The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise:

1. (1) Advanced educational program--A post-basic advanced practice nurse program at the certificate or master's degree level. Beginning January 1, 2007, a master's degree in the advanced practice role and specialty will be required for recognition as an Advanced Practice Nurse.
2. (2) Advanced Practice Nurse (APN)--A registered professional nurse, currently licensed in the State of Texas, who is prepared for advanced nursing practice by virtue of knowledge and skills obtained in an advanced educational program of study acceptable to the board. The advanced practice nurse is prepared to practice in an expanded role to provide health care to individuals, families, and/or groups in a variety of settings including but not limited to homes, hospitals, institutions, offices, industry, schools, community agencies, public and private clinics, and private practice. The advanced practice nurse acts independently and/or in collaboration with other health care professionals in the delivery of health care services.
3. (3) Authorization to practice--The process of reviewing the educational, licensing, certification and other credentials of the registered nurse to determine compliance with the board's requirements for approval as an advanced practice nurse.
4. (4) Board--The Board of Nurse Examiners for the State of Texas.
5. (5) Current certification--Initial certification and maintenance of certification by certifying bodies recognized by the board.
6. (6) Current practice--Maintaining competence as an advanced practice nurse by practicing as a clinician, educator, consultant or administrator.
7. (7) Monitored anesthesia care--refers to situations where a patient undergoing a diagnostic or therapeutic procedure receives doses of medication that create a risk of loss of normal protective reflexes or loss of consciousness and the patient remains able to protect the airway for the majority of the procedure. If, for an extended period of time, the patient is rendered unconscious and/or loses normal protective reflexes, then anesthesia care shall be considered a general anesthetic.

8. (8) Outpatient setting--Any facility, clinic, center, office, or other setting that is not a part of a licensed hospital or a licensed ambulatory surgical center with the exception of all of the following:

   1. (A) clinic located on land recognized as tribal land by the federal government and maintained or operated by a federally recognized Indian tribe or tribal organization as listed by the United States secretary of the interior under 25 U.S.C. Section 479-1 or as listed under a successor federal statute or regulation;
   2. (B) a facility maintained or operated by a state or governmental entity;
   3. (C) a clinic directly maintained or operated by the United States or by any of its departments, officers, or agencies; and
   4. (D) an outpatient setting accredited by either the Joint Commission on Accreditation of Healthcare Organizations relating to ambulatory surgical centers, the American Association for the Accreditation of Ambulatory Surgery Facilities, or the Accreditation Association for Ambulatory Health Care.
9. (9) Protocols or other orders--Written authorization to initiate medical aspects of patient care which are agreed upon and signed by the APN and the physician, reviewed and signed at least annually, and maintained in the practice setting of the APN. Protocols or other orders shall be defined to promote the exercise of professional judgment by the APN commensurate with his/her education and experience. Such protocols or other orders need not describe the exact steps that the APN must take with respect to each specific condition, disease, or symptom and may state types or categories of drugs which may be prescribed rather than just list specific drugs.
10. (10) Shall and must--Mandatory requirements.
11. (11) Should--A recommendation.

Source Note:The provisions of this §221.1 adopted to be effective April 20, 2000, 25 TexReg 3251.