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Practice - APRN Scope of Practice

The Texas Board of Nursing recognizes that advanced nursing practice is dynamic. The scope of advanced practice evolves through experience, acquisition of knowledge, evidence-based practice, technology development and changes in the health care delivery system. Therefore, advanced practice registered nurses (APRNs) may need to practice in new settings, perform new procedures, and develop new skills during their professional careers. It is common for the Board of Nursing to receive questions such as, "Can an APRN treat a patient with that condition?", or "Is it within the scope of practice of an APRN to perform that procedure?"

 

Scope of practice is defined as the activities that an individual health care provider performs in the delivery of patient care. Scope of practice reflects the types of patients for whom the advanced practice registered nurse can care; what procedures/activities the advanced practice registered nurse can perform; and influences the ability of the APRN to seek reimbursement for services provided.

 

Determining scope of practice includes: 

  • Advanced practice education and licensure in a role and population focus
  • Legal implications (e.g. compliance with the Nursing Practice Act and Board Rules)
  • Scope of practice statements as published by national professional specialty and advanced practice nursing organizations

 

Both professional and individual scopes of practice exist. Professional scopes of practice are derived from professional specialty and advanced practice registered nursing organizations. An individual APRN may or may not practice the full scope of the professional role and population focus. Decisions regarding individual scope of practice are complex and related to an APRN's knowledge, skills and competencies. Each APRN must practice within their individual scope.

 

Professional Scope

 

National professional specialty and advanced practice registered nursing organizations broadly define scope of practice for each role and population focus. These organizations produce documents addressing role, function, population served, and practice setting. They offer APRNs the broadest parameters for scope of practice. Therefore, professional scopes of practice are recommended as the initial resource in defining an individual's scope of practice.

 

Individual Scope

 

Formal advanced practice registered nursing education is the foundation for the individual's scope of practice and evolves over the professional lifetime of the individual. Clinical experience in various settings, continuing nursing education, formal course work and developments in healthcare all impact individual scope of practice. However, there are finite limits to expansion of scope of practice without completing additional formal education. APRNs cannot change their legally recognized titles or designations through experience or continuing nursing education; these changes may only be achieved through additional formal educational preparation and meeting all legal requirements to use that title and practice in that role and/or population focus set forth by the BON.

 

Making a Scope of Practice Determination

 

It is incumbent upon every APRN to seek appropriate information, support, and resources to inform their practice decisions. APRNs have a fundamental duty to ensure safe patient care, and one of the most important actions an APRN can take toward fulfilling that responsibility is by making sound scope of practice determinations. The Board’s APRN Scope of Practice Decision-Making Model (APRN DMM) can help APRNs make scope of practice determinations. The following questions comprise the APRN DMM and help clarify whether an act is within an APRN's scope of practice: 

  1. Is the performance of the act prohibited by the Texas Nursing Practice Act, Board’s rules or regulations, or any federal, state, or local laws, rules or regulations affecting the area of practice?
  2. Is the performance of the act consistent with APRN education in your role and population focus of Texas APRN licensure?
  3. Is performing the act consistent with interpretations on scope of practice from advanced practice nursing organizations or national professional specialty organizations representing your role and population focus of licensure?
  4. Is the performance of the act consistent with Board position statements, guidelines, and institution policies and procedures?
  5. Is the performance of the act supported by evidence-based practice and consistent with the current standard of care?
  6. Have you received appropriate education and training to perform the act, and do you currently possess the depth and breadth of knowledge necessary to perform it safely and competently?
  7. Do you have the knowledge and appropriate resources to perform the act under the current circumstances, and address potential complications that may result?
  8. Are you fit to perform the act safely and competently?
  9. Do you have a written delegation mechanism, with an appropriate physician, providing authority for the performance of relevant medical aspects of care?
  10. Would a reasonable and prudent APRN licensed in the same role and population focus perform the act in a similar circumstance?
  11. Are you prepared to accept accountability for the provision of safe care and the outcome of the care rendered? 

 

Adding New Procedures and/or Patient Care Activities

 

APRNs are not licensed with a generic "APRN" title; rather, they are licensed in a specific advanced practice role and population focus. The scope of practice for APRNs of different specialties overlap but no one APRN role or population focus can encompass the full scope of practice of another. AN APRN’s scope of practice has licensure-related limitations, meaning that an APRN cannot practice within the full scope of another APRN role and population focus without completing an appropriate APRN program and obtaining the additional licensure to practice from the Board of Nursing.

 

When incorporating new patient care activities or procedures into their existing APRN role and population focus, the APRN should reflect on the factors identified in Board Rule 221.12. In determining whether a particular action falls within an APRN's authorized professional and/or individual scope of practice, the following factors will be considered: 

  • Whether the APRN received training for the performance of act in their advanced educational program;
  • Whether the act falls within generally acceptable standards of care for the APRN's role and population focus area, as determined by a professional specialty organization;
  • Whether the APRN has demonstrated competence in performing the act through supervision and/or training by a qualified practitioner;
  • Whether the APRN has been credentialed and/or holds a privilege to perform the act at a health care facility;
  • Whether the APRN has completed additional training post-APRN licensure in their role and population focus to perform the act. Considerations for appropriate additional training include:
    • Type of instruction (e.g., online instruction; in-person instruction; didactic instruction; or clinical instruction);
    • The learning objectives, content, materials, and methods for evaluating participation;
    • Length and/or quantity of the training;
    • The qualifications of the training provider;
    • Whether the training has been certified by a professional specialty organization for the APRN's role and population focus area;
    • Whether the training is consistent with evidence-based practice;
    • Sponsorship by an educational institution (e.g., fellowship, or precepted experience);
    • Whether the training is provided by an entity in conjunction with the use of the entity's product, drug, or medical apparatus/equipment.

 

All training must include a method of objective and verifiable participant competency following completion of the training. It is the responsibility of the APRN to maintain records of all completed training and competencies.

 

The Texas Board of Nursing recognizes that individual scopes of practice will vary and that what is within the individual scope of practice for one APRN may not be within the individual scope of practice for another APRN authorized to practice in the same role and population focus. However, it is important to keep in mind that the Board holds each APRN accountable for knowing and practicing within their professional and individual scope of practice.

Board Action: Adopted Texas Board of Nursing policy 10/2005, reaffirmed 07/2018, revised 01/2024.

For frequently asked questions (FAQs) related to APRN Scope of Practice click here.

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