Discussion: Professional Nursing and State-Level Regulations NURS 6050

Sample Answer for Discussion: Professional Nursing and State-Level Regulations NURS 6050 Included After Question

Discussion: Professional Nursing and State-Level Regulations NURS 6050

Discussion: Professional Nursing and State-Level Regulations NURS 6050

 In the state of Virginia, Advanced Practice Registered Nurses (APRN) are licensed within their education and certification in a specialty (Virginia Department of Health Professions, n.d).  In Virginia, nurse practitioners (NP) with fewer than five years of experience must enter into a practice agreement with a physician in their field (Virginia Department of Health Professions, n.d).  In 2019, Virginia enacted legislation allowing NPs with five years of clinical experience to apply for the autonomous practice designation, allowing them to practice without a practice agreement (Virginia Department of Health Professions, n.d).  The state of Virginia also allows NPs the authority to prescribe Schedule II through Schedule VI controlled substances (Virginia Department of Health Professions, n.d). 

      The Georgia State Board of Nursing is responsible for regulating and overseeing the education of registered and professional nurses within the state (Georgia Secretary of State, n.d).  Compared to the Virginia State Board of Nursing, the Georgia State Board of Nursing requires that NPs work under a practice agreement with a physician regardless of years of clinical experience (Georgia Secretary of State, n.d).  In Georgia, APRNs, including NPs, can sign prescriptions once the practice agreement is in effect (Georgia Composite Medical Board., n.d).  APRNs can apply for a DEA number if they will be regularly prescribing Schedule I and Schedule II drugs (Georgia Composite Medical Board, n.d).  A DEA number would not be required to prescribe Schedule III through V (Georgia Composite Medical Board, n.d).

Application to Advanced Practice Registered Nurses

     State boards of nursing oversee licensing for nursing (Nurse Journal, 2023).   Existing in all fifty states, state boards of nursing evaluate licensing applications, issue silences, renew licenses, and take disciplinary actions (Nurse Journal, 2023).   Knowing and understanding the regulations enforced by the state in which practice is essential.  By knowing regulations, APRNs can practice safely within their scope.  Following regulations allows for the best and most updated care for patients.

 Examples of How APRNs Adhere to Regulations

     APRNs need to adhere to state board regulations.  By adhering to regulations, APRNs can practice safely and provide effective patient care.  APRNs can adhere to regulations by becoming American Nurses Association (ANA) members.  Members can see reports of nursing-related legislation in the state where they practice (American Nurses Association, n.d).  APRNs also adhere to regulations by completing clinical practice requirements, education, and licensing renewal fees.  By adhering to regulations, APRNs can practice safely and provide effective patient care. 

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.

Discussion: Professional Nursing and State-Level Regulations NURS 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 in your Discussion: Professional Nursing and State-Level Regulations NURS 6050 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 and adhere to the two regulations.

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)

Two 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.

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

Five 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.

Thank you for sharing. New York and New Jersey are significantly different in their state regulations for APRN practicing.  Every advanced practice registered nurse in the state of New York must perform their duties under the supervision of a physician. On the other hand, it is anticipated of the APRN that they will be able to diagnose and treat patients on their own, and the physician will not be personally supervising them while they are treating patients. Although physicians are not required to sign off on patient prescriptions or records, a written agreement and procedure must be drafted to declare that a physician supervises the activities of advanced practice registered nurses. While physicians are not required to sign off on patient prescriptions or records, they are required to declare that they supervise the activities of an APRN. The state conducts routine inspections of these APRNs’ offices to ensure that they are adhering to the agreement between the policy and practices of their designated provider (NursingLicensure.org, 2021). These APRNs can operate independently in their own offices, subject to routine inspections by the state.

Discussion: Professional Nursing and State-Level Regulations NURS 6050 Reference

NursingLicensure.org. (2021, September 21). Become a nurse practitioner in New York | APN license requirements in NY. NursingLicensure.org – A more efficient way to find nursing license requirements in your state. https://www.nursinglicensure.org/np-state/new-york-nurse-practitioner/

Hello Colleague

Thank you for sharing your post on discussing professional and state-level regulations. You mentioned the Nurse Practitioner Association New York State (NPA), which you say is an organization that empowers nurse practitioners and professionals to comply with the legal requirements, as well as provide inputs into policy formulation processes. The NPA is a nursing organization that promotes high standards through the empowerment of nurse practitioners (NPs) and the profession, as you stated, throughout New York State (NYS). The NPA is a nursing organization that may also exist for different. A legislative body passes statutes (written law).  Each state has a nurse practice act (NPA) that establishes a board of nursing (BON) panel of nursing professionals in health care licensure and define the scope and selected may apply to advanced. These two bodies work together to enforce rules and regulations for all nurses in each state.

