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    Discussion: State Practice Agreements
    This week you will have an opportunity to evaluate state practice agreements in your state and examine issues related to NP practice.

    To prepare:
    Review practice agreements in your state
    Identify at least two physician collaboration issues in your state
    By Day 3
    Post a brief description of the practice agreements for NPs in your state and the two physician collaboration issues that you identified. Explain what you think are the barriers to NPs practicing independently in your state. Finally, outline a plan for how you might address NP practice issues in your state


Subject Nursing Pages 2 Style APA


Practice Agreement and Collaborative Issues

                The collaboration between the nursing practitioner and the collaborative physician is referred as the practice agreement which outlines the services that the NP should perform. Notably, this agreement is provided in the Scope of Practice.

Texas Practice Agreement

Texas practice agreement can be summarized in three main categories. For the practice authority, a written agreement between the supervising physician and NP is required, and the protocols are reviewed every year. Considering the prescriptive authority, the written agreement between the collaborating physician and NP should state the devices, drugs, and items that should be used or prescribed (Scope of Practice Policy, 2019). In the practice agreement, another critical category is the nursing practitioner being the primary care provider. NPs are recognized by Texas Board of Nursing as primary care providers, and any healthcare organization should ensure that the advanced registered NPs and physician assistants are present in the healthcare provider network as the primary caregivers.

Physician Collaboration Issues

                One physician collaboration issue is the need for delegation consent between the physician and NP. Since the collaborative agreement from the supervising physician is required, this limits the nursing practitioner from fully executing the practice authority (Young, 2018). This impedes timely attention to the patient. The second collaborative issue is based on the NP as a primary caregiver. The issue emanating here is the possibility of more admissions and referrals. Although NPs fights and struggles target being allowed to execute their authority in full, the level of training to provide comprehensive primary care is limited as compared to that of physicians thus most NPs may refer the patient to specialists or admit the individual pending a checkup by the physician.

Barriers to NPs practicing Independently

                NPs training covers a wide range of responsibilities and services as outlined in their degree program. Some of the services that they are trained to perform include prescribing medication, referring patients, and ordering laboratory tests (Texas Board of Nursing, 2013). In Texas, however, the regional authority restricts them to practice their credentialing, education, and experience fully (Young, 2018). Another impeding factor is the consent agreements from the supervising physicians which implies that the NP cannot execute the full services without authority from the physician. Also, most physician organizations are the barriers to NPs practicing independently based on hostile environment. Most of the physicians oppose NPs independent practice and practicing their full authority.

Solutions to the NP Practice Issues

                The central solution to addressing NPs issues are allowing them to practice according to their training, experience, and credentialing. Also, physicians should provide a supportive environment through effective teamwork and not undermining their practice. Although the agreement authorities are essential in ensuring patient safety, NPs roles as outlined in the Scope of Practice should not be restricted based on lacking these consents. Also, legal actions should be taken against physicians undermining or providing a hostile environment to NPs.

In summary, the practice agreement in Texas is described by practice authority, prescriptive authority, and nursing practitioners being primary care providers. To address the issues related to the practice agreement such as authority agreements and restrictions for NPs to execute their authorities in full, a supportive working environment is required as well as eliminating the NPs restrictions.




Scope of Practice Policy (2019). Texas Scope of Practice Policy: State Profile. Retrieved January 26, 2019, from http://scopeofpracticepolicy.org/states/tx/

Texas Board of Nursing (2013). Practice – APRN Scope of Practice. Retrieved January 26, 2019, from https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp

Young, C. (2018). Texas Nurse Practitioners: The Fight for Full Practice Authority. Retrieved January 26, 2019, from https://www.nursepractitionerschools.com/blog/texas-np-practice-authority
















Appendix A:

Communication Plan for an Inpatient Unit to Evaluate the Impact of Transformational Leadership Style Compared to Other Leader Styles such as Bureaucratic and Laissez-Faire Leadership in Nurse Engagement, Retention, and Team Member Satisfaction Over the Course of One Year

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