Washington and Texas Boards of Nursing comparison

Washington and Texas Boards of Nursing comparison

Comparison of Boards of Nursing in Washington and Texas

The Washington State Board of Nursing consists of 15 members all of whom are appointed by the governor. Three are members of the general public, two are advanced practice nurses, three are licensed practical nurses, and seven are registered nurses.

The Texas State Board of Nursing consists of 13 members. One is an advanced practice nurse, two are registered nurses, three are vocational nurses, and three are faculty members of nursing schools. Of the three faculty members, one must be from a nursing school that offers a bachelor’s degree in nursing, one must be from a school that offers an associate’s degree in nursing, and one must be from a school that prepares vocational nurses. Four are members of the public. Washington and Texas Boards of Nursing comparison

Delegation Authority in Washington and Texas

Washington has very restrictive delegation authority for RNs. A nurse may only delegate medication administration to unlicensed assistive personnel (UAP) in a home health, or hospice agency. In limited circumstances, they may delegate in community-based or in-home settings (Legislature, n.d.). Washington has a Nurse Delegator Program. The Washington State Department of Social and Health Services (DSHS), provides training for registered nurses, so they can teach home health aids and nursing assistants how safely check blood glucose, administer medication, and other patient care that may be delegated to them after they are properly trained (Services, n.d.).  RNs are required to complete the nurse delegation training course prior to taking on any clients (Services, n.d.).

In Texas, delegation rules are much more liberal. The nurse is expected to use their judgment when delegating a task to UAP. The nurse is ultimately responsible for the UAP’s actions and will be held responsible for them. The Board of Nursing advises nurses to use the “Scope of Practice Decision-Making Model” (Nursing, 2019). This is a decision tree that helps the nurse decide if a task is safe to be delegated, thus maintaining safety.  Patient safety “supersedes other mandates such as facility policy or physician orders”. (Nursing, Frequently asked questions – delegation, 2013).

Scope of Practice for ARNPs in Washington and Texas

In Washington, ARNPs have full practice authority.  They must first be licensed to practice in Washington. They can practice independently, without the supervision of a physician. They can diagnose, prescribe schedule II-V medications, order, collect, and perform diagnostic tests. They can also interpret diagnostic tests. They are authorized to provide a wide range of patient care management services (Legislature, ARNP scope of practice, n.d.).

In Texas, ARNPs work under restricted practice. This means that “state practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice” (Practitioners, 2023). NPs can only practice under a physician’s supervision, and the physician must be within 75 miles of the NP. The physician may not supervise more than four NPs, and the physician must also review 10% of the NP’s charts each month. They also cannot prescribe schedule II drugs, such as Adderall. When they prescribe medication, they are limited to only a 30-day supply. Also, the prescription must have the supervising physician’s name and DEA number on it (AP, n.d.). Washington and Texas Boards of Nursing comparison

References

AP, T. (n.d.). 
Nurse practitioner scope of practice
. Retrieved from https://provider.thriveap.com/blog/nurse-practitioner-scope-practice-texas#:~:text=Texas’%20Nurse%20Practitioner%20Supervision%20Laws&text=For%20the%20time%20being%2C%20nurse,nurse%20pr

Legislature, W. S. (n.d.). 
ARNP scope of practice
. Retrieved from https://app.leg.wa.gov/wac/default.aspx?cite=246-840-300

Legislature, W. S. (n.d.). 
Registered nurse-activities allowed-delegation of tasks
. Retrieved from https://app.leg.wa.gov/rcw/default.aspx?cite=18.79.260

Nursing, T. B. (2013). 
Frequently asked questions – delegation
. Retrieved from https://www.bon.texas.gov/faq_delegation.asp.html#t8

Nursing, T. B. (2019, April). Retrieved from Texas board of nursing scope of practice decision-making model: https://www.bon.texas.gov/pdfs/publication_pdfs/Scope%20of%20Practice%20Decision-Making%20Model%20-%20DMM.pdf

Practitioners, A. A. (2023, October). 
State practice environment
. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment

Services, W. S. (n.d.). 
Nurse delegation program
. Retrieved from https://www.dshs.wa.gov/altsa/residential-care-services/nurse-delegation-program Washington and Texas Boards of Nursing comparison