What is Role of an Advance Practice Registered Nurses (APRNs) and How Are They Regulated by the Texas Board of Nursing?

The Texas Board of Nursing (BON) licenses and regulates all types of nurses in Texas, including Advance Practice Registered Nurses (APRNs). Nurses can face disciplinary proceedings concerning their licenses if BON receives complaints against them and finds that they have violated the rules or laws that apply to them. Since the repercussions of these proceedings can be severe, contacting an experienced Texas nursing license defense lawyer should be your first step if you receive notice of a complaint against you. 

Qualifying as an Advanced Practice Registered Nurse 

22 Tex. Admin. Code §221.1 defines an advanced practice nurse (APRN) as a registered nurse that the BON has approved to practice as an advanced practice nurse based on completing an approved advanced educational program, which includes a master’s degree or higher. Under §221.2, APRNs must be focused on one or more of the following roles and focus areas:

  • Roles:
    • Certified Nurse Practitioner (CNP);
    • Certified Nurse-Midwife (CNM);
    • Certified Registered Nurse Anesthetist (CRNA); and
    • Clinical Nurse Specialists (CNS).
  • Focus Areas:
    • Adult-gerontology, including primary and/or acute care;
    • Family/individual care across the lifespan;
    • Neonatal;
    • Pediatrics, including primary and/or acute care;
    • Psychiatric and/or mental health; and/or 
    • Women’s health/gender-related.

APRNs provide health care to individuals, families, and groups in various settings. They may act independently or collaborate with other healthcare professionals to deliver healthcare services. 

APRN and Scope of Practice

Since APRNs are RNs, they can also practice within the same scope of practice as RNs. However, under §221.12, they can also provide various health services based on their education, experience, and the accepted scope of professional practice of their particular specialty area. This scope of practice is defined by national professional specialty organizations or advanced practice nursing organizations recognized by the BON. In addition, an APRN can perform functions within the scope of that practice that is consistent with the Texas Nursing Practice Act (NPA), BON Rules, and state law. Therefore, the scope of practice has both individual and professional aspects. 

The BON has issued a policy statement on APRN Scope of Practice. This policy statement defines the scope of practice as the “activities that an individual health care provider performs in the delivery of patient care.” Scope of practice includes the types of patients an APRN can care for, what procedures or activities an APRN can perform, and the ability of the APRN to seek reimbursement for services provided. 

When an APRN adds a new procedure or patient care activity to their scope of practice, they should maintain documentation of additional education or competency using the following guidelines:

  • Identify the benefit of a new patient care activity, considering consumer demand, standards for safe practice, and interest of the advanced practice registered nurse.
  • Ensure that state or federal statutes and regulations do not constrain the advanced practice registered nurse from incorporating the activity into practice.
  • Identify established professional standards, if available, supporting the performance of the new activity.
  • Establish goals and methods for learning that encompasses knowledge and skills acquisition through which competence is attained.
  • Demonstrate competent performance of the procedure/activity.
  • Maintain records that reflect the acquisition and maintenance of competency.

The scope of practice may vary significantly from one APRN to another, even within the same role and specialty, based on their education and experience. However, the BON will hold each APRN responsible for knowing and practicing within their specific scope of practice. 

Regulation of APRNs by the BON

The BON initially licenses all APRNs and renews and reactivates licenses currently inactive for individuals who have yet to renew them. Additionally, the BON may grant interim approval to eligible APRNs for a limited period. Finally, under §221.7, the BON can grant and deny requests for waivers and exemptions of various certification and licensure requirements for APRNs. 

§221.13 establishes core standards for APRNs to follow. These standards provide that when APRNs provide medical aspects of care, they shall use mechanisms that provide authority for that care, such as protocols or other written authorizations. The APRN and the appropriate physician(s) should jointly develop any such protocols, sign them, review, and resign them at least annually, maintain them in the practice setting, and make them available as necessary to verify the authority to provide medical aspects of care. 

Disciplinary Authority of the BON Over APRNs

§221.17 gives the BON the authority to determine compliance with the following rules related to APRNs:

  • §221.4 – Requirements for Full Authorization to Practice
  • §221.8 – Maintaining Active Authorization as an Advance Practice Nurse
  • §221.16 – Provision of Anesthesia Services by Nurse Anesthetists in an Outpatient Setting

Furthermore, the BON may take disciplinary action against or terminate the authorization of any APRN under Tex. Occ. Code §301.452. This code section outlines the general grounds for disciplinary action by the BON against nurses. In other words, APRNs are subject to all the same grounds for disciplinary action as other RNs and nurses licensed and regulated by the BON. 

Defend Yourself Against Disciplinary Proceedings Involving Your APRN License 

Don’t allow an isolated complaint to wreak havoc on your career. Losing your nursing license can be highly detrimental to your livelihood. If you are facing the loss of your nursing license, we can help you take the steps necessary to challenge the allegations against you in your disciplinary proceedings. Contact a nursing license defense attorney at Bertolino LLP, for advice today. Make an appointment by calling (512) 515-9518 or contact us online to see how we can help.

Call or text (512) 476-5757 or complete a Case Evaluation form