Although a movement called the APRN Consensus Model is attempting to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish an independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.
Another important area to consider and plan for is prescriptive authority. The appropriate board, which may be the medical board, state board of pharmacy, or nursing board, grants prescriptive authority under state law for the appropriate state licensure. The federal government grants the authority to write for a controlled substance, and the Drug Enforcement Administration (DEA) verifies this action through by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.
In this Discussion, you will locate and review the practice agreements in the state in which you plan to practice, identify potential collaboration requirements in your state, and understand the certification and licensing process that you will need to follow.
To begin, I located the Texas Board of Nursing website and read through their rules and regulations regarding Advanced Practice Registered Nurses. According to the board, an APRN in Texas is a registered nurse who has advanced education and clinical competency in one of four roles: Clinical Nurse Specialist (CNS), Nurse Anesthetist (CRNA), Nurse Practitioner (NP), or Certified Registered Nurse Midwife (CRNM). The roles must also be certified by a national certifying body recognized by the Board.
In order for an APRN to practice in Texas without physician oversight, they must have a collaborative agreement with at least one physician that meets certain requirements set forth by the board. This agreement should include clear expectations between the parties such as duties performed by each party and protocols that will be followed under various circumstances. Additionally, there are specific educational criteria that must be met including successful completion of a graduate nursing program accredited by either the Commission on Collegiate Nursing Education or Accreditation Commission for Education in Nursing; passage of a national certification examination relevant to their role; satisfaction of continuing education requirements as specified by their certifying organization; completion of at least two hours of annual pharmacology education related to prescribing controlled substances; and completion of two hours annually on prescribing opiates.
Lastly, APRNs must have prescriptive authority granted from both the federal Drug Enforcement Agency (DEA) as well as from their local state medical board. In addition to general application information required for DEA registration, applicants must submit proof establishing what particular area(s) within health care qualify them for registration with DEA along with documentation that demonstrates why they need access to controlled substances for patient care activities. Once approved, prescribers may obtain pre-printed prescription pads containing controlled substance numbers assigned exclusively to them upon payment of an additional fee per pad requested from DEA .
Practicing as an Advanced Practice RN requires careful attention and preparation when it comes understanding state regulations while also meeting all necessary licensure criteria before beginning practice.