Professional Nursing and State-Level Regulations NRSE 6050

Sample Answer for Professional Nursing and State-Level Regulations NRSE 6050 Included

Professional Nursing and State-Level Regulations NRSE 6050

Professional Nursing and State-Level Regulations NRSE 6050

A Sample Answer for The Assignment: Professional Nursing and State-Level Regulations NRSE 6050

Title: Professional Nursing and State-Level Regulations NRSE 6050

In the United States, different states have APRN boards that are tasked with developing unique regulations to govern how nurse practitioners operate within clinical settings (Yang et al., 2021). Broadly, the regulations set by these boards fall under three broad categories full practice, reduced or restricted. This analysis compares the Practices of APRNS in the state of Maryland where I live, and to another state, North Carolina where practice restrictions differ. In Maryland, Nurse Practitioners have the authority to independently prescribe medications, diagnose conditions, and administer treatments, their counterparts in North Carolina do the same but under the keen supervision of physicians (McMichael & Markowitz, 2023). To demonstrate this by example, a Nurse practitioner in Maryland would be able to autonomously manage chronic conditions like diabetes. Quite the opposite, a Nurse Practitioner in North Carolina would require the oversight and close supervision of a physician to engage in activities such as making adjustments to insulin regimens.

Needless to say, these regulations by APRN boards impact nursing practice in several ways. According to McMichael & Markowitz (2023), in states where nurses have full practice authority for example in Maryland, these healthcare professionals are free to exercise their legal right of practicing autonomously. In their report on this, Alexander and Schnell (2019) wrote that in full practice states, these professionals are authorized to engage independently in activities such as prescribing medications, diagnosing medical conditions, and providing treatments. The benefit this authority has is allowing APRNs to optimize their skills. More importantly, this full practice authority demonstrates a commitment to recognizing the full scope of nursing practice expertise. Suffice it to say, that nurse practitioners must adhere to these stipulated regulations and a practical way in which they can do this is by ensuring that they fully understand the specific requirements that these regulations have. Secondly, they must appreciate the differences between different states, especially those planning to move from one state to another. These two approaches are necessary to ensure that these practitioners abide by the set practice regulations.

Every State has different laws and regulations that impact APRNs practice, determined by individual state legislation and specific agency (Milstead & Short, 2019). The Nurse Practice Act (NPA) defines the regulation of nursing practice, which varies by State, and is governed by its state Board of Nursing (BON) to regulate the practice of nursing with the primary focus to protect the public health, safety, and welfare of its citizens.

The American Nurses Association (ANA) represents all APRNs’ interest and believes that patients’ interests are best served by a health care system in which many different types of qualified professionals are available, accessible, and working together – collaboratively. Therefore, the scope of practice needs to reflect a professional’s true expertise (American Nurses Association, n.d.).

Starting July 2020, APRNs in Florida were able to practice independently, without a physician’s supervision, and to operate primary care practice in family medicine, general pediatrics, and general internal medicine. To qualify, the APRN needs to accumulate 3,000 hours of experience under physician supervision. APRNs have to complete minimum graduate-level course work in differential diagnosis and pharmacology and have not been subject to disciplinary action within the past five years (Florida Board of Nursing, n.d.).

The passage of the bill demonstrates a commitment to the modernization of the way health care is delivered. APRNs can practice to the full extent of their education and abilities to provide the most efficient quality care to patients (American Nurses Association, n.d.). With this passage, people from Florida will have more access to health care, particularly in rural areas that are often underserved.

In contrast, although Texas recently eliminated the requirement of on-site physician supervision for Nurse Practitioners, they remained under restricted practice. State law requires a physician to provide continuous supervision, but the constant physical presence is not needed (Nurse Practitioner Schools, 2019). APRNs provide patient care by delegation from physicians.

A physician must delegate the prescriptive authority through a written document prescribed by law, and certain limitations apply to prescribing Controlled Substances (CSs), as schedules III-V. Schedule II may also be delegated depending on the patient’s pressing needs (Coalition for Nurses in Advanced Practice, n.d.). Supervising physicians are mandated to track prescriptions written by APRNs, perform chart reviews, and meet monthly.

To continue practicing as an APRN in Florida and Texas, one must maintain the State required continuing education courses and an additional three contact hours related to prescribing controlled substances. Texas requires practicing a minimum of 400 hours in their role and population focus area and shall attest to completing additional five contact hours in pharmacotherapeutics (“Texas Board of Nursing – Nurses,” n.d.). To continue practicing as an APRN in Texas, they should maintain and renew their RN and APRN licensed at the same time.

Florida and Texas are just one example of different States with different regulations. Every State has specific laws.  An APRN needs to understand the rules for the State that they are interested in practicing in. One must always ensure that you are practicing within your scope to protect the patients you are caring for and safeguard your license that you worked so hard to obtain.

