Posted: January 28th, 2023

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

APRN Prescriptive Authority for Arkansas and Texas

Prescriptive authority in the state of Arkansas for APRNs requires that the APRN be licensed in the state of Arkansas with prescribing practices within the scope of practice per the practitioner’s certification category. Within one year of beginning an APRN level pharmacology course, the practitioner must complete 300 hours of experience with a qualified preceptor and submit a collaborative practice agreement with an Arkansas licensed physician who has an unrestricted DEA registration number. After meeting these requirements, only then can an APRN prescribe legend drugs and medicines or therapeutic devices specific to the practitioner’s area of practice. For controlled drugs, only Schedule III through V may be prescribed by an APRN. With the exception of hydrocodone combination products, an APRN may not prescribe Schedule I and II controlled substances (Arkansas Department of Health 2018) NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

In the state of Texas, prescriptive authority for APRNs requires the practitioner have successful completion of graduate level pharmacotherapeutics, advanced pathophysiology, and advanced health assessment. The practitioner must also complete 45 hours per course of preceptor experience with a qualified preceptor. If an APRN has prescriptive authority in another state, the practitioner must meet the education requirements of Texas before being able to have prescriptive authority. The practitioner also has the ability to authorize or prevent the use of generic substitutions on prescription drugs. Unlike Arkansas, APRNs in Texas are allowed to prescribe Schedule II controlled substances, but only in the hospital setting (Practice – APRN Scope of Practice 2019) NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

APRN Delegation Regulations for Arkansas and Texas

In the state of Arkansas, an APRN may delegate certain tasks to nurses and/or unlicensed staff. The task may include noninvasive treatments, collection and documentation of data, ambulation, positioning, or turning, and personal hygiene. Tasks that should not be delegated include physical assessments, formulation of the patient’s plan of care, transmitting verbal or telephone orders, and an APRN cannot delegate to unlicensed staff the calling in of prescriptions to the pharmacy (Arkansas Department of Health 2018).

One of the major differences in delegation for the state of Texas is that unlike Arkansas, administration of medication to a patient may be delegated to a medication aide in correctional health, long term care facilities, and home health agencies. All other general criteria for delegation apply for the state of Texas as well, with the responsibility of determining competence of the delegate resting on the delegating APRN (Practice – APRN Scope of Practice 2019).

Prescriptive Authority and Delegation for APRNs with Full Practice Authority

Prescriptive authority and delegation regulations for APRNs with full practice authority may be affected by the continuous state and national barriers that prevent qualifying practitioners from practicing to their full extent. If allowed to work to their full extent of education and training, APRNs will be able to provide services to vulnerable populations, such as minorities and the uninsured (Bosse et al., 2017) NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

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References

Arkansas Department of Health. (2018, December 29). https://www.healthy.arkansas.gov/programs-services/topics/arsbn-adv.-practice.

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761–765. https://doi.org/10.1016/j.outlook.2017.10.002

Practice – APRN Scope of Practice. Texas Board of Nursing – Practice – APRN Scope of Practice. (2019). https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp.

Discussion: Professional Nursing and State-Level Regulations

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

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In New Jersey, while an advanced practice nurse (APN) or nurse practitioner (NP) cannot practice independently, they are recognized as primary care providers.  Otherwise known as a joint protocol, they require “collaboration, and a written protocol with a physician is required when prescribing medications” (NCSLSOP Scope of Practice Policy, 2021).  This collaboration also extends to prescription writing for all medications (The State of New Jersey, n.d.).    The APNs that I have worked with, prescription pads have a medical doctor’s name and NPI number written on them.  When the APNs introduce themselves, they inform the staff of the name of which doctor they are collaborating with.

In comparison, all advanced practice nurses in Florida do not require collaboration.  HB 607 (Autonomous Practice) is a bill that was passed on March 11, 2020, allowing APNs to be autonomous (FLANP).  They can practice independently, including prescription writing of any drug (NCSLSOP Scope of Practice Policy, 2021). Every nurse practitioner does not have to be autonomous, as it is a choice to be independent or collaborate.   Those who choose to practice autonomously will require additional continuing education hours that include “three graduate-level semester classes in differential diagnosis, three graduate-level semester classes in pharmacology” (FLANP), and 3,000 hours of supervision.   The APNs who choose to continue to collaborate will do so under the supervision of a doctor and cannot prescribe control substances NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

While I agree that APNs should practice independently, I agree with the mandatory supervision hours.  Even though nurses are encouraged to advance their education, the balance requires hands-on care and practice.  We do not want book competent nurses that are deficient in critical thinking due to a lack of clinical exposure. The job of the state board of nursing and as a regulatory body is to protect the public from harm.  Florida’s board of nursing made great strife in going from a restricted status of APN licensure to independent status, yet put the correct stipulations in place to protect the public.

References

FLANP. (n.d.). Retrieved from Florida Association of Nurse Practitioners: https://www.flanp.org/page/AutonomousPractice

NCSLSOP Scope of Practice Policy. (2021). Retrieved from National Organizations for State and Local Officials: https://scopeofpracticepolicy.org/states/nj/

The State of New Jersey. (n.d.). Retrieved from New Jersey Division of Consumer Affairs: https://www.njconsumeraffairs.gov/nur/Pages/APN-Certification NURS 6050 Discussion: Professional Nursing and State-Level Regulations