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Advanced Nursing Practice in Texas

In nursing practice, the scope of operation dictates the guiding principles a nurse practitioner (NP) is entitled to operate within. In Texas, the Registered Nurses (RNs) are under a restricted form of practice under physicians’ supervision. The Texas Board of Nursing regulates nursing activities within the state. The practice competencies show the relevant skills that RNs aim to use to develop their clinical work. The nursing career is dynamic, and thus the NP needs to develop leadership skills to guide the members effectively. This paper aims to review the general scope of nursing principles in Texas, the core competencies of RNs within the state, and the leadership to be played by the NP.

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Scope of Practice Guidelines for RNs in Texas

The Texas Board of Nursing requires that all nurses operate within a set code of conduct. In Texas, the RNs must be adherent to the professional nursing conduct of practice. Once licensed, the RN must be supervised for around six months, and the supervision must be demonstrated through documentation (Texas Board of Nursing, 2013c). The new graduates are permitted to perform any clinical function that lies within the scope of nursing practice. It is recommended that the newly recruited and licensed RNs should not practice in hospital settings and avoid practicing in independent settings such as the home. It is to make them gain the relevant clinical practice skills from the hospitals. When the new RNs are employed and licensed, the experienced nurses should be prepared to supervise and mentor the new nurses.

Education and Certification Requirements for NPs in Texas

Becoming an NP in Texas generally entails three stages. These stages include earning a Bachelor of Science in Nursing (BSN), getting a nursing license, and ensuring the maintenance and renewal of the certification (Texas Board of Nursing, 2013a). The BSN is the undergraduate level of study the RNs undertake in the registered nursing training institutions. The BSN precedes the Masters in Nursing (MSN), through which the RNs further their education. The BSN is thus the minimal requirement of any nurse who wishes to practice in any hospital-based in Texas.

In Texas, the Texas Board of Nursing controls the state’s licensing activities of the nurses. For the nurses to earn their license by examination, they must pass a standardized test known as the National Council Licensure Examination (NCLEX) (Texas Board of Nursing, 2013b). Before sitting for the NCLEX, the nurses must succeed in the jurisprudence examination. The nurses must ensure that they renew their licenses as the Texas nursing license are only valid for two years. The verification and renewal of license services are on the Texas Board of Nursing official portal. An RN may get disqualified for licensure because of negligent and unprofessional practice.

Nature of RN Practice in Texas

Full practice entails giving an RN the power to perform patient evaluation, diagnose a disorder, interpret the diagnosis and prescribe the treatment to the patient. In the restriction practice, the state laws restrict the power of the RNs in at least one element of their practice, thus mandating for career-long supervision (Texas Board of Nursing, 2018b). Currently, in Texas, the scope of practice for RNs is restricted, as they have to practice under the supervision of a physician. Christiansen and Champion (2018) proved that up to 2018, most of the RNs in Texas were under supervision. It limits the clinical decisions made by the RNs on the patients.

Prescriptive Authority and Limitations of NP in Texas

Prescriptive authority refers to the ability of the NP to prescribe controlled drugs, devices, and medical services with no restriction. In Texas, rules govern the Prescriptive Authority of the NPS (Texas Board of Nursing, 2018a). The two main limitations of the NP in Texas is that a physician must delegate the Prescriptive Authority through a written document prescribed by the law. The NP in Texas also faces certain limitations in the prescription of controlled substances. The content of the Prescriptive Authority must have full details of the practitioners, a description of the nature of the practice, a treatment plan, and referral information, among other details.

Nurse Practitioner (NONPF) Core Competencies

The NONPF are guidelines that an RN must work hard to acquire to achieve optimal clinical experience and sound decision making. They are gained through independent and interprofessional practice, analyzing and evaluating clinical information to provide evidence-based data, and developing an enhanced knowledge in health care delivery (Thomas et al., 2017). These competencies may be the scientific foundation, leadership, quality, practice inquiry, technology, ethics, independent practice, information literacy, policy, and health delivery system competencies (Thomas et al., 2017). The two competency areas I can strategize to develop are the scientific foundation and quality. In the scientific foundation competency, I will strive to critically analyze the data and evidence to enhance the RN practice. In the quality competence area, I will use the available evidence to improve clinical practice progressively. I will apply the skills in peer review to promote patient cultural excellence.

