Certification and Licensure
The state of Texas defined advanced practice nurse as a registered nurse approved by the board to practice at an advanced level after the completion of advance education program acceptable to the Board (22 Tex. Admin. Code § 11.221.1; Buppert, 2021). The advance practice nurse should be prepared to practice in an expanded role such as nurse practitioner, nurse-midwife, nurse anesthetist, and a clinical nurse specialist providing healthcare to individual, families, and or group in various setting. Practice settings include homes, hospitals, institutions, offices, industry, schools, community agencies, public and private practice. To obtain licensure, the advanced practice registered nurse (APRN) must graduate and advanced education program with curriculum consistent with competencies of the specific areas of practice. Each instructional track/major shall have a minimum of 500 supervised clinical hours as defined by the Board. The supervised experience shall have been directly related to the role and population focus area of licensure and include pharmacotherapeutic management of patients consistent with competencies of the specific areas of practice. The APN can act independently or with collaboration with other health care professionals (22 Texas Admin. Code §11.221.1; Buppert, 2021). Advanced practice registered nurse includes advanced nurse practitioner and advanced practice nurse as defined by administrative code 301.152 (Buppert, 2021). The graduate APRN shall 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 shall have full licensure from the Board of Nursing and have successfully completed graduate level courses in pharmacotherapeutics advanced pathophysiology, advanced health assessment, and diagnosis and management of diseases and conditions within the role and population focus area (Buppert, 2021).
The scope of practice of APRN is in addition to the registered nurse (RN) scope of practice. Texas law requires that APRN shall be under the supervision of a physician with practice protocols and other authorization agreements such as prescribing authority written and signed by the APRN and the physician. This agreement shall be reviewed annually and remain in the practice setting available for verification to authority. The advanced practice nurse remains in authority and professional accountability for advance practice (Bupert, 2021). The APRN is authorized to prescribe drugs and devices allowed by the supervising physician if facility-based authorized either by prescriptive authority or by protocols. The APRN should follow the format of prescription specified by the State of Texas with the US DEA number if prescribing controlled substance. APRN shall prescribe only FDA approved drugs and for off-label purpose if such practice is evidenced-based and within the current standard of care to treat certain diseases and condition. The APRN shall authorize or prevent generic substitution on a prescription in compliance with the current rules of Texas State Board of Pharmacy relating generic substitution. The APRN acts in observation, assessment, diagnosis, intervention, evaluation, rehabilitation, care and counsel, and health teachings of persons who are injured, sick, or ill who are experiencing changes in normal health, promotes and maintain health, and works in the prevention of diseases (Buppert, 2021). The APRN is required to retain the copy of the prescriptive authority agreement until the second anniversary of the date the agreement is terminated. According to the Texas Administrative Code (22 Tex. Admin. Code §221.12; Buppert, 2021), the scope of practice for specialty areas shall be defined by the national professional specialty organizations or advanced practice nursing organizations recognized by the Board. The Board does not prohibit the APRN from practicing the scope of a registered nurse.
To obtain a DEA number, an APRN with full Licensure and prescriptive authority must comply with the following requirements prior to ordering or prescribing controlled substances: (a) The advanced practice registered nurse must have a prescriptive authority number that has been 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 web site or by calling the local DEA office (Texas Board of Nursing, 2013).
APRN shall have periodic meeting with the supervising physician at least once a month to share information relating to patient treatment and care, changes in plan of care, referral and other issues relating to patient management. This meeting shall be documented and available for review from authority.
Currently the APRN limitation to full practice authority (FPA) has been a long battle by the various nursing organization such as the American Nurse Association (ANA). Some scope of practice to specific functions of the APRN requires clarity in the State of Texas such as diagnosing, treatment, admission to hospital and psychiatric institution, referral, teachings, ordering of tests, performing procedures, assisting in surgery, ordering of medical equipment and restraints, certifying use of medical marijuana, and performing palliative care (Buppert, 2021).
Health policy related to APRN practice has been evolving rapidly, both locally and nationally. Legislative and regulatory advances are being made by various APRN organization. Within Texas, the main APRN legislative advocacy group is the APRN Alliance, which is made up of 4 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 among the 12 states that still has restricted practice. Recently, Rep. Stephanie Klick filed full practice authority bill, H.B. 1792, which would remove costly, antiquated regulatory barriers to nurse practitioners and help expand access to care for Texans (NAPNAP, 2021; Texas Nurse Association [TNA], 2019). Since the bill was introduced, members of the Texas Medical Association and other physician groups have been inundating legislative offices with calls, personalized emails, and in-person visits (NAPNAP, 2021). For Texan APRNS, it is going to be a long way battle for unrestricted practice authority.
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. Admim. 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