NUR 513 Topic 2 DQ 1 Identify at least three regulatory bodies or industry regulations that specify certification, licensure requirements, or scope of practice for your specialty

Week 2 Lecture:

Nursing in the 1970s

You would feel lost and confused if you were transported back in time to a hospital ward in the 1970s when the nurses who are now at the end of their careers were students. You would likely be out of your depth as a nurse from that era who suddenly found herself on duty in the present day.

Nursing students were part of the nursing staff allocation.

In 1975, I was accepted as a student nurse in an LPN program at a local hospital. We were given unlimited free meals, three student uniforms (green pin striped) a couple of matching caps, textbooks, and $100 a month as a nursing student. No tuition was charged. The program was a vocation program offered through Sumner county.

As students, we spent 8 hours a day Mon-Fri in class and after 3 months we spent 10 months working 8 hours a day Mon-Fri on the floors with our instructor rotating and we each had a preceptor on every floor that we worked and we also rotated through surgery.

IT WAS PROPER ETIQUETTE TO ALLOW SUPERIORS TO GO THROUGH A DOOR FIRST, AND YOU COULD OFTEN FIND A GROUP OF NURSING STUDENTS FORMING A “GUARD OF HONOR” AT A DOORWAY!

We were absolutely not allowed to use the elevators. We had to use the stairs and our classroom was on the 5th floor. It was a part of our discipline as nursing students. I did sneak a few times and used an elevator as I am sure every one of the students did as well. I was the only single student and got married the week after graduation.

The neatness of the nurse herself, as well as great respect towards licensed nurses was demanded.

We had visiting hours between 2 pm and 5 pm. No children and only two visitors at a time. Before visiting hours all the bed linens had to be straightened, with perfect hospital corners, the overbed tables had to be in a straight line at the bottom of the beds with all the wheels pointing in the same direction. Fortunately, most patients were understanding and endured the trussed-up state until the doors were opened for the visitors.

Our uniforms were the double-breasted type, cinched at the waist with a belt. We also had to learn how to fold and pin the caps into what looked like upside-down ice cream tubs and how to fasten them to our hair with clips so that they remained firmly perched in place all day.

The “mini” was in fashion then, and of course, we all tried to get away with wearing our dresses as short as possible without getting into trouble but the instructor would make sure that our dress was no shorter than the tip of our fingers when we held our arms down at our sides. We were allowed to wear a wedding ring, no engagement ring ☹ and only simple post earrings such as gold, silver, or pearl balls and they had to be tiny. No necklaces. No tattoos or be thrown out. White granny panties, and yes, they checked! White hose, no socks, and white clinic shoes with white shoe laces and they better be polished.

Nursing duties were allocated according to tasks rather than an assignment to particular patients. As the program progressed, the student could do more advanced procedures and tasks.

The food was not portioned packed, except for special diets. It was delivered in a large cart and the nurse in charge dished up for each patient. Other nurses would collect the plates, hand it out to the patients, and then assist those who needed feeding.

Similarly, the patient’s medicines were not dispensed individually by the pharmacy. There was a cart with the full range of medications and from here, using a card system to which the individual patient’s prescriptions had been ordered, a senior nurse would hand out the medicines. Considering this system, it was surprising that very few medication errors occurred.

There were no computers and no electronic records. Everything was written by hand. The patient’s file was kept at the bedside. It contained the admission records, doctor’s notes, prescriptions, and diagnostic reports. There was also a vital signs chart on which the nurse responsible for taking the vital signs of all the patients had to chart them in graph format. Recoding vital signs required the use of a three-colored pen to reflect the three different shifts and was kept on the front of the chart for all to see.

The nursing care plans were introduced towards the late 1980s although this does not mean that there was no planning of nursing care. There was a metal flip folder, with a card for each patient from which the report was handed over to the next shift. Throughout the day any abnormal observations, changes in the patient’s condition, and treatment orders would be entered on this card. The nurse in charge would enter specific nursing instructions and handed over the card to the next charge nurse and individual nurses did not give report on their patients. The charge nurses planning of care was also reflected in the allocation of duties at the start of each shift.

Everything was written in pencil so it could be erased and updated as needed.

A major shift in hospital care has been the reduction in the length of patient stays due to advances in medicine and technology as well as the increased cost of hospital care. Patients remained in the hospital for at least one night even after very minimally invasive surgery. After surgery such as a hysterectomy, patients were on strict bed rest for at least two days and remained in the hospital for five days or, most often, until the sutures were removed. There were no pins and plates for treating fractures and a patient with a fractured femur was placed in traction and remained in the hospital for up to three months. (Consider the mix of the type of patients who most frequently end up with fractured femurs, their immobility while not being ill and young student nurses – made for some interesting times.)

