Texas Advanced Practice Registered Nurse (APRN) Certification and Licensing

Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what are those requirements?

In Texas, nurses are required to comply with the practice authority an agreement between the professional and the supervising physician. They further must abide by the prescriptive authority that is a legal agreement between the physician and the nursing professional that outlines prescription processes (TBN, n.d.) The state requires a physician collaboration for a nurse professional to improve the interventions. The physician is directly responsible for the prescriptive delegation that is a collaborative medical agreement and regulated by the Texan Board of Medicine (TBN, n.d.)

How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in the state of Texas?

In the state, Advanced Practice Registered Nurse (APRN) must be accepted in specialty and satisfy the examination board. They then must be recognized by the federal body certified to operate in the state by the Texas Board of Nursing (TBN, n.d.)  

Application for certification can be submitted online or mailed to the board office for further analysis. The officials in charge write an approval of the application and the applicant must provide proof of current certification. A nurse licensed in another state will be required to produce a copy of the license.

What is your state’s board of nursing website?

https://www.bon.texas.gov/

How does your state define the scope of practice of a nurse practitioner?

The state of Texas defines the scope of practice as all activities that involve individual health care provisions that a professional undertakes in the delivery of patient care. The advanced practice registered nurse may perform only those functions which are within that scope of practice, and which are consistent with the Nursing Practice Act, Board rules, and other laws and regulations of the State of Texas (TBN, 2017).

What is included in your state practice agreement?

The name, address, and all professional license numbers of the parties to the agreement.

Brief description of the nature of the practice, location, or setting.

Either the types or categories of drugs and devices the APRN may order and/or prescribe or the types or categories of drugs and devices the APRN may not order or prescribe.

A general plan for consultation and referral.

A plan for addressing patient emergencies.

The general process for communication and sharing information related to the care and treatment of patients.

A prescriptive authority quality assurance and improvement (QAI) plan that, at a minimum, includes a chart review (identifying the number and how the physician will review charts) and monthly meetings, and describes how the implementation of the QAI activities will be documented.

Signatures by all parties to the agreement with the date the physician or APRN signed the PAA. (Jacob, McKenna & D’Amore, 2015). This information contained on the license card are meant to enhance quality health provisions through management of the existing policies.

How do you get a DEA license?

As an NP who administers, prescribes or dispenses any controlled substance, you must be registered with the federal Drug Enforcement Administration (DEA). To obtain the official order form, you may: Apply online at the U.S. Department of Justice website. This resource is only available to new applicants.

Does your state have a prescription monitoring program (PMP)?

The Texas Prescription Monitoring Program (PMP) collects and monitors prescription data for all Schedule II, III, IV, and V Controlled Substances (CS) dispensed by a pharmacy in Texas or to a Texas resident from a pharmacy located in another state.  The PMP also provides a database for monitoring patient prescription history for practitioners and the ordering of Texas Schedule II Official Prescription Forms (AANP, 2020).

How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

In the state of Texas, physicians are allowed to delegate the signing of prescriptions for medications to physician assistants and advance nurse practitioners as set forth in the Texas Occupations Code §§ 157.051 – 157.060. Through the nursing profession, prescription of controlled substance should be done timely and regarding holistic care. The board limits the scope of practice, and the nurse must carry out prescriptions under the supervision of a physician who should be within a 75-mile radius. They further are not allowed to prescribe Adderall and Norco drugs (TBN, 2017).

                                          References

American Association of Nurse Practitioners. (2020). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

Frequently asked Questions – Advanced Practiced Registered Nurse. Welcome to the Texas Board of Nursing Website. (n.d.). Retrieved December 2, 2021, from http://www.bon.texas.gov/.

Jacob, E. R., McKenna, L., & D’Amore, A. (2015). The changing skill mix in nursing: considerations for and against different levels of nurse. Journal of Nursing Management23(4), 421-426.

