|Type of paper:||Essay|
|Categories:||Healthcare policy Nursing care Human services|
As the roles of nurse practitioners get more important in the country, various bodies strive to regulate the profession (AANP, 2019). The bodies also establish the scope of practice decision-making framework (NCSBN, 2019). However, while the national guidelines are uniform, some other laws are determined by local authorities. For instance, various local laws determine whether nurse practitioners can practice independently or not. The laws also dictate staffing requirements, as well as the protections offered for healthcare workers. State nursing boards also formulate and enforce various rules and regulations within their jurisdictions. This paper seeks to discuss the Texas Nursing Board and compare it to the Oregon Nurses Association.
The Texas Nursing Board licenses nurse practitioners as well as other advanced practice nurses in Texas. The board defines professional nursing as "the performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing" (Texas Board of Nursing, 2013). The board emphasizes that the term does not include medical diagnosis or prescription of corrective or therapeutic measures. Texas is among the states where the practice authority of nurse practitioners is restricted. Under the current scope of practice, nurse practitioners cannot practice without the supervision of a physician in a 75-mile radius. The prescriptive authority of the nurses is also greatly restricted. For instance, nurse practitioners can only prescribe under the supervision of a physician, and cannot prescribe schedule two drugs. Moreover, all prescriptions given by nurse practitioners must have the name, address, phone number, and the DEA number of the supervising physician (Wofford, 2019). To be licensed as a nurse practitioner in the state, one must have completed an advanced practice nursing educational program, as well as received national certification in the specific role and population focus. They must also have completed a minimum of 400 hours of practice in their field in the previous two years and a minimum of 20 contact hours of continuing education in their role and population focus in the last two years. To be certified, one must be a registered nurse and possess a degree.
The Oregon State Board of Nursing licenses nurse practitioners and regulates the practice in Oregon, which is considered to be one of the most nurse-friendly states in the country. The board defines nurse practitioners as nurses who provide healthcare services similar to those provided by a physician. According to the state's Nurse Practice Act, nurse practitioners do not require supervision. To be licensed, one needs to have a registered nurse license, a graduate degree, and national certification. The nurse practitioner must also fulfill the experience requirements of 960 hours in the previous five years or 192 contact hours in the previous two years. The certification requirements in the state are possession of a degree at either the master's or doctoral level. The nurse practitioner must also have completed programs geared towards their intended role and population focus. Following licensure, nurse practitioners in the state are given full prescriptive authority (DeCapua, 2018).
Future of APRN Practice in Texas
The fight for full practice authority for nurse practitioners has been ongoing for years now. In Texas, the restriction on the authority of nurses limits their ability to put their full education and experience into practice. The restriction poses a huge threat to the state's healthcare system since Texas is expected to face one of the most acute shortages of primary care providers in the coming years. The fight against the restrictions has borne some fruits already. For instance, the requirement in the Texas Nursing Practice Act, that a doctor must be on-site to oversee nurse practitioners at all times was recently eliminated. In 2017, a proposal was made to give nurse practitioners autonomous prescribing privileges. Other proposals seeking to authorize nurses to independently order, perform, and interpret diagnostic tests and advanced assessments have also been presented (Lee, 2019). However, such proposals are always opposed by physicians' organization, who stand to lose lucrative contracts were the proposals to sail through (Blore, 2018). However, as the state increasingly faces a shortage, the Act is bound to be changed. However, to meet the demands of all the stakeholders, certain refinements might be made to the Act. For instance, the number of minimum hours required for licensure could be increased.
Benefits of Full Practice to Society and Healthcare System
Full practice authority has several benefits for both society and the healthcare system. A 2016 study sought to find out whether removing restrictions on nurse practitioners would have any impact on the workforce, access to care as well as healthcare utilization, and healthcare costs (Xue, Ye, Brewer, & Spetz, 2016). The study established that removing the restrictions is a viable way of increasing primary care capacity (Xue, Ye, Brewer, & Spetz, 2016). Therefore, Texas should strive to relax the restrictions on nurse practitioners to increase its primary care capacity.
As shown revealed in the discussion, the practice authority and scope of practice of nurse practitioners across the country differ depending on the state's regulatory bodies. For instance, while the Texas Nursing Board requires nurse practitioners to practice under the supervision of a physician, the Oregon State Board of Nursing gives nurses full autonomy. Studies have shown that full authority has several benefits for society and healthcare systems. Texas, therefore, is expected to reconsider its position in light of the increasing demand for primary healthcare in the state.
AANP. (2019). Scope of Practice for Nurse Practitioners. Retrieved from AANP: https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners
Blore, J. (2018, December 28). Texas Nurse Practitioners: The Fight for Full Practice Authority. Retrieved from Nurse Practitioners Schools: https://www.nursepractitionerschools.com/blog/texas-np-practice-authority/
DeCapua, M. (2018, December 3). How Does Nurse Practitioner Authority Vary By State? Retrieved from Nurse Practitioner Schools: https://www.nursepractitionerschools.com/faq/how-does-np-practice-authority-vary-by-state/
Lee, S. (2019, April 4). Nurse practitioners want ability to practice independently in Texas. Retrieved from kxan: https://www.kxan.com/news/texas-politics/nurse-practitioners-want-ability-to-practice-independently-in-texas/
NCSBN. (2019). Scope of Practice Decision-Making Framework. Retrieved from NCSBN: Scope of Practice Decision-Making Framework
Texas Board of Nursing. (2013). Practice - Registered Nurse Scope of Practice. Retrieved from Texas Board of Nursing: https://www.bon.texas.gov/practice_scope_of_practice_rn.asp
Wofford, P. (2019, July 8). Texas Nurse Practitioners Fight for Full Practice Authority. Retrieved from nurse.org: https://nurse.org/articles/texas-nurse-practitioners-fight-for-practice/
Xue, Y., Ye, Z., Brewer, C., & Spetz, J. (2016). Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing outlook, 64(1), 71-85. Retrieved from https://www.sciencedirect.com/science/article/pii/S0029655415002687
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