Discussion: Professional Nursing and State-Level Regulations NURS 6050

Discussion: Professional Nursing and State-Level Regulations NURS 6050

RE: Discussion – Week 5

 The  RNs and APRNs have current opportunities  which  enable them  to  participate actively in policy review:

Policy  planning and policy review work hand in hand : That is, policy review starts at the same time  when a policy is being planned, while the stakeholders are only concerned on evaluating  their ability to buy -in and develop the proposed policy.  (Mil stead & Short, 2019). Now, with the current opportunities RNs and APRNs to actively participate in policy evaluation and  review process in our health facilities,   we need to improve and upgrade ourselves to the positions that can enable us to start having  meetings with the stakeholders of the facilities, which will enable us  to be involved in policy analysis process. Good  example was during the campaign for patient education for  enrollment in  subsidized health insurance plans, for design and implementation phases of Affordable health care Act (ACA): It was only the professional nurses that were allowed to evaluate the  process, and  advocate for cost transparency, and this was done through the professional nurses organisations.  (Milstead & Short, 2019). With the current opportunities that is available for professional  nurses,  if  RNs and APRNs can be active members of professional nurses organizations like- American Nurses Association (ANA), The National League of Nursing (NLN), the American Association of Nurse Practitioners (AANP), and the American Association of College of Nurses (AACN), nurses will be more knowledgeable and well informed with new trends, then relating with ACA to the lawmakers and public, will be easy with the report they are able to provide.

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In addition, active involvement and participation of  RNs and APRNs  during the introduction of new policies and  policy review  in the unit developmental meetings is another opportunity nurses have to evaluate and regulate  policies. For example, when there is noticeable increase in patients fall in a unit,  new policy on  patient bed and -chair alarm system  may be introduced for  high risks for falls  patients in the  unit.  So, before  the unit developmental meeting, where the  bed and  chair alarm system will be discussed for approval, The  RNs  should be able to review the policy and write  down  their expections for the policy, its effectiveness and  its measurable goals.  For the  policy makers to make a decision on  whether they need to support  a  policy or not , they have to be notified at the beginning of the policy review, and at the same time with the plan to implement the new policy.(Laureate Education, 2018).

The challenges these opportunities may present and  how to overcome the challenges:

Professional Nursing and State-Level Regulations NURS 6050

Policy review, involves  other professionals and lawmakers who have various disciplines and from different backgrounds with different  opinions. so, this imposes  lots of  challenges to the RNs and APRNs, even though nursing profession is highly respected in the society.  Depending on their level of understanding and views of patients and health care system, some of them may or may not buy the ideas and suggestions of the nurses,  because of their poor perception on nursing profession. It is unfortunate that, in  this day and age, during my private discussions with some people, I found out that , there are  people who still do not value or appreciate the work  nurses do, because they believe that after giving the patients their medications, nurses do nothing else,  but play around for hours, and earn big money at the end of the day. This is very annoying to hear it from anyone, knowing the type of challenges and stress the nurses go through. In order to overcome this perception, Nurses with our leaders have to continue to focus on doing the right thing per evidence-based practice and also, to organize  health education for the public, whereby, they could be thought or made aware, of what nurses do, which will in turn boost their trust on nurses.

Fear of change: During the introduction of a new policy, some of the staff including nurses may  challenge the policy just for fear of a change. To overcome this challenges, nurse leaders should create early awareness  of the new policy to the staff, including – the analysis, cost, and the expected outcomes, in other to  gain their interest and support, if they may need to  vote for the new policy.

Strategies to communicate the existence of these opportunities:

Two main strategies  to better advocate for or communicate the existence of these opportunities are through:

-Social media.

-Seminars.

Using  social media like  Face book, network groups, and  discussion posting  in the network groups will create a faster  awareness  of the opportunities to people far and near in the profession.

My ability to  constantly attend professional seminars, local and national nursing meetings, and binging back home all that I learnt, will be a good strategy for me to communicate and advocate the existence of RN’s and APRNs opportunities for policy evaluation, and I will create visible posters to create the awareness to every nurse.

References

Laureate Education (Producer). (2018). The Importance of Program Evaluation [Video file].

Baltimore, MD: Author.

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

Burlington, MA: Jones & Bartlett Learning. Retrieved March 11th 2020.

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.

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.

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..

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.

By Day 6 of Week 5

Respond to at least two of your colleagues* on two different days and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples.

Response

Hello I…,

Just a word of advice so you don’t lose points, follow APA format when posting discussions. Make sure you include title of the discussion, which can simply be the same one I used – Professional Nursing and State-Level Regulations, in the center. Also use level 1 headings, which are in bold and also in the center. When referencing, indent the second line and lines to follow and use double-spaced. The writing center is an excellent resource to utilize! I actually signed up for the AANP as a student membership, which is half the cost FYI! In case there are difficulties searching for a preceptor (especially with all attention on COVID-19), I believe mentors will be able to guide me in the right direction and give me tips. As you mentioned, there are several other student resources such as scholarships and grants, NP certification, preperation to start your NP career, and how to stay informed! Unfortunately, several of my patients in the hospital usually have a secondary diagnosis of Alzheimer’s or dementia, contributing to their fall risk. For a person with dementia, the impact of hospitalization can be profound (Ayton, D., et.al, 2017). These individuals may be more likely to experience preventable adverse events such as infections, dehydration, malnutrition and falls (Ayton, D., et.al, 2017) . Impaired cognition has been shown to be the most commonly identified risk factor in patients who fall while in hospital (Ayton, D., et.al, 2017). I recently had a patient, confused and history of dementia, who was already near the nurse’s station with a floor mat in place, but still had a fall. To add additional interventions, I setup “avasys,” which is a video-monitoring system utilized at my hospital, in which the patient is monitored 24/7 and if she attempts to get out of bed, will be re-oriented by the monitoring tech and an alarm will sound so staff can be aware. It is almost intolerable to acknowledge how ill-willed nurses AND nurse practitioners are treated by patients. I recently had a patient who was being assessed by the NP for the day because the MD was not available. The patient literally said, “I don’t want to talk to a nurse practitioner, I want my doctor!” It is sad to see how disrespected nurses are in general, despite all of the education, dedication, and love we have put into nursing. Although social media can have several great benefits like the ones you mentioned, there is also alot of stigmaticism and negativity that sorrounds it as well. Although social media offers many benefits,inappropriate use can create legal problems for nurses, including job termination, malpractice claims,and disciplinary action from boards of nursing (BON),which could negatively impact their nursing license and career (Balestra, M. L., 2018). Social media is a very powerful tool and we must all use it strategically and carefully! Discussion: Professional Nursing and State-Level Regulations NURS 6050

References

Ayton, D., O’Brien, P., Treml, J., Soh, S., Morello, R., & Barker, A. (2017). Nurses’ perceptions of preventing falls for patients with dementia in the acute hospital setting. Australasian Journal on Ageing,

36(4), E70–E72. https://doi-org.ezp.waldenulibrary.org/10.1111/ajag.12474

Balestra, M. L. (2018). Social Media Missteps Could Put Your Nursing License at Risk. Colorado Nurse, 118(4), 16–17.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 5 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 5

To participate in this Discussion:

Week 5 Discussion

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

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)

American Nurses Association. (n.d.). ANA enterprise. Retrieved September 20, 2018, from http://www.nursingworld.org

Bosse, 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.

Halm, M. A. (2018). Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing. Worldviews on Evidence-Based Nursing, 15(4), 272–280. doi:10.1111/wvn.12291

National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved September 20, 2018, from https://www.ncsbn.org/index.htm

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.

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.

Required Media

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

 

Laureate Education (Producer). (2018). Healthcare economics and financing [Video file]. Baltimore, MD: Author.

 

Laureate Education (Producer). (2018). Quality improvement and safety [Video file]. Baltimore, MD: Author.

RE: Discussion – Week 5 Initial Post

     Regulation defined as “a rule or order issued by an executive authority or regulatory agency of a government and having the force of law” (“Regulation,” n.d.). Laws are formed broadly due to the possibility of needed change; regulation transpires from that law to shape the details of implementation (Laureate Education, 2018). Regulation of health professions is required to protect the public interest. With the special type of care nurses provide and the risk for harm, the nursing profession must be regulated (Milstead & Short, 2019, p. 60). Each state has a regulatory agency for nursing. These agencies, such as the North Carolina Board of Nursing (NCBON), establish regulatory laws for nursing practice. The regulatory agencies do this by creating a set of rules often called Practice Acts. These practice acts include regulations regarding the scope of practice, education standards, standards for licensures, titles and certification, Licensure requirements, and disciplinary action (Milstead & Short, 2019, p. 60).

     Advanced Practice Registered Nurses are regulated by this Board Authority. The National Council of State Boards of Nursing (NCSBN) works to help unify rules and regulations between boards across the United States. However, each State BON can have different rules. Below, I will describe two regulations and how they differ in two separate states.

     In North Carolina, an Advance Practice Registered Nurse (APRN), must have a collaborative practice agreement with a supervising physician before they can be approved to practice. This supervising physician must be readily available to the APRN to provide supervision, consultation, collaboration, and evaluation (“Section .0800 – Approval And Practice Parameters For Nurse Practitioners”, n.d.). The APRN must also maintain a backup supervision physician list that she, the supervising physician, and the backup physician has signed. In Maine, an APRN must work under a supervising physician or an experienced APRN for 24 months (“Laws and Rules/Chapters,” n.d.). This time provides the APRN with experience in the field and an opportunity for collaboration and evaluation. After these 24 months, the APRN will apply for license renewal and submit the documentation of the supervision (“Laws and Rules/Chapters,” n.d.). At this point, the APRN can practice independently.

     Continuing education requirements differ in North Carolina than that of those in Maine. Both require 50 Continuing Education credits; however, North Carolina goes on to require specifics for any APRN prescribing controlled substances. The APRN must complete at least one credit hour consisting of education related to addressing controlled substance prescribing practices, signs of abuse or misuse, or chronic pain management (“21 NCAC 36 .0807 Continuing Education (CE)”, n.d.). Maine BON divides their CE’s into different categories, but it does not specify any particular area.

     Advanced Practice Registered Nurses must comply with their Board of Nursing Regulations. There is a division between different states on allowing Full Practice Authority (FPA) for APRNs. Currently, 21 states allow APRNs to practice to their full ability. Bosse et al. (2017) states, “barriers at the state and national levels continue to prevent these highly qualified health care providers from practicing to the full extent to which their education and training have prepared them.” APRN’s should become part of their Nursing Associations and advocate for FPA.

     Concerning the regulations mentioned above, APRNs must understand the rules and regulations that apply to them through their State Boards of Nursing. There must be an understanding of requirements for practice, requirements for renewal of licensure, and required continuing education. Being educated about your practice is the best practice.

Reference

21 NCAC 36 .0807 Continuing Education (CE). (n.d.). Retrieved March 21, 2020, from http://reports.oah.state.nc.us/ncac/title 21 – occupational licensing boards and commissions/chapter 36 – nursing/21 ncac 36 .0807.html

Bosse, 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.

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(6thed.). Burlington, MA: Jones & Bartlett Learning.

Regulation. (n.d.). Retrieved March 21, 2020, from https://www.merriam-webster.com/dictionary/regulation

SECTION .0800 – APPROVAL AND PRACTICE PARAMETERS FOR NURSE PRACTITIONERS. (n.d.). Retrieved March 21, 2020, from http://reports.oah.state.nc.us/ncac/title 21 – occupational licensing boards and commissions/chapter 36 – nursing/21 ncac 36 .0801.html

Professional Nursing and State-Level Regulations

            The boards of nursing are government bodies found in all the fifty states, the District of Columbia US territories. The goal of these boards of nursing is to safeguard the general public against precarious nursing activities via regulation. Regulation is achieved through approving institutions that can offer education in nursing, provides licenses to qualified graduates, and enacting laws associated with nursing practice (Bosse et al., 2017). The paper examines various examples of methods in which the board of nursing regulation affects the practice of nursing and compares and contrasts between Virginia boards of nursing against the Washington board of nursing.

The discussion begins with the scope of practice between Virginia and Washington, which is considerably different. Virginia is one of the states whose APRN’s are under restricted practice while in Washington, the APRNs are allowed fully to carry out their nursing activities. In Virginia, APRNs require management and supervision from physicians to practice in their roles (Virginia Law, 2020). Conversely, in Washington, APRNs have a primary mandate for the care of their patients with no restrictions. APRNs in Washington can diagnose, order, and construe diagnostic exams; and begin and oversee therapies, including prescription therapies and controlled substances, under the complete licensure authorization of the state-specific nursing board (Washington State Legislature, 2020). Despite APRNs in Washington having total autonomy over their practice, they still must acquire supervision, instruction, and consultation where necessary before implementing unfamiliar or novel practices or procedures.

The other difference between APRNs in Washington and Virginia is their capacity to prescribe treatments, primarily controlled substances. In Virginia, APRNs have policies and rules on the controlled substances they can prescribe (Virginia Law, 2020). APRNs have the power to prescribe Schedule II to Schedule VI drugs. However, APRNs must still sign an electronic or written agreement with the patient care team physician indicating their prescriptive activities and the controlled substances they can or cannot prescribe (Virginia Law, 2020). In contrast, in Washington, provided the Nursing Commission has approved an APRN, they have the authority to prescribe Schedules II through IV drugs and schedule V drugs of the Uniform Controlled Substances Act (Washington State Legislature, 2020). Regarding the continuation of education hours, in Virginia, APRNs must finish eight hours of pharmacology education, and two hours must be dedicated to the prescription of controlled substances. Conversely, in Washington, APRNs must go through fifteen hours of pharmacology for every license renewal period, and the hours dedicated explicitly to the prescription of controlled substances are not specified.

There is an advantage of giving APRNs the license to work within their full scope of training and expertise, such as in Washington State (Washington State Legislature, 2020). The authority is crucial to ensuring APRNs provide quality and comprehensive primary care services to vulnerable groups. There are several advantages in states where APRNs have Full Practice Authority (FPA), for example, reduced emergency room checkups for non-management healthcare, reduced cases of patient hospitalizations. Also, it leads to lower costs for preventive care compared to physicians, and lowered prescription of drugs often associated with overdose fatalities (Bosse et al., 2017). Devoid of the autonomy to practice nursing in line with the range of their learning and training, most APRNs are prevented from operating in restrictive states. Conferring to Neff et al. (2018), the most disadvantaged are the vulnerable patients who seek primary healthcare services given that it is predicted that by 2025 there would be a shortage of primary health care services in the U.S.

The discussion shows show the two states of Virginia have different laws that govern the practice of APRNs. Nonetheless, the scope of practice of APRNs is essential to the general public since it enables APRNs to practice within a comprehensive scope of practice. For nurses to comply with state-specific policies, they need to stay updated with NPA controlling their state’s practice to ensure they practice within their scope.

References

Bosse, 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. https://doi.org/10.1016/j.outlook.2017.10.002

Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., 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. https://doi.org/10.1016/j.outlook.2018.03.001

Virginia Law. (2020). Code of Virginia. https://law.lis.virginia.gov/vacode/title54.1/chapter29/.

Washington State Legislature. (2020). ARNP Scope of Practice. https://apps.leg.wa.gov/wac/default.aspx?cite=246-840-300.

NURS_6050_Module03_Week05_Discussion_Rubric

Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response
Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100