Professional Nursing and State-Level Regulations NRSE 6050

Professional Nursing and State-Level Regulations NRSE 6050

Professional Nursing and State-Level Regulations NRSE 6050

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The state I currently reside in, Virginia, offers an avenue for Advanced Practice Registered Nurses (APRNs) to practice independently. It, however, is becoming increasingly difficult to do so because, in 2022, the Virginia Board of Nursing (BON) is increasing the clinical practice mandate from 2 years to 5 years. (Regulations governing the licensure of Nurse Practitioners, 2021, 18VAC90-30-86 section) This regulation will soon differ from states like Delaware, allowing nurses to practice autonomously after two years or 4000 hours of clinical practice. (Deleware Board of Nursing, 2021) There are no current regulations concerning the APRN Multistate Licensure Compact in Virginia. In contrast to Virginia, Delaware is one of 2 states to enact legislation for multistate licensure for APRNs and North Dakota. (National Council of State Boards of Nursing [NCSBN], 2021) As an APRN, if unchanged in Virginia, these regulations will require three years more experience to allow one to practice independently. You are only authorized to practice in the state of Virginia. Delaware is more lenient. It requires only two years of clinical experience to practice independently, and you are licensed to practice in all states participating in the APRN compact, which currently rests at 2 states.


Deleware Board of Nursing. (2021). Division of professional regulations. Stae of Delaware.

National Council of State Boards of Nursing. (2021). Aprn compact | ncsbn. NCSBN.

Regulations governing the licensure of Nurse Practitioners, 18 VAC 90-30-10 C.F.R. §§ 54.1-2400 and 54.1-2957 (2021).

People, regardless of political affiliation, often get concerned when they consider how the government’s apparent competing interests may affect matters that are important to them. Healthcare is no exception in this regard. Some people believe that interests that are not good to society can help or hinder local, state, and federal policies and regulations.

Legislators are the ones who give legislative benefits, and their primary goal is to get re-elected. Legislators must consequently boost their chances of re-election, which necessitates political support. When faced with legislative requests, legislators are perceived to be logical and to assess costs and benefits.
However, the costs and benefits to society of enacting certain legislation are not considered in the legislator’s cost-benefit analysis. Instead, the benefits are the additional political support the politician would receive for supporting the law, as well as the political support they would lose as a result of their conduct. Legislators will support legislation if the benefits outweigh the drawbacks (positive political support). (page\s27)

Comparing regulations from various state/regional boards of nursing can be a beneficial exercise. This can help to share insights that may be useful if a state/region changes in the future. Furthermore, nurses may be required to be licensed in multiple states or regions.

All 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands have boards of nursing (BONs). Similar entities may exist for different regions as well. BONs’ mission is to protect the public through the regulation of nursing practice. BONs implement state/region regulations for nurses, which include laying out the requirements for licensure and defining the scope of nursing practice in that state/region.

This is insightful Vanna, nurses have essential responsibilities in the policy-making processes. In other words, their contributions are significant in ensuring that important nurse’s practices are incorporated in the policy document. Nurses are therefore regarded as great resources in the policy review processes. Becoming part of the nursing team within an organization is one of the best approaches of getting involved in the policy review (Dueñas et al., 2016). Nurses have different teams where they interact and

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

contribute towards the policy making processes. There are different teams within a healthcare institution. These teams often operate to ensure that there is the implementation of the best policies that can guide the healthcare practices. Getting involved in the development of these policies often prove to be essential for the nurses as they get to gain skills and knowledge necessary in the management of general healthcare system.

Teams involved in the policy-making processes have to look for the best possible ways to enhance different practices within the healthcare institution. Becoming a member of professional nursing organization is another way that nurses can get involved in the policy review and policy-making processes (Kilbourne et al., 2018). Professional organizations consists of lobbyist who have great experiences at articulating the issues to the state representatives and other leaders who may raise the issue at the national and international levels. Professional nursing organizations also provides an avenue for people to express their thoughts in different healthcare issues. Becoming part of these organizations is critical in ensuring that different aspects of healthcare systems are addressed in line with the standards that have been developed (Dixit & Sambasivan, 2018). Communicating the existence of opportunities for the policy reviewers can be achieved through encouraging peers in the work environment to verbalize the grievances to the persons who are responsible for changing the policy.

Also Read: Discussion: NURS 6050 Population Health

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Dueñas, M., Ojeda, B., Salazar, A., Mico, J. A., & Failde, I. (2016). A review of chronic pain impact on patients, their social environment and the health care system. Journal of pain research9, 457. Retrieved from:

Kilbourne, A. M., Beck, K., Spaeth‐Rublee, B., Ramanuj, P., O’Brien, R. W., Tomoyasu, N., & Pincus, H. A. (2018). Measuring and improving the quality of mental health care: a global perspective. World psychiatry17(1), 30-38. Retrieved from:

Dixit, S. K., & Sambasivan, M. (2018). A review of the Australian healthcare system: A policy perspective. SAGE open medicine6, 2050312118769211. Retrieved from:

RE: Discussion – Week 5-Main Post

Nurses are expected to be well-versed in state regulations pertaining to their particular field of expertise. Each state has its own unique set of rules and regulations, and the scope of practice will also differ from state to state. In this essay, I’ll go through the distinctions between Missouri’s and Mississippi’s nursing regulations.

It is the responsibility of the APRN to ensure that they are knowledgeable of the rules and regulations of the state in which they are obtaining certification or employment. As an example, APRNs are restricted or limited in their practice in Missouri and Mississippi. If they had complete practice power, they would be able to prescribe any medication their patients needed without having to rely on a partnering physician. Limited NP practice makes it difficult for them to give care in places where primary health care practitioners are scarce (The impact of Nurse Practitioner Regulations on Population Access to Care, 2018). Having patients who aren’t seeking approval would make it easier for doctors to treat them. The APRN should familiarize themselves with the regulating board and the Nurse Practice Act of the state in which they plan to practice.

References: (2020a). How to Become a Nurse Practitioner in

Mississippi/ APRN Certification in

NursingLicensure.Org-A More Efficient Way to Find Nursing License Requirements in

Your State. (2020b). How to Become a Nurse Practitioner in Missouri/APRN Certification

Requirements in More Efficient Way to Find Nursing License

Requirements in Your State.



Position statement: Full practice authority for advanced practice registered nurse/s is necessary to

transform primary care. (November 2017). ScienceDirect.

The impact of nurse practitioner regulations on population access to care. (2018). ScienceDirect.


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)


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.



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.

Professional Nursing and State-Level Regulations NRSE 6050 SAMPLE

Different states have different regulations for the Advance Practice Registered Nurse, but all aim to protect the public’s health by regulating the activities of health care professionals (Milstead, 2019). The power derived from the passage of the Nurse Practice Act allows the state board of nursing to set and regulate standards for safe nursing practice within its jurisdiction for nurses who have the qualification and for advanced practice, including licensure requirements and license renewal, as well as any necessary disciplinary actions (Milstead, 2019).

When comparing my home state’s APRN board of nursing regulation to that of Nebraska, the first thing I noticed is that the Georgia state regulatory body is the board of nursing, whereas Nebraska’s is the Department of Health and Human Services. The credentialing criteria are similar, but the scope of practice differs slightly. The practice authority allows limited actions for APRN practice requiring supervision by a health care provider throughout the APRN’s practice or team management before an APRN such as an NP can provide care to patients (American Association of Nurse Practitioners (AANP), 2018). The practice authority in Georgia requires a written protocol between the NP and the supervising physician that specifies medical acts delegated by the physician and demands an immediate session with the physician (Scope of Practice Policy, 2019). It’s no surprise that in my practice, an NP is not permitted to initiate care or participate in the patient discharge process.

On the other hand, Nebraska state and licensure law allow all NPs to practice autonomously, allowing them to assess patients, diagnose, order diagnostic tests, initiate and manage treatments, and prescribe all medications, including control substances, without the supervision of a provider (Nebraska legislature, n.d). Allowing APRNs full practice access will allow for an increase in experience and the expansion of the talents inherent in nurse practitioners, as well as significant innovations in the nursing profession; it will also encourage other NPs to spring up to fill the gap created by the shortage of providers in America.

In Georgia, an NP can only prescribe a schedule III to V control substance if operating under the prescriptive authority of a supervising physician by submitting a written protocol to the supervising physician and permission is granted (American Medical Association (AMA), 2017). While in Nebraska, an NP may prescribe both legend drug and Schedules II-V controlled substances after the NP has put in first 2000 hours of practice under the supervision of a physician as well as completing 30 hours of education in pharmacotherapeutics and the board does not track the number of the NPs with DEA numbers (AMA, 2017). Both states require that providers should register in the prescription drug monitoring program (PDMP) for Benzodiazepines and opiates but the difference is that APRN in Georgia is practicing under the prescriptive authority of a physician and are not able to delegate access to PDMP unless a nurse who has prescriptive authority (Georgia Department of Public Health, 2018). While in Nebraska, APRN has prescriptive authority; thus, can delegate access to PDMP (Borcher, 2016).

It would be to the perfect interest of patients and the society as a whole for all the APRN in America to have equal full legal authority in all the states as in Nebraska to enable them to practice within the full scope of the education and experience they have earned through rigorous academic and clinical training. According to Doyle et al., (2017), NPs have all it takes to practice to the full scope of education gained; this prompted the IOM to call on states with unjustifiably restrictive regulations on the NPs like Georgia state to amend the law that will authorize NPs to practice to the full scope of their ability across the countries. Also as mentioned earlier, allowing NPs to have full practice authority that would enable them to practice and prescribe independently would assist in addressing the workforce shortage allowing underserved areas to have access to health care as well as all Americans in general (Doyle et al., 2017)


American Association of Nurse Practitioners. (2018). Retrieved from

American Medical Association. (2017). Retrieved from

Borcher, K. C., & Houseman, R. (2016). Nebraska and Prescription Drug Monitoring Program. Retrieved from

Doyle, J. M., Zangaro, G. A., Howie, B. A., & Bigley, M. B. (2017). Retrospective Evaluation of the Advanced Nursing Education Expansion Program. The Journal for Nurse Practitioners, 13 (97), 488-495 DOI:10.1016/j.nurpra.2017.04.019

Georgia Department of Public Health. (2018). Retrieved from

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

Nebraska legislature (n.d). Retrieved from

Scope of practice policy. (2019). Georgia Scope of Practice Policy: State Profile. Retrieved from

RE: Discussion – Week 5

The National Council of State Boards of Nursing (NCSBN) is a non-profit organization that brings together various nursing regulatory bodies to discuss and work on a variety of interests and concerns. They are currently the world leader in nursing regulatory knowledge (National Council of State Boards of Nursing, 2020). The NCSBN represents all 59 nursing regulatory bodies in the United States. They define nursing care safety standards and issue licenses to practice (National Council of State Boards of Nursing, 2020). My home state of North Carolina and Texas are the two APRN regulatory boards I chose for this discussion board.

The first aspect of North Carolina nursing regulation that I investigated was the education and certification requirements. Nurse practitioners must provide certification evidence from a national credentialing body, according to 21 NCAC 3.0805. (NC Board of Nursing, 2020a). A nurse practitioner education program with 400 didactic and preceptorship hours must be completed. Health assessment and diagnosis, pharmacology, pathophysiology, disease management, prevention services, client education, and role development are all required courses (NC Board of Nursing, 2020a, para. #1).

I then researched the continuing education requirements for APRNs in North Carolina. According to 21 NCAC 36.0807, 50 hours of continuing education are required each year to maintain practice approval. The ANCC or ACCME, other credentialing bodies, or practice relevant courses must provide 20 of the hours (NC Board of Nursing, 2020b, para. #1). If the APRN prescribes controlled substances, one hour of continuing education must be devoted to substance use acts.

Texas APRN educational requirements, on the other hand, are approved by the State of Texas accrediting board. The program must be at the Master’s level of nursing education, according to Rule 219.1, and the director and faculty must all comply with the Nurse Practice Act and Board of Nursing regulations (Texas Board of Nursing, 2018). The education program should have uniform standards, and it should promote safe and effective advanced practice nursing as a developmental guide, as well as provide criteria for evaluating new APRNs (Texas Board of Nursing, 2018).

Texas APRNs are required to complete 20 hours of professional development, or they can obtain, maintain, or renew national nursing certification approved by the Texas Board of Nursing (Texas Board of Nursing, 2019). Pharmacotherapeutics must receive 5 additional contact hours. Competencies must be obtained during the two-year period preceding license renewal (Texas Board of Nursing, 2019).

APRNs are subject to licensure and continuing education requirements because they must demonstrate and maintain educational competence. Both states have misconduct regulations, and failing to adhere to competent care can result in unsafe practice, patient harm, and being seen in front of the nursing board, with the possibility of having a license revoked. With advanced practice licensure comes autonomy, which comes with the expectation and responsibility for professionals to stay current and competent when practicing at all times.

