PMHNP Practice in the state of Texas
PMHNP Practice in the state of Texas
- Describe the PMHNP practice environment for the State of Texas, highlighting restrictions or limitations for practice.
- Compare the PMHNP practice environment in the state of Texas with a neighboring state
- Describe a professional and/or clinical practice issue a new PMHNP will need to consider and address with the certification, licensure, credentialing, or relocation process.
Psychiatric-Mental Health Nurse Practitioner (PMHNP) Practice Environment PMHNP Practice in the state of Texas
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The practice of licensed advanced practice registered nurses (APRNs) like the psychiatric-mental health nurse practitioner (PMHNP) is regulated by individual states, while certification is national. The PMHNP like any other nurse practitioner – and depending on the state – can therefore be under restricted practice, reduced practice, or have full practice authority and autonomy (Peterson, 2017). By February 2017, there were still twelve restrictive states to APRN practice. One of these states is Texas (Peterson, 2017). This paper therefore takes a look at the current PMHNP practice environment in Texas and compares it with the neighboring state of Louisiana. It also briefly examines the process of certification and licensure that the fresh PMHNP must contend with.
State of Practice of the PMHNP in the State of Texas
Texas is one of the states in which the nurse practitioner (NP) still does not have full practice authority and autonomy (Peterson, 2017; Blore, 2019; Scope of Practice Policy, 2019a). According to Peterson (2017), “Texas falls at the lower end of the spectrum regarding the freedoms it offers NPs…. [This is] due to pressure from members of the State Medical Board.” The American Association of Nurse Practitioners’ (AANP) definition of full practice authority is power given to the NP by the state practice and licensure legislation to autonomously assess patients, diagnose, test, prescribe medication, and follow up patients; only referring to the physician as appropriate and sticking to the state board of nursing guidelines (Peterson, 2017).
Limitations and Restrictions on the PMHNP in their Practice in Texas
As per the classification of the American Association of Nurse Practitioners, the state of Texas falls under the ‘restricted practice’ group of states for the nurse practitioner (Peterson, 2017). First and foremost, to obtain licensure to practice in Texas after board certification, the PMHNP has to show evidence of a written contract of agreement with a physician who will supervise their practice and offer oversight in everything they do – at a fee (Peterson, 2017; Blore, 2019; Scope of Practice Policy, 2019a). The PMHNP has to pay the physician for this so called “prescriptive delegation” agreement very expensively (Blore, 2019). This happens despite the very advanced postgraduate training that NPs acquire. According to the Scope of Practice Policy (2019a), PMHNPs are recognized by the state of Texas as primary health care providers, where there is a scarcity of physicians. To further complicate matters for the NP, their practice is not only regulated by the Texas Board of Nursing, but also by the Texas Board of Medicine (Blore, 2019). Rules in the Texas Administrative Code prescribe what the NP can and cannot do. Restricted practice authority is found under rule 221.13. Rule 222.5 also requires the NP to obtain prescriptive authority through that collaborative agreement, which must clearly name the drugs that the NP will be allowed to prescribe under the supervision of the physician (Scope of Practice Policy, 2019a). PMHNP Practice in the state of Texas
There however appears to be a ray of hope for Texas NPs, as an NP working with the Department of Veteran Affairs was recently (2017) the very first to be granted full practice authority (FPA) in Texas. This was however not anchored in legislation; therefore NPs working in the private sector still cannot have FPA (Jimenez, 2017).
PMHNP Practice in Texas versus Louisiana
While Texas is a ‘restricted practice’ state as per the American Association of Nurse Practitioners (AANP), neighboring Louisiana, on the other hand, is a bit better and falls under the ‘reduced practice’ category. According to the AANP (2016), quoted in Peterson (2017), reduced practice for the NP means “The NP has the ability to engage in at least one element of the NP practice and is regulated through a collaborative agreement with an outside health discipline to provide patient care.” Despite having to sign a collaborative agreement with a physician, the NP in Louisiana has more autonomy in this arrangement as the relationship with the physician is meant for consultation and referral purposes only. They don’t have to be supervised in everything they do. In fact, even though the collaborative agreement has to state the prescriptive authority of the NP, the arrangement in Louisiana allows them to freely prescribe – including controlled schedule II-V substances (Scope of Practice Policy, 2019b). In all, therefore, the state of Louisiana is much less restrictive to the PMHNP than Texas; and would, therefore, be preferred for practice.
Certification and Licensure for the New PMHNP
To obtain full licensure to practice in either Texas or Louisiana, the new PMHNP needs to first obtain national board certification from the American Nurses Credentialing Centre (ANCC) by taking a competency examination (ANCC, n.d.). But to obtain this board certification itself, the prospective PMHNP must be registered and have completed an accredited postgraduate training and education in psychiatry and mental health nursing (ANCC, n.d.; 2U, Inc., 2018). The PMHNP applies for the certification examination online and pays a fee of up to $395. If they are a member of any professional body like the American Psychiatric Nurses Association, however, they may pay as low as $270 (2U, Inc., 2018). After a successful application, the new PMHNP has to study for the certification examination for three months after which they then sit for the same. If they pass this competency examination, they get awarded the PMHNP-BC (board certification), which they then use to get licensure in the state they wish to practice in (2U, Inc., 2018; ANCC, n.d.) PMHNP Practice in the state of Texas
Texas is more restrictive than Louisiana for PMHNP practice.
ANCC [American Nurses Credentialing Centre] (n.d.). Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC). Retrieved on 18 June 2019 from https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/
Blore, J. (Ed.) (2019). Texas nurse practitioners: The fight for full practice authority. Retrieved 18 June 2019 from https://www.nursepractitionerschools.com/blog/texas-np-practice-authority/
Jimenez, S. (26 July 2017). Texas grants first nurse practitioner full practice authority. Retrieved 18 June 2019 from https://www.nurse.com/blog/2017/07/26/texas-grants-first-nurse-practitioner-full-practice-authority/
Peterson, M.E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74-81. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/
Scope of Practice Policy (2019a). Texas scope of practice policy: State profile. Retrieved 18 June 2019 from http://scopeofpracticepolicy.org/states/tx/
Scope of Practice Policy (2019b). Louisiana Scope of Practice Policy: State Profile. Retrieved 18 June 2019 from http://scopeofpracticepolicy.org/states/la/
2U, Inc. (2018). Psychiatric and Mental Health Nurse Practitioner (PMHNP). Nursing License Map. Retrieved on 18 June 2019 from https://nursinglicensemap.com/advanced-practice-nursing/nurse-practitioner/psychiatric-and-mental-health-nurse-practitioner-pmhnp/
PMHNP Practice in the state of Texas