Texas Board of Nursing. (2017). Texas administrative code: Standards of nursing practice.  http://www.bon.texas.gov/rr_current/217-11.asp

I read about the PMHNP requirements and authority in the state of Texas, and I found out the differences between Texas and the state of Maryland where I reside.  Maryland has established a different modus operandi for nurse practitioners (NPs). The state’s practice agreement specifies the extent of the professionals’ practice authority. NPs are responsible for assessing patients, diagnosing, ordering, and interpreting diagnostic testing. Professionals are also permitted to initiate and manage treatments, including prescribing medications and controlled substances. Nonetheless, the state board of nursing licensure is required (AANP, 2021). Maryland does not require physician involvement or oversight because it has complete prescription authority. On the other hand, Texas restricts or limits NP’s scope of practice, including prescription authority, and requires an advanced practice nurse to collaborate with a physician (TBON, 2018). Most health care customers argue that these restrictions increase the state’s health care access problems (Boyle and Mumba, 2018). Consumers in the United States of America increasingly seek health treatment from Advanced Nurse Practitioners (ANPs). The establishment of ANPs has also aided in closing the gap in access to health care for the poor. Giving full authority to ANP’s helps bridge this gap.

References

American Association of Nurse Practitioners (AANP). (2021, August 4). State practice environment. https://www.aanp.org/advocacy/state/state-practice-

environment

Boyle, M. K., & Mumba, M. N. (2018). Barriers and Facilitators for Implementing the Nurse Practitioners Full Prescriptive Authority: A Systematic Literature Review.

Texas Board of Nursing. (2013). Obtaining a DEA Number. Retrieved from  https://www.bon.texas.gov/applications_obtaining_dea_number.asp.

I am also from Texas and was interested to see if I understood the same information as you. From my comparison, it looks like we both have the same understanding. I was partially concerned due to what I had read about being within a 75-mile radius and prescription authority according to the Scope of Nursing (American Association of Nurse Practitioners, 2020). I have been under the impression the physician had to be within the same facility when practicing as a PMHNP.

            I did a lot of traveling nursing when the pandemic hit; with Texas having a compact state, it helped tremendously. I have been researching if there is a need for traveling PMHNP and if the license works the same way. I have been investigating the Texas BON but have not had much luck finding this information (Texas Board of Nursing, 2020). However, it seems every time you look at the BON; you find out something new about your license.     

            I would love to stay in contact with you as we are nearing the end. Sometimes things seem a little easier than they are, and maybe we can help each other out along the way, being from the same state.  

References:

American Association of Nurse Practitioners. (2020). State practice environment. Retrieved January 0, n.d., from https://www.aanp.org/advocacy/state/state-practice-environment.

Texas Board of Nursing. (2020). Texas Board of Nursing. Retrieved December 1, 2021, from https://www.bon.texas.gov/newaprn.asp.

You explained that Texas, APRNs are required to comply with the practice authority an agreement between the professional and the supervising physicians. I believe these guidelines are for the purpose of public safety. I would like to say, although New Mexico does not require supervision of APRNs, the provider must be Board certified and if not yet certified the APRN must be supervised by another APRN or a physician. However, ANCC Board certification provides formal recognition of knowledge and skills in a specialty. It is important that nurses know how to obtain Board certification upon graduation. This discussion is relevant and this week’s discussion topic highlights the importance of certification as it is important that APRNs meet the minimum standards for certification. Passing the ANCC exam ensures that practitioners are meeting predetermined eligibility criteria that include experience in a specialty area passing a certification examination required. According to Ma, Godwin, McNeely & Ramirez, (2021) Board certification signifies knowledge, expertise, and a commitment to professional growth, responsibility.

The AANP forum (2016) explained that it is important that APRNs consult and refer to other health care providers as warranted by patient needs and remain accountable to the public and the state board of nursing for meeting standards of care. The NM Board of nursing is a regulatory body whose mission is to protect the public through effective regulation of nursing practice. I currently reside and practice in the state of NM and like the ANCC the NM Board of nursing ensure nurses are meeting the minimum standards by requiring that nurses are safe practitioners by demonstrating that the nurse is able to pass the Board Certification exam.

References

AANP forum. (2016). The Journal for Nurse Practitioners, 12(6), A27-A30. doi:http://dx.doi.org/10.1016/j.nurpra.2016.04.017

Ma, H. L., Godwin, C., McNeely, H. L., & Ramirez, J. (2021). Board certification: A role for the             nurse             educator. The Journal of Continuing Education in Nursing, 52(11), 497-499.             doi:http://dx.doi.org/10.3928/00220124-20211008-02

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