ANP-650 topic 1 dq 2
ANP-650 topic 1 dq 2
I am a registered nurse practicing in the state of Texas. I have read my state’s Nurse Practice Act.
The Texas Board of Nursing recognizes advance nursing practice and recognizes that the scope of practice continues to evolve with experience, attainment of knowledge, evidence-based practice, technology advancement, and changes within the healthcare delivery system (Texas Board of Nursing, 2013b). APRNs may practice in new settings, perform new procedures, and develop new skills throughout their professional career (Texas Board of Nursing, 2013b). Professional scopes of practice come from professional specialty and APRN organizations with individuals choosing whether or not to practice to their full scope of the professional role and specialty (Texas Board of Nursing, 2013b). Each APRN must practice within their individual scope of practice that is based on personal knowledge, skills, and competencies (Texas Board of Nursing, 2013b). National professional specialty and APRN organizations broadly define the scope of practice for each role with documents that address the role, function, population served, and practice setting (Texas Board of Nursing, 2013b). In Texas, National certification examinations serve to assess the nurse’s knowledge of the APRN core and role competencies for the specific population focus area on which the nurse is educated and seeking licensure (Texas Board of Nursing, 2013b). APRNs are not allowed to change their legally recognized titles or designations by gaining experience or continuing education, these changes can only be made with additional formal education and meeting all the legal requirements to use the title and practice in the specialty as designated by the BON (Texas Board of Nursing, 2013b) ANP-650 topic 1 dq 2.
To add a new procedure or patient care activity, the APRN should maintain documentation of additional education and competency (Texas Board of Nursing, 2013b). I would need to identify the benefit for the new activity or procedure, consumer demand, standards for safe practice, and whether it is within my best interest based on state and federal statutes and regulations, identification of established professional standards for supporting the performance of the new activity or procedure, and outline goals and methods to learn all knowledge and skills required to gain competency (Texas Board of Nursing, 2013b). Next, I would have to demonstrate competency and maintain records that reflect attainment and sustaining of competency (Texas Board of Nursing, 2013b). The Standards of Nursing Practice Rule 217.11 requires that APRNs only accept assignments that take into consideration patient safety and correspond with personal education, experience, knowledge, and physical and emotional ability (Texas Board of Nursing, 2013a).
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Prior to prescribing any controlled substance for pain and devices the APRN is required to review and access the prescription monitoring program and obtain a valid prescription authority number (Texas Board of Nursing, 2013d). After obtaining these standards, the APRN can order and prescribe controlled substances in Schedules III-IV including a refill not to exceed a 90-day supply as a new prescription or refill for patients two years and older (or in our case for our patient population, patients 13 and older) (Texas Board of Nursing, 2013d). Schedule II medications can only be ordered and prescribed in a hospital practice based on hospital medical staff or committee outlined in bylaws that ensure patient safety which can include patients admitted for 24 hours or greater, receiving services in the emergency department, or patients with a written certification of terminal illness who have selected hospice care and will receive care from a qualified hospice provider (Texas Board of Nursing, 2013d). Under Rule 222.4 the APRN can order devices that are authorized under prescriptive authority agreement or within the protocols or written authorization within a facility-based practice for patient population within scope of practice for licensure and comply with requirements for chart reviews within either agreement (Texas Board of Nursing, 2013c). Texas is a collaborative agreement state that requires APRNs to have the physicians name, address, telephone number, on prescription drugs and DEA number for controlled substances (Texas Board of Nursing, 2013a).
References
Texas Board of Nursing (2013a). Frequently asked questions-Advanced Practice Registered Nurse. https://www.bon.texas.gov/faq_practice_aprn.asp.html#t8
Texas Board of Nursing (2013b). Practice-APRN scope of practice. https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp.html
Texas Board of Nursing. (2013 c). Texas administrative code: Examining boards: Texas Board of Nursing: Advanced Practice Registered Nurses with prescriptive authority:Minimum standards for prescribing or ordering drugs and devices.https://www.bon.texas.gov/rr_current/222-4.asp.html ANP-650 topic 1 dq 2
Texas Board of Nursing. (2013 d). Texas administrative code: Examining boards: Texas Board of Nursing: Advanced Practice Registered Nurses with prescriptive authority: Renewal of prescriptive authority. https://www.bon.texas.gov/rr_current/222-2.asp.html
ANP-650 topic 1 dq 2 Topic 1 DQ 2
For California-based learners, review the advanced practice rules for nurse practitioners in California using the resource, “Board of Nursing Links by State,” located on the college page of the Student Success Center under the AGACNP tab.
