Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.
The concept of Full Practice Authority (FPA) is central to how these regulations apply to an APRN’s legal scope of practice. FPA allows APRNs to utilize their full education and experience without physician oversight.2
In Texas, the state regulation imposing the Delegation Agreement ($\text{PAA}$) requirement directly restricts the APRN from practicing to the full extent of their education.
Impact: Even if an APRN graduated with competencies in ordering complex imaging or managing specific controlled substance regimens (part of their education), their legal authority is limited to what is explicitly permitted or delegated by the signing physician in the $\text{PAA}$. This means the legal scope is narrower than the educational scope.
The regulations for APRNs are governed by the respective State Boards of Nursing (BONs).1 The primary differences often lie in the requirements for Collaborative Practice and Prescriptive Authority.
| Regulatory Area | Texas (TX) - Texas Board of Nursing | California (CA) - California Board of Registered Nursing |
|---|---|---|
| Full Practice Authority (FPA) | No. Requires a signed Delegation Agreement (Prescriptive Authority Agreement, or $\text{PAA}$) with a delegating physician or dentist for prescriptive practice. | Yes (for qualifying Nurse Practitioners, Certified Nurse Midwives, and Clinical Nurse Specialists). Allows practice without standardized procedures or physician supervision upon meeting specific criteria (e.g., 3 full-time years of practice). |
| Prescriptive Authority | Requires a $\text{PAA}$ which dictates the drugs/devices the APRN can prescribe, the methods of consultation, and required quality assurance meetings. The $\text{PAA}$ is reviewed and signed by the APRN and the delegating physician. | Independent. Qualifying APRNs (under $\text{AB}$ 890) can prescribe without physician delegation, oversight, or collaboration after satisfying experience requirements. |
| APRN Title/Role | Advanced Practice Registered Nurse. Must be certified in a recognized role (e.g., $\text{NP, CRNA, CNS, CNM}$) and hold a Texas $\text{RN}$ license. | Nurse Practitioner ($\text{NP}$), Certified Nurse-Midwife ($\text{CNM}$), Clinical Nurse Specialist ($\text{CNS}$), Certified Registered Nurse Anesthetist ($\text{CRNA}$). Each role is separately recognized and regulated. |
| Example of Differing Practice | A Texas $\text{NP}$ must have a physician delegation contract in place to order narcotics or sign prescriptions, even if they are practicing in a primary care setting for common acute illnesses. | A qualified California $\text{NP}$ can open an independent primary care clinic and prescribe all medications, including Schedule II-V controlled substances, without a formal agreement with a physician. |
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