Professional Nursing and State-Level Regulations NRSE 6050 References

•  American Nurses Association. (n.d.). Scope of practice. ANA. https://www.nursingworld.org/practice-policy/scope-of-practice/
• Coalition for Nurses in Advanced Practice. (n.d.). Waiting for the redirection… Waiting for the redirection… https://cnaptexas.com/aprn-practice/prescribing/prescribing-in-texas/
• Florida Board of Nursing. (n.d.). HB 607 passes legislature – Impact to RNs, CNAs, and APRNs. Florida Board of Nursing – Licensing, Renewals & Information. https://floridasnursing.gov/hb-607-passes-legislature/
• Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics A Nurse’s Guide (6th ed.). Jones and Bartlett Learning.
• Nurse Practitioner Schools. (2019, November 15). Texas nurse practitioner practice authority: The fight for FPA. NursePractitionerSchools.com. https://www.nursepractitionerschools.com/blog/texas-np-practice-authority/
• Texas Board of Nursing – Nurses. (n.d.). Welcome to the Texas Board of Nursing Website. https://www.bon.texas.gov/newaprn.asp

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

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RE: Discussion – Week 9

To Prepare:

• Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
• Consider how key regulations may impact nursing practice.
• Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.

For California, which is the state I currently reside in, NPs have restricted practice. According to the American Association of Nurse Practitioners (2022), there are three practice environments for NPs: full practice, reduce practice, and restricted practice. There are currently 11 states including California who are restricted practice.

Restricted practice means that during the NPs career they must be supervised by a physician to be able to practice and the physicians must agree with the NPs assessment and approve the care plan and prescriptions associated with that assessment (American Association of Nurse Practitioners, 2022).

Recently, the California governor signed AB 890 which provides two different routes an NP can take to independently practice. One route taken effect since January 2021 allows NPs to continue to practice in any healthcare facility as long as there is one or two physicians employed there but does not have to be directly supervised while the other NP route which will take effect in January 2023 allows NPs to practice independently and open their own clinic, but they would have to be in good standing and have practiced three plus years (Montague, 2020). Even with this information, the AANP still shows California as being a restricted practice state maybe the official change won’t occur until 2023.

For Minnesota, where Walden University is located, NPs have full practice. This means that NPs can diagnose, prescribe medications including controlled substances, order and interpret diagnostic tests, and initiate and manage treatments based on the licensure of the state board of nursing (American Association of Nurse Practitioners, 2020).

However, new NPs must work 2,080 hours under what Minnesota calls a collaborative management in which the NP must work collaboratively with a physician (Minnesota Board of Nursing, 2022).

To my understanding since the California governor signed the AB 890, this allows NPs in California to practice to their full scope independently just like a full practice state so APRNs in both California and Minnesota can practice fully if they are in good standing with the board and continue to meet the requirements to keep their license.

Professional Nursing and State-Level Regulations NRSE 6050 References

• American Association of Nurse Practitioners. (2022). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment
• Minnesota Board of Nursing. (2022). Advanced practice registered nurse (APRN) licensed general information. https://mn.gov/boards/nursing/advanced-practice/advanced-practice-registered-nurse-(aprn)-licensure-general-information/
• Montague, A. (2020, December 15). Expanding scope of practice for nurse practitioners in California: AB 890 compromises to permit independent practice. The Source on HealthCare Price and Competition. https://sourceonhealthcare.org/expanding-scope-of-practice-for-nurse-practitioners-in-california-ab-890-compromises-to-permit-independent-practice/

By Day 3 of Week 5

Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected. 

READINGS

1 Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

• Chapter 4, “Government Response: Regulation” (pp. 57–84)

2 http://www.nursingworld.org/

3Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761–765. doi:10.1016/j.outlook.2017.10.002

Note: You will access this article from the Walden Library databases.

4 https://class.waldenu.edu/bbcswebdav/institution/USW1/202050_27/MS_NURS/NURS_6050/artifacts/USW1_NURS_6050_Halm_2018.pdf

5 https://www.ncsbn.org/index.htm

6 Neff, D. F., Yoon, S. H., Steiner, R. L., Bumbach, M. D., Everhart, D., & Harman J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379–385. doi:10.1016/j.outlook.2018.03.001

Note: You will access this article from the Walden Library databases.

7 Peterson, C., Adams, S. A., & DeMuro, P. R. (2015). mHealth: Don’t forget all the stakeholders in the business case. Medicine 2.0, 4(2), e4. doi:10.2196/med20.4349

Note: You will access this article from the Walden Library databases.

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Professional Nursing and State-Level Regulations NRSE 6050 SAMPLE

Different states tend to have unique regulations for the Advance Practice Registered Nurse but all aims at securing the interest of the public health safety by regulating the activities of the health care professionals (Milstead, 2019). The board of nursing of a state acts on the power derived from the Nurse Practice Act passage that allows them to set and regulate standard for safe nursing practice within its jurisdiction for nurses that have the qualification and for advanced practice including licensure requirements and license renewal as well as any necessary disciplinary actions (Milstead, 2019).

Comparing the State of Georgia, my home state APRN board of nursing regulation to that of the State of Nebraska; the first thing I noticed is that Georgia state regulatory body is the board of nursing while that of Nebraska is the Department of Health and Human Services. The credentialing criteria are similar, but there are some differences in the scope of practice.

Georgia state practice regulation has a restrictive tendency; the practice authority allows limited actions for APRN practice requiring supervision by health care provider throughout the APRN’s practice or team management before an APRN such as an NP can provide care to patients (American Association of Nurse Practitioners (AANP), 2018).

