According to NCSBN (2021b), nursing regulatory body (NRB) was developed to protect the safety, health, and welfare of the public regarding nursing practice. The Advanced Practice Registered Nurse (APRN) scope of practice is defined by the Nurse Practice Act, state regulations, and statutes overseen by the state board of nursing. The board of nursing holds APRNs accountable for conduct regarding ethical, legal, and standards of professionalism. In 2008 the Consensus Model was developed, and the goal was to have all states follow the same model for APRNs. The focus of the Consensus Model was on developing consistency in education, certification, licensure, accreditation, independent practice, and independent prescribing for the APRN (NCSBN, 2021a).
According to Mark (2018), in 2018, 23 states had adopted the consensus model allowing APRNs to practice independently while other states still require supervision or collaboration with a physician. Since 2018 additional states have followed suit and are now full practice states for APRNs, but still other states are reduced or restrictive practice. Having variations in regulations and scope of practice is why the APRN must understand these variations from state to state. In this discussion, a comparison grid of Minnesota and Texas Board of Nursing’s regulations regarding prescribing of drugs and therapeutic devices and the authority to pronounce death and provide the cause of death for the death certificate will be highlighted.
MN Board of Nursing |
Tx Board of Nursing |
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| Prescribing authority on drugs and therapeutic devices. | Under 148.235, APRN has full independent practice to:
Diagnosis, order therapy, and give referrals to other health care facilities and providers.
Prescribe, dispense, obtain, sign for, administer, and document over the counter, legend, and controlled substances, including sample medications, but must abide by Drug Enforcement Administration (DEA) requirements regarding controlled substances.
Must file all DEA registrations and numbers with the board, and the board will maintain current records.
Plan, order, and initiate a treatment including medical devices and equipment, nutrition, diagnostic services, and supportive services.
Above points cited in: (Minnesota Board of Nursing, 2020).
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Under Chapter 222 (19 & 20), the APRN has restrictive practice to:
Must have a prescriptive authority agreement between the APRN and a physician where the physician delegates to the APRN the act of prescribing or ordering a drug (legend, over-the-counter or drug sample) or device.
Controlled Substances may be ordered under the prescription agreement but cannot exceed 90 days. If a renewal is needed beyond 90, days the delegated physician needs to be consulted or needs to do a chart review if unable to see the patient in person. In addition, APRNs cannot order controlled substances for a patient under two years of age without in- person or chart consult.
The prescriptive authority agreement may reference or include the terms of a protocol or other written authorization between the APRN and physician.
The APRN must apply for prescriptive authority and renew every two years, including having documentation of five hours of continuing education in pharmacotherapeutics.
APRN’s works off protocols or other written authorization from a delegating physician to provide medical interventions of patient care. The protocols are signed by the APRN and delegating physician, reviewed annually, and maintained in the practice setting. Protocols or other written authorization are designed to promote professional judgment by the APRN. Therefore, the protocol or written authorization does not need to detail the precise steps in the treatments plan. Instead, the protocol may indicate types or classifications of drugs or devices that may or may not be prescribed by the APRN. The APRN must have a monthly meeting with the delegating physician face-to-face or telecommunication to keep prescription authority agreement and protocols active.
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