Discussion Post: State Board of Nurses and Scope of Practice

According to Thomas, Benbow, & Ayars (2010), state boards of nursing are authorized
by state legislatures and statutes to oversee and guarantee an ongoing competent and safe
practice of licensees. They review the scope of practice across different nurse levels, including
advanced practice. They also address education and licensure issues. Essentially, state statutes
often promulgate specific practice changes through state boards of nursing.
Most Recent Regulation Promulgated Through Texas’s State Board of Nursing for

Advanced Practice

In Texas, “prescription authority” is one of the recent regulations the state has been
fighting to allow for advanced practice registered nurses (APRNs). Although Texas does not
grant APRNs the “full prescription authority,” under Rule 217.11, the State Board allows APRNs
to prescribe drugs based on the prescriptive mandate granted under Chapter 222 of the Board’s
Administrative Code. Section 222.2 of the Board’s Code describes the conditions under which
the Board can grant an APRN “Approval for Prescriptive Authority,” including having full
licensure from the Board to practice in the state as an advanced practice RN and submitting
documentation showing successful completion of graduate-level courses. However, under Code
22.5, an APRN can only prescribe after entering a “Prescriptive Authority Agreement” with a
physician. This means that the physician delegates to the APRN the act of ordering or
prescribing medications (Casetext Inc., 2021).

How State Regulations are Supported within My Place of Employment
My organization supports the “prescription authority” law stipulated by the Board in
multiple ways. One way is by codifying it into the organization’s policies, ensuring that the new
rule is written in “black and white” for all APRNs to read and comprehend. The second way is

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by training all APRNs about the Board’s rules/codes applicable to the regulation, including
licensure and appropriate agreements with physicians.
How States Differ in Terms of Scope of Practice and the Impact on Professional Nurses

Across the United States

Finally, the scope of practice differs among states based on permissions or activities
specific health care practitioners/professionals are allowed by particular state statutes or
jurisdiction to perform. These activities or roles are based on experience, training, education, and
licensure. For example, some states like Texas only allow APRNs to prescribe drugs under
special agreements signed with physicians, while other states like Arizona and Alaska grant
APRNs “full-practice authority.” These scope of practice limitations impeded job opportunities
for professional nurses across the country because nurses are restricted to work in certain zones
due to their training and expertise. Healthcare facilities are also likely to suffer from staffing
shortages in stricter states as nurse professionals tend to stay away.

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References

Casetext Inc. (2021). 22 Tex. Admin. Code § 222.5. https://casetext.com/regulation/texas-
administrative-code/title-22-examining-boards/part-11-texas-board-of-nursing/chapter-
222-advanced-practice-registered-nurses-with-prescriptive-authority/section-2225-
prescriptive-authority-agreement
Thomas, M. B., Benbow, D. A., & Ayars, V. D. (2010). Continued competency and board
regulation: One state expands options. Journal of Continuing Education in Nursing,
41(11), 524-528.