In the state of Georgia, the practice authority requires a written protocol between the NP and the overseeing physician which specifies medical acts delegated by the physician and demands an instant session with the physician (Scope of Practice Policy, 2019). No wonder at my practice setting an NP is not allowed to initiate care nor partake in a patient discharge process.

On the other hand, Nebraska state and licensure law permit all NPs to exercise autonomy in practice such that they can assess patients, diagnose, order diagnostic tests, initiate and manage treatments, prescribe all medications including control substances without a provider’s supervision after fulfilling the criteria for doing so (Nebraska legislature, n.d).

Allowing APRNs to have full practice access will enable an increase in experience and expand the talents inherent in the nurse practitioners and encourage significant innovations in the nursing profession; also motivates other NPs to spring up in filling the gap created by the shortage of providers in America.

In Georgia, an NP can only prescribe a schedule III to V control substance if operating under the prescriptive authority of a supervising physician by submitting a written protocol to the supervising physician and permission is granted (American Medical Association (AMA), 2017). While in Nebraska, an NP may prescribe both legend drug and Schedules II-V controlled substances after the NP has put in first 2000 hours of practice under the supervision of a physician as well as completing 30 hours of education in pharmacotherapeutics and the board does not track the number of the NPs with DEA numbers (AMA, 2017).

Both states require that providers should register in the prescription drug monitoring program (PDMP) for Benzodiazepines and opiates but the difference is that APRN in Georgia is practicing under the prescriptive authority of a physician and are not able to delegate access to PDMP unless a nurse who has prescriptive authority (Georgia Department of Public Health, 2018). While in Nebraska, APRN has prescriptive authority; thus, can delegate access to PDMP (Borcher, 2016).

It would be to the perfect interest of patients and the society as a whole for all the APRN in America to have equal full legal authority in all the states as in Nebraska to enable them to practice within the full scope of the education and experience they have earned through rigorous academic and clinical training.

According to Doyle et al., (2017), NPs have all it takes to practice to the full scope of education gained; this prompted the IOM to call on states with unjustifiably restrictive regulations on the NPs like Georgia state to amend the law that will authorize NPs to practice to the full scope of their ability across the countries. Also as mentioned earlier, allowing NPs to have full practice authority that would enable them to practice and prescribe independently would assist in addressing the workforce shortage allowing underserved areas to have access to health care as well as all Americans in general (Doyle et al., 2017)

Professional Nursing and State-Level Regulations NRSE 6050 References

• American Association of Nurse Practitioners. (2018). Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment
• American Medical Association. (2017). Retrieved from https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-prescriptive-authority.pdf
• Borcher, K. C., & Houseman, R. (2016). Nebraska and Prescription Drug Monitoring Program. Retrieved from http://www.nebraskahospitals.org/file_download/inline/c0cd1c7d-0de6-477d-b92c-0cee2f87f23d
• Doyle, J. M., Zangaro, G. A., Howie, B. A., & Bigley, M. B. (2017). Retrospective Evaluation of the Advanced Nursing Education Expansion Program. The Journal for Nurse Practitioners, 13 (97), 488-495 DOI:10.1016/j.nurpra.2017.04.019
• Georgia Department of Public Health. (2018). Retrieved from https://dph.georgia.gov/pdmp
• Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning
• Nebraska legislature (n.d). Retrieved from https://nebraskalegislature.gov/laws/statutes.php?statute=38-2315
• Scope of practice policy. (2019). Georgia Scope of Practice Policy: State Profile. Retrieved from http://scopeofpracticepolicy.org/states/ga/#practitioner-nurse-practitioners

Advanced practice registered nurses practice is distinct state by state and the APRN scope of practice and regulative criteria vary from nurses with same qualifications and titles in each state (Milstead & Short, 2019). In comparing APRNs in Texas and New Mexico, there are differences in regulations based on the respective nursing boards and the scope of practice authority. In Texas, the APRN board of nursing regulations mandates nurse practitioners to restricted practice. The NPs can only engage in one element of practice and should be on career-long supervision of a physician. APRNs should also have registered nurse license, graduate degree and have national certification. The Texas Board of Nursing also mandates APRNs to meet the Nurse Practice Act and all its requirements (Texas Board of Nursing, 2021). In New Mexico, Nurse practitioners are under the Nurse Practice Act and must register with the Prescription Monitoring Unit. The APRNs have full practice authority and can prescribe drugs and controlled substances. The APRNs are also regulated by the state Board of Nursing and should have national certification and graduate degree qualification (NMNPC, 2020). The implication is that certified family nurse practitioners (FNPs) as a specialty in APRN may also have variations based on states. In Texas, family nurse practitioners must have supervising physicians to provide patient care. However, in New Mexico FNPs are allowed to practice independently to the full extent of their training and education.

The regulations impact APRNs who have legal authority to practice to the full level of their education and experience as they set guidelines for those practicing with the profession to protect their titles and the public (Laureate Education, 2018). APRNs comply with the regulations by ensuring that they update their licenses, meet the requirements for continuing education and training and enhancing patient safety and competence in their nursing practice.

Professional Nursing and State-Level Regulations NRSE 6050 References

Laureate Education (Producer). (2018). The Regulatory Process [Video file]. Baltimore, MD:

            Author.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).

            Burlington, MA: Jones & Bartlett Learning.

New Mexico Nurse Practitioner Council (2020). Practice Regulations.

            https://www.nmnpc.org/page/PracticeRegs

Texas Board of Nursing. (2021) Practice-APRN Scope of Practice.

            https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp

Healthcare access and delivery continues to grow in the United States as advanced practice registered nurses (APRNs) work through the legislative and regulatory process to enact and amend current statutes and regulations in individual states (Phillips, 2014). If nurses at all levels can come together and join various organizations with one mind and push forth for APRNs to practice at their full potential in all states of the nation, it will come to pass. There are a lot of benefits. I believe the best, just like in states that allow APRNs full practice authority, the rate of hospitalization and health issue has; been reduced if such conditions can be successful in the healthcare sectors that can be applied in other states that restrict APRNs from practicing to their full potential. I equally accept your statement; “To adhere to the certification and licensure regulations, APRNs must ensure that they have obtained the appropriate certification and licensure from a recognized national certification organization such as the American Nurses Credentialing Center.” To practice well, one must be certified, and there must be rules and regulations that will guard and checkmate such activities.

Major organizations of nursing professionals have endorsed the Consensus Model, indicating the importance of this significant step toward standards and consistent quality in APRN education and practice. Diverse regulatory criteria, such as variable accreditation standards, disparate certification and licensing requirements, inconsistent population foci, and scopes of practice, represent barriers to optimized APRN function within today’s complex healthcare system and, ultimately, reduced access to safe, quality care for patients (Rounds et al., 2012). Please note that the ‘Consensus Model’ for APRN Regulation is a proposed solution to simplify and unify the regulation of advanced nursing practice concerning licensure, certification, accreditation, and educational standards (Rounds et al., 2012). Nurses need to acquire all the necessary education they can get to be ready to practice at the highest level of their profession; nurses also need to join politics to make it easier to enact bills that will benefit the healthcare industry and help the masses, especially the less privileged.

Having a high educational level and involvement in a professional organization are each individually statistically associated with perceiving practice barriers, engaging in political activism, and willingness to speak with media. Emerging nurse leaders need an understanding of policy issues, an appreciation of the profession’s potential, and enhanced advocacy skills. To address the nation’s health needs, APRNs need to recognize practice barriers, develop advocacy skills, and take action for policy changes to enhance the legal authority to practice to the full extent of APRNs’ education and training (Kung & Rudner, 2015). Thank you for your input.

References:

Kung, Y. M., & Rudner Lugo, N. (2015). Political advocacy and practice barriers: A survey of Florida APRNs. Journal of the American Association of Nurse Practitioners, 27(3), 145-151.

Phillips, S. J. (2014). 26th Annual Legislative Update: Progress for APRN authority to practice. The Nurse Practitioner, 39(1), 29-52.

Rounds, L. R., Zych, J. J., & Mallary, L. L. (2012). The consensus model for regulation of APRNs: Implications for nurse practitioners. Journal of the American academy of nurse practitioners, no-no.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of A

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Mission of California Board of Registered Nurses to Protect the Public.

The California Board of Registered Nursing (BRN) is responsible for ensuring that nurses in California meet the standards of practice and are competent to provide safe and effective care to patients. The mission of the California Boards of Nursing is to protect the people through the regulation of nursing practice. The BRN achieves its mission by setting standard for nursing, education, licensure, and practice. They investigate complaints made against nurses and take disciplinary action when necessary to protect the public from unsafe nursing practices. The boards work closely with schools, employers and other stakeholders to promote high-quality nursing care and to make sure the nurses are up to date with new policies and procedures license (California Board of Registered Nursing, n.d).

California Key Regulations

Key regulations can have significant impact on nursing practice in California. One example of a key regulation that has impact on nursing practice is the requirement for nurses to maintain a valid license. The board requires nurses to renew their licenses every two years and o complete continuing education requirements to ensure that they are up to date with the latest developments in the fields. Failure to maintain a valid license can result in disciplinary actions, including revocation of the license (California Board of Registered Nursing, 2021). Another key regulation that impacts nursing practice in California is the Nurse Practice Act (NPA). This act outlines the scope of practice for registered nurses and licensed vocational nurses in the state. It defines the legal and ethical responsibly for the nurses and sets standard for nursing education, licensure and practice (NCSBN, n.d). Nurses must adhere to the NPA to ensure that they are providing safe and effective care to patients.

Key Regulations for Nursing Practice in California and Montana

Two key regulations that are in important to focus on by BRN and Montana Board of Nursing (MBON) in this discussion are the scope of practice and prescriptive authority:

-In California, the scope of practice for APRN’s they are authorized to diagnose and treat illnesses, order in interpret diagnosis test, and prescribe medications. However, APRN’S must worked under the supervision of a physician (California Board of Registered Nursing, 2021).  

-In Montana, the scope of practice for APRNs is defined by the MBON. APRNs in Montana are authorized to diagnose and treat illness, order and interpret diagnostic test and prescribe medications However, APRNs in Montana have full practice authority, which means that do not need to work under the supervision of a physician (Montana Board of Nursing,2021).

-Another important APRN regulation to fucus is on prescriptive authority. In California, APRNs are authorized to prescribe medications, but they must have standardized procedure in place that outlines their prescriptive authority. The must also registers with the Drug Enforcement Administration (DEA) (California Board of Registered Nursing, 2021).  

– In Montana, APRNs also have prescriptions authority, but they must obtain a separate license from the MBON in order to prescribe medications. APRNs must also register with the DEA. This regulation is design to ensure that prescribing medications is safe and appropriate (Montana Board of Nursing,2021).

Professional Nursing and State-Level Regulations NRSE 6050 References

California Board of Registered Nursing . (nd). About us. Retrieved from https://www.rn.ca.gov/about_us/

Links to an external site.

California Board of Registered Nursing . (2021). Laws and regulations. Retrieved from https://www.rn.ca.gov/about_us/

Links to an external site.

California Board of Registered Nursing. (2021). Scope of practice for advance practice registered nurses. https://www.rn.ca.gov/scope-of-practice-for-advanced-praxctice-registaered -nurses/

Links to an external site.

Montana Board of Nursing. (2021). Advanced practice registered nurse (APRN) scope of practice. https://boards.bsd.dli.mt.gov/nur/aprn-scope-of-practice

NCSBN. (n.d.). Find your nurse practice act.  https://www.ncsbn.org/policy-gov/npa

Links to an external site. toolkit/npa.page

Nurse practitioners usually work in areas where health care is needed. Unlike physicians who follow the money, nurse practitioners establish their practice in areas with the greatest health care need (Davis et al., 2018). To perform optimally, nurses should work to the fullest of their training, education, and experience. However, state-level regulations affect how nurses work, including collaboration and the power to prescribe certain medications.

Advanced Practice Registered Nurses (APRNs) work under the reduced practice in Alabama. The defining element of the reduced practice is the state regulations reducing the nurses’ ability to engage in at least one element of practice (American Association of Nurse Practitioners, 2022). One of the board’s regulations is a career-long regulated collaborative agreement with a physician; the practice commences once all the requirements are met (Alabama Board of Nursing, n.d.). The other regulation is prescribing controlled substances with varying levels of restrictions. Nurse practitioners do not have full authority to prescribe some controlled substances (Schedule II-V). The situation is somewhat different in Texas, where nurse practitioners function under restricted practice. In Texas, APRNs work under career-long supervision from physicians to provide patient care (Wofford, 2019). They cannot prescribe Schedule II drugs.

The abovementioned regulations apply differently to APRNs who have the legal authority to practice within the full scope of their education and experience. Unlike APRNs under reduced or restricted practice, APRNs under the full practice authority do not need career-long supervision or collaboration. State practice and licensure laws allow them to diagnose, treat, and prescribe medications and controlled substances (American Association of Nurse Practitioners, 2022). To adhere to the required regulations, APRNs should fully understand standardized procedures and execute their mandates as authorized.

Patient care quality and access depend on the availability of health practitioners. Despite this critical need, some states limit nurses’ ability to practice according to their education and training. Alabama is among such states since nurses are required to work under reduced practice. This implies that nurse practitioners must collaborate with another health care provider, primarily a physician.

Professional Nursing and State-Level Regulations NRSE 6050 References

Alabama Board of Nursing. (n.d.). Advanced practice nursing. https://www.abn.alabama.gov/advanced-practice-nursing/

American Association of Nurse Practitioners. (2022). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

Davis, M. A., Anthopolos, R., Tootoo, J., Titler, M., Bynum, J., & Shipman, S. A. (2018). Supply of healthcare providers in relation to county socioeconomic and health status. Journal of General Internal Medicine, 33(4), 412–414. https://doi.org/10.1007/s11606-017-4287-4

Wofford, P. (2019). Texas nurse practitioners fight for full practice authority. nurse.org. https://nurse.org/articles/texas-nurse-practitioners-fight-for-practice/

Discussion: Professional Nursing and State-Level Regulations

Advanced practice registered nurses practice is distinct state by state and the APRN scope of practice and regulative criteria vary from nurses with same qualifications and titles in each state (Milstead & Short, 2019). In comparing APRNs in Texas and New Mexico, there are differences in regulations based on the respective nursing boards and the scope of practice authority. In Texas, the APRN board of nursing regulations mandates nurse practitioners to restricted practice. The NPs can only engage in one element of practice and should be on career-long supervision of a physician. APRNs should also have registered nurse license, graduate degree and have national certification.

The Texas Board of Nursing also mandates APRNs to meet the Nurse Practice Act and all its requirements (Texas Board of Nursing, 2021). In New Mexico, Nurse practitioners are under the Nurse Practice Act and must register with the Prescription Monitoring Unit. The APRNs have full practice authority and can prescribe drugs and controlled substances. The APRNs are also regulated by the state Board of Nursing and should have national certification and graduate degree qualification (NMNPC, 2020). The implication is that certified family nurse practitioners (FNPs) as a specialty in APRN may also have variations based on states. In Texas, family nurse practitioners must have supervising physicians to provide patient care. However, in New Mexico FNPs are allowed to practice independently to the full extent of their training and education.

The regulations impact APRNs who have legal authority to practice to the full level of their education and experience as they set guidelines for those practicing with the profession to protect their titles and the public (Laureate Education, 2018). APRNs comply with the regulations by ensuring that they update their licenses, meet the requirements for continuing education and training and enhancing patient safety and competence in their nursing practice.

Professional Nursing and State-Level Regulations NRSE 6050 References

Laureate Education (Producer). (2018). The Regulatory Process [Video file]. Baltimore, MD:

            Author.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).

            Burlington, MA: Jones & Bartlett Learning.

New Mexico Nurse Practitioner Council (2020). Practice Regulations.

There is no question that political parties weigh little when it comes to matters that affect the welfare of the populace. The case in point is health care. There is a notion out there that the enactment of a given law is usually influenced by a vote at the polling station. The political climate has been that discussions about the Affordable Care Act (ACA) have created division among us and this is seen when individuals elected by the people only act on things that appeal to the voters. History has therefore taught us that voters’ expectations shape the debate and outcome of a given law. Owing to the voters’ expectations, individuals running for political offices must work hard to be elected or re-elected. Voters anticipate that politicians will be sensible when weighing the pros and cons of a given law. In this case, the pros would be the support a politician gets from supporting given legislation and the cons would be the opposition he/she gets as a consequence of his action.

The vast majority of Americans show little interest when it comes to matters concerning the repeal and replacement of ACA. All they care about is whether they will have health care coverage tomorrow and whether prescription drugs will still be affordable. On the other hand, providers want to serve the people without imposing exorbitant prices. The state views the ACA as an opportunity to conserve the existing job numbers and businesses.

Although the ACA has recorded a huge success, it still faces the possibility of being repealed and replaced. Several proposals have been put forth to either repeal or replace the ACA. There is a proposal to leave the ACA the way it is and not repeal or replace it. The effect of this proposal would be that the federal government will have to spend more on the ACA and this in turn will increase the federal debt. Voters who care about the federal debt would not support this proposal.

Some politicians have proposed to repeal and replace ACA with the American Health Security Act. With this proposal, health care cost is expected to increase by 1 trillion, a concern to people who are worried about the government debt. It is also said that endorsing this proposal will cause a decrease in expenditure and an increase in the number of people without health care coverage by 10 million. (Rand Corporation, 2019)

Another proposal is to repeal ACA and not replace it at all. It is anticipated that this proposal will save the government approximately $1 trillion – money that will be channeled to other government programs. The richest 1% support this proposal in that it will reduce their tax burden. However, this proposal would lead to an increase in insurance premiums and an estimated 15% of the population will have no health care coverage. The proposal is supported by voters who would health care coverage get health care coverage elsewhere. This proposal would not win support from the 40 million people who would go without health care coverage because they do not have the financial ability to afford coverage.

The single-payer approach was also proposed to replace ACA. The single-payer approach includes the American Health Care Act (AHCA). The AHCA aimed at abolishing the individual mandate. The single-payer approach established continuous coverage for individuals with or without coverage and changed the income-based rate to a fixed age-based rate. It is anticipated that this proposal would initially increase the deficit by 40 million before bringing it down to 6 million. This proposal would also deny health care coverage to 15 million Americans. Individuals concerned with the federal debt would be in favor of this proposal as opposed to the 15 million people who would go without coverage due to the proposal. The politicians who support the proposal would garner support from voters who are concerned with the government debt and lose the support of the 15 million who do not have health care coverage (Rand Corporation, 2019).

The above analysis speaks to the influence voters have on political decisions.

 

            First off, your post is very informative, and I liked you broke down the subject matter.   I agree with the point you made that legislators’ goal is that they remain in office and would do anything to get support for re-election.  One of the reasons why so many Americans opposed the ACA is because of their mistrust of the federal government (Dalen, Waterbrook and Alpert, 2015).   According to the authors, the percentage of people who trust the government fell from 78% back in 1964 to only 24% in 2014 (Dalen, Waterbrook and Alpert, 2015).

            The authors point out that the U.S. is one of the few first-world countries that doesn’t guarantee ongoing access to healthcare for all its citizens however, the Republican’s argument was that the ACA will lower the standard of healthcare provided in the U.S. (Dalen, Waterbrook and Alpert, 2015).  According to research, the one element that was highly unfavored was that all Americans were mandated to have insurance or else pay a fine (Dalen, Westbrook and Alpert, 2015).  

 

The Mission of State and Regional Boards of Nursing

State and regional boards of nursing play an influential role in regulating and overseeing Advanced Practice Registered Nurses (APRNs), comprising Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), Certified Nurse Midwives (CNM), and Certified Registered Nurse Anesthetists (CNRA). These boards, operating under state governmental authority and often in collaboration with regional regulatory bodies such as the National Council of State Boards of Nursing (NCSBN), establish and enforce standards for APRN education, licensure, and practice (NCSBN, n.d.). They ensure that APRNs meet the required competencies to provide safe, high-quality care, outlining their scope of practice, which may vary based on state laws and regional healthcare needs. By doing so, these boards protect public health and welfare while facilitating APRNs’ increasingly vital contributions to the healthcare system.

Illinois Board of Nursing Key Regulations

According to the Illinois General Assembly (n.d.), in Illinois, an individual is qualified for licensure as an APRN if they submit a completed application and pay any dues, hold a valid RN license to practice in Illinois, successfully complete requirements to practice, hold, and/or maintain current national certification as an NP, CNS, CNM, or CNRA from the appropriate national certifying body as determined by the Illinois Department of Financial and Professional Regulation (IDFPR), and pass the criminal background check.