“Beds and backs,” a routine done three times a day, fell into disuse mainly because of early mobilization and shorter patient stays. Usually, in teams of two, nurses went to each patient, in turn, seeing to patient comfort, making general observations, and taking action to prevent pressure sores. Bedridden patient’s backs, hips, heels, and elbows were rubbed and creases and crumbs removed from the linen. Pillows were plumped up, water jugs filled, and the general surrounding tidied.

Bedsores were frequently big enough to put your fist in and the bone was exposed. Pressure sores were treated with Maalox mixed with white sugar which was applied to the entire pressure sore inside and out and a heat lamp was shined on the pressure ulcer for 30 minutes 3-4 times a day. Patients with this level of pressure sores came in with them from nursing homes or occasionally from a patient’s home. If the pressure ulcer was on the patient coccyx, you could see the coccyx bone, just as you could see the hip bones, but when on the coccyx we had to tape one of the buttocks to the side rail for 30 minutes while the heat lamp was shining on the pressure ulcer in order to fully expose the coccyx area. There was no staging of pressure ulcers. Red areas or barely open areas were rubbed down and further than that there were huge pressure ulcers that were treated with the Maalox, sugar, and heat lamp.

Patient requests would be attended to, and anything unusual in the patient’s condition would be reported to the nurse in charge. There was less focus on infection control then, and you didn’t wash your hands between each patient! We had to clean patients stool and urine off of them with our bare hands. If we wore gloves, which weren’t around anyway except sterile gloves, the medical communities train of thought was that if we wore gloves the patients would think that we thought that they were dirty so we had anti-rooms in the halls about every four rooms apart and we went there to scrub up after cleaning up a patient and it was just soap and water. We did not know any different so it wasn’t a big deal to us. Now…..yuck!

Very little technology was in place to assist in monitoring patients. The temperature was taken with a mercury thermometer, you wore a pin watch for counting the patient’s pulse and respirations, and BP was measured with an aneroid sphygmomanometer. On general floors, most beds did not have an oxygen supply – you wheeled in a portable oxygen cylinder when a patient needed oxygen, there were no pulse oximeters.

IV fluids came in glass bottles and if you needed to control the speed of administration you either counted the drops per minute, or you stuck on a length of tape on which you marked the minutes or hours. There were no IV pumps or IV medications. The top of the IV bottle was flat and the patient would go to the restroom and put the IV bottle on the floor upside down on the flat end. By the time they got back to the bed a lot of their blood was in the IV bottle but it was just rehung and the blood was run back in with the fluids

The IV lines had just the roller clamps and very often patient with dementia or just bored would play with the roller clamp. It was not unheard of to go back to check on a patient IV and within 30 minutes 1000 ml had infused and the patient was having difficulty breathing. We just stopped the IV infusion for a while.

When starting an IV the needle remained in the patient’s arm. Every patient with an IV, which was just for hydration because there were no IV meds, had to have an arm board taped to their arm to keep the needle from bending or coming back out through the patient skin and blood pouring out all over.

Very few intensive care beds were available in the hospital. Most of the ICU’s were converted side rooms of specialist units, on each floor, with two to four beds. A cardiac monitor and a central venous pressure line were the only advanced equipment used in these units. The venous pressure line was inserted via the median basilic vein and very rarely anywhere else such as the intrajugular vein as is the most commonly used today. There were no ports of any kind.

Dialysis was available but was very complicated and lasted for 12 hours and there were no dialysis machines. The dialysis was peritoneal and therefore there were no dialysis shunts or ports. Patient died of septic infections due to lack of sterility with peritoneal dialysis although at that time no one knew what sepsis was. Mechanical dialysis was available by the late 70’s in big hospitals and by the early to mid-80’s in smaller hospitals.

There were no intermediate-high care units. Critically ill patients were mostly treated inside rooms on the floor where a form of patient allocation was used when one of the nurses on the staff complement of the unit was allocated to special one on one care.

The first big nursing strike was in 1972 when 97,000+ nurses went on strike due to pay. The second nursing strike due to pay occurred in 1974. After 1974 the average pay for a nurse went up by 30%.

Other interesting tidbits:

·        Nurses lived and died by the Kardex, a folded card-stock roadmap to all things for the patient, completed in pencil and continuously crossed out or erased and updated during every shift

·        MAR’s were hand-written every day on the night shift and would last for 24 hours. The nurse initialed when a med was given. Black Ink 7 am-3 pm, Green Ink for 3 pm-11 pm and Red Ink for 11 pm- 7 am. Military time was not used.

·        Universal precautions didn’t exist.

·        HIV, C-diff, VRE, and MRSA did not exist.

·        Electrophysiology studies were done at the bedside to discover and treat arrhythmias.

·        A patient suffering an MI stayed in the hospital for a minimum of 2 weeks and was not allowed to do anything including taking a shower or drinking anything either cold or hot.

·        All patients were given a backrub at bedtime by their nurse.

