NURS 6050 Discussion: Professional Nursing and State-Level Regulations

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

State of Florida:

•         As a APRN in the State of Florida, NP’s can practice independently if an agreement is signed with a physician.

•         They can even open their own practice without a physician being present at the time of service.

•          NP’s can serve as the primary care provider

•         NPs in Florida can prescribe medication along with controlled substance.

•         In Florida a Physician must sign a death certificate.

State of Virginia:

  • As a APRN in the State of Virginia Nurse practitioners do not have the freedom to practice independently; they must work under the supervision of a licensed physician.
  • As of 2012, Virginia State Law defines this NP-physician relationship as a “Patient Care Team” requiring both consultation and collaboration between the nurse practitioner and

physician.

•         In Virginia, an NP can sign a death certificate.

 

The regulations are somewhat different in each state. In Florida you can work independently. In Virginia you don’t have the freedom to work independently. You must work under a licensed physician. In Virginia NP’s must complete eight hours of continuing education in pharmacology or pharmacotherapeutics every 12 months to maintain prescriptive

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

authority. Nurse practitioner to prescribe drugs in Virginia he/she must have this outlined in a written practice agreement with a licensed physician in addition to a written protocol.

In Florida, there is no additional CEs to maintain prescriptive authority.

APRN’s have went to further their education and learn the necessary skills to assess, diagnose, and knowledge prescribe medications to patients. APRN’s in both states must obtain their certification to practice in both states.

References

13, F. J., & 12, ray M. (2020, March 24). Nurse practitioner scope of practice: Virginia. ThriveAP. Retrieved December 27, 2021, from https://thriveap.com/blog/nurse-practitioner-scope-practice-virginia

Family nurse practitioner scope of practice in Florida. St. Thomas University Online. (2020, May 14). Retrieved December 27, 2021, from https://online.stu.edu/articles/nursing/fnp-scope-of-practice-florida.aspx

RE: Main Post – Week 5 Risa Weaver

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Advanced Practice Registered Nurse Board of Nursing Regulations for Minnesota and Florida

Similarities and Differences

            I compared two advanced practice registered nurse (APRN) boards of nursing regulations of Minnesota and Florida. I will begin by reviewing some similarities of the two states’ regulations and then delve right into the differences between the two states.

Florida and Minnesota both are regulated by their respective Boards of nursing (BON), and in addition, Florida is also regulated by the Board of Medicine American Association of Nurse Practitioners, [AANP], (2021). National Council of State Boards of Nursing, [NCSBN], (n.d.-b). indicates that Florida APRNs practice under a restricted license, under both the Board of Medicine (BOM) and Board of Nursing (BON). Both boards govern APRN practice and licensure in Florida, transferring the authority from the BON to the BOM Bosse et al. (2017). Likewise, in Minnesota, APRN’s practice under the most pliable scope of practice; a full, unrestricted practice regulatory structure AANP (2021).

APRN’s in Minnesota is one of the four specialists with master’s degrees including, “Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM), and Certified Nurse Practitioner (CNP)” (Minnesota Board of Nursing, n.d.). The national certification exam appropriate to role and focus is required after education is completed. In addition, recognition and authority to practice are granted via licensure and registration National Council of State Boards of Nursing [NCSBN], (n.d.-a). Also, APRNs in Minnesota are authorized to prescribe schedule 2-5 medications and can diagnose NCSBN (n.d.-a). NSCBN (n.d.-a) further expresses continuing competence includes that the APRN must maintain national certification congruent with role and focus. Lastly, disciplinary records are in the same database that contains nurse registry data and held there indefinitely and available to the public NCSBN (n.d.-a).

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Like Minnesota, APRNs in Florida include “Certified Nurse Practitioner (CNP), Certified Nurse Midwife (CNM), Clinical Nurse Specialist (CNS), and Certified Registered Nurse Anesthetist (CRNA)” (NCSBN, n.d.-b). Like that of Minnesota, the National Certification exam is required after education is completed to obtain the Nurse Practitioner degree. Dissimilar to Minnesota, recognition, and authority to practice is granted via licensure only NCSBN (n.d.-b). Also, according to NCSBN (n.d.-b) unlike Minnesota regulation, APRNs in Florida can only prescribe with full authorization within protocol under a supervising physician and can diagnose. Again, different from Minnesota, continuing competence includes that the APRN complete continuing education (CE) credits documented with a vendor or CE broker each biennial renewal NCSBN (n.d.-b).

According to the APRN Consensus Model by State scoring grid (NCSBN, n.d.), Minnesota scored “28 points – 100%” and Florida “21-27 points – 75-96%”. The difference is Florida APRNs must have a “written collaborative agreement under independent practice” and prescribing whereas Minnesota does not need the written collaborative agreement for independent practice and prescribing as a regulation (NCSBN, n.d.-b).

Apply regulations to Full-Scope of Practice

APRN’s in Minnesota have legal authority with an independent full scope of practice and prescription authority post achievement of RN license, graduate degree, and becoming nationally certified as an APRN. What that entails for Minnesota, is different for Florida in areas related to state legislation that outlines the scope of practice among nurse practitioners within each respective state. The regulations I have selected include medication prescription rights of nurse practitioners and continuing competence of the APRN degree. The BON is the ultimate source for any nurse practitioner for a strong and reliable resource for reviewing the scope of practice. The BON has the Nurse Practice Act that contains the scope of practice of APRN’s Milstead & Short (2019).  It is in the APRN’s best interest to understand their scope of practice thoroughly and soundly.  By doing so, it allows the provider to provide competent care, for regulations are present to protect the public, not oneself.

APRN’s must engage voluntarily and actively in self-regulation of their degrees to maintain obeying the blueprint of rights of being a trusted APRN including adhering to regulations. With each state being governed by its BON and or other organizations, each state has regulations that are specific to them Milstead & Short (2019). Nurses must look within at their values and standards that frame their ethical blueprint combined with legal regulations. Together these values provide guiding staples to provide safe and competent care Milstead & Short (2019). For example, when obtaining a specialty, a nurse needs to follow the set standards of that organization and use them within her/his scope of practice and application. And if working in another state, or within her state, staying up-to-date on current regulations, for some part of health care is always active in court attempting to be reformed. Laureate Education (2018) describes the very fact the regulations merit tracking for these very regulations apply to our practice. Furthermore, tracking regulations will keep APRNs informed of current regulations that may have been removed, altered, or simply by establishing parameters of how the law will be implemented Laureate Education (2018).

References

American Association of Nurse Practitioners. (2021). State Practice Environment. Retrieved June 25, 2021, from aanp.org

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

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vnhook, 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.

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

Minnesota Board of Nursing. (n.d.). Advanced Practice Registered Nurse (APRN) Licensed General Information. Retrieved June 21, 2021, from https://www.mn.gov

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

National Council of State Boards of Nursing (NCSBN). (n.d.-a). United States-Minnesota. Retrieved June 22, 2021 from https://www.regulatoryatlas.com/jurisdiction-detail?Jurisdiction=Minnesota

National Council of State Boards of Nursing (NCSBN). (n.d.-b). United States-Florida. Retrieved June 22, 2021 from https://www.regulatoryatlas.com/jurisdiction-detail?Jurisdiction=Florida

Hi Tamika,

It was great reading your discussion post this week. Very informative and useful as these are two states I have considered relocating to after I have graduated from the PMHNP program.

It is so interesting to me that each state may differ in the scope of practice or breadth of practice that is regulated for APRNs. As you wrote Florida APRNs are unable to sign a death certificate whereas in Virginia an APRN is able to sign a death certificate.

(Milstead, 2019) “Both [American nursing association] ANA and the [National Council of State Boards of Nursing] NCBSN have proposed model rules and regulations for the governing of advanced practice nursing. The actual practice acts are inevitably a product of individual states’ political forces, so titles, definitions, criteria for entrance into practice, scopes of practice, reimbursement policies, and models of regulation are state-specific”.  A question I have for you however is that do you think that APRNs should have a nationalized regulatory body that is consistent nationwide?

