2.8 APRN Authority: Chapter 221, Prescriptive Authority and the APRN Role in Delegation
Key Takeaways
- APRN recognition is governed by 22 TAC Chapter 221 and is granted in a specific role and population focus; practising outside that role and population focus exceeds the licence.
- Because NPA §301.002 excludes medical diagnosis and prescription from nursing, an APRN's authority to prescribe rests on delegated prescriptive authority under TOC Chapter 157, not on the APRN licence alone.
- 22 TAC §217.11(3) and the Board's delegation FAQ address the APRN role in delegation: an APRN may delegate as an RN does, and separately may receive delegated medical acts from a physician.
- An APRN remains subject to every standard in 22 TAC §217.11 and to the same unprofessional conduct rule, §217.12, that applies to LVNs and RNs.
APRN Authority: Chapter 221, Prescriptive Authority and the APRN Role in Delegation
Why this is on the NJE: The very first row of the BON Resource List is "APRN role in delegation — Nursing Practice — Rule 217.11(3), FAQ: Delegation and the Advanced Practice Nurse." The Board also lists the APRN scope page and a separate APRN Decision-Making Model. Section 2.2 introduces the APRN among the three scopes; this section covers the authority structure the NJE actually tests.
Three Separate Sources of Authority
An APRN in Texas is not simply "an RN with more scope." The authority to practise comes from three distinct places, and an item that conflates them is testing exactly this point.
| Source | What It Grants | Where It Lives |
|---|---|---|
| RN licensure | The full professional nursing scope: comprehensive assessment, nursing diagnosis, plan of care, evaluation | NPA §301.002(2), 22 TAC §217.11(3) |
| APRN licensure / recognition | Advanced practice within a specific role and population focus — for example, Family Nurse Practitioner, Certified Registered Nurse Anesthetist, Clinical Nurse Specialist, Certified Nurse-Midwife | 22 TAC Chapter 221 |
| Delegated prescriptive authority | Authority to sign prescription drug orders, within a prescriptive authority agreement with a delegating physician | TOC Chapter 157 |
[!CAUTION] The APRN licence does not, by itself, authorise prescribing. NPA §301.002 excludes acts of medical diagnosis and the prescription of therapeutic or corrective measures from the definition of nursing — at every level, APRN included. Prescriptive authority in Texas is delegated by a physician under Chapter 157. An APRN who prescribes outside the terms of a valid prescriptive authority agreement is not merely in breach of contract; they are performing an act outside their legal authority.
Role and Population Focus Is a Real Boundary
Texas issues APRN licensure in a role and a population focus. Both constrain practice.
- A Family Nurse Practitioner is educated and certified across the lifespan for primary care. Taking a position managing ventilated patients in an adult ICU raises a genuine role-and-population question.
- A Pediatric Nurse Practitioner treating adults is outside their population focus.
- A CRNA administering anaesthesia is squarely inside their role; the same CRNA running an independent primary care clinic is not.
This is the reason the APRN Decision-Making Model adds questions the general model does not: whether the act is consistent with the APRN's education in the role and population focus of Texas licensure, and whether it is consistent with interpretations from advanced practice or national specialty organisations representing that role and population focus (Section 2.6).
The APRN and Delegation — Both Directions
The Resource List entry is "APRN role in delegation," and the reason it earns its own row is that the APRN sits on both sides of delegation.
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| DIRECTION 1 -- THE APRN AS DELEGATOR (acting as an RN) |
| |
| An APRN holds RN licensure, so the APRN may delegate nursing |
| tasks to unlicensed personnel on exactly the same terms as any |
| other RN, under 22 TAC Ch. 224 and Ch. 225. The APRN credential |
| does NOT expand what may be delegated or to whom. |
| |
| DIRECTION 2 -- THE APRN AS DELEGATEE (receiving medical acts) |
| |
| A physician may delegate medical acts to an APRN. That is what |
| makes prescribing and other medical aspects of care lawful, and |
| it is why the APRN DMM asks whether a WRITTEN delegation |
| mechanism with an appropriate physician exists. |
| See Position Statement 15.11, Delegated Medical Acts. |
| |
| THE TRAP: an APRN cannot re-delegate a delegated MEDICAL act to |
| a UAP or an LVN. Medical authority delegated to the APRN |
| personally does not travel further down the chain. |
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APRNs Are Not Exempt From Anything
A recurring wrong answer treats the APRN as operating under a separate rulebook. The opposite is true — Chapter 221 is additional to, not instead of, the general framework:
| Requirement | Applies to APRNs? |
|---|---|
| 22 TAC §217.11 Standards of Nursing Practice | Yes — in full, including the duty to the patient at §217.11(1)(B) |
| 22 TAC §217.12 Unprofessional Conduct | Yes |
| Mandatory reporting under NPA §301.402 | Yes |
| Peer review and Safe Harbor under Chapter 303 and §217.20 | Yes |
| Continuing competency under 22 TAC Chapter 216 | Yes, plus APRN-specific requirements |
| The nurse's duty superseding facility policy and physician orders (PS 15.14) | Yes |
An APRN who accepts an unsafe assignment, fails to report a colleague's impairment, or practises outside their population focus faces the same enforcement pathway as any other nurse (Chapter 5).
Realistic Clinical Scenario & Legal Analysis
Scenario
Nurse practitioner Salma holds Texas APRN licensure as a Family Nurse Practitioner with prescriptive authority delegated under a prescriptive authority agreement with Dr. Whitfield. Dr. Whitfield leaves the practice abruptly on a Friday. On Monday, Salma continues seeing patients and signs prescriptions, reasoning that she is licensed and certified and that a replacement physician will sign a new agreement within a fortnight. She also asks the clinic's LVN to "call in the routine refills for the stable hypertension patients under my authority" while she catches up on charting.
Legal Analysis
- Prescribing without a current agreement exceeds Salma's authority. Prescriptive authority in Texas is delegated under TOC Chapter 157. When the delegating physician's agreement ends, the delegated authority ends with it. Salma's APRN licence and national certification do not independently authorise prescribing, because NPA §301.002 excludes prescription from the definition of nursing at every level.
- Her general nursing scope survives. Salma may continue to practise professional nursing under her RN licensure and may perform advanced practice acts that do not depend on delegated medical authority. The rupture is specific to the medical aspects of care.
- Directing the LVN to call in refills is a re-delegation of a medical act, and it is not permitted. Prescriptive authority is delegated to Salma personally. She cannot pass it to an LVN, who in any event holds a directed nursing scope that does not include prescribing.
- Running the APRN DMM would have stopped her at the delegation question — is there a written delegation mechanism with an appropriate physician providing authority for the relevant medical aspects of care? On Monday morning the answer was no, which is a stop sign (Section 2.6).
- Correct action: suspend prescribing immediately, notify the practice, arrange a new prescriptive authority agreement before resuming, and in the interim route prescription needs to a physician or an APRN with current authority.
A family nurse practitioner's delegating physician retires, terminating their prescriptive authority agreement. The APRN continues to see patients and sign prescriptions while a replacement is recruited. What is the correct analysis?
An APRN wishes to have an unlicensed assistive person perform a nursing task in an outpatient clinic. What governs that decision?
A pediatric nurse practitioner accepts a position at an adult internal medicine clinic managing chronic disease in patients aged 40 to 80. Which consideration is most directly raised?