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BON-APN Case Analysis 

 Case Analysis ;  Based on Texas Occupations Code and Statutes Regulating the Practice of Nursing, As Amended 2013 (www.bon.state.tx.us (Links to an external site.)). Rules 217.11 (Links to an external site.); 217.12 (Links to an external site.); 221 (Links to an external site.); 222. (Links to an external site.)
CASE 
At the time this incident occurred, the individual had been an ANP for 21 years and had prescriptive authority for eight (8) years.  He had been employed in the practice setting in which the incident occurred and worked with the same delegating physician for 17 years.
The ANP had been experiencing difficulty sleeping and anxiety over a period of time due to personal issues. Rather than discuss these issues with his delegating physician, he wrote prescriptions for lunesta and lorazepam in someone else’s name and attempted to fill them at the local pharmacy. The pharmacist recognized that the prescriptions were fraudulent and reported the incident to local law enforcement.  The ANP was arrested and ultimately received a sentence of two years deferred adjudication community supervision for a third degree felony ---possession of a controlled substance by fraud-prescription”.
Instructions:
Read the Adult Nurse Practitioner case and note all Rules that apply.  Note: When responding to the questions, identify the applicable rule by using number/s and or letter/s of the statute/regulation.  For example: Rule 224.1 (2) (A). Do not include the text of the rule in your response.
221.    Identify the appropriate statements from Rule 221.13 Core Standards for Advanced Practice that relate to this case?
222.    Identify the appropriate statements from Rule 222.4 Minimum Standards for Carrying Out or Signing Prescriptions that relate to this case?
223.    Identify the appropriate statements from Rule 217.12 Unprofessional Conduct that relate to this case?
224.    Identify the appropriate statements from Rule 222.10 Enforcement that relate to this case?

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 BON-APN Case Analysis

The Texas Board of Nursing seeks to protect the public by ensuring that every nurse in the state is competent enough to practice safely. Nurses are also mandated to adhere to the set guidelines for best practice. In the case study, the ANP has practiced for 21 years with prescriptive authority for 8 years. He is experiencing anxiety and difficulty sleeping for a long time but does not discuss it with the delegating physician. Instead, he fakes prescriptions for Lunesta and Lorazepam using another patient's name and attempts to fill the prescription at a local pharmacy. Eventually, he is apprehended and charged with the offense.

Core Standards for Advanced Practice

The core standards for nursing practice are a guide for advanced nurses in their conduct and practice in Texas. The BOP-APN case is an example of gross misconduct under rule 222.13 (a). It is evident that although the nurse understands the law of proper conduct and functioning as an APRN, he acts in defiance and engages in gross misconduct. His actions are not within the stipulated boundaries of the appropriate advanced practice category.

Minimum Standards for Prescribing or Signing Prescriptions

The minimum standards for prescribing or signing of prescriptions is a guide for APRNs to remain within the scope of practice in delegating their responsibilities to patients. However, the case summary shows a violation of rule 222.4 (1) (B) by going against the minimum prescription requirements in Texas. Although the law is clear that prescriptions are only for patient populations, the APRN in the case unlawfully writes one for his personal use. He also violates rule 222.4 (3) by failing to comply with the requirements outlined in the prescription directives protocols of supervising physicians to the APRN. The pharmacy’s recognition of the fraudulent prescription and the court action is evidence that the APRN violated the minim requirements in prescription orders.

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Unprofessional Conduct

The case analysis depicts a situation of unprofessional conduct for the APRN intended to prevent the client and the general public from illegal conduct. Under rule 217.12 (1) (A), the nurse carelessly fails in conforming to the minimum standards of acceptable nursing practice in rule 222.4. He also fails to practice within the modified scope of practice within the required accommodations of rule 217.2 (3) for prescriptive authority.  In contrast, there is evidence of misconduct within the stipulation of rules 217.2 (6) (H) and B through falsifying the prescription for personal use. He wrongfully uses the name of a patient to obtain controlled drugs which are consistent with providing false and misleading information to the pharmacy. All the entries in the prescription are wrong and indicate an intention to abuse the professional authority of APRNs.

The case shows that the APRN has been sick for a long time from anxiety and reduced sleep. Under rule 217.12 (E), he accepts his nursing responsibilities when there is clear proof that his health could be a hindrance to unsafe or ineffective care for patients. Evidence shows that inadequate sleep impairs performance and attention and results in an increased possibility for medical errors (Lockley et al., 2006). Therefore, the APRN's decision to continue working irrespective of her poor health is gross misconduct under Texas law by predisposing patients to adverse health consequences.

Enforcement

Under Texas law, violation of the prescription authority warrants disciplinary action. Under section 222.10 (2), the nurse violates the prescription authority by prescribing drugs for personal use. The violation makes him subject to termination of authority to order or prescribe through the disciplinary action of the board. The board is also mandated to report the conduct in question to the Texas Medical Board and the Texas Physician Assistant Board and start an investigation for the AP and the assistant physician under rule 222.10 (c) (d). The board also keeps a list of APRNs that go through disciplinary action in accordance with violation of the prescriptive authority in accordance to rule 222.10 (g). 

 

 

References

Lockley, S. W., Barger, L. K., Ayas, N. T., Rothschild, J. M., Czeisler, C. A., & Landrigan, C. P. (2007). Effects of health care provider work hours and sleep deprivation on safety and performance. The Joint Commission Journal on Quality and Patient Safety, 33(11), 7-18.

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