Reference

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

Hello Tamika,

This discussion board is indeed an eye opener to what the regulations are, in other states. It is amazing that Virginia is so close to Maryland and while Maryland has full practice autonomy, Virginia Nurse practitioner has to practice in collaboration with a physician. Some state laws require career-long regulated collaborative agreement with another health care provider for the NP to provide care.

According to Poghosyan et al, 2021, there is a growing body of evidence about the impact of NP work environment on the quality of care and patient outcomes.  Therefore, considering that removing restrictions on NPs may also lead to better care and patient outcomes. Policymakers should consider taking action to remove restrictions nationwide and give NPs full practice autonomy.

References

Poghosyan, L., Ghaffari, A., Liu, J., Jin, H., & Martsolf, G. (2021). State policy change and organizational response: Expansion of nurse practitioner scope of practice regulations in

New York State. Nursing Outlook, 69(1), 74–83. https://doi.org/10.1016/j.outlook.2020.08.007

​Response Post

Thank you Tamika for your informative post. I am still surprised when learning that every state is different. Maryland is

fortunate to be one of a growing number of states where APRNs have full practicing authority

(Maryland Board of Nursing [MBON], n.d.). Maryland’s NP’s are regulated by the Board of Nursing, we have the

authority to practice as a Primary Care Provider, this gives the community more options on their choice of healthcare.

Licensed APRNs can prescribe scheduled II-V medications independently (NCSL Scope of Practice, 2021). Florida differs

in that is regulated by both the Board of Nursing and the Board of Medicine, this combination usually leads to stricter

regulation. In Florida, an APRN can gain independence after 3,000 hours under the supervision of a

physician (American Association of Nurse Practictioners [AANP], 2021).   I could not agree more that when an APRN

has the full practicing authority it is in the best interest of the community. With the increased shortage of healthcare

workers and the Covid pandemic at a rise having highly skilled NP’s available to perform independently is more than a

natural progression but a valued need. Healthcare, especially the Nurse Practitioner is expected to be one of the

fastest-growing fields in 2022(Richards & Terkanian, 2013). This discussion really gave me a better understanding of

how each state differs in regulations and that it’s important to choose wisely where you want to live and work.

References

Richards, E., & Terkanian, D. (2013). Occupational employment projections to 2022. U.S. Bureau of Labor Statistics. Retrieved December 30, 2021, from 

          https://www.bls.gov/opub/mlr/2013/article/occupational-employment-projections-to-2022.htm

In terms of controlled substances, I agree that the rules and regulations in California are geared towards preventing the misuse and abuse of drugs within the healthcare context. According to state laws, a prescription for a controlled substance shall solely be issued in scenarios where the medical purpose is legitimate and by an individual practitioner that is acting in his or her usual course of professional practice (California Law, 2021). An order for an addict or habitual user of controlled substances which is issued as part of an authorized narcotic treatment program and an order purporting to be a prescription issued under legitimate research or treatment are considered as legal prescriptions. On the other hand, In Maryland, an oral prescription for a Schedule II controlled substance may only be dispensed in an emergency as allowed under state laws (Davis et al., 2019). Schedule III and IV controlled substances cannot be refilled or filled more than 5 times or more than 6 months after the date the prescription was issued. Moreover, Schedule II prescriptions have no expiration and cannot be refilled.

References

California Law. (2021). California Legislative Information. Retrieved from https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=HSC&division=10.&title=&part=&chapter=4.&article=1.

Davis, C. S., Lieberman, A. J., Hernandez-Delgado, H., & Suba, C. (2019). Laws limiting the prescribing or dispensing of opioids for acute pain in the United States: A national systematic legal review. Drug and alcohol dependence194, 166-172. https://doi.org/10.1016/j.drugalcdep.2018.09.022