·        There were no outpatient surgeries. Most surgical patients stayed as an inpatient for 7-10 days.

·        GI bleeds were managed by inserting tubes with balloons (attached to football helmets) to tamponade varices.

·        Warm-water-heated metal bedpans were used for patient comfort.

·        Central venous pressure was measured with water manometers.

·        Nurses used the second hand of a wristwatch to calculate I.V. drip rates.

·        White oxford lace-up shoes were the norm for nurses.

·        Only operating-room (OR) staff and physicians wore scrubs.

·        Nurses wore all white, cap, either pantsuit or dress and must wear white granny panties. Colored underwear or bikini underwear would show through the white uniform and you would be sent home!

·        . One pair of post earrings, one wedding band, no stones, and no tattoos

·        Hair longer than shoulder length had to be up and under the nursing cap.

·        Vital signs recording required a three-colored pen to reflect the three different shifts.

·        Nurses mixed antibiotics without pharmacist assistance and were not available until the late 1970s.

·        Nurses became proficient in I.V. sticks by practicing on one another.

·        Patients were weighed manually.

·        Requisitions were completed on typewriters.

·        Public health meant well-baby check-ups at the new mother’s home.

·        Grandma died at home.

·        Patients heading for the OR had their body hair shaved with hand razors.

·        Most surgery patients were admitted to the hospital the night before.

·        Nursing caps were still mandatory.

·        The nurse carried the doctor’s charts and walked behind the doctor as he made rounds.

·        Dr’s. did not have beepers or cell phones. Nurses were scared of doctors and drew straws when one had to be called.

·        There were no ultrasound, CT, or MRI machines. Most surgeries were listed as exploratory because the surgeon had no idea what was going on inside the patient.

·        No pulse oximetry

·        No accucheck machines, urine had to be tested for sugar QID and insulin was given according to which of four colors the urine changed to after a clinitest tablet was added to the urine.

·        No fetal monitors existed; the baby was deemed ok when it was born alive

·        No dinemapps

·        No ventilators

·        The Physician’s Desk Reference and the U.S. Pharmacopeia were chained to the desk, were the common drug references.

·        Nurses carried trays with cups of pills and med cards.

·        Cancer was a definite death sentence.

·        Staff and patients smoked in the hospitals

·        Nurses and doctors smoked at the nurse’s station

·        There was no HIPAA. Nurses knew everyone’s business and many did tell friends and even just acquaintances their patients’ private medical information.

Nursing yesterday, today and tomorrow

Nursing has changed dramatically over the past 4-5 decades and will probably change as much or more over the next forty-five years, and this is why continuing education has become so important. While developments in society, medicine, and technology will change the landscape, it could never replace the essence of nursing – caring for other human beings at a time of need.

BTW- After graduation my rate of pay was $3.25 an hour and that was a good wage. Minimum wage was .90 an hour. My brand-new car was $2,999.99. Advertised as still being under $3,000. However, for me it was free. My parents promised me a brand-new car, of my choice, if I finished LPN school. I did not realize until the second day of class that I was in nursing school. I thought I was in school to be a CNA. Obviously at that time I had no interest in education! Oh, how times changed! (For the better)!

The Board of Registered Nursing is a state driven regulatory body associated with a large array of business regarding details such as RN licensure, standards of practice and disciplinary actions (California Board of Registered Nursing. 2022). The California Nurse Practice Act encompasses the laws of California pertaining to elements within our field. It is updated every year and helps govern the innerworkings of the California Board of Nursing business and profession codes as well as the core regulations. (California Board of Registered Nursing. 2022). The federal regulatory process has many different initiatives for nurses and the healthcare system. One that is very important is the Patient Protection and Affordable Care Act (ACA). The ACA addresses affordable insurance, affordable healthcare and medical innovation for low-income families (U.S. Department of Health & Human Services. 2022).

These regulatory bodies strongly impact nursing practices, patient outcomes, and positive actions within the everchanging healthcare system (DeNisco & Barker, 2019). It is vital within the nursing profession to stay up to date on annual changes within our practice. The significance of different improvements influence nursing and healthcare by providing straight forward knowledge and definition of expectations required to maintain the high standard of care within the medical system. It is important for these entities to research and identify the disparities associated with different regions of the country to pinpoint specific community needs and actively combat unique inequalities and imbalances associated with all types of societies and cultures.