In your response, acknowledge that you have read the Nurse Practice Act for California. Identify the professional codes and business practices regulated by the California Board of Nursing for nurse practitioners. Explain how standardized procedure guidelines are governed within California, detail at least two standards for nurse practitioners outlined by the California Board of Nursing, and discuss the regulations of furnishing and ordering medications, drugs, and devices within the state. How do national, state, and local regulations affect the AGACNP scope and practices? Support your answer with a minimum of two APRN peer-reviewed resources ANP-650 topic 1 dq 2.
ANP-650 topic 1 dq 2
I work in California, and I have read the Nurse Practice Act for California. Nurse Practitioners in California operate under a practice agreement until they have completed transition to practice requirements, at which point they may be eligible for full practice authority. This transition involves 4600 hours of supervised practice and other requisites (State of California, 2023a). Nurse Practitioners are expected to adhere to the standards outlined by the California Board of Registered Nursing. This involves delivering safe, competent, and ethical care to patients. In terms of business practices, NPs are required to have a collaborative agreement with a physician if they wish to furnish (i.e., order and/or prescribe) drugs or devices (State of California, 2023a). NPs operate under standardized procedures, which are collaboratively developed protocols between physicians and NPs, delineating the NPs’ scope of practice (State of California, 2023a). NPs can furnish drugs and devices under physician supervision (State of California, 2023a). They need a “furnishing number” from the Board of Registered Nursing and a DEA number for controlled substances.
Standardized procedures are formal, written instructions for certain medical tasks that allow registered nurses or nurse practitioners (NPs) to perform functions that are usually considered part of the medical practice (State of California, 2023b). These procedures vary across different states, healthcare organizations, and even individual practice settings (Phillips, 2019). Standardized procedures can provide a framework for NPs to prescribe medication. These protocols outline the types of medications NPs are allowed to prescribe, under what circumstances, necessary patient follow-up, and steps to take in case of adverse reactions (State of California, 2023a). Another standardized procedure could provide guidelines for an NP to conduct minor surgical procedures, specifying the types of surgeries allowed, the level of physician oversight required, post-procedure care, and protocols for managing complications (Phillips, 2019). For instance, an NP working in a dermatology practice might follow a standardized procedure for performing skin biopsies, detailing necessary preparatory steps, the actual procedure, and the handling of the sample afterward ANP-650 topic 1 dq 2.
The passage of AB 890, which expands the independent practice of nurse practitioners (NPs) in California, necessitates a review and alignment of intersecting statutes, regulations, and various aspects of healthcare operations. This legislation can help address priority policy issues such as increasing access to care in underserved communities, managing the opioid crisis, and caring for vulnerable older adults (Chan et al., 2021). Research indicates that allowing NPs to practice independently can lead to enhanced healthcare outcomes, including increased access to routine checkups, decreased emergency department usage, and reduced healthcare costs. Additionally, independent NP practice has been associated with improved quality of care for chronic diseases and improved patient functionality in long-term care facilities. States with independent NP practice also saw increased access to treatment for opioid use disorders (Chan et al., 2021).
As for how national, state, and local regulations affect the AGACNP scope and practice, national guidelines provide a broad framework that is adapted and specified by each state to fit its unique context (Phoenix & Chapman, 2020). The Institute of Medicine’s Future of Nursing report’s first recommendation was to eliminate scope of practice barriers for APRNs, which has prompted significant progress in regulatory changes at the state and federal levels (Phoenix & Chapman, 2020).
Local regulations, including institutional policies, can further limit or specify the scope of practice. Regulations may dictate aspects of practice like prescriptive authority, degree of physician involvement, and types of patients or conditions the NP may treat (Phoenix & Chapman, 2020).
References
Chan, G., Duderstadt, K., & Dower, C. (2021). Aligning nurse practitioner statutes in California. https://www.chcf.org/wp-content/uploads/2021/07/AligningNursePractitionerStatutesCA.pdf
Phillips S. J. (2019). 31st Annual APRN Legislative Update: Improving state practice authority and access to care. The Nurse Practitioner, 44(1), 27–55. https://doi.org/10.1097/01.NPR.0000550248.81655.30
Phoenix, B. J., & Chapman, S. A. (2020). Effect of state regulatory environments on advanced psychiatric nursing practice. Archives of Psychiatric Nursing, 34(5), 370–376. https://doi.org/10.1016/j.apnu.2020.07.001
State of California. (2023a). Business and Professions Code: Division 2, Chapter 6. Nursing. California Legislative Information.
