Texas FNP Scope of Practice

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    Need advise/opinions. I am graduating this May, and will become an FNP (certification exam pending). I have gotten a job with a CV surgery group who will be paying for my first assist. The problem is, I'm getting conflicting information about a FNP's scope of practice regarding ICU patients. Am I not able to see the patients in the ICU? I'm not going to be managing drips, vent settings, or doing any bedside procedures, it would basically just be checking on them from a surgical standpoint. I just think it's strange that I can do first assist, but then can't check on the patient post op if they are in the ICU? Also, as a FNP I a work in a ED, and critical patients come in there! There are too many rules! Advise please!

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  2. 3 Comments...

  3. 0
    I think this maybe better served in the APN section of this board

    Advanced Practice Nursing for Nurses | Nursing Students
  4. 0
    Will move to the APN forum.
  5. 0
    Quote from jennylynn_1983
    Need advise/opinions. I am graduating this May, and will become an FNP (certification exam pending). I have gotten a job with a CV surgery group who will be paying for my first assist. The problem is, I'm getting conflicting information about a FNP's scope of practice regarding ICU patients. Am I not able to see the patients in the ICU? I'm not going to be managing drips, vent settings, or doing any bedside procedures, it would basically just be checking on them from a surgical standpoint. I just think it's strange that I can do first assist, but then can't check on the patient post op if they are in the ICU? Also, as a FNP I a work in a ED, and critical patients come in there! There are too many rules! Advise please!
    Texas is very straight forward. The NP can't work outside their training which is defined by:

    • 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

    Presumably as an FNP you were not trained didactically or clinically to take care of acutely or critically ill post CV surgery patients.

    The specific answer that you are looking for is found here:
    APN Scope of Practice

    Q: I am authorized to practice in a particular specialty area. I want to expand my scope of practice to include a second specialty area. (Examples of this situation include but are not limited to: adult health expanding to include pediatrics, family practice expanding to include care of patients with complex psychiatric pathologies, and primary care expanding to include acute/critical care). Can I do this by completing continuing education activities specific to the specialty and working with another advanced practice nurse authorized in that specialty or a physician?
    A: There are finite limits to expanding one's scope of practice without completing additional formal education and obtaining the requisite authorization to practice in the additional role and/or specialty from the BON. When incorporating a new patient care activity or procedure into one's individual scope of practice, the board expects the advanced practice nurse to verify that the activity or procedure is consistent with the professional scope of practice for the authorized role and specialty and permitted by laws and regulations in effect at the time. For example, a women's health nurse practitioner or nurse-midwife who wishes to incorporate performance of colposcopies in his/her practice may do so without obtaining an additional authorization to practice from the BON because this activity is consistent with the professional scope of practice for those roles.
    If the activity is not consistent with the professional scope of practice for the authorized role and specialty, additional formal education and authorization from the BON in the second role and/or specialty is required. For example, an advanced practice nurse who is authorized to practice in gerontological nursing wishes to provide advanced practice nursing care to all adult patients. In order to do so, he/she must complete education that will prepare him/her in an advanced practice role and specialty that encompasses advanced practice nursing care of adults of all ages. Rule 221.4(c) requires that this additional education meet the curricular requirements outlined in Rule 221.3, relating to advanced practice nursing education. After completing the additional formal education, you must obtain national certification in the additional role and specialty as well as authorization to practice in the particular role and specialty from the BON before you begin practicing in the additional specialty or role.

    Also note the rules for first assist:

    Q: What requirements need to be met for advanced practice nurses who want to first assist and be reimbursed for their services?
    A: HB 1718, passed in the 79th Regular Legislative Session (2005), amended the Nursing Practice Act to include Section 301.353. This section defines a nurse first assist as an individual who:

    • Is licensed to practice as a RN,
    • Has completed a nurse first assistant educational program approved or recognized by an organization recognized by the board, and
    • Is either (1) certified in perioperative nursing (CNOR) OR (2) recognized by the board as an advanced practice nurse and qualified by education, training or experience to perform the tasks involved in perioperative nursing.

    Therefore, if you are recognized by the board as an advanced practice nurse and qualified by education, training or experience to perform the tasks involved in perioperative nursing, you will only need to complete a nurse first assistant educational program. The nurse first assistant educational programs recognized by the Texas Board of Nursing are the nurse first assistant educational programs that are included on the Competency and Credentialing Institute's (CCI's) list of acceptable RNFA programs. You may access that list of programs on-line at the following URL: http://www.cc-institute.org/cert_crnf_prep_rnfa.aspx.
    Please note: Advanced practice nurses who are recognized by the BON as nursemidwives may complete the American College of Nurse-Midwives' (ACNM's) process for incorporating first assistant responsibilities for obstetrical and/or gynecological procedures into their scopes of practice in lieu of a course accepted by CCI.

    The ER position is more difficult but would probably follow under the primary care to critically ill rules. Bottom line you really need to have your ACNP to do what you are doing in Texas.


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