prescribe controlled substances in schedule III to V to APRNs. Examples of Schedule III narcotic medications are buprenorphine and Tylenol with codeine. Schedule IV drugs are clorazepate, alprazolam, and phenobarbital. And Schedule V are drugs that have the least potential for abuse like antidiarrheals and antitussives with small amounts of narcotics (Arcangelo & Peterson, 2013). APRNs may also prescribe Schedule II drugs like morphine or hydromorphone in a hospital-facility based practice or as a part of plan of plan of care for treatment of person who has terminal illness. Schedule II drugs cannot be delegated to APRNs in a free-standing emergency department as it is not located within the hospital setting. All Texas Controlled Substances must have a federal DEA number and a physician must delegate prescriptive authority to the APRN before signing a prescription for a controlled substance (Drug Enforcement Agency, n.d.). Prescribing Scheduled drugs have the potential to induce addiction and dependency either physiologically or psychologically that is why we should utilize sound professional judgment when prescribing controlled substances. We must maintain a patient’s written record of all controlled substances including enough information to justify the diagnosis and warrant the treatment.
APRNs who prescribe controlled substances in the State of Texas need to be aware of upcoming changes to the laws regarding prescribing and ordering these drugs. Due to a new law on the books (SB 195), beginning September 1, 2016 all APRNs who prescribe controlled substances will no longer have to register with the Texas Department of Public Safety in order to prescribe these medications. The DPS registration process will not be replaced by another process. Going forward, however, APRNs will continue to be required to register with the US Drug Enforcement Administration to prescribe and order controlled substances (Roberts, 2016).
Identify which national certifying board options are recognized by your state board. Explain which options best suit your professional needs and why. Describe the application processes for these options.
Nurse practitioners in Texas may specialize in a variety of settings such as primary care, behavioral, pediatric, adult and gerontology, and acute care. Adults and gerontology in acute care setting best suit my professional needs since I have been working as a registered nurse in long-term acute care facility for more than 10 years. Most of our patients are adults and geriatrics which have complex medical conditions. There were times that doctors do procedures at bedside like debridements, paracentesis, chest tube insertion, intubation, and central line insertions. Dealing with older people and geriatrics is challenging so I decided to go with adult gerontology acute care to pursue my professional career and be an Adult-Gerontology Acute Care Nurse Practitioner someday. The AGACNP involves taking care of adults, from young to old, collaborate with the physician, and provides comprehensive care in variety of settings in and out of the hospital. To become an AGAC-NP, it requires a Master of Science in Nursing specialize in Adult and Gerontology Acute Care. He/She should be a Registered Nurse with a Bachelor degree or Associate degree. The AGAC-NP student focused on adult and geriatrics in acute care setting and should successfully complete the required 500 supervised clinical hours. After graduation, they are required to take and successfully pass the licensure exam in state of Texas by the American Nurses Credentialing Center (ANCC) for AGAC-NP to start their practice. (Texas Board of Nursing, 2005).
The APRNs play a significant role in the advancement of the health care system in the United States. The scope of practice for APRNs varies from state to state and the role of APRNs is becoming more dominant due to high demands as healthcare is more accessible nowadays to most of the people. The Nurse Practice Act in state of Texas regulates the nursing education, licensure, and practice to protect and promote the welfare of the people of Texas. The Texas BON ensures that each individual holding a license as a nurse practitioner is competent to practice safely. The Board fulfills its mission through the regulation of the practice of nursing and the approval of nursing education programs (Texas Board of Nursing, 2013).
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice:
A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Burroughs, R., Dmytrow, B., & Lewis, H. (2007). Trends in nurse practitioner professional
liability: an analysis of claims with risk management recommendations. Journal Of Nursing
Law, 11(1), 53-60 8p. Retrieved from Walden Library databases.
Roberts, S. (2016). Important changes to your controlled substance registration. Retrieved from http://www.texasnp.org/news/302401/Important-Changes-to-Your-Controlled-Substance-Registration.htm
Texas Board of Nursing. (2005). Practice – APRN Scope of Practice. Retrieved from https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp