State Practice Agreements Assignment

State Practice Agreements Assignment

Practice agreements for PMHNPs in Texas

Psychiatric mental health nurse practitioners (PMHNPs) in Texas practice autonomously or/and in collaboration with a physician. PMHNPs might deliver patient care in accordance with protocols or any other type of written authorization developed by both a physician and the nurse practitioner.  As Buppert (2017) indicates,  the nurse practitioner acts in collaboration with the physician or independently to observe, assess, diagnose, intervene, evaluate, rehabilitate, counsel and care, and perform health teachings of patients. PMHNPs might prescribe controlled substances, devices, or drugs as outlined within a practice agreement with the overseeing physician. State Practice Agreements Assignment


Physician collaboration issues in Texas

The requirement for nurse practitioners to collaborate with a physician restricts PMHNPs from fully practicing in accordance with their education, credentialing and licensure. The collaborating physician must assess ten percent of nurse practitioners charts monthly and nurse practitioners can prescribe only a thirty day supply of drugs, with all prescriptions containing the name, DEA number, phone number and address of the collaborating physician. Collaboration with a physician also limits the ability of patients to access health care, especially in remote, underserved regions of Texas.

According to Parsons and Girard (2014), nurse practitioners in Texas act under restrictive authority since they are required to practice under supervision by a physician. A physician cannot collaborate with more than four nurse practitioners, which limits the availability of providers, notably in rural counties where there are only a few physicians. In addition, a physician is required to practice within seventy-five miles from the practice site of nurse practitioner which puts a further limitation on the availability of providers in these underserved regions. State Practice Agreements Assignment

Barriers to PMHNP practicing independently in Texas

State regulations and laws are the key barriers to PMHNPs independent practice in Texas. PMHNPS are trained to act as independent health care providers with the ability to diagnose prescribe medication, make patient referrals and order lab tests. However, regional practice authority is established by scope of practice legislation which restricts the ability of PMHNPs to fully practice to the level of their training, credentialing and experience. Altman et al (2016) argue that in Texas, it is mandatory for nurse practitioners to practice with a physician’s oversight and act in accordance to the guidelines outlined in written collaborative agreement from  the supervising physician. Additionally, state regulations don’t permit insurance companies to reimburse nurse practitioners unless the supervising physician possesses a contract with these companies.

The ability of PMHNPs to practice independently is further hindered by hospital bylaws. Altman et al (2016) there is no requirement for the physical presence of a physician at the on-site to supervise nurse practitioners. Nevertheless, hospital licensing legislations does not acknowledge nurse practitioners as members of the medical staff who might perform patient admissions and discharge. Majority of hospitals endows privileges to nurse practitioners as associate health care providers.

How I might address PMHNP practice issues in Texas

I might address  PMHNPs  practice issue in Texas by lobbying healthcare policy makers to ease restrictions on scope of practice that entail insurance, regulatory and legislative barriers. I would advocate for the amendment of Texas scope of practice laws to allow PMHNPs to practice autonomously and for increased independence within Texas Medicaid program so as to strengthen the capacity of primary care. Greater nurse practitioner independence would amplify patients’ access to care and also free up physicians to attend to more complicated patient cases.  I would also advocate for the removal of impediments to hospital privileges and recommend that PMHNPs be entitled to hospital clinical privileges, admission of patients and be recognized members of the medical staff and allowed to undertake assessments of hospital admission, perform physical tests and document medical histories. State Practice Agreements Assignment


Altman, S., Butler, A., & Shern, L. (2016). Assessing Progress on the Institute of Medicine Report the Future of Nursing. Washington, D.C: The National Academies Press.

Buppert, C. (2017). Nurse Practitioner’s Business Practice and Legal Guide.  Burlington, MA: Jones & Bartlett Learning.

Parsons, M., & Girard, N. (2014). Strategies for National Quality and Payment Policy, Issues of Perioperative Nursing Clinics.  Philadelphia, PA: Elsevier Health Sciences.


State Practice Agreements Assignment

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