by: Rosabel Zohfeld, MSN-Ed, APRN, FNP-C
According to Al-Jammal, Al-Khasawneh, & Hamadat, 2015, the delegation of authority transmits power from a high entity to a low entity power. The authorized individual and or the person giving the authority exercises those powers through the duration of the agreement between both parties. The individual in charge of the one who gives the authority decides what duties and tasks the authorized individual may or may not be able to perform (Al-Jammal, Al-Khasawneh, & Hamadat, 2015).
Unfortunately, in Texas, Nurse practitioners, and NPs, are required by the Texas Nursing Practice Act to have a written collaborative agreement. This agreement between a nurse practitioner and a physician refers to the supervision by a physician of the NP’s work. It was not only until recently that the state of Texas finally eliminated the entire on-site presence of a physician to oversee an NP’s job (Blore, 2019). Under Texas law, patient access to NPS is restricted. Currently, they are not authorized to sign Do Not Resuscitate orders (DNR). NPS in Texas is only authorized to sign death certificates in /certain circumstances (AANP, 2018a).
In contrast, the state of New Mexico, NM, authorizes NPs to practice to the full extent of their license and training. NPS in NM can evaluate, diagnose, treat and prescribe medications. They can do so without physician supervision and or collaborative agreement. In addition, NPS in NM can still not sign DNR orders. However, they can sign death certificates (AANP, 2018b).
In Texas, the Texas Nurse Practitioner (TNP) organization continues to support legislation to allow NPS in the state of Texas to have full practice authority. A statewide system would enable patients to have full access to all NP services. The TNP’s 2019 legislative agenda includes the following topics:
• H.B. 1792/ S.B. 2438: Full Practice Authority; for NPs to practice to the full extent of their training and education
• H.B. 2250/ S.B.1308: Adequate prescriptive authority to NPs for all scheduled II controlled drugs, regardless of specialty or practice setting
• H.B.278/ S.B.311: The modernization of the current framework for the physician/NP delegation. To have the meetings in any way preferred such as videoconference, facetime, and not just face-to-face.
• H.B. 387/ S.B.1022: NPS signature recognition on health-related forms such as worker’s compensation
• H.B. 3128: NPs signature recognition on sports clearance forms
• H.B. 912: To improve the ability of APRNs to practice telemedicine and Telehealth and to expedite fast-tracking licensure applications for those APRNs who would like to hold a TX license and have agreements that recognize the APRN license across borders (TPN, 2019).
It is of great importance that NPS understand clearly how state regulations and laws impact their practice. A state with full NP practice laws and licensure is the model recommended by the national academy of medicine. A full practice authority state for NPS allows the NP to have full authority under the state board of nursing. Currently, Washington, Oregon, Idaho, Montana, Wyoming, South Dakota, North Dakota, Nebraska, Minnesota, Iowa, Nevada, Colorado, Arizona, New Mexico, Maine, Vermont, New Hampshire, Connecticut, Road Island, Maryland, District of Columbia, Alaska, Hawaii, Guam, & the Northern Mariana Island, are states that have full practice laws for NPs. States like New York, Pennsylvania, West Virginia, Kentucky, Ohio, Indiana, Illinois, Wisconsin, Utah, Kansas, Mississippi, Arkansas, Louisiana, Alabama, Puerto Rico, Virgin Islands, & American Samoa have laws that reduce the NPs’ abilities of engagement in at least one practice element. These states require a career-long collaborative agreement with a healthcare provider for the NP to provide care. In some instances, it limits to one or more aspects of the NP practice. States with restricted approaches for NPs limit and restrict the engagement of NPs with at least one practice element. There is a requirement for a physician and other health care providers' supervision and delegation (delegated authority) for the NP to provide care (AANP, 2019c).
An important key point for my future practice, and many other NPS practicing in Texas, is to be able to practice to the full extent of the APRN licensure. NPS is independent, knowledgeable, and skilled professionals that can practice under their licenses. They can practice independently from a physician and or without a physician’s supervision (Buppert, 2018).
One could argue that a state like New Mexico, where there is full unrestricted practice for NPs, could offer more and better opportunities. Nonetheless, there are other factors and circumstances to be considered before making a decision. I think that the state of Texas is moving towards general practice for NPs shortly. I would not mind staying around and being part of the change. I would seek employment in the state of Texas as a new NP graduate. Later on, depending on how much progress is made towards full authority and other important issues, I may consider either staying or possibly relocating my family to an NP-friendly state with a full practice. All in all, I believe that through advocacy and legislation in Texas, we are getting closer to many positive changes that will undoubtedly impact the future of the NP practice (AANP, 2019c).
References:
Al-Jammal, H. R., Al-Khasawneh, A. L., & Hamadat, M. H. (2015). The impact of the delegation of authority on employees’ performance at great Irbid municipality: case study. International Journal of Human Resource Studies, 5(3), 48-69.
American Association of Nurse Practitioners, AANP. (2018a). Texas State Policy Fact Sheet. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment/state-policy-fact-sheets/texas-state-policy-fact-sheet
American Association of Nurse Practitioners, AANP. (2018b). New Mexico State Policy Fact Sheet. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment/state-policy-fact-sheets/new-mexico-state-policy-fact-sheet
American Association of Nurse Practitioners, AANP. (2019c). State Practice Environment. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment/state-policy-fact-sheets/new-mexico-state-policy-fact-sheet
Blore, J. (Ed.). (2019). Texas Nurse Practitioner Practice Authority: The Fight for FPA. Retrieved from https://www.nursepractitionerschools.com/blog/texas-np-practice-authority/
Buppert, Carolyn (2018). Nurse Practitioner's Business Practice and Legal Guide (p. 8). (6th ed.). Jones & Bartlett Learning. Kindle Edition.
Texas Nurse Practitioners, TPN. (2019). TNP's 86th Legislative Session Recap. Retrieved from https://www.texasnp.org/page/AdvocacyIssue
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