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Nursing laws can only function properly if nurses know their state’s current laws governing practice (Howard, 2011).

The responsibility falls on the state because the United States Constitution does not include provisions to regulate nursing practice. A state has the authority to make laws to maintain public order, health, safety, and welfare under police powers (Guido, 2010). Nursing leaders wanted to legitimize the profession in the eyes of the public, limit the number of people hired out as nurses, raise the quality of professional nurses, and improve education standards in schools may apply to advanced practice, in addition to the state’s need to protect the public (Penn Nursing Science, 2012).

All states and territories (NPA) have strengthened a nurse practice act. The legislature of each state passes the NPA. However, the NPA does not provide the nursing profession with the necessary guidance. As a result, each NPA creates a board of nursing (BON) with authority to create administrative rules or regulations to clarify or narrow the scope of the law. Before they are enacted, these rules and regulations are subjected to public scrutiny (NCSBN, 2020).

The Nurse Practice Act delegated authority to an administrative agency or BON to regulate the practice of nursing and enforce the law, to maintain a balance between the nurse’s right to practice nursing and the responsibility to protect the public health, safety, and welfare of its citizens (Brous, 2012). The state statute determines the composition of the BON and selects at least two aprn. Some states delegate authority to the governor to appoint members to the BON, while others require nominations from professional organizations and appointment by the director or head of the regulatory agency.

Do you know if New York State gives the governor the authority to appoint members to the BON based on suggestions from professional nursing organizations such as the Nurse Practitioner Association you mentioned, or if New York State requires nominations from professional organizations with appointment by a director or head of a regulatory agency?

Discussion: Professional Nursing and State-Level Regulations NURS 6050 REFERENCES

Brous, E. (2012). Nursing licensure and regulations. In D.J. Mason, J. K. Leavitt, & M. W. Chaffee (eds). Policy and politics in nursing and health (6^th ed). St. Louis, MO Saunders. Retrieved March 23, 2020, from

https://www.nursing/regulations>politcs

Guido, G. W. (2010). Legal & ethical issues in nursing (5^th ed). Boston, MA: Pearson. Retrieved March 23, 2020, from

https://wwwlegal/ethical/issues/regulations

Howard, P.K. (2011). The death of common sense: How the law is suffocating America. Retrieved March 23, 2020, from

https://www.free.org>articles>death

Penn Nursing Science. (2012). History of Nursing Timeline. Retrieved March 23, 2020, from

www.nursing.upenn.cdu/nhhc/pages/timeline

Kathleen A. Russell, JD, MN, RN (2012). Nurse Practice Acts Guide and Govern Nursing Practice. Retrieved March 23, 2020, from

https://NCSBN>2012_JNR_NPA_G

National Council of State Boards of Nursing (2020). About U.S. Nursing Regulatory Bodies. Retrieved March 23, 2020, from

https://about-nursing-regulatory

Discussion:  A Comparison of Advanced Practice Registered Nurses (APRN) within my current state versus another.

I truly enjoy learning about other States’ regulations regarding our future careers. I feel like the Virginia Board of Nursing regulation regarding two years or 4000 hours of clinical practice isn’t a terrible regulation before being able to work independently. Still, increasing that to a five-year requirement (2021) may be a little excessive. Living in California and learning about our regulations, I have learned that at this time, we cannot practice or furnish drugs independently without physician supervision apply to advanced practice registered. According to the California Nurse Practitioners: Laws and Regulations, “the furnishing or ordering of drugs or devices by nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician but does include (1) collaboration on the development of standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner (BRN, 2019). I hope the regulations will allow for more autonomy for future APRNs, especially when more healthcare workers are needed.

Discussion: Professional Nursing and State-Level Regulations NURS 6050 References

Board of Registered Nursing. (2019). Nurse Practitioners: Laws & Regulations. Sacramento, California; State of California Department of Consumer Affairs – Board of Registered Nursing. https://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf

Regulations governing the licensure of Nurse Practitioners, (2021).

https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePractitioners.pdf

CALIFORNIA STATE/REGION REGULATIONS

In 2017, over 20 states passed legislation that emphatically impacted access to and delivery of healthcare to patients nationwide. As in previous years, professional advanced registered nurses (APRN) organizations and Boards of Nursing (BON) have worked indefatigably in their respective legislative sessions to ensure patients had access to high-quality healthcare in their states.

I currently work and live in the State of California. In this discussion least two aprn board and, I will explain the differences in legislative law and the scope of practice of APRNs within California and Alaska.

APRNs are registered nurses who have completed further education to prepare them to convey a broad range of services, including diagnosing and treating acute and chronic illnesses.

California, up until recently, was 1 of 22 states that restricted aprons by requiring them to work with physician oversight (Joanne Spetz, 2018).

On October 12, 2019, Senate Bill number 323 (SB 323), chapter 848, was authorized by Senator Edward Hernandez and assembly member Susan Eggman and approved by our Governor, which granted over 18,000 California nurse practitioners full practice authority (CANP, 2020) bons is the protection.

Full Practice Authority is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests and initiate and manage treatments, including prescribing medications under the exclusive licensure authority of the state board of nursing (BON) (CANP, 2020).

Even though APRNs in California have been given full practice authority, under the scope of practice for California APRNs, they must have a standardized procedure or protocol that must be developed and approved by a supervising physician.

According to Ed Hernandez, SB 323 has been a fight for some time. Senator Ed Hernandez felt SB 323 was a necessary law that needed to be passed related to the 2.5 million previously uninsured Californians receiving health coverage under the Affordable Care Act to ensure more trained healthcare professionals (CANP, 2020).

APRNs in California also have prescriptive authority, which means drugs or devices furnished by the APRN must be ordered in accordance with the policies and protocols outlined in the agreement with the supervising physician’s mission of bons. The APRN may furnish drugs and devices within the APRN’s area of practice. Physician involvement is required when an APRN is furnishing schedule ll or all controlled substances, and a patient-specific protocol is required (California Scope of Practice Policy: State Profile, 2020).

APRN as primary care provider is recognized in state policy as primary care providers.  This means a person responsible for coordinating and providing primary care to members within the scope of practice of their license to practice, initiating referrals, and maintaining continuity of care. A primary care provider may be a primary care physician or nonphysician medical practitioner, nurse practitioner, certified nurse-midwife, or physician assistant (California Scope of Practice Policy: State Profile, 2020). Review the resources, reflect on and lay out the requirements by state practice.

To summarize, APRNs in California and under the legislative SB 323 are given the privileges to full practice authority and have prescriptive authority while under physician authority.

But as California continues to face a growing shortage of primary care physicians, the Legislature is considering allowing NPs with additional training and certification to work independently (Aguilera, 2020). According to author Elizabeth Aguilera, the State Assembly passed Assembly Bill 890 requirements for licensure and define, freeing many NPs from needing to operate under a supervising physician’s agreement (Aguilera, 2020). Assembly Bill 890 will create a path for NPs who want to work independently by opening their practice. The bill, carried by Santa Rosa Democratic Assemblyman Jim Wood, now goes to the Senate (Aguilera, 2020).

The California Board of Nursing (BRN) grants legal authority to practice and regulate/issue separate certifications to APRNs. Defined in the statute regulatory environment and the regulations, APRN includes certified nurse practitioner (CNP), NP (in statute), clinical nurse specialist (CNS), Certified Nurse Midwife (CNM), and certified registered nurse anesthetist (CRNA) roles. NPs function under standardized procedures or protocols when performing medical functions collaboratively developed and approved by the NP, physician, and administration in the organized healthcare facility where they work (Philips DNP, APRN, FNP-BC, FAANP, 2018)).

NP standard of procedure (SOP) is defined within the standardized procedures commensurate with the NP’s education and training, not in statute or regulation (Philips DNP, APRN, FNP-BC, FAANP, 2018).

APRNs are not legally in California authorized to admit patients to the hospital; however, individual hospitals may grant APRNs hospital privileges (Philips DNP, APRN, FNP-BC, FAANP, 2018). Also, APRNs do not require California national certification to enter practice (Philips DNP, APRN, FNP-BC, FAANP, 2018).

APRNs in California are regulated by a BON or a combination of a BON and  BOM (the board of medicine). Oversight exists requirement or attestation for physician supervisors, delegation, consultation, or collaboration for authority to practice and prescriptive authority (Phillips, DNP, APRN, FNP-BC-FAANP, 2018).

APRN certification in California requires the completion of a master’s, postgraduate, or doctorate from an accredited NP program and then a certification from a nationally recognized certifying body such as the American Academy of Nurse Practitioners or the American Nurse Credentialing Center (California Health Care Foundation, 2018). NP certification in Californian can be obtained by completing an NP education program that meets BRN standards or by certification through a national organization whose environment and the regulations selected standards are equivalent to those of the BRN (California Health Care Foundation, 2018). California has 23 approved NP programs (California Health Care Foundation, 2018). Since January 2008, California has required NP applicants who have not been qualified or certified as an NP in California or any other state to possess a master’s degree in nursing or a graduate degree in nursing and complete an NP program approved by the board and regulations selected by your colleague. An NP must have BRN certification to practice in California, but certification from a national professional association is not required California Health Care Foundation, 2018 (California Health Care Foundation, 2018).

In California, NP practice is governed by the state nurse practice act California Health Care Foundation, 2018 (California Health Care Foundation, 2018). The Board of Registered Nursing has promulgated regulations that require NP to work under standardized procedures for authorization to perform medical functions (California Health Care Foundation, 2018). This means NPs collaborate with physicians and adhere to standardized procedures developed through collaboration among administrators and health professionals.  There are no rules regarding the proximity of the physician to the NP, meaning a physician can provide supervision from hundreds of miles away.

State regulations regarding APRN scope of practice vary from state to state. The Model Act defines the scope of practice for APRNs to include conducting assessments, ordering and interpreting diagnostic procedures, establishing diagnoses, prescribing, ordering, administering, dispensing, and furnishing therapeutic measures, delegating to assistive personnel, and consulting with other disciplines and providing referrals (California Health Care Foundation, 2018). The Model Act recommends that APRNs be licensed independent practitioners. (California Health Care Foundation, 2018).

ALASKA STATE/REGION REGULATIONS

Alaska is one of the first states to embrace the role of the APRN. Alaska began to adopt state laws giving NPs more freedom as early as the 1980s. On July 21, 1984, Eileen Mountano, RN, Alaska Board of Nursing Chairperson, signed an adoption order for new regulations regarding ANPs in Alaska. ANPs at the time included Certified Nurse Practitioners and Certified Nurse-Midwives (Hartz MSN, FNP, 2014). The new regulations would repeal a requirement for a signed collaborative agreement between a physician and ANP that must be approved by the Alaska Medical Board (). In 1987 every state, additional regulations gave ANPs independent authority to prescribe controlled drugs Scheduled ll-lV (Hartz MSN, FNP, 2014). According to the author, Alaska was one of the first states to adopt broader licensing authority in the 1960s and remains one of the only 19 states along with the District of Columbia that allows NPs to practice with full autonomy (Hartz MSN, FNP, 2014).

The nursing education statutes in Alaska result from legislation passed by the legislature. They are what gives the Board of Nursing its powers and authority to regulate nurses for the protection of the public (Hartz MSN, FNP, 2014).

In 1981 SB 238 was introduced to update the nursing statutes. It included the current definition of “advanced nurse practitioner” and “nurse anesthetist” and gave the BON authority to regulate the groups.  (Hartz MSN, FNP, 2014).

The bill was passed in 1982, and by 1983 work had begun on new ANP regulations and in 1984, it was passed (Hartz MSN, FNP, 2014).

Currently, APRNs working in Alaska have the freedom to practice independently, with the supervision of a physician. Physician involvement is not necessary for diagnosing, treating, or prescribing for patients in any way. Alaska’s laws for APRNs are some of the most liberal in the nation (Nurse Practitioner Scope of Practice: Alaska, 2014).

Prescribing laws allow APRNs freedom in their practice. Again, physician involvement is not necessary for the NP to prescribe. In order, though for NPs to write prescriptions, NP must submit an application to the state board of nursing as well as complete 15 contact hours of education in advanced pharmacology and clinical management within the two years immediately before the date of the initial application (Nurse Practitioner Scope of Practice: Alaska and nursing regulations between my home state, 2014). NPs in Alaska must also renew their authority to prescribe every two years. To renew their prescribed privileges, the NP has to take 12 hours of continuing education in advanced pharmacotherapeutics and 12 hours of continuing education in clinical management (Nurse Practitioner Scope of Practice: Alaska, 2014).

APRNs in Alaska are regulated by a BON and have full, autonomous practice and prescriptive authority without a requirement or attestation for physician supervision, delegation, consultation, or collaboration (Nurse Practitioner Scope of Practice: Alaska, 2014).

Discussion Professional Nursing and State-Level Regulations NURS 6050 REFERENCES

California Scope of Practice Policy: State Profile (2020). Retrieved March 21, 2020, from

www.httpps://scopeofpracticepolicy.org>states>ca

California Association for Nurse Practitioners (2013). New Full Practice Authority Bill Introduced. Retrieved March 21, 2020, from

www.https://canpweb.org>press-releases

Joanne Spetz (May 2, 2019). California’s Nurse Practitioners: How Scope of nursing Practice Laws Impact Care. Retrieved March 21, 2020, from

https://www.chcf.org>publication

Elizabeth Aguilera (February 13, 2020). Will California give nurse practitioners more authority to treat patients when facing a doctor shortage? Retrieved March 21, 2020, from review key regulations for nursing.

https://www.CaliMatters<projects>doctors-short

Nurse Practitioner Scope of Practice: Alaska (May 23, 2014). Retrieved from

https://www.MidlevelU>Blog

Lynn Hartz MSN, FNP (June 2014). Alaska Nursing Today vol 2. Retrieved March 22, 2020, from

Https://www.NursingALD.com>pdf>Ala

California Health Care Foundation. California’s Nurse Practitioners: How Scope of Practice Laws Impact Care (September 2018). Retrieved from

https://www.chcf.org>2018/09

Susanne J. Philips, DNP, APRN, FNP-BC-FAANP (January 2018). 30^th Annual APRN Legislative Update. Improving Access to healthcare one time at a time. Retrieved from

https://www.ncbi,nlh.gov>pub

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.

Discussion: Professional Nursing and State-Level Regulations NURS 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/

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.

Discussion: Professional Nursing and State-Level Regulations NURS 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.

Comparison of Board of Nursing Regulations in Kentucky and Iowa

            Every state has similarities and differences in its nursing regulations. The boards of nursing in each state help nurses and advanced practice nurse practitioners (APRNs) know what is in their nurse practice acts (NPAs) including the most important provision of protecting public safety (Milstead & Short, 2019). Kentucky is regulated by the Kentucky Board of Nursing (KBN) (Kentucky Board of Nursing, n.d.-b). Iowa is regulated by the Iowa Board of Nursing (Iowa Board of Nursing, n.d.). Iowa is listed as a full practice state while Kentucky is listed as a reduced practice state. Full practice means that APRNs are allowed to practice to their full scope of education and experience and can work without supervision and collaboration from a physician (American Association of Nurse Practitioners, n.d.). Reduced practice means that APRNs must work in collaboration with a physician and there are limits on elements of APRN practice such as prescriptive authorities (American Association of Nurse Practitioners, n.d.).

            In Kentucky, APRNs must work in collaboration with a physician in the same or similar specialty to prescribe nonscheduled drugs for four years (National Council of State Boards of Nursing, 2023). After four years, the APRN does not have to work in collaboration with a physician. After one year of practicing as an APRN, APRNs can enter into a collaboration agreement with a physician to start prescribing Schedule II through V controlled substances. Other than prescribing nonscheduled and controlled substances, APRNs do not have to be under the supervision of a physician (Kentucky Board of Nursing, n.d.-a). In Iowa, APRNs can prescribe and administer controlled substances without collaboration with a physician and can practice to the full extent of their knowledge and experience (Iowa Legislative Services Agency, n.d.). There are similarities in the licensure requirements for both Kentucky and Iowa. In both states, applicants must have an active registered nurse (RN) license, a graduate degree in a nurse practitioner program, and must have a national certification.

Application to Advanced Practice Registered Nurses

            Full practice freedom is essential to better healthcare access and patient outcomes. APRNs who have full practice freedom will be able to help those in rural areas get better access to healthcare because they will be able to make up for the projected physician shortage by 2025 (Neff et al., 2018). It has been shown that states that have reduced or restricted practice laws have been negatively affected by this due to a lack of access to care in rural or underserved areas (Neff et al., 2018). The limitations on prescribing controlled substances can also negatively affect patient outcomes because patients will not be able to get the correct treatment they need without having to jump through the many hoops it takes to get a controlled substance from an APRN who is in a reduced or restricted practice state.

References:

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

Links to an external site.

Iowa Board of Nursing. (n.d.). Home: Iowa Board of Nursing. Home | Iowa Board of Nursing. https://nursing.iowa.gov/

Links to an external site.

Iowa Legislative Services Agency. (n.d.). Iowa Administrative Code. Iowa legislature – rule listings. https://www.legis.iowa.gov/law/administrativeRules/rules?agency=655&amp;chapter=7&amp;pubDate=06-28-2023

Links to an external site.

Kentucky Board of Nursing. (n.d.-a). APRN independent practice. Kentucky Board of Nursing. https://kbn.ky.gov/Practice/Pages/APRN-Independent-Practice.aspx

Kentucky Board of Nursing. (n.d.-b). Mission. Kentucky Board of Nursing. https://kbn.ky.gov/about/Pages/mission.aspx

Links to an external site.

National Council of State Boards of Nursing. (2023). 314.042 license to practice as an advanced practice registered nurse — Application — Renewal — Reinstatement — Use of “APRN” — Prescriptive authority under CAPA-NS and CAPA-CS — Exemption from CAPA-NS requirement — Administrative regulations. (Effective until June 29, 2023). NCSBN. https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51271

Links to an external site.

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.

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

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

Good post. Milstead & Short (2019) note, “state practice-specific board processes are similar from state to state but vary to some extent because their laws are determined by individual state legislatures, and their regulations are determined by the specific agency” (p. 58). Therefore, I agree with you that it is very important for APRNs to be well-informed of the state’s rules and scope of practice in the state they want to work in, especially if one desires to have full practice authority. The lack of continuity of nursing regulations among U.S. states can be confusing, and our job is to provide safe, high-quality, and ethical patient care, so we should stay updated on the regulations that pass into law in each state.

I currently live in Illinois and I wish to move to California in the future, so I compared these two U.S. states in my main discussion post this week. In 2020, Governor Newsom in California signed Assembly Bill 890, which created two new categories of NPs that can function within a defined scope of practice without standardized procedures. Category one “103 NP” status requires an APRN to work in a group setting with at least one physician or one surgeon within the population focus of their National Certification for at least 3 years in good standing before entering category two “104 NP” status, which allows the APRN to work independently within the population focus of their National Certification. Before being completely independent, the “104 NP” APRN has to work another 3 years in that role (California Board of Nursing, n.d.). I think it would be worthwhile to move to California and complete 6 years of this process to open my own clinic and bridge the gap where there is a shortage of physicians. There have also been systematic reviews of studies on the effectiveness and safety of NP/APN-led primary care, reporting positive effects of NP/APN service on clinical outcomes and patient satisfaction with lower costs (Woo et al., 2017, p. 2).

To obtain FPA in Illinois, an APRN must submit an application to the Illinois State Board of Nursing and a notarized declaration demonstrating they have completed at least 250 hours of continuing education or training and at least 4,000 clinical experience hours after attaining national certification (Illinois General Assembly, n.d.). This is almost twice as many hours as what Minnesota requires! Expanding the collaborative agreement between the APRN and a licensed certified NP, a certified clinical nurse specialist, or a physician in Minnesota will help bridge the gap more efficiently than having the only option to work under a physician when trying to obtain FPA. This is great news!

Thank you very much for your post and for taking the time to explain the different terms associated with APRNs and the responsibilities of regulators – including protecting the patient, protecting ARNPs, and clarifying the scope of practice of APRNs to ensure that they are fully operating within the parameters set forth by the legislature as authorized by the board of nursing in their respective states of practice. As a well-trained APRN, understanding the scope of practice is crucial in ensuring patient safety and achieving the best outcomes regardless of the state of practice. While researching the APRN requirement and restrictions in Virginia, I also realized that APRNs must collaborate with physicians in consultation and collaboration. As such, an electronic practice or written agreement is required in most cases (with few exceptions) to prove that an APRN is working with at least one patient care team physician. It is also new to me that in Virginia, APRNs must have a joint license from the Board of Nursing and Medicine – which prescribe the rules governing the licensure of APRNs and similar advanced degrees (law.lis.virginia.gov, n.d.).

Unlike Virginia, APRNS in Washington State (WA) has more autonomy and freedom and can practice fully and independently without looking for a collaborating physician. In addition, Washington does not have any joint licensure requirement by the Board of Nursing and Medicinewhichis is a requirement in Virginia. WA Board of Nursing (Nursing Care Quality Assurance Commission (NCQAC)) is a state regulatory authority responsible for protecting public health and safety. NCQAC ensures that the competency and quality of different healthcare professions within WA are current and compliant with the laws. This body also investigates accusations, takes disciplinary actions against licensed individuals if necessary, and could revoke an individual’s license in severe cases of gross infringements on patients’ rights and privacy and certain unprofessional behaviors unexpected of individuals held with very high ethical expectations and standards (NCQAC, n.d.).   

  References

Continuing competency. Nursing Care Quality Assurance Commission. (n.d.-a). https://nursing.wa.gov/licensing/maintain-license/continuing-competency

Title 54.1. professions and occupations. § 54.1-2957. Licensure and practice of nurse practitioners. (n.d.). https://law.lis.virginia.gov/vacode/title54.1/chapter29/section54.1-2957/

Each state has a Board of Nursing (BON) that works to protect the general population of each state. This is done by ensuring medical professionals follow all guidelines and practice safely. The Illinois BON regulates continuing education, medical practices, and license verification and holds many nursing laws in the state. Given the variation between APRNs and related state statutes, rules, and regulations, APRNs must clearly understand how their scope of practice is defined by those laws and regulations, as well as any opinions promulgated by the state regulatory agency (American Nurse Association,2017). NPs and decision-makers must comprehend how state rules and regulations affect their practice, so they are not at risk of losing their license.  

  

            Illinois does not have as much freedom as other states regarding practicing independently. NPs in Illinois must work under a collaborative practice agreement with a physician. Doctors are not needed to be present in person when the NP is there treating patients. Simply put, the doctor must be reachable for consultations on both the phone and in person, and meetings with the collaborating doctor and NP must occur at least once every month. Additionally, nurse practitioners in Illinois must complete 45 hours of continuing education in pharmacology before obtaining schedule II prescriptive authority. Even after doing so, the collaborating physician must expressly delegate the advanced practice nurse prescriptive authority within your collaborative practice agreement. The physician must specifically outline which schedule of controlled substances you will be prescribing (“Professions, Occupations, and Business Operations,” n.d.). 

  

            Each state has different regulations, titles, scopes of practice, and regulatory standards (Milstead & Short, 2019), yet they have similar standards. In contrast, nurse practitioners in Colorado are free to diagnose and treat patients. Colorado nurse practitioners can prescribe medications without physician supervision after an initial period. Nurse practitioners must complete an 1800-hour preceptorship and 1800-hour mentoring, both with the help of a doctor, to be granted the freedom to prescribe (Mattern,2018). Although Colorado NPs can prescribe freely, it takes countless hours to work and prescribe independently.  

  

Twenty-four states have full practice authority, sixteen have limited authority, and twelve have restricted authority. Out of the twenty-four full practice states, Oregon Advanced Practice Registered Nurses have the legal authority to practice within the full scope of their education and experience. Without the involvement of a physician, NPs can prescribe, diagnose, and treat patients. Like doctors can set up and run their independent practices, nurse practitioners who work in places with full-practice laws are also permitted to do so.  

  

Since Illinois significantly differs in these regulations due to reduced authority, an Oregon NP does not need to collaborate with a doctor as they have a full scope of practice. In this case, patients may experience quicker and more effective care as one person is responsible for the patient. The same goes for medication prescribing in a whole practice place. When a patient visits an NP in Oregon, the patient is getting direct care and has better access to care. Additionally, it creates a better, more efficient health care system as patient care is not being tossed around from provider to provider. The patient has one provider to diagnose them and one to treat and educate them as needed. If necessary, the NP can send a referral for the patient if the diagnosis needs a specialist. 

  

  

References  

American Nurses Association. (2017). APRN state law and regulation. ANA. Retrieved  

September 27, 2022, from https://www.nursingworld.org/practice-policy/advocacy/state/aprn-state-law-and-regulation/  

  

Illinois General Assembely . (n.d.). Professions, Occupations, and Business Operations.  

225 ILCS 65/ Nurse Practice Act. Retrieved September 27, 2022, from  

https://ilga.gov/legislation/ilcs/ilcs4.asp?DocName=022500650HArt.%2B65&ActID=13

12&ChapterID=24&SeqStart=16500000&SeqEnd=17850000  

  

Mattern, J. (2018). Advanced practice nurses: Nurse practitioner (NP) – CCHN. COLORADO  

COMMUNITY HEALTH NETWORK SCOPE OF PRACTICE MATRIX FIELD OF  

PRACTICE: NURSING (BOARD OF NURSING). Retrieved September 27, 2022, from  

https://members.cchn.org/pdf/cdhn/Nursing_Scope_of_Practice.pdf

  

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

 

Sample Answer for The Assignment: Discussion: Professional Nursing and State-Level Regulations NURS 6050

Title: Discussion: Professional Nursing and State-Level Regulations NURS 6050

Jones & Bartlett Learning.  

It was interesting to read about your states of Kentucky and Iowa. It always fascinates me that laws can be so different in different states when much other aspects related to the states are very similar or even the same (Milstead & Short, 2019). For example, you point out in your post that in Kentucky, nurse practitioners are not allowed to practice without being supervised by a physician, which results in a smaller scope of practice as well as reduced practice authority for such workers. However, there are also exceptions in which the nurse practitioner can prescribe certain medications without the need of the physician to be present. This is something that is similar to what occurs in my own state of Michigan, nurse practitioners (NP) cannot operate as primary care providers without having a physician being present. This means that an NP working in the state of Michigan cannot operate independently and must have a physician present to oversee as well as to order any kind of work that the NP does. At the same time, NPs in Michigan are allowed to prescribe certain medications to patients. The medications that the NPs are not allowed to prescribe, they can still do so if the task were to be delegated by a physician. Moreover, you also mention that in Iowa, nurse practitioners are able to perform without the supervision of a physician, which is similar to what I wrote about in Arizona (NCSLSOP, 2023). However, one difference that I noted was that you mentioned in Iowa, a nurse practitioner is allowed to prescribe narcotics; however, in Arizona, prescription of narcotics by nurse practitioner requires that at least one other nurse practitioner or physician sign off on such a prescription.

Eucharia, I found your post very intriguing. Nurses make up more than fifty percent of the healthcare profession (Godsey et al., 2020). The level of care that is provided by nurses is unmatched by any other profession in healthcare. Being able to utilize and expand our skillset based on our education and experience will continue to prevail as health disparities continue to increase. The need for registered nurses will continue to rise according to this article to 371,500 new nurses by the year 2028 (Godsey et al., 2020). This shows a growing demand for nurses related to increased acuity and decreased access to primary care providers. This is another reason why it is important to consider the role for advanced practice registered nurses and expand the level of care provided by them. 

Another article that is credible, recent, and peer-reviewed found that nurse practitioners perform as well as physicians in specialty settings in terms of patient outcomes (Carranza, 2021). The outcomes of this study suggest that education and satisfaction were also similar or exceed expectations from APRNs to physicians. This article provides evidence that nurse practitioners provide safe, effective, and comprehensive care. These findings could be utilized in the future to advocate for autonomy for the nurse practitioner community around the United States and beyond. Expanding practices for nurse practitioners to provide care as primary care providers could also alleviate the strain of disparities in the healthcare community and help to provide adequate care to the most vulnerable populations. 

Thank you for your insightful post!