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The first scholarly activity for nurses would be a subscription to subscribe and review the nursing practice journals. I will analyze the effectiveness of the available scientific research recommendations to prevent patient falls in hospitals in the scientific foundation competency. These recommendations include using side bed alert alarms and close patient supervision (Radecki et al., 2018). The second scholarly activity I will perform under the quality competency is using education to sensitize people on lifestyle change to prevent diabetes and hypertension. (Bakris et al., 2019) It is achieved by using the institution’s academic resources, such as the library and the internet source. Academic evidence exists that education and sensitization make people adopt behaviors such as exercising and proper nutrition. This can help prevent the onset of many lifestyle-associated diseases.

Leadership Skills Required by the NP

Nurses are leaders in modern-day clinical practice, and thus, they need to have essential leadership skills. As the nursing practice is dynamic, the leader must develop the skills to guide the members in implementing the changes (Shirey, 2017). The performance of various clinical practices depends on the quality of leadership shown by the RN. An NP should have the three best leadership skills: effective communication and collaboration, proper decision-making, and coping effectively with change.

In any health care setting, the nurses, as leaders, need to communicate with their colleagues effectively. It is a crucial component of building inter collaboration within the clinical environment (Shirey, 2017). In nursing, collaborative teamwork produces improved patient care, thus making the patient feel confident in the health care structure. The leaders must be role models to other colleagues to encourage cooperation in the organization. Effective communication is also vital in helping in the reduction of the risks, such as misdiagnosis and improper prescription, in the clinical practice. The health care system is often hindered by practitioner errors that prolong patient hospital stay or worsen the disease status. Nurses who are concerned with listening to their patients and colleagues build a formidable relation within the organization.

Proper decision-making in the clinical practice improves the patient-nurse relationship and the nurse-nurse relationship. The nurse leaders must demonstrate to other colleagues their proficient decision-making even in complex situations (Murray et al., 2017). The NP must explain to the patient with confidence the need to perform a medical procedure to eliminate any doubt. The leader must adhere to the values and principles of nursing practice in their decision-making. Every decision, including the financial choices in hospitals, must be explained by the NP leader to their colleagues. The leader must embrace diversity and cultural awareness in decision-making.

In the modern era, a nurse leader must embrace positive change within the health institution. In recent years, there has been an integration of technology into various treatment methods, and thus it requires the NP leader to cooperate with these changes (Beydler, 2017). A leader intolerant to changes creates mixed reactions within the clinical setting, affecting optimal clinical practice. NP leaders should support technological advancements aimed at improving patient safety and quality of health care.


Experienced nurses or physicians must supervise newly licensed RNs in health institutions. The Texas Board of Nursing is responsible for the license renewal of the RNs. The BSN is the minimum requirement of becoming an RN; the RN must pass NCLEX for certification. The RN practitioners in Texas face a limitation of the Prescribed Authority in the administration of controlled substances. Two of the competence areas an NP can aim to improve are the scientific foundation and quality competencies. The three leadership skills an NP can demonstrate are enhancing proper communication and collaboration, being adaptive to change, and good decision making.


Bakris, G., Ali, W., & Parati, G. (2019). ACC/AHA versus ESC/ESH on hypertension guidelines. Journal of the American College of Cardiology, 73(23), 3018–3026. Web.

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Beydler, K. W. (2017). The role of emotional intelligence in perioperative nursing and leadership: Developing skills for improved performance. AORN Journal, 106(4), 317–323. Web.

Christiansen, B., & Champion, J. D. (2018). Examining doctor of nursing practice clinical competency. The Journal for Nurse Practitioners, 14(5), e93–e100. Web.

Murray, M., Sundin, D., & Cope, V. (2017). The nexus of nursing leadership and a culture of safer patient care. Journal of Clinical Nursing, 27(5-6), 1287–1293. Web.

Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient’s perspective: A qualitative study. Applied Nursing Research, 43, 114–119. Web.

Shirey, M. R. (2017). Leadership practices for healthy work environments. Nursing Management (Springhouse), 48(5), 42–50. Web.

Texas Board of Nursing. (2013a). Texas Board of Nursing – Education – Where to Begin/Starting a Nursing Program. Web.

Texas Board of Nursing. (2013b). Texas Board of Nursing – Graduates & NCLEX Examinations. Web.

Texas Board of Nursing. (2013c). Texas Board of Nursing – Practice – Guidelines. Web.

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Texas Board of Nursing. (2018a). Texas Board of Nursing – Education – Remediation Education. Web.

Texas Board of Nursing. (2018b). Texas Board of Nursing – Practice – APRN Scope of Practice. Web.

Thomas, A., Crabtree, M. K., Delaney, K., Dumas, M. A., Kleinpell, R., Marfell, J., & Wolf, A. (2017). Nurse practitioner core competencies content. The National Organization of Nurse Practitioner Faculties. Web.

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