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Idea Transcript
A Guide for APRN Practice in Texas Table of Contents
Page
Introduction ………………………………………………………………………..
…. 1
Chapter 1: Registered Nurse and APRN Licensure ………………………...
…2 …. 2 …. 4 … 11 … 20 … 21
1.1 Definition of Advanced Practice Registered Nurse ………………………..… 1.2 Registered Nurse Licensure ……………………………………………………. 1.3 Advanced Practice Registered Nursing Licensure ………………………… 1.4 Standards of APRN Practice …………………………………………………. 1.5 Scope of Practice ………………………………………………………….…….
Chapter 2: Foundations of APRN Practice: Governing Laws, Rules & Agencies 2.1 Structure of Federal and State Governments ………………………….…… 2.2 Development of Laws …………………………………………………….…... 2.3 Organization of Texas Law: What APRNs Should Know …….…………… 2.4 Nursing Practice Act: What APRNs Should Know …………….…………... 2.5 Board of Nursing: What APRNs Should Know …………………………..…… 2.6 Texas Rules and Regulations: What APRNs Should Know…. ……..….… 2.7 BON Rules, Guidelines & Position Statements About APRNs ….……...… 2.8 The Texas Register …………………………………………………………….. 2.9 TNA's Annotated Guide to the Nursing Practice Act and BON Rules……. 2.10 Other Texas Agencies, Statutes and Rules Impacting APRNs….………… 2.11 Federal Law: What APRNs Should Know………………….......................
Chapter 3: Foundations of APRN Practice: Professional Organizations 3.1 Professional Membership, Certifying and Accrediting Organizations…..... 3.2 NCSBN and the Consensus Model for APRN Regulation ………………….. 3.3 National APRN Professional Membership Organizations …………….….…. 3.4 Texas State and Regional APRN Professional Organizations …………...… 3.5 Local & Area APRN Professional Organizations …………………………….. 3.5 Texas RN/APN PAC ……………………………………………………...…… 3.7 Free APRN Publications & Other Resources …………………………….…
Chapter 4: Prescriptive Authority ……………………………………………... 4.1 Obtaining & Renewing a BON Prescriptive Authority Number …………… 4.2 The History of APRN Prescriptive Authority in Texas ……………………... 4.3 How SB 406 Changes Delegated Prescriptive Authority.…………………. 4.4 Definitions………………………………………………………………….…… 4.5 General Prescriptive Authority Requirements & Limitations…………….… 4.6 Delegating/Authorizing Physicians …………………………………………….. 4.7 The Prescriptive Authority Agreement ………………………………………. 4.8 Enforcing the PAA and Prescribing Standards…..................……………….. 4.9 Practices Serving Medically Underserved Populations…………………….. 4.10 Facility-based Practices ………………………………....………….………. 4.11 Protocols ……………………………………………………………………… 4.12 Alternate Delegating Physicians ………………………………….………….. 4.13 Registering & Terminating Prescriptive Authority Delegation…………….
4.14 Obtaining and Renewing DPS and DEA Numbers ………………………. 4.15 Prescribing Controlled Substances ……………………….……………….. 4.16 Information Required on a Prescription Signed By an APRN…………… 4.17 Calling Prescriptions to the Pharmacy for the APRN ………….…..…….. 4.18 The APRN’s Name on the Rx Label……………………………………….. 4.19 Signing for and Distributing Drug Samples ….……………………….……
…127 …132 …135 …136 …136 …137
Chapter 5: Practice Issues for NPs and CNSs ………………………………
5.1 The CNS and NP Roles ………………………………………………………. 5.2 Scope of Practice and Competence …………………………………………. 5.3 Using Alternative & Complementary Therapies ……………………………. 5.4 Certain Functions that Require Additional Training ……………………….. 5.5 Complying with OSHA Regulations………………………………………….. 5.6 Complying with CLIA…………………………………………………………... 5.7 Complying with HIPAA / ICD-10 Implementation…………………………… 5.8 APRNs Delegating to Unlicensed Personnel ………………………………. 5.9 RNs and LVNs May Accept Orders From APRNs …………………………. 5.10 Ordering Health Care Services ……………….………….………………… 5.11 Forms and Certifications: What APRNs May Sign…. ……………………. 5.12 The Role of NPs and CNSs in Texas Workers’ Compensation …….......... 5.13 The Role of NPs and CNSs in Nursing Facilities ……………………….… 5.14 Employment Issues and Contracts …………………………………………. 5.15 APRN-Owned Practices …………………………………………………….. 5.16 Credentialing & Privileging Basics ………………………………………….. 5.17 Comparisons of State Scopes of Practice for NPs …………………………. 5.18 Additional Resources for NPs and CNSs ………………………………….... BON letter confirm ordering diagnostic tests in APRN’s scope …………………
Chapter 6: Clinical Practice Issues for CRNAs ……………………………... 6.1 The CRNA Profession & Licensure in Texas….……………………............ 6.2 Scope of Practice and Competence………………………………………….. 6.3 Types of Anesthesia Providers ……………………………………………… 6.4 Aspects of CRNA Practice that Must Be Delegated ………………………… 6.5 Doctors Authorized to Order Anesthesia by a CRNA …………………….. 6.6 Responding to Concerns about Vicarious Liability ……………………….…. 6.7 Settings in Which CRNAs Practice: When is registration required?..……… 6.8 Including New Procedures in a CRNA’s Scope of Practice ……………… 6.9 RNs and LVNs May Accept Orders from APRNs …………………………… 6.10 Orders Written by CRNAs …………………………….……………..………... 6.11CRNAs May Order Controlled Substances Without DEA Registration …... 6.12Other RNs Administering Certain Anesthetic Agents……………….…….. 6.13 CRNA Credentialing, Privileging & LIP Status………………….…………. 6.14 Anesthesia Department Requirements …………………………………… 6.15 Anesthesia Care Team Model and the TEFRA 7 ………………………… 6.16 Documenting the Standard of Care in Anesthesia ………………………. 6.17 Reimbursement by Certain Public Healthcare Programs ……………….. 6.18 The Opt-Out …………………………………………………………………… 6.19 Employment Issues and Contracts ………………………………………… 6.20 CRNA-Owned Practices …………………………………………………….
