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 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 Nurse Examiners to receive questions such as, "Can an advanced practice registered nurse treat a patient with that condition?", or "Is it within the scope of practice of an advanced practice registered nurse 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 advanced practice registered nurse to seek reimbursement for services provided.

Determining scope of practice includes:

• Advanced practice education in a role and specialty
• 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 advanced practice registered nurse may or may not practice the full scope of the professional role and specialty. Decisions regarding individual scope of practice are complex and related to an advanced practice registered nurse's knowledge, skills and competencies. Each advanced practice registered nurse must practice within his/her individual scope.

Professional Scope

National professional specialty and advanced practice registered nursing organizations broadly define scope of practice for each role. These documents address role, function, population served, and practice setting. They offer advanced practice registered nurses 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. Advanced practice registered nurses 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 specialty set forth by the BON.

The following questions may help to clarify whether a new activity/procedure can be incorporated into an individual's scope of practice:

• Is it consistent with one's professional scope of practice?
• Is it consistent with statutory or regulatory laws?
• Is it consistent with one's education in the role and specialty?
• Is it consistent with the scope of one's recognized title or does it evolve into another advanced practice title recognized by the board requiring additional formal education and legal recognition?
• Is it consistent with the Standards of Nursing Practice outlined in Board Rule 217.11?
• Is it consistent with evidence-based care?
• Is it consistent with reasonable and prudent practice?
• Are you willing to accept accountability and liability for the activity and outcomes?

Adding New Procedures and/or Patient Care Activities

When adding a new procedure or patient care activity, the advanced practice registered nurse should maintain documentation of additional education and competency. An advanced practice registered nurse may add new procedures or patient care activities to his/her individual scope of practice by using the following suggestions:

• Identify the benefit for a new patient care activity, taking into consideration consumer demand, standards for safe practice, and interest of the advanced practice registered nurse.
• Ensure that state or federal statutes and regulations do not constrain the advanced practice registered nurse from incorporating the activity into practice.
• Identify established professional standards, if available, supporting the performance of the new activity.
• Establish goals and methods for learning that encompass knowledge and skills acquisition through which competence is attained.
• Demonstrate competent performance of the procedure/activity.
• Maintain records that reflect the acquisition and maintenance of competency.

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 advanced practice registered nurse may not be within the individual scope of practice for another advanced practice registered nurse authorized to practice in the same role and specialty. However, it is important to keep in mind that the Board holds each advanced practice registered nurse accountable for knowing and practicing within his/her professional and individual scope of practice.

Adopted by the Texas Board of Nursing policy in 10/20/2005

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

RETURN