In Illinois, APRNs who have completed the necessary training and education have been granted full practice authority (FPA) under section 225 ILCS 65/65-43 of the Nurse Practice Act. This allows APRNs to have FPA to practice without a collaborative agreement with a physician. To obtain FPA, the APRN must submit an application and a notarized attestation to the IDFPR, demonstrating that they have completed at least 250 hours of continuing education or training and at least 4,000 hours of clinical experience after first attaining national certification. APRNs with a practitioner license may prescribe, administer, and dispense over-the-counter medications, legend drugs, and Schedule II through V controlled substances. APRNs may also prescribe benzodiazepines or Schedule II narcotic drugs, such as opioids, but only in a consultation relationship with a physician. Advanced practicing nurses with a collaborative practice agreement must collaborate and consult with their collaborating physician at least once a month, but there is no requirement for this to be a face-to-face meeting (AMA, 2017).

California Board of Nursing Key Regulations

I decided to research and compare Illinois and California’s APRN regulations as I hope to move from Illinois to California in the future. According to the California Board of Registered Nursing (n.d.-b), an individual must hold a valid RN license issued by the California Board of RNs (BRN), obtain a postgraduate degree, earn national NP certification, and complete the certification application by the BRN. APRNs in California can assess, diagnose, and manage their patients’ health conditions by ordering and interpreting diagnostic tests, prescribing medications, and initiating and managing treatment plans. In September 2020, Governor Newsom of California signed Assembly Bill 890, which created two new categories of NPs that can function within a defined scope of practice without standardized procedures: 103 NP allows an NP to work in a group setting with at least one physician and one surgeon within the population focus of their National Certification and 104 NP allows an NP to work independently within the population focus of their National Certification (California Board of Nursing, n.d.-a). This law requires an NP to work as a 103 NP in good standing for at least 3 years before becoming a 104 NP. At this time, the BRN is only able to certify 103 NPs.

APRNs Scope of Practice

According to Neff et al. (2018), barriers imposed by state NP regulations impede optimal and independent practice, negatively affecting access to primary care in underserved areas. This constraint to NPs’ scope of practice limits NPs’ geographic spread and, thus, their ability to provide primary care in those areas that already lack access to PCPs. 20% of the US population lives in rural areas, but few have access to healthcare resources: only 9% of PCPs in these areas, and compared with urban and suburban areas, there are fewer nurses and doctors per capita (p. 380). FPA for APRNs is pivotal in maximizing their contributions to healthcare, particularly in areas grappling with provider shortages and health disparities. APRNs can independently provide a comprehensive range of services, including diagnosing and managing acute and chronic conditions, ordering and interpreting diagnostic tests, and prescribing medications. This independence can improve healthcare access and outcomes, especially in rural and underserved areas where APRNs may be the primary healthcare providers. Granting FPA also enhances the efficiency of healthcare delivery by eliminating the need for physician oversight, which can sometimes lead to delays in care. According to Bosse et al. (2017), access to high-quality, affordable, and comprehensive primary care healthcare services is critical to our nation’s health, and APRNs can help meet this need (para 2). Therefore, granting FPA to APRNs can expand the reach of healthcare services and uphold the quality of care, fostering a more effective, responsive, patient-centered health system.

Conclusion

In conclusion, state and regional boards of nursing serve an essential role in the regulation of APRNs. By establishing and enforcing education, licensure, and practice standards, these boards ensure that APRNs are equipped to provide safe and competent care. By defining the scope of practice, which may vary according to state laws and regional health needs, these boards enable APRNs to contribute significantly to the healthcare system. It is very important for us to know the APRN regulations of the state we live in and may move into to follow the regulations of each state’s board of nursing and serve our patients efficiently and safely.

https://www.nmnpc.org/page/PracticeRegs

Texas Board of Nursing. (2021) Practice-APRN Scope of Practice.

https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp

Thank you for an informative post. As the writer read the various student’s responses, there is a common theme that our professional responsibility is to understand and monitor the requirement set by the board of nursing in the practice state we choose to work. Noted differences existed in each state’s regulations in assessing the scope of practice imposed on Nurse practitioners. Convincing the writer that one state is better in state regulations is unfounded now. It seems excessive that California requires nurse practitioners to be supervised for 4,600 hours by a physician (Ibarra, 2022). What does this say about other states that have less supervision and does not recommend the DNP vs MS?

Utilizing Psychiatric Mental Health Nurse Practitioners in California face employment challenges (Chapman et al., 2021). A barrier mentioned is that PMHNPs require supervision under a psychiatrist in California. Nurse practitioners in this state are often in contractual positions with lower pay than physicians and lack benefits (Chapman et al., 2021). The authors found that psychiatric nurse practitioners also made sense from the business side to generate revenue for practices (Chapman et al., 2021).  

The writer appreciates learning so much from the student in the class. It has given her a lot to consider as she approaches her degree. 

