Prescriptive Authority Comparison between Texas and California

1.Texas

Prescription of medicine in Texas is done under strict guidelines as provided for in section SB 406. Since its creation in 2013, section SB 406 allows physicians to delegate the duty of prescribing medication to nurse practitioners based in any location in Texas. TMB Rule 193.6 further gives physicians the power to delegate the work of ordering and prescribing prescription drugs, nonprescription drugs, medical devices, and medical equipment to a physician assistant and APRNs. This means that in Texas, all APRNs can prescribe all drugs in schedules II-V with very few limitations (Molassiotis et al., 2021). The Prescriptive Authority Agreement-PAA is the tool that allows APRN nurses to have the authority to prescribe medication in Texas. There are certain conditions that nurses must meet in Texas before being conferred the power to prescribe. One of the conditions is that an APRN must have an active practicing license given by the BON. Without a valid license, a APRN cannot and must not do prescription. The second critical requirements for APRNs before being allowed to prescribe medicine is to have a valid authorization number issued by BON. This prescriptive authorization number identifies each nurse every time they order for a prescription. The last condition for APRNs in Texas to complete before being allowed to prescribe drugs is not having a prior ban or investigation by BON.

1. California

Just like Texas, prescriptive laws in California are very strict and highly regulated. The California Nursing Practice Act-CNPC asserts that all registered NPs-Nurse Practitioners have the authority to provide basic primary care. However, when it comes to prescription, a collaborative agreement is used in prescribing pharmaceuticals. Even then, NPs in California cannot prescribe medicine without authorization from a supervising physician. California has a tool called a ‘restricted practice authority’ which requires nurses to have an agreement with a doctor before being allowed to prescribe medicines, interpret any diagnostic tests, or perform any other critical services (O’Connor et al. 2018). Still, NPs in California can prescribe all drugs and medications in schedules II-V. This is inclusive of all the highly addictive drugs in schedule II. However, any restrictions by Californian NPs must be done under a collaborative practice agreement.

Pros and Cons of Each State

Cons

The cons noticed in both the state of California and Texas is that both states do not allow their NPs to prescribe medicine/drugs without authority from a physician. In the case of California, a collaborative practice agreement is the tool that allows NPs in the state to prescribe medicine, handle any sensitive, tools, and interpret diagnoses. In Texas, TMB Rule 193.6 give physicians the power to delegate the work of ordering and prescribing prescription drugs, nonprescription drugs, medical devices, and medical equipment to a physician assistant and APRNs. This means that in Texas, all APRNs can prescribe all drugs in schedules II-V with very few limitations.

Pros

In both California and Texas, all NPs have the right to prescribe even the most sensitive drugs such as schedule II drugs. Another con is that NPs in the 2 states have the capacity to order for drugs even remotely without having to be physically present. The only requirement is that NPs must have an active practicing license prescriptive registration number. This means that NPs in the state of California and Texas can prescribe just about any drug as long as it is authorized by the supervising doctor.

Discussion on Changes

In the case of California, there has been a spirited fight by nurses to have the limitation on prescriptions lifted. For example, in this state NPs work alongside doctors through standardized protocols that require collaboration, signatures and approvals. In my view, these protocols are critical in ensuring patient safety. However, it is my view that there are some prescriptions that nurses can make without needing the approval of physicians. For example, APRNs who are highly trained, educated, and experienced nurses can accurately prescribe some medication on their own based on the years of education and the experience they have in the field. Having to wait for approval from doctors is sometimes painful for nurses because sometimes they see situations that they can handle effectively but have to wait for approval which sometimes take long depending on a doctor’s schedule.

Future Stakes

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