The scope of practice for Advanced Practice Registered Nurses (APRNs) is a subject of debate in the legal medical community. In particular, the level of education and experience of these specialists allows them to work in a variety of settings and have a certain degree of autonomy in the performance of their functions. However, in some states, the scope of practice of APRNs is limited by state regulations and laws, Nursing Acts, and institutional restrictions. Ortiz et al. (2018) note that extending the autonomy of APRNs has no significant effect on patient outcomes but does not reduce them. This statement is also supported by Grimes et al. (2018), who emphasize that regulations of the activities of APRNs do not result in improved quality and safety of care. However, in some states, such as Texas, laws prescribing the scope of practice of APRNs are quite strict. At the same time in Florida these regulations allow nurses to have a wider range of practice and a certain degree of autonomy.
APRN practice is based on the characteristics of the setting, educational level, specialty and role. In Texas, APRN scope of practice is prescribed by Rule 221.12 of rules and regulations relating to nurse education, experience, licensure and practice (Texas Board of Nursing, 2022). Scope of practice depends on the specialty area and “shall be defined by national professional specialty organizations or advanced practice nursing organizations recognized by the Board” (Texas Board of Nursing, 2022, p. 168). APRN scope of practice must be within the scope of the Nursing Practice Act as well as the laws of the State of Texas. Additionally, APRNs perform functions in addition to those permitted for registered nurses (RNs). Thus, in the state of Texas, the scope of practice for APN is defined quite broadly and largely depends on the specialty and role performed.
Compared to regulations in Texas, the scope of practice for APRN is less well defined in Florida. APRN activities in Florida are regulated by the Nurse Practice Act and cover a wide range of functions (The 2022 Florida Statutes, n.d). This document describes the basics of autonomous and supervised operation of APRNs in various medical settings. The Texas Nursing Practice Act does not provide additional explanations related to the various activities of a nurse in various settings (Texas Board of Nursing, 2021). The Florida Nurse Practice Act describes the functions and scope of practice of APRNs under different settings in more detail. Thus, in Florida, APRNs have more legal restrictions on their practice, as they must follow strict regulations in addition to the mandates of the organizations.
The scope of practice in Florida is described in more detail and the functions of APRNs are limited. However, in Florida, in contrast to Texas, APRNs can participate in autonomous practice in primary care (The 2022 Florida Statutes, n.d). In Texas, they need to be under the supervision of a physician regardless of the setting (Texas Nurses Association, 2021). The document states that “Texas is one of the few states that still require such supervision” (Texas Nurses Association, 2021, p. 1). Essentially, Texas APRNs scope of practice is limited to assisting physicians, although they may not even meet patients. In Florida, these restrictions are less severe and APRNs have more authority in dealing with patients independently.
Grimes, D. E., Thomas, E. J., Padhye, N. S., Ottosen, M. J., & Grimes, R. M. (2018). Do state restrictions on Advanced Practice Registered Nurses impact patient outcomes for hypertension and diabetes control? The Journal for Nurse Practitioners, 14(8), 620-625.
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of Nurse Practitioner practice regulations on rural population health outcomes. Healthcare, 6(2), 1-8.
Texas Board of Nursing. (2021). Nursing Practice Act, Nursing Peer Review & Nurse Licensure Compact. Texas Board of Nursing. Web.
Texas Board of Nursing. (2022). Rules and regulations relating to nurse education, licensure and practice. Texas Board of Nursing. Web.
Texas Nurse Association. (2021). Full practice authority for APRN. Texas Nurse Association. Web.
The 2022 Florida Statutes. (n.d). Online Sunshine. Web.