Scope of Practice for Advanced Practice Registered Nurse

This professional development plan will outline the scope of Practice of the Advanced Practice Registered Nurse ( APRN) in the state of Texas. A personal assessment using Benner Novice to Expert ladder tool will be used to assess this writers’ strengths and weakness. Local, state and national networking marketing strategies will be identified. A personal professional resume will be added to conclude professional experience.

All advanced practice registered nurses seeking licensure in the state of Texas must be licensed registered nurses with a valid license that has multistate privileged including compact states to practice. Texas prepared nurses seeking to practice have restricted practice limitations although they have prescriptive authority.  In order to apply to the Texas Board of Nursing, the registered nurse must have completed a Masters program or Post certificate in Family nurse Practitioner if that is the specialty sought (Buppert, 2015). The clinical hours for completion of degree should not be less than 500 hours in clinical setting..

Family nurse practitioner (FNP), certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS) (DeNisco, 2015) all comprise of nurses with APRN licenses.   They have to pass the board-certified exam so as to sit for the national licensure certificate as a APRN in the state of Texas (Texas SOP Legislation, 2020). PRN have Prescriptive Authority Number §301.152, Occ. Code & 22 TAC, Chapter 222. They are limited to prescribe controlled substances and medicines in schedule III through V. They can only prescribe no more than 90 day supply. All medications have to dispensed by prescription. APRN Regulation includes the LACE essential elements: licensure, accreditation, certification and education (AACN, 2011).

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Texas Medical Board Regulates Physicians who Delegate Prescriptive Authority §§157.051 – 157.060, Occ. Code & 22 TAC §193.6. Physicians can prescribe controlled substances. Physicians are required by the state to review at least 10 percent of  the APRN patient charts at random every month. They have to prescribe medications under the supervision of the physician. Their prescriptions also include physician name, address, DEA number, and phone number. (Wofford, 2019).

Following the Patricia Benners model, it is easy to identify where we stand in clinical expertise, confidence in delivering patient centered care.  Patricia Benner’s model stands on how a nurse develop nursing knowledge, skill, clinical competence and comprehension of patient care through complete theoretical training and experiential learning from novice stage to expert stage (Davis & Maisano, 2016; Homard, 2013; Walker-Reed, 2016). Development through these phases is affected from clinical experience, length of working time in profession (Blum, 2010).

Having been a nurse for almost eight years, it is evident in the strengths seen due to education and experience as I deliver nursing care. Strengths seen in clinical judgement are evident, including the high quality of care. Clinical skills expertise are seen as I work in various units be it medical surgical, telemetry and even when doing wound care or IV infusion.  I would like to focus more on being a better wound care nurse since that is a passion that I have and would like to pursue as I open my wound care private practice.I am excited about getting certified as a wound care nurse while attending seminars and conferences that zone in on APRN that have the above practice.

I am fearful on how to run a practice since I am not a business type of person. Billing and getting clientele is an issue that I am trying to overcome. I will network since am fearful of having a rental property will need to be paid monthly so I have to get patients. Having cash flow and emergency money is also a concern that I will work on getting through considering getting monies from the bank as loans or withdrawing some money from my retirement to help keep the practice afloat.

I hope to learn that in everything even as a new FNP, there will be a great need to get a mentor to help advise me and also encourage me as I run my new practice. I love to work out physically since it’s a requirement in the military and it’s a great coping tool to reduce stress. I will use the various local network groups and identify point of contacts that I can consult with in times of doubt. The last coping skill I will use is my spiritual faith and family members for encouragement.

My goals for the first three months is to set up the physical practice. I would do that by making sure that I have the human and supply resources to help start the business. I would make sure that I have a dependable receptionist, technician to assist in wound care. I would also make sue that I have supplies for at least 6 months already in place. 

 As an expert nurse, research of evidence-based practice is seen in the use of the latest technology proved to provide the best results in patient care.  Expert Nurses who are both well-educated and experienced have no problem to give individualized nursing care as they better observe subtle relevant changes problems and use a developed keen intuition of future events that may occur (Amaral & Ferreira, 2014; Fraley, 2016).

