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Discussion: Professional Nursing and State-level Regulations
The National Council of State Boards of Nursing (NCSBN) is an independent organization that serves as an umbrella on nursing regulation bodies working towards a common goal of protecting public safety. In their advocacy and mandate to protect the public, empowering these nursing regulatory boards made them a world leader in regulatory excellence (National Council of State Boards of Nursing, n.d.). For this discussion I chose my home state Texas and the neighboring state, Louisiana, to expound on the Advanced Practice Registered Nurse (APRN) regulations.
The first regulation is the licensure requirement for the APRN to practice. There is no licensure examination in Texas for APRNs. Instead, a national certification recognized by the Texas Board of Nursing is a requirement to obtain licensure. A completed post-graduate program from an accredited college or university, a minimum of 400 hours in advance practice, and 20 hours in continuing education within the last 24 calendar months are the additional licensure requirements (Texas Board of Nursing, n.d.). Furthermore, there is no licensure by endorsement in Texas. If a licensed APRN from another state would like to practice in Texas, they must comply with the Texas board of nursing requirements.
In comparison, the Louisiana state board of nursing requires licensure by examination to practice as APRN. Licensure by endorsement can be processed if a licensed APRN from another state seeks to practice in Louisiana. Educational and certification requirements were similar to Texas’ except for the 500 hours of clinical practice required in Louisiana (Louisiana State Boards of Nursing, n.d.).
The other regulation is the prescribing authority in each state. Texas, with restricted capacity, APRNs can diagnose and treat patients but need a delegating physician to prescribe medications. APRN must have a prescriptive authority number issued by the Texas board of nursing before submitting the controlled substance registration form. APRNs must also access the prescription monitoring program before prescribing any controlled substance especially for patients treated for chronic pain (Texas Board of Nursing, n.d.).
In Louisiana, under reduced practice capacity, APRNs will need physician oversight to prescribe, diagnose and treat patients. A Collaborative Practice Agreement (CPA) where APRN and licensed physician mutually agreed on specific parameters is required in seeking practice. Approval of Prescribing Authority (PA) privileges in collaboration with licensed physicians issued by the Louisiana state board of nursing must also be obtained prior to writing orders and prescriptions. In addition, six hours of continuing education in pharmacotherapeutics yearly is required as part of the compliance (Louisiana State Board of Nursing, n.d.).
In conclusion, Texas and Louisiana post similar licensure and prescribing authority requirements. Louisiana may seem to impose stricter rules in prescribing medications due to its reduced practice capacity for APRNs. Both states’ regulations emphasized protecting the public’s safety and ensuring a safe practice environment for APRNs. Regardless of what state an APRN chooses to practice, awareness and adherence to state board regulations will serve as a guide in safely performing their duties.
Guidelines for interpreting scope of practice for aprn’s [PDF]. (2017). https://www.lsbn.state.la.us/Portals/1/Documents/Forms/apscope.pdf
Kelt, B. (2020). Pai [PDF]. https://www.lsbn.state.la.us/Portals/1/Documents/Forms/PAI.pdf
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 4, “Government Response: Regulation” (pp. 57–84)
National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved December 27, 2021 from https://www.ncsbn.org/index.htm
State practice environment. (n.d.). American Association of Nurse Practitioners. Retrieved December 27, 2021, from https://www.aanp.org/advocacy/state/state-practice-environment
Texas board of nursing – practice – aprn scope of practice. (n.d.). https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp