peer responses week 1
imazdm25
Document51.docxResponse to Esther nkwanyuo
Wk 1 Discussion Main
Certifying As an Advanced Practice Nurse in the State of Texas
According to the nurse practice act, Senate Bill (SB) 406 ended the mandate of having a physician onsite supervise the Advanced Practice Registered Nurses (APRNs) and raised the number of APRNs a physician can supervise from four to seven. Thus, a physician is needed for collaboration in Texas but does not have to be on site (Texas Board of Nurse,2022). The nurse practitioner must practice within 75 miles of the supervising physician.
Furthermore, physicians can assign power to order Schedule II controlled drugs in hospitals and hospice settings and need periodic face-to-face encounters between APRNs and the assigning physician.
How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in Texas?
· There are two ways to apply for licensure in Texas, with or without prescriptive authority. The Required fee is $100 for APRN licensure only. If you request APRN licensure with prescriptive power, the required price is $150 nonrefundable. The individual must have an RN license with compact privilege must have completed an accredited school for their APRN. The RN must have completed a post-basic advanced educational study suitable for practice in an APRN role and population focus area allowed by the Board. The application can be submitted online or in the paper. Alongside the application will include transcripts, a copy of one's compact license, if RN license is from a different compact state (Jacobs, 2021).
The Application process for Certification in your Texas
The initial process requires the individual to login into the nurse portal from the Texas board of nurses' website. Create an account, manage a profile, apply for licensure through the portal using initial APRN licensure, submit application and registration fee, and check the Texas nurse portal for submission updates. Usually, take 10 to 15 business days, but allow at least 30 days.
State Board of Nursing Website
How does Texas define the scope of practice of a nurse practitioner?
According to the Texas Board of Nurses, Scope of practice is defined as the venture that an individual health care provider can carry out in the delivery of patient care. Scope of practice shows the types of clients for whom the APRN can care, what course of action the APRN can perform, and influences the ability of the advanced practice registered nurse to seek reimbursement for services provided (Texas Board of Nursing, 2022).
What is included in your state practice agreement?
This agreement includes state practices and licensure laws, carrier supervision, and agreement. The various classes of drugs and devices the APRN may order and/or prescribe or the types or categories of drugs and devices the APRN may not order or prescribe; Signatures by all parties to the agreement with the date the physician or APRN signed the PAA.
How do you get a DEA license?
The APRN must have a prescriptive authority number that the Texas Board of Nursing has issued before submitting the controlled substance registration form. DEA applications may be obtained via the DEA's website or by calling the local DEA office telephone number (Texas Board of Nursing, 2022).
Does Texas have a prescription monitoring program (PMP)?
Yes, Texas does have a PMP. The PMP is engaged in monitoring and gathering prescription data II, III, and V Controlled Substance (CS) The role of an APRN includes: Before prescribing any controlled substance for patients being treated for pain, APRNs s access and review PMP authorized by Chapter 481, Health and Safety Code, (2) APRNs must access and check the PMP before ordering opioids, benzodiazepines, barbiturates, or carisoprodol. Except the client has a diagnosis of cancer or is under hospice care. AS APPLICABLE, the APRN notes on the prescription or in the electronic prescription record that the patient was diagnosed with cancer or is receiving hospice care.
How does your state describe a nurse practitioner's controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
Yes. APRNs must maintain a prescriptive authority agreement or protocol with a physician. The APRN must file a separate application with the state Department of Public Safety for controlled substances registration to order controlled substances. (Board website (http://www.bne.state.tx.us). Most APRNs ordering a 90-day supply of CSS in Schedules 3 -5, to person’s age two years and older (Coalition for Nurses in Advanced practice, 2018).
Individual states regulate NP practice. Currently, 22 states and the District of Columbia, or 44%, have adopted full practice authority licensure and practice laws for NPs. Full practice authority is defined by the American Association of Nurse Practitioners (AANP) as follows: "State practice and licensure law provides for all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing." The remaining states are categorized as either "reduced practice" (17 states, or 34%) or "restricted practice" (12 states, or 24%). The AANP further defines these categories as follows:
Reduced Practice: The NP can participate in at least one part of the NP practice and is regulated through a joint pact with an outside health discipline to provide patient care.
Restricted Practice: The NP can participate in at least one part of NP practice and involves supervision, delegation, or team management by an outside health discipline to provide patient care. Texas is a restrictive state; this obstacle can be self-limiting and detrimental to the patients, particularly those situated in rural areas. Several research has shown that the medical Board's claim citing safety as a concern has not been founded to be true. The same study found that many safety concerns were more significant with physicians than with APRNs (Peterson, 2017).
Several guidelines act as obstacles, and they impact the roles of APRNs in Texas; these obstacles include federal guidelines, state laws, old-fashioned insurance institutional practice, and reimbursement models (National Academics of Sciences, Engineering, and Medicine, 2016). That was most surprising the number of barriers APRNs face.
References
Coalition for Nurses in Advanced Practice. (2018). Prescribing Controlled Substances in Texas. https://cnaptexas.com/aprn-practice/controlled-substances-prescribing/#:~:text=Most%20APRNs%20are%20limited%20to,TSBP%20through%20the%20AWARxE%20clearinghouse.