California Board of Registered Nursing. (2022). Nursing Practice Act. https://www.rn.ca.gov/practice/npa.shtml

U.S. Department of Health & Human Services. (2022). About the Affordable Care Act. https://www.hhs.gov/healthcare/about-the-aca/index.html

DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

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Hi,  I agree with your discussion of the different roles of a nurse educator and a nurse practitioner. The responsibilities and roles of these two types of nurses are different. The Nurse practitioner’s (NPs) responsibility, as you mentioned in your post, it is to “provide direct patient care” by “diagnosis and providing treatment” (American Nurses Association, 2022). The NP ethical guidelines are also different from the Nurse Educator’s; for example, the NP must ensure that the patient receives the health needed to improve their health condition by ensuring clear communication within them. In contrast, the Nurse educator must educate the student on the importance of following the code of ethics to provide excellent patient care to patients and families. References

American Nurses Association. (n.d.). About ANA. ANA. https://www.nursingworld.org/ana/about-ana/

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One nursing regulatory body (NRB) in the state of Georgia is the Georgia Board of Nursing under the Georgia Secretary of State, Brad Raffensperger. The Georgia Board of Nursing is a member of the National Council of State Boards of Nursing (NCSBN), a not-for-profit organization made up of the NRBs from all 50 states, Washington D.C and four U.S. territories (National Council of State Boards of Nursing, n.d). Because nursing has such a key role in the health care system, it is vital that it is done in a safe, evidence-based, consistent manner. Each of the members of the NCSBN has a law called the Nurse Practice Act that explains in detail every aspect of nursing, including but not limited to what duties, responsibilities, educational requirements, licensing, and scope of practice are necessary to ensure that nursing is being practiced safely in their state or territory. Each nurse must function in a way that is in line with this law to maintain their license. Nursing regulatory bodies such as the Georgia Board of Nursing are responsible for enforcing the Georgia Registered Professional Nurse Practice Act.

Another nursing regulatory body that enforces the requirements of the Georgia Nurse Practice Act is the Oncology Nursing Society (ONS). Although ONS is a nursing organization that focuses on the specialty of oncology, it builds its specialty scope of practice on the foundation of the Nurse Practice Act of each state or territory. The Oncology Nursing scope and standards set minimal standards as well as requirements to become Oncology Nurse Certified (OCN). The Oncology Nursing scope and standards also provide initial and annual competencies to individual oncology nurses so that they can gain and/or improve their knowledge in the field of oncology ((Lubejko & Wilson, 2019)

The specialty of Public Health Nursing is regulated by the Georgia Department of Public Health Office of Nursing. The Georgia DPH Office of Nursing acts as a nursing regulatory body to ensuring that Public Health nurses practice in a way that is in line with the Georgia Nurse Practice Act, the Georgia Board of Nursing rules and regulations, and scope of practice by developing policies and procedures, and providing leadership, and assistance to public health nurses in their communities. (dph.georgia.gov, n.d)

NUR 513 Topic 2 DQ 1 Identify at least three regulatory bodies or industry regulations that specify certification, licensure requirements, or scope of practice for your specialty References:

About NCSBN. NCSBN: Leading regulatory excellence. (n.d.). Retrieved August 13, 2022, from https://ncsbn.org/about.htm

Lubejko, B. G., & Wilson, B. J. (2019). Oncology nursing: Scope and standards of Practice. Oncology Nursing Society.

Office of Nursing. Georgia Department of Public Health. (n.d.). Retrieved August 13, 2022, from https://dph.georgia.gov/clinical-services/office-nursing

Nursing regulatory bodies are government agencies that ensure safe nursing practices (National Council of State Boards of Nursing [NCSBN], 2022a). These regulatory bodies help outline the rules and regulations of certification and licensure requirements, scope of practices, etc. Two regulatory bodies include the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN). The ANA was founded in 1896 and has become one of the largest nursing organizations in the United States. (American Nurses Association [ANA], n.d.).

The ANA advocates and lobbies for the interests of all specialties of nursing. One of the stated priorities of the ANA is to also expand the roles and responsibilities of Registered Nurses and Advanced Practice Nurses in providing primary care (ANA, n.d.). The NCSBN is an independent organization that represents interests of the states as opposed to nursing organizations (Loversidge, 2021). The NCBSN helps oversee the Nurse Licensure Compact (NLC), which allows nurses to practice and have a valid license in multiple states (NCSBN, 2022b). Just recently, in 2020, the NCBSN began the APRN Compact that will be enacted once seven states have accepted the legislation (NCSBN, 2022b). Additionally, the NCSBN created the APRN Consensus Model which is used by states to adopt APRN regulations and definitions that are the same which helps the standards of practice and education be uniform across the country (NCBSN, 2022c).

On top of the ANA and NCSBN, each state has their own board of nursing and nurse practice acts. The Arizona Board of Nursing (AZBN) oversees any nurse in Arizona with a certificate or license to make sure they are safe and competent in their nursing practice (Arizona State Board of Nursing [AZBN], 2018). In addition, the AZBN oversees nursing education, licensure, and complaints/official discipline. There is no federal nurse practice act, so it is the responsibility of each state to have and maintain their own. The AZBN and other boards of nursing derive their mission from their nurse practice act since that is where all rules and regulations about scopes of practice, education/licensure requirements, titles, and more are laid out (AZBN, 2018).

The Arizona nurse practice act also outlines that Arizona is part of the NLC. I think that the NLC is a very beneficial legislation and I hope that the APRN Compact is enacted soon. Having registered nurses be able to practice in multiple states helps relieve overwhelmed health systems, especially during states of emergencies, like natural disasters and the COVID-19 pandemic. It is important for APRNs to have the same opportunities since their practices have proven essential during the recent pandemic.

NUR 513 Topic 2 DQ 1 Identify at least three regulatory bodies or industry regulations that specify certification, licensure requirements, or scope of practice for your specialty References

American Nurses Association. (n.d.). About ANA. ANA. https://www.nursingworld.org/ana/about-ana/

Arizona State Board of Nursing. (2018). About the organization. Arizona State Board of Nursing. https://www.azbn.gov/

Loversidge, J. M. (2021). Government response: Regulation. In S. M. DeNisco (Eds.), Advanced practice nursing: Essential knowledge for the profession (4th ed., pp. 211-236). Jones & Bartlett Learning.

National Council of State Boards of Nursing. (2022a). About U.S. nursing regulatory bodies. NCSBN. https://www.ncsbn.org/about-nursing-regulatory-bodies.htm

National Council of State Boards of Nursing. (2022b). Licensure compacts. NCSBN. https://www.ncsbn.org/compacts.htm

National Council of State Boards of Nursing. (2022c). APRN consensus model. NCBSN. https://www.ncsbn.org/aprn-consensus.htm

In Wisconsin, nurses are licensed and certified by the Department of Safety and Professional Services (DSPS). The DSPS maintains the Board of Nursing (BON), introduces and upholds the laws and administrative code of conduct for nurses. The BON for WI sates that nurse educator or faculty standards include: an unencumbered, active RN license, a graduate degree in nursing, or in lieu of a nursing graduate degree, a different interdisciplinary graduate degree that is relatable to the course material (Board of Nursing, 2021). Additionally, the WI BON has rules and regulations regarding advanced practice nurse prescribers that require licensure.

The U.S. Department of Education is the federal agency that determines regulations and professional practice standards for nurse education, they determine the standards that the state BON must meet to have an approved and accredited nurse education program (Board of Nursing Professional Licensure Requirements, 2022). The CCNE, or Commission on Collegiate Nursing Education, is recognized by the U.S. Department of Education as a regulatory and accreditation agency that determines an educational institution’s nursing program. The CCNE uses evidence-based practice and research to ensure the continued integrity and quality of nurse education programs (CCNE accreditation, 2022).

State nursing boards use research and EBP from the NCSBN, the CCNE and AACN, as well as state-based information sources to update and uphold nursing practice and licensure to improve public health and health care. They often participate in legislative councils, lobby congressional members, and submit peer-reviewed research and reports to the regulatory board for new laws of practice. As laws and regulations are updated, this cascades down through practicing nurses and educators into nursing schools and training programs to continually improve nursing education, practice, and professional development and standards.

References

Board of Nursing. (2021). Wisconsin.gov. Retrieved from Department of Safety and Professional Services: https://docs.legis.wisconsin.gov/code/admin_code/n/1.pdf

Board of Nursing Professional Licensure Requirements. NCSBN. (2022). Retrieved from https://www.ncsbn.org/nursing-regulation/education/board-of-nursing-professional-licensure-requirements.page

CCNE accreditation. American Association of Colleges of Nursing (AACN). (2022). Retrieved from https://www.aacnnursing.org/CCNE

Every state and territory in the US has rules for nurses. These laws are described by the Nursing Practice Act (NPA). The NPA is interpreted and enforced by the nursing boards in each state and territory. Fifty states, the District of Columbia, and four US territories have state nursing boards (BON) that control NPA. The boards make sure that state or territory laws are followed. The legislature gives the nursing board the power to punish nurses who break the law. The BON is the entity with the authority to discipline an unsafe nurse. The BON’s jobs include

Making, changing, and enforcing rules

setting standards for nursing education.

Setting fees for licensure, making sure criminal background checks are done on applicants

and giving licenses to applicants.

making sure nurses get continuing education.

collecting and analyzing data about the nursing workforce.

Furthermore, carrying out disciplinary procedures These boards are members of the NCSBN (www.ncsbn.org). NCSBN encourages evidence-based regulatory excellence to protect patients and the public. The BON regulates how nurses do their jobs by using NPA terms. The BON must also keep US citizens from getting bad care from nursing homes. NCSBN and the APRN committee developed the Consensus Model to help states regulate APRN duties, licenses, accreditation, certification, and education uniformly.