State of California (2023b). Article 7. Standardized Procedure Guidelines. California Code of Regulations.
ANP-650 topic 1 dq 2
For learners based in states other than California, review the advanced practice rules for nurse practitioners in your respective state using the resource, “Board of Nursing Links by State,” located on the college page of the Student Success Center under the AGACNP tab.
In your response, identify the state in which you practice and acknowledge that you have read your state’s Nurse Practice Act. Identify the professional codes and business practices regulated by the state for nurse practitioners and explain how invasive procedure privileges are granted within your state. Detail at least two standards for nurse practitioners within your state and discuss the regulations for ordering medications and devices within your state. How do national, state, and local regulations affect the AGACNP scope and practices? Support your answer with a minimum of two APRN peer-reviewed resources.
ANP-650 topic 1 dq 2
I live and work in the state of Texas and have downloaded and read my state’s Nurse Practice Act (NPA). To be able to perform invasive procedures, five criteria need to be met. I would need training on how to perform the procedure, determine if the procedure falls within generally accepted standards of care appropriate for my role and for my population focus (determined by a professional specialty organization), demonstrate clinical competence and/or experience in performing the action as an advanced practice registered nurse (APRN) by supervision and training of a qualified practitioner, have privileges at the health care facility to perform the procedure, and, where applicable, have completed any additional training adequate for the action being performed (Texas Board of Nursing, 2023). The Texas Board of Nursing (BON) (2023) determines “additional training” adequacy by the type of instruction provided (online, in-person, didactic, or clinical), the learning objectives, content, materials, and methods for evaluating participation, the length and quality of the training, the qualifications of the instructor, if the training is certified by a professional specialty organization for the APRN’s role and population focus, how the training was sponsored (in my case by an educational institution and precepted experience), and if it was with the correct drug/equipment/product. I should have competencies and am responsible for maintaining my own records. Failure to stay withing my scope of practice in population focus could result in disciplinary action.
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According to the Texas BON (2001), one core standard for advanced practice is knowing and conforming to the Texas NPA as well as all current local, board, state, and federal rules, regulations, and standards affecting the advanced role and specialty. Another is that the APRN practice within the advanced specialty and role according to his/her advanced educational preparation (Texas Board of Nursing, 2001). Overall, the core standards for the APRN in Texas encourages him/her to know and practice in the role he/she has been prepared for. This provides safety not only for the APRN, but for the patients they are caring for.
To prescribe or order drugs and/or devices in the state of Texas, the APRN needs to be issued a prescription authorization number. To obtain this, an APRN must have full licensure from the BON and is considered to have met the course requirements of advanced pharmacotherapeutics, pathophysiology, and health assessment, diagnosis and disease management since those courses are required for their education to sit for boards. To maintain prescriptive authority, the APRN must complete a minimum of five contact hours of continuing education in pharmocotherapeutics every two years, in addition to the CE’s required to maintain his/her license (Texas Board of Nursing, 2020) ANP-650 topic 1 dq 2.
Laws are interpreted and rules are created by regulatory agencies, shaping the way new laws are executed and outlining what the APRN can or cannot do, either independently or under supervision (DeNisco, 2021, p. 242). Although many states have or are moving towards full practice authority which is recommended ty the National Academy of Medicine, Texas has restricted practice, meaning, for now, state laws require supervision, delegation, or team management by another health provider to be able to provide care (American Association of Nurse Practitioners, 2022).
References:
American Association of Nurse Practitioners. (2022). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment
DeNisco, S. (2021). Advanced practice nursing: Essential knowledge for the profession. Jones & Bartlett Learning.
Texas Board of Nursing. (2001). Texas administrative code: Examining boards: Texas board of nursing: Advanced practice nurses: Core standards for advance practice. https://www.bon.texas.gov/rr_current/221-12.asp.html
Texas Board of Nursing. (2023). Texas administrative code: Examining boards: Texas board of nursing: Advanced practice nurses: Scope of Practice. https://www.bon.texas.gov/rr_current/221-12.asp.html
Texas Board of Nursing. (2020). Texas administrative code: Examining boards: Texas board of nursing: Advanced practice registered nurses with prescriptive authority: Renewal of prescriptive authority. https://www.bon.texas.gov/rr_current/222-2.asp.html