All NPAs are first licensed and must retain the RN licence to retain the extended exercise licence. An APRN must not accept a transfer: within the scope of an RN [board rule 221.12 (2) (texreg.sos.state.tx.us/public/readtac TacPage? p_dir p_rloc-p_tloc-p_ploc-p_tac-ti-22-pt-11-ch-221-rl-12] When the APRN operates in the RN, the field of practice is limited to that of the RN. RNAs, which are also APRN, should not enter the APRN area and deal with activities such as medical diagnosis and control or prescribing during exercise in the RN. It is also important to note that an RN that holds the current licence as an APRN is maintained at the highest level of its training and skills. On the other hand, there may be a situation in which a nurse takes care of an RN patient and, because of her knowledge and skills in medical diagnosis and management, there may be signs and symptoms of a medical condition that is not easily visible for an RN that is not an NRPA. In this case, the RN has no right to diagnose and manage this particular patient, since he is at that time outside the scope of RNA practice, but must recognize the disease (based on his advanced practical training) and take appropriate care measures, for example. B notify an appropriate provider. The Boards 15.15 Boards` Jurisdiction Over a Nurse`s Practice in Any Role and Use of the Nursing Title (www.bon.texas.gov/practice_bon_position_statements_content.asp#15.15) provides further details. In addition, the dual-licence nurse should determine how she identifies when interacting with the public, based on the preference and installation policy. During the RN exercise, RNAs must clearly identify themselves as registered nurses in accordance with Rule 217.10 (www.bon.texas.gov/rr_current/217-10.asp).
RNAs that are also licensed as APRN are not prohibited from using the name APRN when practicing RN. However, the use of APRN login information during RN practice may mean to colleagues that APRN is used in the role of APRN, although it is actually practiced in the RN role. This may lead the NRNPA to be invited or to expect to exercise beyond the scope of the RN if it does not have an appropriate medical delegation. The nurse and employer may want to think about these concepts and plan ahead to avoid role confusion.  Medical assistants may be parties to an AAP. The Texas Law on Delegated Standards Powers is exactly the same for APRN and PAS. The agreement through the standards authority determines who can serve as an assistant physician when other medical supervision is used. When one or the other physicians participate in quality assurance and improvement meetings with the APRN, this information must be included in the Standardization Authority Agreement.