SECTION 221.4. Licensure as an APRN

(a) Application for Initial Licensure as an APRN.

(1) An applicant for licensure as an APRN in this state shall submit to the Board the required fee specified in §223.1 of this title (relating to Fees), verification of licensure or privilege to practice as a registered nurse in Texas, and a completed application that provides the following information:

(A) Graduation from an APRN graduate or post-graduate program, as evidenced by official documentation received directly from an APRN education program accredited by a nursing accrediting body that is recognized by the Board and the U.S. Secretary of Education and/or the Council for Higher Education Accreditation (CHEA), or its successor organization, as recognized by the Board; and

(B) Documentation of education shall verify the date of graduation; credential conferred; number of clinical hours completed; completion of three separate graduate level courses in advanced physiology and pathophysiology; advanced health assessment; advanced pharmacology that includes pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of all broad categories of agents; role and population focus area of the education program; and evidence of meeting the standards of APRN education set forth in this rule.

(2) In order to be licensed in this state, all APRN applicants must be currently licensed as a registered nurse in Texas or hold a current privilege to practice as a registered nurse in Texas.

(3) In order to be licensed in this state, all APRN applicants must take and pass the appropriate APRN national certification examination in the APRN role and population focus congruent with the applicant's educational preparation. Only those national certification examination(s) recognized by the Board for each APRN role and population focus area shall be accepted. Certification must remain current at all times.

(4) Identification of any state, territory, or country in which the applicant holds or previously held a professional license or credential, if applicable, must be provided. Required information includes:

(A) The number, type, and status of the license or credential; and

(B) The original state or country of licensure or credentialing.

(5) An applicant must provide the date and jurisdiction the applicant previously applied for a license in another jurisdiction and either was denied a license, withdrew the application, or allowed the application to expire, as applicable.

(6) An applicant must provide a detailed explanation and supporting documentation for each affirmative answer to questions regarding the applicant's eligibility for licensure.

(7) An individual who has reason to believe that he or she may be ineligible for APRN licensure or prescriptive authorization may petition the Board for a declaratory order as to his or her eligibility by submitting a petition, on forms provided by the Board, and the fee required in §223.1 of this title (relating to Fees).

(A) The petition shall include:

(i) a statement by the individual indicating the reason(s) and basis of his/her potential ineligibility;

(ii) if the potential ineligibility is due to the individual's criminal history, all court documents, including, but not limited to: indictments, agreements for pre-trial diversion or deferred prosecution, orders of deferred adjudication, judgments, probation records, and evidence of completion of probation, as applicable;

(iii) if the potential ineligibility is due to the individual's mental health condition or diminished capacity, verifiable and reliable evidence of controlled behavior and consistent compliance with recommended treatment, including compliance with a prescribed medication regime, for a reasonable amount of time, as applicable;

(iv) if the potential ineligibility is due to the individual's substance use disorder and/or the abuse/misuse of alcohol or drugs, verifiable and reliable evidence of sobriety and abstinence from drugs and alcohol, which may include evidence of the completion of inpatient, outpatient, or aftercare treatment, random drug screens, individual or group therapy, and/or support group attendance; and

(v) an evaluation that meets the criteria of the Occupations Code §301.4521 and §213.33 of this title (relating to Factors Considered for Imposition of Penalties/Sanctions), if applicable.

(B) Once the Board has received all necessary information, including the information required by subparagraph (A) of this paragraph, an investigation shall be conducted. The investigation will be based upon an evaluation of the individualized factors of the case, the potential risk of harm the individual's practice may pose to patients/clients and/or the public, and the individual's ability to meet the requirements of §213.27 (relating to Good Professional Character), §213.28 (relating to Licensure of Individuals with Criminal History), and §213.29 (relating to Fitness to Practice) of this title, as applicable. Based upon the individualized facts of the case, the Board may approve licensure or prescriptive authorization without encumbrance, impose probationary conditions or restrictions on the individual's ability to practice advanced practice nursing in this state, or limit or deny licensure or prescriptive authorization.

(C) If the Executive Director proposes to find the individual ineligible for licensure or prescriptive authorization, the individual may obtain a hearing before the State Office of Administrative Hearings (SOAH). The Executive Director shall have discretion to set a hearing and give notice of the hearing. The hearing shall be conducted in accordance with §213.22 of this title (relating to Formal Proceedings) and the rules of SOAH. When in conflict, SOAH's rules of procedure will prevail. The decision of the Board shall be rendered in accordance with §213.23 of this title (relating to Decision of the Board).

(D) An individual whose petition is denied may re-petition or seek licensure or prescriptive authorization after the expiration of one year from the date of the proposal to deny eligibility.

(8) An applicant must attest, on forms provided by the Board, to having completed a minimum of 400 hours of current practice with the last 24 calendar months in the APRN role and population focus area for which the applicant is applying, unless the applicant has completed an APRN education program in the advanced practice role and population focus area within the last 24 calendar months.

(A) If less than four years, but more than two years, have lapsed since completion of the APRN education program, and/or the applicant does not have 400 hours of current practice in the APRN role and population focus area during the previous 24 calendar months, the APRN shall be required to demonstrate proof of completion of 400 hours of current practice obtained under the direct supervision of a qualified preceptor who meets the requirements of §221.10 of this chapter (relating to Reactivation or Reinstatement of APRN Licensure).

(B) If more than four years have lapsed since completion of the APRN education program, and/or the applicant has not practiced in the APRN role during the previous four years, the applicant shall successfully complete a refresher course or extensive orientation in the appropriate APRN role and population focus area that includes a supervised clinical component by a qualified preceptor who meets the requirements of §221.10 of this chapter.

(i) The course(s)/orientation shall be of sufficient length to satisfy the learning needs of the applicant and to assure that he/she meets the minimum standard for safe, competent care and include a minimum of 400 hours of current practice as described in this paragraph. The course(s)/orientation shall cover the entire scope of the authorized APRN role and population focus area. Content shall comply with the requirements specified in the form titled "Requirements for APRN Refresher Course or Extensive Orientation", which is adopted by reference in §221.10 of this chapter.

(ii) The preceptor must provide written verification of satisfactory completion of the refresher course/extensive orientation on forms provided by the Board and assurance that the individual has reviewed current practice-related information pertinent to his/her APRN role and population focus area.

(9) An applicant must attest, on forms provided by the Board, to having obtained 20 contact hours of continuing education within the last 24 calendar months appropriate for the APRN role and population focus area for which the applicant is applying. Continuing education in the APRN role and population focus area must meet the requirements of Chapter 216 of this title (relating to Continuing Competency). The 20 contact hours required for RN licensure may be met by the 20 hours required by this paragraph.

(10) APRN applicants who wish to practice in more than one role and/or population focus area shall complete additional education in the desired area(s) of licensure in compliance with the education requirements set forth in this chapter and meet all requirements for licensure in each additional role or population focus area. To apply for licensure for more than one role and/or population focus area, the applicant shall submit a separate application and fee for each desired role and/or population focus area. Additional licensure is required for those licensed APRNs seeking to iclude an additional:

(A) APRN role and population focus area;

(B) Population focus area within the same APRN role; or

(C) APRN role within the same population focus area.

(b) Licensure of an Internationally Educated APRN.

(1) An internationally educated applicant for licensure as an APRN in Texas shall:

(A) Graduate from a graduate or post-graduate level APRN education program equivalent to an APRN education program in the United States that is accepted by the Board. All curricular requirements set forth in this rule must be met.

(B) Submit documentation through an official transcript directly from the international nursing education program and an original Credential Evaluation Service (CES) Full Education course-by-course report, sent directly from an approved organization for the license being sought.

(2) An internationally educated APRN applicant shall meet all other licensure criteria required of applicants educated in the United States.

(c) Application for Licensure by Endorsement.

(1) An applicant for licensure by endorsement as an APRN in this state shall submit to the Board the required fee as specified in §223.1 of this title, verification of licensure or privilege to practice as a registered nurse in Texas, and a completed APRN application that provides the following information:

(A) Graduation from a graduate or post-graduate level APRN education program, as evidenced by an official transcript or other official documentation received directly from a graduate program accredited by a nursing accrediting body that is recognized by the U.S. Secretary of Education and/or Council for Higher Education Accreditation, or its successor organization, as acceptable by the Board.

(B) Documentation of education shall verify the date of graduation; credential conferred; number of clinical hours completed; completion of three separate graduate level courses in advanced physiology and pathophysiology, advanced health assessment, and advanced pharmacology that includes pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of all broad categories of agents; role and population focus area of the education program; and evidence of meeting the standards of nursing education in this rule.

(2) An applicant must provide evidence of current certification by a national certifying body in the APRN role and population focus area appropriate to the APRN educational preparation. National certifications accepted for APRN licensure shall meet the requirements for national certification programs set forth in this rule. Primary source verification of certification is required.

(3) An applicant must attest, on forms provided by the Board, to having completed a minimum of 400 hours of current practice within the last 24 calendar months in the APRN role and population focus area for which the applicant is applying, unless the applicant has completed an APRN education program in the APRN role and population focus area within the last 24 calendar months.

(A) If the applicant has not been in clinical practice in the APRN role and population focus area for at least 400 hours within the past two years, the applicant shall provide evidence of:

(i) Satisfactory completion of 20 contact hours of continuing education within the two years prior to applying for licensure; and

(ii) If less than four years but more than two years have lapsed since completion of the APRN education program and/or the applicant does not have 400 hours of current practice in the APRN and population focus area during the previous 24 calendar months, the APRN shall be required to demonstrate proof of completion of 400 hours of current practice obtained under the direct supervision of a qualified preceptor who meets the requirements of §221.10 of this chapter.

