Posted: January 8th, 2023

Nursing Regulations in Virginia, Texas and Michigan

Nursing Regulations in Virginia, Texas and Michigan
The nursing profession faces a dynamic regulatory landscape across different states in the United States. While some states have more restrictive policies governing nursing practice, others offer more autonomy and flexibility for nurses. An analysis of nursing regulations in Virginia, Texas and Michigan provides insights into the varying degrees of independence afforded to nurses. This paper will comprehensively discuss and compare the key regulatory aspects for nurses such as nurse practitioners and advanced practice registered nurses in these three states.
Virginia's Nursing Regulations
The Board of Nursing in Virginia oversees the regulation of nursing practice through the Nurse Practice Act. Traditionally, Virginia had more restrictive policies that required nurse practitioners (NPs) to maintain a collaborative agreement with physicians (Virginia Law, n.d.). However, in recent years, the state has taken positive steps to expand the scope of nursing practice. A landmark bill was passed in 2018 that removed the requirement for NPs to have physician supervision or collaborative agreements (Smith et al., 2020). This allowed NPs to evaluate patients, diagnose medical conditions, and develop and manage treatment plans independently.
While gaining more autonomy, some restrictions still apply to NPs in Virginia. For instance, NPs need physician sign-off to prescribe certain controlled substances or to order certain diagnostic tests like MRI scans (Smith et al., 2020). Additionally, the state board maintains strict licensing requirements for all nurses. Candidates must graduate from an accredited nursing program and pass the National Council Licensure Examination (NCLEX) to obtain an active registered nurse (RN) license (Virginia Board of Nursing, 2022). Licensed nurses also need to complete 20 hours of continuing education every two years to maintain their license.
Texas' Nursing Regulations
In comparison, the regulatory environment in Texas offers less flexibility and independence for nurses. The Texas Board of Nursing is responsible for the regulation of nurses and nursing education through the Texas Nursing Practice Act (Texas Board of Nursing, n.d.). Currently, NPs in Texas cannot practice without the supervision of a physician within a 75-mile radius (Portia, 2019). Supervising physicians are also required to review a minimum of 10% of charts for patients seen by NPs under their supervision monthly.
These restrictive policies have faced criticism from nursing organizations for limiting the full scope of NP practice (Portia, 2019). In response, Texas has made some progress in recent legislation. A 2021 bill allowed NPs to evaluate patients and make diagnoses independently without physician involvement (Texas Legislature, 2021). However, physician supervision is still mandated for treatments. Overall, Texas maintains a more physician-centric model of healthcare that provides less autonomy to nurses compared to other states like Virginia.
Michigan's Nursing Regulations
Interestingly, Michigan does not have a standalone Nurse Practice Act like most other states (Michigan Department of Licensing and Regulatory Affairs, 2020). Instead, the Public Health Code outlines the regulatory framework for nursing. This appears to provide more flexibility and independence for advanced practice registered nurses (APRNs) in Michigan. For instance, APRNs can prescribe non-scheduled prescription drugs without physician sign-off (Michigan Department of Licensing and Regulatory Affairs, 2020).
Additionally, APRNs have full practice authority in Michigan based on their education and certification (Michigan Center for Nursing, 2022). This means they can evaluate patients, diagnose medical conditions, order and interpret diagnostic tests, develop treatment plans and prescribe medications without physician involvement or supervision. The regulatory environment in Michigan thus allows for a higher degree of autonomy compared to more restrictive models like Texas.
Discussion and Conclusion
In summary, an analysis of nursing regulations reveals variations in the levels of independence afforded to nurses across Virginia, Texas and Michigan. Virginia offers an intermediate approach that has progressively expanded nurse practitioner scope of practice in recent years. Texas maintains the most restrictive policies through mandatory physician supervision requirements. On the other hand, Michigan provides the highest degree of autonomy and flexibility for APRNs through full practice authority.
As healthcare delivery models evolve, a balanced regulatory approach is needed. Restrictive policies can limit the potential of nursing to address provider shortages and expand access to care. Meanwhile, patient safety must be ensured through appropriate education, certification and oversight. States will continue refining their nurse practice acts based on evidence and changing healthcare needs. Overall, more autonomy for nurses through reduced barriers appears beneficial when balanced with necessary safeguards.
References
Michigan Center for Nursing. (2022). Advanced practice registered nurses (APRNs) in Michigan. https://www.micenterfornursing.org/aprn
Michigan Department of Licensing and Regulatory Affairs. (2020, June). Frequently asked questions: Advanced practice registered nurses. State of Michigan. https://www.michigan.gov/lara/0,4601,7-154-72600_72603_27529_27542-113335--,00.html
Portia, W. (2019). Texas nurse practitioner regulation: A state comparison. Journal of the American Association of Nurse Practitioners. https://doi.org/10.1097/JXX.0000000000000170
Smith, S., Buchanan, H., & Cloutier, R. (2020). Virginia NP scope of practice: A legislative case. The Nurse Practitioner, 45(2), 33–37. https://doi.org/10.1097/01.NPR.0000654803.50310.fa
Texas Board of Nursing. (n.d.). About the Texas Board of Nursing. https://www.bon.texas.gov/about_bon.asp
Texas Legislature. (2021). HB 852. https://capitol.texas.gov/BillLookup/History.aspx?LegSess=87R&Bill=HB852
Virginia Board of Nursing. (2022). Licensure requirements. https://www.dhp.virginia.gov/nursing/nurse/license/
Virginia Law. (n.d.). Code of Virginia: Chapter 30. Regulation of Nursing. https://law.lis.virginia.gov/vacode/title54.1/chapter30/

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