Weaknesses noted is my lack of delegation and mentoring of novice, advanced beginners and competent nurses. Goals for the future is to have a novice nurse shadow me during shift work so as to teach them the rational knowing medication during of medical administration and things to look out for in patient to avoid crisis. Mentoring the above nurses through the emphasis of following evidence-based practice is important and the joining of hospital-based committees will be emphasized. The objectives would be to teach and educate the new nurses by equipping them with the knowledge learned over the years.

Local professional organizations like The North Texas Nurse Practitioners ( NTNP)serve the interests of nurse practitioners in Texas and provide career advertisements, By laws of scope of practice including lawyers, malpractice prevention and conferences to enrich the NPs.  This organization is affiliated with Texas Nurse Practitioners ( TNP) that is also a  local organization that providers various avenues of  local career job fairs and employment opportunities. Other National professional organizations like the American Association of Nurse Practitioners

AANP) also provide guidance on employment opportunities including advisement on compact licensure countrywide (North Texas Nurse Practitioner, 2019).

The Dallas Morning News newspaper has been identified as a networking and, marketing tool for local nurse practitioners in the area.  This newspaper specifically showcases nurse practitioners that have their own practices and are caring for minority groups in low social economic, underserved and remote rural areas (Dallas News, 2019). On the state level, The APRN Legislative Update serves as a networking tool to help national networking for APRN. It provides current legislative information that affects various states. This is a through quarterly subscriptions.

In conclusion, APRN in the state of Texas need a graduate degree and have to have an active RN license. They must pass a national examination in order to be board certified. Unfortunately, although they are providers, they have a restrictive license and cannot prescribe narcotics and are bound by a code of ethics seen in the limitation of their scope of practice. APRN have to work under a physician who has to audit their charts and address difficult cases including issuing prescriptions for narcotics for the family nurse practitioner.  

A personal assessment was done by referencing Patricia Benners Novice to Expert ladder and strengths and weaknesses were addressed. Goals and objectives were stated on how this writer would positively impact the profession by mentoring novice and advanced beginners’ nurses.  Various professional organizations were identified in local, state and national levels that provide employment opportunities for the APRN.

Networking and marketing strategies were addressed that assist the APRN in knowing the valuable assets available to them so as to practice safely.

References

• Amaral, A. F. S., & Ferreira, P. L. (2014). Adaptation and validation of the Clinical Nursing Expertise Survey to the Portuguese nursing population. Escola Anna Nery, 18(3), 496-502
• American Association of Colleges of Nursing. (2011). The Essentials of Master's Education in Nursing.
• Buppert, C. (2015). Nurse practitioner’s business practice & legal guide (5th ed.). Retrieved from https://bookshelf.vitalsource.com
• DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Retrieved from               https://bookshelf.vitalsource.com
• Fraley, T. E. (2016). Transitioning Novice Nurses to Expert Nurses in Progressive Telemetry Care.
• Peterson, Mary. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the Advanced Practitioner in Oncology. 8(1): 74–81.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/#__ffn_sectitle.
• Texas Board of Nursing.  (2018).  Retrieved from http://www.bon.texas.gov/faq_practice_aprn.asp
• Texas Scope of Practice (SOP) Legislation. (2020). Texas Scope of Practice Policy: State Profile.  Retrieved from  http://scopeofpracticepolicy.org/states/tx/
• Wofford,P (2019) Texas Nurse Practitioners Fight for Full Practice Authority. https://nurse.org/articles/texas-nurse-practitioners-fight-for-practice/
• Wolbert, Lynda.  (2017). Advanced Practice Registered Nurses in Texas.  Coalition for Nurses in Advanced Practice. Retrieved from http://www.cnaptexas.org.
• Yusra, R.Y. , Findyartini, A., & Soemantri, D. (2019).  Healthcare professionals’ perceptions regarding interprofessional collaborative practice in Indonesia.  Journal of Interprofessional Education and Practice. (15): 24-29.  Retrieved from http://www.sciencedirect.com/science/article/abs/pii.S2405452618301666/