Chapter 7: Practice Issues for CNMs …………………………………………. 7.1 The Case for Nurse-Midwifery………………………………………………….. 7.2 CNM Education, Standards, Scope and Licensure……….………………… 7.3 Scope of Practice and Competence ………………………………..……….. 7.4 Aspects of CNM Practice Requiring Physician Delegation or Collaboration. 7.5 Functions Prohibited or Requiring Additional Training………………….….. 7.6 Complying with CLIA…………………………………………………………... 7.7 Complying with HIPAA & Implementing ICD-10….………………………… APRNs Delegating to Unlicensed Personnel ………………..………………..… 7.7 RNs and LVNs May Accept Orders from APRNs ………………..…………... 7.8 Orders and Delegation by CNMs …………………………………………..... 7.9 Forms and Certifications: What May CNMs Sign? ……………………..……. 7.10 Vital Statistic Filings Required by Law ………………………………..….... 7.11 Newborn Services & Education CNMs Must Provide ……………….……. 7.12 Public Health Surveillance and Reporting Requirements……………....… 7.13 Providing Care for Adolescents ………………………………………………. 7.14 Out-of-Hospital Births ………………………………………………………….. 7.15 Credentialing & Privileging ………………………………………………….. 7.16 CNMs in the Medicare and Medicaid Programs…………………………… 7.17 Women’s Health & Family Planning Programs ……………….……………. 7.18 Employment Issues and Contracts ………………………………………… 7.19 Responding to Concerns about Vicarious Liability …………………………. 7.20 CNM-Owned Practices ……………………………………………………… 7.21 Additional Resources for CNMs ……………………………………………. Comparison Chart of CNMs & Licensed Midwives …………………….............
Chapter 8: BON Disciplinary Process, TPAPN & Peer Review …………… 8.1 Overview of BON Disciplinary & Enforcement Functions …………………… 8.2 Behavior the May Result in Disciplinary Action………………………………. 8.3 Filing a Complaint………………………………………………………………. 8.4 Reporting to Peer Review or Claiming Safe Harbor…………………………. 8.5 What to Do If Under Investigation……………………………………………. 8.6 BON Complaint Investigation Process………………………………………. 8.7 Informal Resolution / Settlement………………………………………………. 8.8 Formal Disciplinary / Settlement Process ……………………………………. 8.9 Nurse’s Rights & Other Disciplinary Process Rules……………………..….. 8.10 Disciplinary Actions / Assessment of Fines & Other Costs…………..……. 8.11 BON Options on Disciplinary Action …………………………………………. 8.12 APRN Licensure and the Disciplinary Process………………….….….…… 8.13 BON’s Authority to Require Certain Evaluations ……………………..……. 8.14 Intemperate Use & Peer Assistance / TPAPN……………………….…….. 8.15 Reinstating a Nursing License & APRN Licenses ……………………..…..
Chapter 9: Liability, Tort Reform, Malpractice and Liability Insurance .…. 9.1 Laws Governing Torts …………………………………………………………... 9.2 When a Claim Occurs ………………………………..………………………… 9.3 Malpractice and Tort Reform ……………………………………………………
Chapter 10: National Practitioner and Health Care Integrity & Protection Data Banks ………………………………………………………....
…319 …322
10.1 The National Practitioner Data Bank (NPDB) & Data Bank Merger………. 10.2 Healthcare Integrity and Protective Data Bank (HIPDB) ……………….… 10.3 General NPDB-HIPDB Information ……………………………………….… 10.4 Glossary ………………………………………………………………………. 10.5 Contacting The Data Banks ………………………………………………….
....327 …328 …331 …334 …336 …338
References/ Endnotes ………………………………………………………....
…339
NOTES ON REFERENCES Hyperlinks: This manual contains many links in the text and footnotes that take the reader directly to the reference material. Hyperlinks are noted by underlined text. Footnotes: References that the reader may need to be readily accessible are footnoted at the bottom of the page and noted by small Roman numerals. Endnotes: Most references appear at the end of the manual and are divided by chapter and noted by Arabic numerals. Access Date: All Internet links and references were last accessed on or after July 15, 2013.