Consensus Model In Texas

In the Texas, state law prohibits Advanced Practice Registered Nurses (APRNs) including nurse practitioners (NPs) from practicing to the full extent of their education and clinical ability. Currently, Texas law requires than an APRN receive approval from an individual physician prior to engaging in the practice of advanced nursing. This type of complex regulatory scheme is outdated and restricts patients’ access to care, creates geographic disparities in services, and unnecessarily increases health care costs. For example, current law requires APRNs to meet periodically face-to-face with a supervising physician; with few physicians choosing to practice in rural areas, many APRNs who are willing to work in rural areas are essentially forbidden from delivering care to these underserved areas.

Credentialing from advanced practice registered nurses (APRNs) perspective is defined as “furnishing the documentation necessary to be authorized by a regulatory body or institution to engage in certain activities and use a certain title” (Hanson, 2014). Credentialing is also define from a local institutional process that consider specific documentations for APRN before they assume the practice role as APRN within their facility. In health care system, credentialing ensures individuals meet required standards of practice and is prepared to perform those duties implied by the credentials. National certification and education are considered as part of credentialing for APRN to acquire basic level of competence to practice. (Hanson, 2014)

According to reports found on the web page MEDPAGETODAY (2014) there has been an increase in the independent practice for advanced practice registered nurses (APRN). The article quotes data from the American Association of Nurse Practitioners (AANP) which reports 17 states and the District of Columbia allowing “full practice” with this meaning the APRN evaluates, diagnoses, orders testing, prescribes medication and initiates and manages treatments. 21 states require “collaborative agreement” with a physician and 12 requiring supervision of a physician. Collaborative agreement scope of practice varies by state and institution of employment.

Under this model, the licensure enables the APRN to legally provide care to the public, with the required education and training, they are allowed to practice within the scope of practice depending of the States where they want to practice. The education

The historic article by Safriet (1992) fully lists and analyzes the major challenges facing the advanced practice nurse (APN). At the time the article was written compared to now, a few aspects are changing. In areas where change has occurred, it has been an exceedingly slow process. Change for APNs is often dependent on legislation and regulatory authorities which receives half-hearted support, at best, from the medical establishment (Safriet, 1992). Since the first day nurses were given any authority to practice outside of regular practice, physicians only objected when it began to encroach upon their perceived hierarchal status or potential for compensation (Hamric, Hanson, Tracy, & O’Grady, 2014). The concern that this

When deciding to advance a nursing career from registered nurse to an Advanced Practice Registered Nurse or APRN, there are many avenues to choose from. Advanced Practice Registered Nurse is a broad term for a Registered Nurse who has obtained at least a Master’s Degree in Nursing. Every nurse has different interests, and reasons for the type of nursing they choose; as well as strong suits in his or her specialty. For this reason it is important to research all education categories of APRNs. Categories of Advanced Practice Registered Nursing include Nurse Practitioners, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists. Each type of Advanced Practice Nurse has a broad scope of practice, giving a Registered Nurse who is looking to

APRNs must have a valid license issued by the state board of nursing prior to practicing or offering to practice health care for any individual (H.B.4334, 2016). To obtain licensure, one must submit a written application, verified by oath, with an application fee to the state board of nursing (H.B.4334, 2016). The applicant must have a registered nurse’s license which is in good standing, have satisfactorily completed a graduate-level program in nursing, and have obtained a certification level recognized and approved by the state board of nursing such as a certified nurse practitioner, certified nurse anesthetist, etc. (H.B.4334,

As an advanced practice nurse (APN), it is necessary to know the scope of practice for various states. There are four areas which consists certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), certified nurse practitioner (CNP), and certified nurse specialist (CNS). According to Goudreau (2011), clinical nurse specialist need to understand the distinct differences in license, accreditation, certification, and education (LACE) across states. To demonstrate the differences in practice, these areas will be examined for the states of California, Illinois, Ohio, and Washington. According to the National Council of State Boards of Nursing (NCSBN) (2014b), there are differences between states on APRN that needs to be standardized

Senate Bill 127 in Ohio has been getting a lot of attention since June 24, 2015. March 16, 2015 the bill was introduced to the Senate. On March 17, the bill was referred to the committee, Health and Human Services. On June 24 Health and Human Services was reported, added into place and passed by the Senate. Then, on June 25 the bill was introduced to the House. On October 1, 2015 the bill was referred to the committee, Community and Family Advancements. Currently the Ohio’s Senate Bill 127 is in the stage of trying to be put into place (LegiScan, Ohio SB127 | 2015-2016 | 131st General Assembly,

Texas has a rapidly growing population with complex healthcare needs, but has limited resources in terms of healthcare provider workforce. There is an expanding need for healthcare in Texas even without taking federal reform into account. Currently, more than forty percent of states have adopted full practice authority licensure and practice laws for Advanced Practice Registered Nurses (APRN). Texas is not one of them. Currently, APRN’s are regulated by both the Texas Board of Nursing and the Texas Medical Board. Passage of Senate Bill 681 would grant full practice authority to APRN’s, and therefore be regulated exclusively by the state nursing board.

These elements serve as proof of acquiring and completing required formal education, skill and experience from a graduate program formal educational agencies to practice. The state of recognizes the four APRNs specialty namely CRNA, CNM, CNS and CNP. As a practicing nurse in Texas, I found out Texas’ implementation status of the consensus model is between 50-71% striving towards uniformity. According to the updated version of the consensus model, practice in Texas is a collaborative standardized care. This new model will have a positive effect on practice parameters and safety to patients in that, it will let to APRNs influx into the state which will directly ameliorate APRN to patient ratio, availability, accessibility, cost and quality of care due to competition. There is a nationwide demand for health care professionals meanwhile existing ones face restriction in their practice. The long impending nursing shortage, one of the many health professional shortages begun a movement to utilize all health care providers to the full extent of their education and training (National Association of Clinical Nurse Specialist's Statement on the APRN Consensus Model Implementation,

Advanced Practice Registered Nurse (APRN) has evolved tremendously since it was establish in 1965 to service vulnerable populations, however there are still barriers that must be addressed in order to free APRNs from limitation imposed by state scope of practice (SOP) laws and payers, which disrupts health care financing/costs, access, delivery, and quality patient care. Currently, only one third of the states in the U.S. permit APRNs to fully practice within their scope without limitations (Hain & Fleck, 2014; Yee, Boukus, Cross, and Samuel, 2013).

Advanced Practice Nursing (APN) covers four types: Certified Nurse Practitioners, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists.

First off, APN’s will now be called APRN which stands for Advanced Practice Registered Nurse which goes into effect immediately. Newly graduated APRN’s will still need collaborative physicians or APRN’s until they complete 4000 hours of clinical experience as well as 250 hours of continuing education credit. It is only then that APRN’s are given authority to practice independently. Also, newly graduated APRN will have limitations on prescriptive authority until they fulfill the requirements (Illinois General Assembly, 2017).

As our healthcare continue to evolve, Advanced Nurse Practitioners' role is a crucial key component in the way health care is delivered in multiple settings, particularly in the primary care to improve patient's health outcomes. Nevertheless, the existing barriers limit nurse practitioners to practice to full capacity or extent of their training and education. One of the main obstacles faced by the advanced practitioners are the laws that govern the profession. Presently, NP practice rules and regulations vary from state to state(Hain and Fleck, 2014).