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It is important that advanced practice nurses have knowledge of their scope of practice in their own state to determine their limitations because some state may have their own restrictions. In many states, advanced practice nurses are able to practice to their full extent (which are green) without collaboration or under the supervision of an onsite physician, whereas, others are considered as a restricted state (red) because an advanced practice nurse is unable to independently work without a physician present. California is one of the many states that are considered restricted and are in red. Being an APN in a restricted state meant that some of an advanced practice nurse’s abilities are restricted by state law and regulations. According to Chaunie Brusie (2020), Full Practice Authority (FPA) meant that advanced practice nurse is able to work to the full extent of their practice without the need of a physician present or oversight. Furthermore, some California Standardized Procedure requirements for nurse practitioners are to be knowledgeable and experienced to perform certain functions or procedures. APN is required to provide satisfactory evidence that these requirements are met through either education, training, or experience. Although California is one of the restricted states, the proposed law AB 890 (which will take effect in 2023) will allow nurse practitioners to independently practice only after working under a physician for at least three years and completing residential hours (Reynolds, 2020). As a result, this will help many people to have access to healthcare providers and for rural and underserved places to have provider primary care providers available.





I live in the state of Texas where I will be practicing as an APRN/NP. Unfortunately, my home state falls under the red zone on the state practice environment which means Texas is a restricted practice state. State practice and licensure laws restrict the ability of NP to practice independently instead state law requires career-long supervision, delegation, or team management by another health care provider in order for the NP to provide patient care. Despite attempts from nursing organizations to advocate for independent practice laws, nurse practitioners in Texas must work under physician supervision. In 2009 and 2011, the nursing organization proposed to change these laws but were not successful. Nurse practitioners must practice within 75 miles of the supervising physician. Physicians may not supervise more than four nurse practitioners at one time. The supervising physician must also randomly review at least 10 percent of the nurse practitioner’s patient charts each month.

Nurse practitioners are only allowed to prescribe under physician supervision. They may only prescribe a 30-day supply of medications and are not allowed to prescribe schedule 2 drugs. All prescriptions written by the nurse practitioner must include the supervising physician’s name, address, DEA number, and phone number. Physicians may also delegate ordering and prescribing schedule III-V controlled substances subject to four limitations; duration of prescription may not exceed 90 days, requires consultation with a physician to continue the same drug after 90 days, prescribing for a controlled substance for a child under age 2 requires prior consultation with the delegation physician and consultation with the physician must be noted in the patients’ medical record (Texas Medical Association, 2021).

Although APRNs are highly trained and able to provide a variety of services, they are prevented from doing so because of barriers like state laws, federal policies, outdated insurance reimbursement models, and institutional practices and culture. APRN role not well understood and lack of professional recognition is another barrier to practice (Schirle et. al., 2018). As an individual nurses, we have the most direct contact with patients which allows guidance and confidence to patients and their families. It is unfortunate that we must depend on political decisions to have health care decision-making.

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