Over the past years, there has been an increasing demand for primary care, and this has led to rising demand for nurses. As a result, several individuals have become more interested in the career, and due to the sensitivity of healthcare services, the nursing board provides various restrictions to practicing nurses to limit its practice at the nation and state levels. The primary purpose of the guidelines is to ensure that nurses deliver quality services to patients. Over time, states and regulatory bodies update and adjust laws and modernize healthcare. However, the restrictions differ from one state to another, and when one moves to another state, they will have to know its rules. Therefore, Advanced Nurse Practitioner practice in the state of Texas define the scope of the profession, and this has various implications on the nursing practice.
Texas is a restrictive state; hence nurses have limited freedom that are provided to them. The state denies NPs the right to practice to the full extent of their license in the delivery of nursing care and services to patients. The Board of Nursing in Texas defines the scope as: "The advanced nurse practitioner acts independently and/or in collaboration with the health team in the observation, assessment, diagnosis, intervention, evaluation, rehabilitation, care and counsel, and health teachings of persons who are ill, injured or infirm, or experiencing changes in normal health processes; and in the promotion and maintenance of health or prevention of illness..." (21 Texas Administrative Code 221.13; Texas Board of Nursing, 2019). Therefore, nursing practitioners may be required to work independently or in collaboration with a health team in the provision of nursing services within the state’s jurisdiction. However, nurses retain professional accountability in their respective areas in the care they provide to patients. In this case, nurse practitioners in Texas practice to the extent of their licenses and within their scope.
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Texas recognizes nurse practitioners as primary care providers who are responsible for prescribing drugs, devices, and controlled substances as required by a written agreement they sign with a supervising physician. It is a requirement that the supervision must be continuous. However, this supervision does not require the constant physical presence of the physicians to oversee the practice of the nurses. Nurse practitioners in Texas are mandated to provide medical care as per rules and procedures or other written authorization that they jointly establish with a physician ("Texas Board of Nursing - Laws & Rules - Nursing Practice Act," 2019). Those with proper training and appropriate training are in a position to receive a federal waiver which allows them to distribute buprenorphine-containing products provided the supervising physician has the necessary certification, training, and permission to treat and manage patients opioid use disorder. Therefore, nurses working in collaboration with physicians should follow various protocols that they agree in a written document.
In the past years, there have been attempts to eliminate the restrictive rules on advanced nurse practitioners. In Texas, there exist regulatory impediments rather than legislative prohibitions. For example, the state does not consider advanced practice registered nurses ( APRNs ) as medical staff members who can admit and discharge patients, but most give them privileges as affiliated health providers ("Texas Board of Nursing - Laws & Rules - Nursing Practice Act," 2019). The restrictions that the state of Texas puts on advanced nursing practice is a great barrier to the provision of efficient, affordable, high-quality, and all-inclusive healthcare services to patients. These nurse practitioners possess the necessary education, knowledge, skills, and experience to provide care services and are ideally positioned to help improve care to patients. However, the existence of restrictive policies is a barrier to the highly qualified nurse practitioners because it limits them from practicing to the full extent that their education and training have prepared them.
The restrictive nature of the laws in Texas provides several benefits to patients in the administration of medication despite the barriers to nurse practitioners. One of the benefits is that it leads to decreased medication errors because physicians supervise the administration of dosages and state the route and directions of use (Barnes et al. 2017). As a result, it leads to improved treatment and lower cases of illnesses and in extreme cases, the death of patients. Furthermore, nurses are aware of their accountability in the provision of nursing services to patients; hence will provide them with quality care. The partnership between nurse practitioners and physicians leads to improved inter-professional collaboration and team care. Furthermore, the process leads to increased long-term survivorship in multisystem and proper coordination of service delivery in care facilities. Therefore, the law that requires physicians to supervise nurse practitioners provides various benefits to the provision of healthcare care and leads to better quality and cost-effective services.
Advanced Nurse Practitioner (ANP) involvement is one strategy for nurses to participate in helping in removing barriers to practice for APN in Texas. As a result, this will increase their political power in the nursing field. Being active in the state’s organizations provide nurse practitioners with an opportunity to transform the nursing profession, and this helps to improve health and healthcare (Ryan & Rosenberg, 2015). ANP involvement provides nurses with an opportunity to step outside their clinical practice roles and offers them a chance to be involved in political processes. Hence, they will take part in shaping health policy, and this means that they will participate in changing laws that restrict their scope of practice. Therefore, ANP involvement provides nurse practitioners with an opportunity to eliminate barriers that discourage them from providing primary care services to patients.
Nurse practitioners have a unique and influential position in the healthcare system because they spend more time with patients and their families as compared to other health professionals who have less direct contact with the patients. Nurses are first responders to individuals during the time of distress and great needs; hence have a deeper understanding on the provision of safe, affordable, and high-quality care to meet the specific demands of patients (Ryan & Rosenberg, 2015). Over the past years, the career has grown to become a reputable, respected, and trusted profession in the country. Furthermore, the number of nurses is higher than that of other professional healthcare workers, and this puts them in a position to comfortably campaign for their needs. Therefore, ANP involvement is beneficial to nurse practitioners in eliminating barriers to their practice because their position enables them to organize and advocate for change using their collective strengths, outstanding reputation, and extraordinary skills and experiences.
In conclusion, Texas is a restrictive state in advanced nursing practice, and its procedures and licensure laws restrict to engage in at least one element of their profession. The state, therefore, acts as a barrier to the advanced nurse practice because it limits their scope of work. Advanced practice registered nurses ( APRNs ) have the necessary education, training, skills, and experience to provide care to services but licensing laws and practices limit their practice. However, nurse practitioners can engage in advanced nurse practitioner to enable them to eliminate the barriers that exist in their line of duty. Their participation provides them with an opportunity to influence laws and policies that limit their work in the delivery of services to patients. Therefore, nurse practitioners have a significant role in eliminating barriers that restrict their ability to deliver practical, affordable, and high-quality care and services to patients.
References
Barnes, H., Maier, C. B., Altares Sarik, D., Germack, H. D., Aiken, L. H., & McHugh, M. D.
(2017). Effects of regulation and payment policies on nurse practitioners’ clinical practices. Medical Care Research and Review , 74 (4), 431-451.
Ryan, S. F., & Rosenberg, S. (2015). Nurse practitioners and political engagement: Findings
from a nurse practitioner advanced practice focus group & national online survey.
Texas Board of Nursing - Laws & Rules - Nursing Practice Act. (2019). Retrieved from
http://www.bon.state.tx.us/laws_and_rules_nursing_practice_act.asp
Texas Board of Nursing. (2019). Retrieved from https://www.bon.texas.gov/