Jacobs, A. (2021, December 15). How to become a nurse practitioner in Texas - TX: APRN Certification and jobs. GraduateNursingEDU.org. Retrieved February 28, 2022, from https://www.graduatenursingedu.org/texas
National Academies of Sciences, Engineering, and Medicine. (2016). Assessing progress on the Institute of Medicine report The Future of Nursing. National Academies Press.
Peterson, M. (2017). Barriers to practice and the impact on Health Care: A nurse practitioner focus. Journal of the advanced practitioner in oncology. Retrieved February 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/
Texas Board of Nursing (2021). Obtaining DEA number. https://www.bon.texas.gov/applications_obtaining_dea_number.asp
Texas Board of Nursing (2021). Scope of Practice of A Nurse Practitioner https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp
Texas Board of Nursing. (2019). Controlled-substance Prescriptive Authority. https://www.bon.texas.gov/rr_current/222-5.asp
Texas Board of Nursing. https://www.bon.texas.gov/practice_nursing_practice_aprninfo.asp
Texas Prescription Monitoring Program. Texas Prescription Monitoring Program (PMP). (n.d.). Retrieved February 28, 2022, from https://www.pharmacy.texas.gov/PMP/
-------------------------------------------------------------------------------------------------------------------------------------------Response to Jenrry Medinilla
Week 1: Discussion. Main Post
Hello professor Benjamin, and classmates:
Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.
The state of Florida defines an Advanced Registered Nurse Practitioner (ARNP) as any person certified in the state to practice professional nursing and who is a licensed nurse practitioner, including a Mental Health and Psychiatry Nurse Practitioner (MHPNP). According to the Florida Board of Nursing, a signed protocol must illustrate the reciprocal contract between physician and ARNP. In addition, this protocol must contain general data like the signatures of professionals involved in the agreement in which the physician is the supervising part, as well as the name, address, certificate and DEA numbers of all the professionals. Other equally fundamental details are the location where the practice will take place and the duties and responsibilities of the stakeholders.
However, after meeting certain requirements, ARNP can register for self-directed practice. These requirements include holding an operational Florida APRN license. In addition, the concerned party, besides having no disciplinary actions, must meet at least 3000 CE hours under a physician's oversight within the past 5 years, three graduate-level semester hours in differential diagnosis and pharmacology achieved within the last five years.
How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?
The process to get certified in Florida as an MHPNP is the same for all APRNs. As per the Florida Board of Nursing, the applicant must have a valid Registered Nurse (RN) license from any U.S. state, has met all the requirements from an approved MSN or post MSN program, shows evidence of a national advanced practice diploma from an authorized nursing specialty board, as well as verification of malpractice insurance or exemption.
What is your state's board of nursing website?
The website is https://floridasnursing.gov
How does your state define the scope of practice of a nurse practitioner?
An ARNP is allowed to practice in practically every health care setting, and this practice comprises assessment, prescribing, performing duties, managing, and analyzing diagnostic and laboratory studies. Also, making diagnosing diseases; starting and overseeing therapy, including "prescribing medication and non-pharmacologic treatments; coordinating care; counselling; and educating patients and their families and communities." (AANP, 2015)
How do you get a DEA license?
In order to prescribe any regulated substance, the ARNP must register with the federal Drug Enforcement Administration (DEA). The American Association of Nurse Practitioners (AANP) recommends either applying online at the U.S. Department of Justice website, which is only available for new applicants or getting in contact via phone with the DEA Headquarters Registration Unit to request a hard copy of the official form, which is usually mailed within 10 working days. Once in possession of the document, the applicant must fill out and submit the form with all requested information (DEA Form 222a) to DEA's Registration Unit's P.O. Box in Washington D.C.
How does your state describe a nurse practitioner's controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
According to the Florida Board of Nursing, the bill HB 423, which became law on 4/14/2016, enables an ARNP to prescribe regulated substances detailed in Schedule II, Schedule III or Schedule IV as illustrated in s. 893.03 Florida Statutes, starting January 1, 2017. (Florida Board of Nursing, 2017). Florida senate website mentions that ARNP's prescribing rights for controlled substances documented in Schedule II are restricted to a seven-day supply and does not authorize ordering psychotropic drugs for children under 18 years of age unless prescribed by an MHPNP. In addition, an MHPNP may prescribe certain controlled substances under HB 977. Finally, this bill authorizes a psychiatric nurse operating within the framework of an established collaboration protocol with a psychiatrist to prescribe psychotropic regulated medications to treat psychiatric conditions.
Does your state have a prescription monitoring program (PMP)?
The Florida Prescription Drug Monitoring Program is known as E-FORCSE®, which stands for Electronic-Florida Online Reporting of Controlled Substance Evaluation Program. According to floridahealth.gov, it was created in 2009 to promote securer prescribing of controlled substances to decrease drug misuse and diversion in Florida. Since ARNP's may prescribe controlled substances, an E-FORCSE account is required. Therefore, applicants must provide general personal information and prescriber's DEA, NPI, and professional license numbers. Likewise, the applicant must provide the email address of his supervisor(s). (floridahealth.gov)
