Texas State APRNs Prescriptive Authority

APRNs in Texas do not have full practice authority under current state law. While doctors no longer have to be on-site to supervise, APRNs must have a collaborative agreement with a physician. This collaborative agreement requires that the supervising physician conduct chart reviews and hold monthly meetings with the APRN to discuss care plans and any issues with patient care.  According to the Texas nursing practice act, APRNs must have written prescriptive delegation from a supervising physician. This allows the APRN to prescribe medications, including controlled substances. However, the supervising physician’s name, address, and telephone number must be included on the prescription drug order. If the prescribed medication is a controlled substance, the supervising physician’s DEA number must also be included. In addition, APRNs may only prescribe controlled substances in Schedule II in a hospital based facility and as part of care relating to a patient  who has been admitted to the hospital for a length of stay of 24 hours or grater, or is receiving services or is receiving services in the emergency department or as part of the plan of care for the treatment of a person who has a terminal illness and is receiving hospice care. Other schedule related restrictions for APRNs include limiting prescriptions of controlled substances in III-V to a 90 day supply and requiring consultation with delegating physicians for patients under 2 years old ((Frequently Asked Questions – Advanced Practice Registered Nurse 2013).

In the state of Texas, the collaborative and prescribing agreement are considered the same so for the purposes of this discussion, my answer is the same for both questions. I think that some APRNs in Texas should be able to practice independently. Texas is a very large state (geographically) with large rural areas. These areas are traditionally underserved and APRNs, particularly Family Nurse Practitioners could help increase access to medical care in these areas. However, I do think that there should be some limitations, depending on scope of practice. The current practice act gives APRNs quite a bit of leeway in determining appropriate scope. Requiring a collaborative physician is an attempt to limit instances where APRNs might try to provide care out of their scope. I also think that nurse anesthetists and certified nurse midwives should have collaborative agreements with physicians of some sort. While current laws may be overly restrictive, these are practice areas in which I think it might be beneficial to have a collaborative team. In the case of prescriptive authority for Schedule II-V drugs, I think that current regulations are reasonable because the state does allow APRNs to prescribe all classes of medications. I do think that NPAs should allow APRNs to prescribe all classes of drugs. However, there should be some limitations based on the APRNs education and practice setting.

Dermatologic conditions such as rashes can be difficult to treat because there are many potential causes. Rashes can be caused by viruses, fungi, physical irritation, parasites, plants, insects, bacteria, and even some autoimmune disorders (Rashes, 2020). and treatment will depend on the cause. While most APRNs can easily manage common rashes, determination of the cause of rare or unusual rashes may present a challenge for even the most experienced clinicians. As such, it is important to ensure that proper assessment is taking place. Collaboration could look like having multiple providers examine the rash and determining which, if any, laboratory tests should be ordered.

 

References

Frequently Asked Questions – Advanced Practice Registered Nurse. (2013). Retrieved

December 23, 2020, from https://www.bon.texas.gov/faq_practice_aprn.asp

Rashes. (2019, June 20). Retrieved December 24, 2020, from https://ufhealth.org/rashes

Discussion 1

Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:

  1. Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a collaborative agreement, and explain why/why not.
  2. Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.
  3. Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.
  4. Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

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