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Practice Issues for NPs and CNSs

  • The traditional CNS role focues on improving nursing care for a population of patients.
  • About 20% of CNSs also engage in treatment for individual patients and have prescriptive authority.
  • All CNSs that use any title or credential (including certification) implying he/she is a clinical nurse specialist must have authorization to practice as a CNS from the Texas BNE.
  • The NP role focues on managing treatment for individual patients within a specific population of patients.
  • NPs with certificate education are grandfathered and not required to obtain a master degree unless they fail to maintain their national certification and BNE authorization.
  • Role analysis of two CNS and NP specialities show identical functions. Psychiatric Mental Health CNSs and NPs and Gerontological CNSs and NPs may be hired for the same jobs.
  • NPs and CNSs specializing in psychiatric mental health nursing may independently diagnose from the DSM Manual.
  • The scope of practice from CNSs and NPs is based on the population of patients the APN was educated to treat in the advanced practice nursing program, and cannot be expanded beyond that population of patients without additional advanced practice nursing education.
  • The limits of an individual APN's practice are based on the APN's competencies.
  • In Texas, APNs who determine medical diagnoses and prescribe medications or medical devices for patients must have those aspects of their practice delegated by a physician through protocols (Practice Agreement Protocols).
  • NPs and CNSs educated in primary care may care for certain hospitalized patients that are not critically ill.
  • APNs may perform certain first assisting and radiologic procedure, but only if they have additional training required by law.
  • APNs may delegate administration of immunizations to unlicensed personnel, but they may not delgate administration of prescription drugs to unlicensed persons.
  • A BNE position statement verifies that LVNs and RNs may accept orders from APNs.
  • APNs may order health care services including physical therapy, occupational therapy, diagnostic tests, and durable medical equipment. However, the Texas aMedicaid Program requires a physician order for these services.

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