APRNs can comply with these regulations by staying current on education and practices related to the care they provide. They can also join professional organizations, which provide access to journals and opportunities for continuing education. The American Association of Nurse Practitioners (AANP) is an excellent example of a professional organization that offers APRNs advocacy, CE hours, journal subscriptions, and other benefits (American Association of Nurse Practitioners, n.d.). Additionally, APRNs can become certified and gain expertise in their field.


American Association of Nurse Practitioners. (n.d.). Membership.

National Council of State Boards of Nursing. (2020). About U.S. nursing regulatory bodies.

NC Board of Nursing. (2020a). Education and certification requirements for registration as a nurse practitioner.

NC Board of Nursing. (2020b). Continuing education (CE).

Texas Board of Nursing. (2018). Advanced practice registered nurse education.

Texas Board of Nursing. (2019). Requirements for APRNs.

An Advanced Registered Nurse Practitioner (ARNP) is a certified registered nurse who has completed national certification for a specialized area (Arizona Board of Nursing, 2020) such as Psychiatric Mental Health Nurse Practitioner (PMHNP). This nurse will compare the regulations from two of the places she has lived in, Alaska and Arizona

According to Ariz. Rev. Ann § 32-1601(20) (ARNP) has full independent authority and practice under licensure authority of the State Board of Nursing instead of a licensed physician (NCSL Scope of Practice Policy, 2021). The same is true in Alaska, (ARNP) have full independence to practice without the supervision of a physician according to Alaska Admin. Code §12-44.400. This means that both states allow (ARNP) to

  1. Examine a patient and establish a medical diagnosis by client history, physical examination, and other criteria.
  2. For a patient who requires the services of a health care facility: Order and interpret laboratory, radiographic, and other diagnostic tests, and perform those tests that the RNP is qualified to perform.
    1. Admit the patient to the facility,
    2. Manage the care the patient receives in the facility, and
    3. Discharge the patient from the facility.
  3. Prescribe, order, administer and dispense therapeutic measures including pharmacologic agents and devices if authorized under R4-19-511, and non-pharmacological interventions including, but not limited to, durable medical equipment, nutrition, home health care, hospice, physical therapy, and occupational therapy.
  4. Identify, develop, implement, and evaluate a plan of care for a patient to promote, maintain, and restore health.
  5. Perform therapeutic procedures that the RNP is qualified to perform.
  6. Delegate therapeutic measures to qualified assistive personnel including medical assistants under R4-19-509.
  7. Perform additional acts that the RNP is qualified to perform and that are generally recognized as being within the role and population focus of certification. (ARIZONA STATE BOARD OF NURSING, 2017)

One key difference is in the prescribing and dispensing authority within each state. Arizona requires that evidence of a minimum of 45 contact hours of education within the three years immediately preceding the application be submitted, covering one or both of the following topics consistent with the population focus of education and certification: Pharmacology, or Clinical management of drug therapy (ARIZONA STATE BOARD OF NURSING, 2017). While Alaska requires the applicant to provide evidence of completion of 15 contact hours of education in advanced pharmacology and clinical management of drug therapy within the two-year period immediately before the date of application (DIVISION OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING, 2021)


Arizona Board of Nursing. (2020, July 24). Arizona Board of Nursing Scope of Practice APRN Questions & Answers SCOPE OF PRACTICE Nurse Practitioners. Retrieved from Arizona Board of Nursing:



NCSL Scope of Practice Policy. (2021). State Overview: Arizona. Retrieved from NCSL Scope of Practice Policy:

MAIN POST RE: Discussion – Week 5

APRN Board Regulations in Texas and California

In the present healthcare environment, the role of nurses as a crucial element of the system is increasingly recognized. As such registered nurses often rely on Advanced Practice degrees in pursuit of independent provision of care. According to Schober (2018) their ability to promote accessible and safer care is acknowledge internationally, and new opportunities for nurses arise. In order to meet the requirements of independent practice, the usual procedure comprises a postgraduate degree that helps nurses reach a new level of expertise on the solid foundation obtained previously. Having complete the stage of education, advanced practice nurses are able to commence the new phase of their careers. However, in the case of the United States, the exact nature of advanced nursing practice may vary across different states.

For example, Texas is one of the territories where APRN practitioners benefit from the independent practice opportunities. More specifically, this state’s Nursing Practice Act introduces a possibility of independent work for an advanced practice nurse who meets the primary requirements. In order to obtain this status, an educated professional needs to complete licensing and certification procedures that will provide them with the required credentials (Texas Board of Nursing, 2021). The situation is different in California where advanced practice nurses cannot work without a physician’s supervision as per the Nursing Practice Act. Major changes are projected for the near future, as APRNs will be released from compulsory supervision in 2023 (California Board of Professional Nursing, 2021). However, the present-day situation remains the same. Another key difference between Texas and California consists of the APRN’s prescriptive authority. In the first case, while nurses can be independent practitioners, their prescriptive authority is to be delegated by a physician. In California, the lack of independence translates into the compulsory participation of a physician or a surgeon in all prescriptions.


California Board of Professional Nursing. (2021). Nursing Practice Act. Retrieved September 24, 2021, from

Schober, M. (2018). Global emergence of nurse practitioner/advanced practice nursing roles. Journal of the American Association of Nurse Practitioners, 30(4), 182–184.

Texas Board of Nursing. (2021). Nursing Practice Act. Retrieved September 24, 2021, from

According to the Rules and Regulation of the State of Georgia:

Rule 410-11-.14 Regulation of Protocol Use By Advanced Practice Registered Nurses as Authorized by O.C.G.A. Section 43-34-26.3


1. Adhere to a written nurse protocol agreement that is dated and signed by the APRN, the delegating physician, and any other designated physician(s); the APRN’s area of practice shall be in the same or comparable specialty as that of the delegating physician; the protocol shall specify the medical acts delegated to the APRN as provided by O.C.G.A. § 43-34-25 and shall provide for immediate consultation with the delegating physician or a designated physician if the delegating physician is not available; and Shall contain written provisions regarding the procedure for ordering controlled substances which comply with paragraph (b)(1) of O.C.G.A. § 43-34-23, if the ordering of controlled substances is included as a delegated medical act in the nurse protocol agreement.

Shall bear a current review date; be available upon request; and specify parameters under which delegated medical acts may be performed to include kinds of diagnostic studies which may be ordered, the extent to which radio logic image tests may be ordered, provisions for the reading and interpretation of such tests by a physician who is trained in the reading and interpretation of the tests, circumstances under which prescription drugs orders may be executed, number of refills which may be ordered, include a frequency of follow up review of the patient by the physician, including patients who are on controlled substances;  No prescription drug orders submitted by an APRN for Schedule I or II controlled substances.

Standard of Education in Georgia:

1. Hold a current license to practice as a registered professional nurse in Georgia,

2. Hold a current authorization to practice as an advanced practice registered nurse in Georgia

3. In any local board of education which has a school nurse program; or in a health maintenance organization that has an exclusive contract with a medical group practice and arranges for the provision of substantially all physician services to enrollees in health benefits of the health maintenance organization.


According to the Rules and Regulation of the State of  California:

4060. Controlled Substances
No person shall possess any controlled substance, except that furnished to a person upon the
prescription of a physician, dentist, podiatrist, or veterinarian, or furnished pursuant to a drug order
issued by a certified nurse-midwife pursuant to Section 2746.51, a nurse practitioner pursuant to
Section 2836.1, or a physician assistant pursuant to Section 3502.1. This section shall not apply to
the possession of any controlled substance by a manufacturer, wholesaler, pharmacy, physician,
podiatrist, dentist, veterinarian, certified nurse-midwife, nurse practitioner, or physician assistant,
when in stock in containers correctly labeled with the name and address of the supplier or producer.
Nothing in this section authorizes a certified nurse-midwife, a nurse practitioner, or a physician
assistant to order his or her own stock of dangerous drugs and devices.

Standards of Education in California:

1: Be a registered nurse

2. An institution of higher education that offers a baccalaureate or higher degree in
nursing, medicine, or public health.

3. Have had one academic year’s experience, within the last five (5) years, as an
instructor in a school of professional nursing, or in a program preparing nurse

The comparison of APRN between the state of Georgia and California varies. California has a one year academic years experience, with five years restriction, while the state of Georgia has no year restriction.

According to the Rules and Regulations of the State of Georgia: No prescription drug orders submitted by an APRN for Schedule I or II controlled substances, and according to the The state of California (DCA) Department of consumers Affairs: No person shall possess any controlled substance, except that furnished to a person upon the
prescription of a physician, dentist, podiatrist, or veterinarian, or furnished pursuant to a drug order
issued by a certified nurse-midwife pursuant to Section 2746.51, a nurse practitioner pursuant to
Section 2836.1, or a physician assistant pursuant to Section 3502.1