Reference

Chapman, S. A., Phoenix, B. J., Hahn, T. E., & Strod, D. C. (2018). Utilization and Economic

     Contribution of Psychiatric Mental Health Nurse Practitioners in Public Behavioral Health

     Services. American Journal of Preventive Medicine, 54(6), S243–S249.

     https://doi.org/10.1016/j.amepre.2018.01.045

Ibarra, A. B. (2022, November 16). Nurse practitioner requirements are changing, allowing them to

     practice without physician supervision. CalMatters. https://calmatters.org/health/2022/11/nurse-

The US Constitution accord states the authority to enact laws that control professional and Occupational titles, the scope of practice, and regulatory standards. These laws are exclusive to each state (Mistread & Short, 2021). As stated in the American Nurses Association (ANA) (n.d.), the nurse practice act defines the APRN practice which is also controlled by the Board of Nursing (BON). Practice authority can be defined as a Nurse Practitioner’s ability to practice with or without physician oversight (ANA, 1996). 

Each state has given the APRN authority to practice within the scope of their education and experience. For instance, in the state of North Carolina, the Nurse practitioner (NP) is barred from practicing without the supervision of a physician whereas, in states like Minnesota, NPs are given full authority to practice independently without the supervision of a physician. In states where NPs have full authority to practice, NPs can assess, evaluate patients, write treatment plans, diagnose, order, and interpret diagnostic tests and write prescriptions for medication and controlled substances (State Practice, environment, 2021). 

In the state of Minnesota where I come from, a bill was passed in 2014 that granted NPs and other APRNs full practice authority. However, in the new law, nurse practitioners and clinical nurse specialists will have to complete 2080 hours of practice under the supervision of a physician or experienced APRN before they can be given full authority to practice. It is worth noting that although NPs are given authority to practice autonomously, they can only do so within the scope of their clinical and professional training and within the purview of their knowledge and experience. AN NP who practices independently is allowed to consult with other health care providers about a patient’s condition and initiate referrals for complex medical cases and emergencies. Under the new Law in Minnesota, APRNs can prescribe scheduled drugs with proper DEA registration. However, each hospital, clinic, or practice group can set its standards regarding prescribing. 

In North Carolina, NPs are not allowed to practice independently without collaboration or practicing agreement with a supervising physician. Another thing that makes North Caroline unique is that NPS must obtain permission from a physician approved by the board as the NP’s supervisor and the physician must spell out distinctly in the collaboration agreement the drugs that the NP may prescribe. About the controlled substance, the NP must have a DEA number. This number is used on each prescription written or ordered. In North Carolina just like most states, NPs have the authority to prescribe scheduled ii-iv drugs and scheduled V drugs (Johnson, 2002). 

  

  

References 

Association, A. N. (2004). Nursing: Scope and standard of practice (American nurses association) (5th ed.). Amer Nurses Assn. 

Johnson, P. (2002). The board of nursing and the regulation of nurse aides in NC. North Carolina Medical Journal, 63(2), 112–113. https://doi.org/10.18043/ncm.63.2.112 

Logic, S. (n.d.). Nurse practitioner laws & rules. https://www.ncbon.com/practice-nurse-practitioner-nurse-practitioner-laws-rules 

Milstead, J. (2011). Health policy and politics: A nurse’s guide (Milstead, health policy and politics) (4th ed.). Jones & Bartlett Learning. 

N/a. (1996). Scope and standards of advanced practice registered to nurse. Amer Nurses Assn. 

In the state of Kentucky, advanced practice registered nurses cannot practice without collaboration with a physician. Here in Kentucky, we have reduced practice authority (Writers, 2023). This means that we cannot independently treat patients; we must be overseen by a physician. Since becoming a nurse five years ago, I have found the rules and regulations regarding scopes of practice of APRN’s to be very interesting as each state varies but are all required to pass a national exam. According to the Kentucky Board of Nursing, an APRN can prescribe non-narcotic medications for up to 30 days if a collaborative physician is unable to perform duties related to the agreement (Title 201 Chapter 20 Regulation 057 • Kentucky Administrative Regulations • Legislative Research Commission, n.d.). This means that a nurse practitioner has 30 days to find another collaborating physician to continue the practice of a APRN. This would also mean that without a physician’s collaboration, there are no narcotics or controlled substances that can be prescribed in the state of Kentucky. 

Around 600 miles away, Iowa is one of the closer states to Kentucky that grant full practice rights to advanced practice registered nurses (Writers, 2023). According to the Iowa board of nursing, for APRNs to prescribe narcotics, they must document opioid continued education every three years (Advanced Registered Nurse Practitioner – Role & Scope | Iowa Board of Nursing, n.d.). Providing APRNs with the autonomy to prescribe controlled substances with continued education allows for the APRN to practice prescribing all medications without being overseen by a physician. 

According to one article which is credible and peer-reviewed, states who provide NPs with full practice have fewer hospitalizations, fewer deaths related to medication prescriptions, provided care at a lower cost, and reported increased collaboration between physicians and nurse practitioners (Bosse et al., 2017). These are all benefits of utilizing nurse practitioners’ education and experience to the full extent. Providing needed education hours to continue to improve patient outcomes with evidence-based practices are one way the nursing boards can be sure to promote safety of patients. Having a national licensure exam should provide the nursing boards of every state with the practitioner’s ability to examine and treat patients based on their symptoms and the APRN’s education and skillset.