(B) If the applicant has not been in clinical practice for more than the past four years, the applicant shall provide evidence of satisfactory completion of 45 contact hours of pharmacotherapeutics within the two years prior to application. The applicant must also successfully complete a refresher course or an extensive orientation in the appropriate APRN role and population focus area that includes a supervised clinical component by a qualified preceptor who meets the requirements of §221.10 of this chapter.

(C) The course(s)/orientation shall be of sufficient length to satisfy the learning needs of the applicant and to assure that he/she meets the minimum standard for safe, competent care and include a minimum of 400 hours of current practice as described in this paragraph. The course(s)/orientation shall cover the entire scope of the authorized APRN role and population focus area. Content shall comply with the requirements specified in the form titled "Requirements for APRN Refresher Course or Extensive Orientation", which is adopted by reference in §221.10 of this chapter.

(D) The preceptor must provide written verification of satisfactory completion of the refresher course/extensive orientation on forms provided by the Board and assurance that the individual has reviewed current practice-related information pertinent to his/her APRN role and population focus area.

(4) Identification of any state, territory, or country in which the applicant holds a professional license or credential, if applicable, must be provided. Required information includes:

(A) The number, type, and status of the license or credential; and

(B) The original state or country of licensure or credentialing.

(5) An applicant must provide the date and jurisdiction the applicant previously applied for a license in another jurisdiction and either was denied a license, withdrew the application, or allowed the application to expire, as applicable.

(6) An applicant must provide a detailed explanation and supporting documentation for each affirmative answer to questions regarding the applicant's eligibility for licensure.

(7) An individual who has reason to believe that he or she may be ineligible for APRN licensure or prescriptive authorization may petition the Board for a declaratory order as to his or her eligibility by submitting a petition, on forms provided by the Board, and the fee required in §223.1 of this title (relating to Fees).

(A) The petition shall include:

(i) a statement by the individual indicating the reason(s) and basis of his/her potential ineligibility;

(ii) if the potential ineligibility is due to the individual's criminal history, all court documents, including, but not limited to: indictments, agreements for pre-trial diversion or deferred prosecution, orders of deferred adjudication, judgments, probation records, and evidence of completion of probation, as applicable;

(iii) if the potential ineligibility is due to the individual's mental health condition or diminished capacity, verifiable and reliable evidence of controlled behavior and consistent compliance with recommended treatment, including compliance with a prescribed medication regime, for a reasonable amount of time, as applicable;

(iv) if the potential ineligibility is due to the individual's substance use disorder and/or the abuse/misuse of alcohol or drugs, verifiable and reliable evidence of sobriety and abstinence from drugs and alcohol, which may include evidence of the completion of inpatient, outpatient, or aftercare treatment, random drug screens, individual or group therapy, and/or support group attendance; and

(v) an evaluation that meets the criteria of the Occupations Code §301.4521 and §213.33 of this chapter (relating to Factors Considered for Imposition of Penalties/Sanctions), if applicable.

(B) Once the Board has received all necessary information, including the information required by subparagraph (A) of this paragraph, an investigation shall be conducted. The investigation will be based upon an evaluation of the individualized factors of the case, the potential risk of harm the individual's practice may pose to patients/clients and/or the public, and the individual's ability to meet the requirements of §213.27 (relating to Good Professional Character), §213.28 (relating to Licensure of Individuals with Criminal History), and §213.29 (relating to Fitness to Practice) of this title, as applicable. Based upon the individualized facts of the case, the Board may approve licensure or prescriptive authorization without encumbrance, impose probationary conditions or restrictions on the individual's ability to practice advanced practice nursing in this state, or limit or deny licensure or prescriptive authorization.

(C) If the Executive Director proposes to find the individual ineligible for licensure or prescriptive authorization, the individual may obtain a hearing before the State Office of Administrative Hearings (SOAH). The Executive Director shall have discretion to set a hearing and give notice of the hearing. The hearing shall be conducted in accordance with §213.22 of this title (relating to Formal Proceedings) and the rules of SOAH. When in conflict, SOAH's rules of procedure will prevail. The decision of the Board shall be rendered in accordance with §213.23 of this title (relating to Decision of the Board).

(D) An individual whose petition is denied may re-petition or seek licensure or prescriptive authorization after the expiration of one year from the date of the proposal to deny eligibility.

(8) APRN applicants who wish to practice in more than one role and/or population focus area shall complete additional education in the desired area(s) of licensure in compliance with the educational requirements set forth in this chapter and meet all requirements for licensure in each additional role or population focus area. To apply for licensure for more than one role and/or population focus area, the applicant shall submit a separate application and fee for each desired role and/or population focus area. Addition licensure is required for those licensed APRNs seeking to include an additional:

(A) APRN role and population focus area;

(B) Population focus area within the same APRN role; or

(C) APRN role within the same population focus area.

Source Note: The provisions of this §221.4 adopted to be effective February 27, 2019, 44 TexReg 833