LAW
Patient safety first Dentists widen scope, nurses withdraw rules
BY KARA NUZBACK Thanks to opposition from the Texas Medi- cal Association and other organizations, the Texas Board of Nursing (TBON) has withdrawn proposed rules that would have allowed advanced practice registered nurses (APRNs) to make medical diagnoses. TMA works continually to promote patient safety and physicians’ role as leaders in the health care delivery team. According to TBON’s proposed rules, published May 30 in
the Texas Register, APRNs, by definition, could be held account- able for “the assessment, diagnosis, and management of pa- tient problems.” To read the pro- posal, visit
http://bit.ly/1nxAujG. The proposed rules divided APRNs into four categories — certified clinical nurse specialist (CNS), certified nurse-midwife, certified nurse practitioner (CNP), and certified registered nurse anesthetist — and purport diag- nosis privileges in the CNS and CNP categories.
“The Clinical Nurse Special- ist is educated in diagnosis and treatment of health/illness states, disease management, health promotion, and prevention of ill- ness and risk behaviors within a population focus area in compli- ance with state law,” the proposal reads.
The proposal also said a CNP
would provide diagnosis and management of chronic medical conditions. TMA President Austin King, MD, and leaders from nine
other Texas medical societies sent a letter to TBON opposing the rules. “Throughout the proposed rules, APRNs are given the au-
thority to ‘diagnose’ medical conditions, yet the Texas Occupa- tions Code … expressly defines ‘professional nursing’ as not including the acts of medical diagnosis,” the letter states. “To be valid and enforceable, the rules must conform to statutory requirements and restrictions in Texas laws.”
Dr. King stressed the proposed TBON rules “should recog- nize that medical acts are delegated by licensed physicians, and the same medical standards of practice should apply to APRNs when performing delegated medical acts as apply to physicians.”
TBON Assistant General Counsel Jena Abel says TBON
“It’s death by a thousand cuts. Independent practice is clearly the goal.”
withdrew the proposed rules at its July 18 meeting. She says the opposition to the proposal surprised the board. She says the intent of the rule change was to update termi- nology and align the rules with the National Council of State Boards of Nursing so that APRNs could more easily cross state lines and continue to practice without jumping through too many administrative hoops. Ms. Abel says the TBON staff plans to meet with some of the groups that oppose the new rules, including TMA, and come up with a proposal that both nurses and physicians are happy with. “We’re not trying to expand scope,” Ms. Abel said. “Hope- fully, at the end, we’ll be able to bring a better proposal back to the board where everyone’s on the same page.” She says the staff plans to come up with a new proposal in time for TBON’s Oct. 23 meeting.
The proposal would then be subject to a new public comment period.
Separate standards Rep. John Zerwas, MD (R-Richmond), also penned a letter to TBON opposing its proposal to allow APRNs to diagnose patients. “Broadly speaking, any expansion of scope of practice is de-
serving of a legislative conversation and is not something that should be conducted through the board’s rulemaking process,” he wrote.
September 2014 TEXAS MEDICINE 27
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