The Virginia Board of Nursing and Medicine regulates the practice of nurse practitioners in Virginia. In the medical field, a nurse’s area of practice is determined by her education, national certification, and ongoing skills. Both boards will hold nurses responsible for a wide range of personal health services for which they are trained and qualified and for which they will work with and be supervised by a doctor. Nurse Practitioners promote and maintain patient health; diagnose, treat, and manage acute and chronic illnesses; advise and counsel individuals and families; receive prescriptions; give out therapeutic measures, tests, treatments, and medications; and manage acute and chronic illnesses. To plan for situations that are outside of the nurse practitioner’s area of practice and expertise by consulting with and referring patients to other health care providers as needed, and to evaluate health outcomes.

They need license renewals biennially. The Board makes rules about who can apply, and how the exam is run. An applicant must pass a board test. The Board has to decide what conditions a person applying for a license has to meet. The Board issues a license to a person who meets these requirements, passes the required exam, pays the required fee, and shows that they are mentally and physically fit to be a nurse.

Huynh, A. P., & Haddad, L. M. (2022, July 18). Nursing Practice Act-StatPearls-NCBI Bookshelf. Nursing Practice Act-StatPearls-NCBI Bookshelf; www.ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK559012/

Like in most nursing professions there has been a tremendous shift in practice, staffing, etc. but many school nurses were under fire and essentially hated by parents for the first time which has lead to an a exodus of nurses in this specialty. Typically we are a support to families going through health crises but during COVID we were, “…enforcing public health rules that [we] did not make and could not change” (Nierenberg, 2021) in an effort to balance keeping kids physically in school while also keeping the population safe from COVID infection. Parents and families have come to either celebrate our role or despise it; it was and continues to be a difficult balancing act.

As for other the effects the pandemic had on this niche, I feel it actually highlighted the work of school nurses and shone a light to what the practice is and what it is not! Most people think of school nursing as band aids, temp checks, and ADHD meds. but people began to see that the practice is one of public health and of being the health and safety “expert” within the school setting. It may be too soon to tell if the new legislation will affect the number of nurses in this role but I actually believe that the legislation will give further credit and importance to what school nurses do. As I mentioned, enacting seizure action plans and training staff was something we always already did but now that it is law, we are held to a higher level of accountability and responsibility than before and one that makes sense given the importance of the task!

Reference:

Neirenberg, A. (2021). School Nurses Feel Like “The Enemy”. The New York Times, https://www.nytimes.com/2021/11/17/us/school-nurses-covid.html

The Board of Registered Nursing is a state driven regulatory body associated with a large array of business regarding details such as RN licensure, standards of practice and disciplinary actions (California Board of Registered Nursing. 2022). The California Nurse Practice Act encompasses the laws of California pertaining to elements within our field. It is updated every year and helps govern the innerworkings of the California Board of Nursing business and profession codes as well as the core regulations. (California Board of Registered Nursing. 2022). The federal regulatory process has many different initiatives for nurses and the healthcare system. One that is very important is the Patient Protection and Affordable Care Act (ACA). The ACA addresses affordable insurance, affordable healthcare and medical innovation for low-income families (U.S. Department of Health & Human Services. 2022). 

These regulatory bodies strongly impact nursing practices, patient outcomes, and positive actions within the everchanging healthcare system (DeNisco & Barker, 2019). It is vital within the nursing profession to stay up to date on annual changes within our practice. The significance of different improvements influence nursing and healthcare by providing straight forward knowledge and definition of expectations required to maintain the high standard of care within the medical system. It is important for these entities to research and identify the disparities associated with different regions of the country to pinpoint specific community needs and actively combat unique inequalities and imbalances associated with all types of societies and cultures. 

 

California Board of Registered Nursing. (2022). Nursing Practice Act. https://www.rn.ca.gov/practice/npa.shtml   

 

U.S. Department of Health & Human Services. (2022). About the Affordable Care Act. https://www.hhs.gov/healthcare/about-the-aca/index.html 

 

DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124 

REPLY 

One nursing regulatory body (NRB) in the state of Georgia is the Georgia Board of Nursing under the Georgia Secretary of State, Brad Raffensperger. The Georgia Board of Nursing is a member of the National Council of State Boards of Nursing (NCSBN), a not-for-profit organization made up of the NRBs from all 50 states, Washington D.C and four U.S. territories (National Council of State Boards of Nursing, n.d). Because nursing has such a key role in the health care system, it is vital that it is done in a safe, evidence-based, consistent manner. Each of the members of the NCSBN has a law called the Nurse Practice Act that explains in detail every aspect of nursing, including but not limited to what duties, responsibilities, educational requirements, licensing, and scope of practice are necessary to ensure that nursing is being practiced safely in their state or territory. Each nurse must function in a way that is in line with this law to maintain their license. Nursing regulatory bodies such as the Georgia Board of Nursing are responsible for enforcing the Georgia Registered Professional Nurse Practice Act.  

Another nursing regulatory body that enforces the requirements of the Georgia Nurse Practice Act is the Oncology Nursing Society (ONS). Although ONS is a nursing organization that focuses on the specialty of oncology, it builds its specialty scope of practice on the foundation of the Nurse Practice Act of each state or territory. The Oncology Nursing scope and standards set minimal standards as well as requirements to become Oncology Nurse Certified (OCN). The Oncology Nursing scope and standards also provide initial and annual competencies to individual oncology nurses so that they can gain and/or improve their knowledge in the field of oncology ((Lubejko & Wilson, 2019)  

The specialty of Public Health Nursing is regulated by the Georgia Department of Public Health Office of Nursing. The Georgia DPH Office of Nursing acts as a nursing regulatory body to ensuring that Public Health nurses practice in a way that is in line with the Georgia Nurse Practice Act, the Georgia Board of Nursing rules and regulations, and scope of practice by developing policies and procedures, and providing leadership, and assistance to public health nurses in their communities. (dph.georgia.gov, n.d)  

  References: 

About NCSBN. NCSBN: Leading regulatory excellence. (n.d.). Retrieved August 13, 2022, from https://ncsbn.org/about.htm  

 

Lubejko, B. G., & Wilson, B. J. (2019). Oncology nursing: Scope and standards of Practice. Oncology Nursing Society.  

 

Office of Nursing. Georgia Department of Public Health. (n.d.). Retrieved August 13, 2022, from https://dph.georgia.gov/clinical-services/office-nursing  

  

REPLY  

 I never knew there was a regulatory body which governed Oncology! I think that is amazing and so very important given the prevalence of cancer in todays society and the unique speciality cancer requires in healthcare. I have a friend who works on an oncology unit who just became chemotherapy certified. She reported the exam was very challenging. I could appreciate why this exam would be necessary to verify competency in this area of nursing. Thank you for sharing. 

In Kansas where I reside, the Kansas State Board Nursing recently authorized Nurse Practitioners (NP) to practice in the absence of a collaborative agreement alongside of a physician while practicing (Kansas State Board Nursing, 2022). One of these updated changes includes providing restructuring evidence based care to patients with the knowledge base of clinical skills and expertise, while providing care through patient advocacy (Kansas Administration Regulations, 2022). I feel this change allows the NP a greater ability to strengthen clinical judgment, confidence from education and training earned, as well as providing further patient care access. 

References 

 State Board Nursing. (2022). Kansas State Board Nursing Website.  Retrieved from https://ksbn.kansas.gov/ 

 Kansas Administrative Regulations. Kansas Secretary of State – KAR Regulations. (n.d.). Retrieved August 

13, 2022, from https://sos.ks.gov/publications/pubs_kar_Regs.aspx?KAR=60-11-104  

REPLY  

Each state has an agency that is responsible for the nurses in their state and how they practice, these are called nursing regulatory bodies. The point of these nursing regulatory bodies Is to protect the public’s health by practicing safe nursing (National Council of State Boards of Nursing [NCSBN], 2022a). Each state has its own Nurse Practice Act that is enforced (NCSBN,2022a). Each states act has rules and regulations such as qualifications for licensure and scope of practice. Two nursing regulatory bodies are the Arizona State Board of Nursing and the American Nurses Association. Within the Arizona State Board of Nursing is the Advanced Practice Advisory Committee who provides recommendations to the Board on issues involving advanced practice (Arizona State Board of Nursing, 2018). 

The Arizona State Board of Nursing has a plethora of information as they regulate licensure requirements, specify certification, and scope of practice for your specialty. Within the Arizona State Board of Nursing is the Advanced Practice Advisory Committee who provides recommendations to the Board on issues involving advanced practice (Arizona State Board of Nursing, 2018). Some of the goals of this committee are to clarify regulatory sufficiency of the four Advanced Practice roles and develop recommendations for change related to Advanced Practice (Arizona State Board of Nursing, 2018). For example, Certified Registered Nurse Anesthetists in Arizona have their scope of practice laid out on Arizona State Board of Nursing and the Arizona State Legislature. CRNA’s in Arizona are able to administer anesthetics under the direction of a physician or surgeon before, during, or after a surgery/procedure in certain settings that are clearly listed (Arizona State Board of Nursing, 2018). 

 

I actually really enjoyed reading through the APRN Conesus Model as it gave really good insight into the roles, licensure, accreditation, certification and education. As we discussed last week in this course the number of APRN’s are growing exponentially to try and keep up with forever changing healthcare needs in our growing country. The consensus discusses that as nursing practice evolves and health care needs of the population change, new APRN roles or population focus may change over time (NCBSN, 2022b).  Every APRN role uses a significantly differentiated set of competencies and there is a plan in place to help the role evolve. 

 References 

 

Arizona State Board of Nursing. (2018). About the organization. Arizona State Board of Nursing. https://www.azbn.gov/ 

 

National Council of State Boards of Nursing. (2022a). About U.S. nursing regulatory bodies. NCSBN. https://www.ncsbn.org/about-nursing-regulatory-bodies.htm 

 

National Council of State Boards of Nursing. (2022b). APRN consensus model. NCBSN. https://www.ncsbn.org/aprn-consensus.htm 

REPLY 

Regulatory bodies for nursing exist to protect the public when receiving nursing care. Nurses are under the federal and state legislation to ensure they are educated appropriately, licensed correctly, practice within their scope, and receive disciplinary action when there are violations of their state’s or territories Nurse Practice Act (National Council of State Boards of Nursing, 2022). The National Council of State Boards of Nursing (NCSBN) is an entity that encompasses all the regulatory bodies of the 50 states, the District of Columbia, and United States territories. The purpose of NCSBN is to support these regulatory bodies in their role to safeguard the public as well as support nurses in their practice.  

NCSBN influences the requirements for education within nursing by providing a framework for state boards of nursing to license and educate their nurses. Further, NCSBN provides research and tools for individual boards of nursing to make decisions on what education, licensure, scope, and disciplinary action makes sense given the states laws and regulations. The laws and regulations are then put into place by state lawmakers. This is the creation of each states Board of Nursing and Nurse Practice Act. Additionally, NCSBN advocates for nurses and their scope of practice. NCSBN paired with APRN’s to advocate for the APRN Consensus Model which, “promotes a uniform regulatory process based on nationally accepted standards for certification, licensure, and practice” (DeNisco, 2019, p. 244). There is a push for federal funds and accreditation to schools that teach to the consensus model. By incorporating the consensus model into APRN standards and education, it allows APRN’s to bring their practice to other states outside of their licensure state thus expanding access to healthcare for many populations (DeNisco, 2019, p. 244).  

 

The Minnesota Board of Nursing (MnBON) is the regulatory body for nursing in Minnesota. In general, with support from NCSBN, MnBON is responsible for enforcing

Texas State Board of Nursing is my primary license home which is not a multistate but with the need to work in the state of Georgia, I change my license to a Nurse Licensure Compact (NLC) state which permitted me to practice in Georgia.

The agreement between NLC practice states allows registered nurses like me and of practical nurses (LPN) holders to enjoy the full potential of nursing which is caring for patient regardless of one’s state of residence. This privilege grants nurses the benefit to practice in our home state and in other compact states. The NLC is an initiative aimed at increasing access to patient care across state lines by streamlining multistate licensure requirements (Bergman et al., 2022)

Think about the mobility and flexibility benefits of multistate license to practice without the need to obtain multiple licenses from each state in responding to needs or in supporting our colleagues across the borders. The benefit of effective and efficiency in telehealth is another one. With NLC, a nurse can reside in NYC and work or support healthcare in LAX, with the use of telehealth rendering services to patient, as presented by Bright her article that telehealth/e-health interventions are increasing in use (Bright 2023). Location do no longer stand as a barrier to access to healthcare elevating the problem of nursing shortage in certain regions, simultaneously minimize unnecessary barriers to access to care for their citizens as the case was during the COVID 19 pandemic because, telehealth has been used for various topics  including diagnosis and management, education and training, consultation, and surveillance, as well as to provide an umbrella term for the various novel technologies used to improve the delivery of healthcare services (Alkhawaldeh et al., 2023) .

The NLC idea enhances collaboration among nurses, improving engagement, and interconnections by understanding what unique ideas other state is implement that can be of benefit in other state.

If nursing is to be a strong unify body, all states should endorse the NLC and be a participant. Whether a nurse practice electronically or in person, must uphold the nurse practice act of the state in which the patient being treating is located (Bergman et al., 2022). In making she nurses abide by the nursing practice act, licensure and disciplinary information on nurses are shared among the Compact States and the public through a comprehensive database called NURSYS (Bergman et al., 2022).

Bergman, E. & Morley, C. (2022). Public Policy: Nurse Licensure Compact as a Lesson in Legislative Action for the Case Management Community. Professional Case Management, 27 (1), 26-29. doi: 10.1097/NCM.0000000000000542.

https://oce-ovid-com.lopes.idm.oclc.org/article/01269241-202201000-00007/HTML

Bright, A., & Doody, O. (2023). Mental health service users’ experiences of telehealth interventions facilitated during the covid‐19 pandemic and their relevance to nursing: An integrative review. Journal of Psychiatric and Mental Health Nursing. https://doi-org.lopes.idm.oclc.org/10.1111/jpm.12943

M. Y. Alkhawaldeh et al., “Telehealth for obstetrics and gynecology outpatinets: Improving patients’ experiences during the COVID-19 pandemic,” 2023 IEEE 47th Annual Computers, Software, and Applications Conference (COMPSAC), Torino, Italy, 2023, pp. 1418-1422, doi: 10.1109/COMPSAC57700.2023.00217.