PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050

Nurse Practice Acts (NPAs) usually mandate that the Board of Nursing (BON) develop rules that outline the criteria for applicants eligible to take licensing exams and obtain licenses. These rules include specific eligibility criteria, application procedures, and approved examinations (such as national certifying exams for APRNs). In addition, the rules also cover renewal procedures and fees. (Milstead & Short, 2019). 

With that being said, APRNs should have full practice authority, but In the United States, Regulations that may differ from state to state are the scope of practice for APRNs. Texas has specific regulations regarding the practice authority and limitations for APRNs. For example, APRNs in Texas must work under a written collaborative agreement with a physician, which outlines the scope of practice and supervision requirements. APRNs must collaborate with a physician, and the agreement must be reviewed and updated annually.

On the contrary, in Colorado, APRNs have full practice authority, which includes the ability to diagnose, treat, and prescribe medications and independently manage patient care. They can work autonomously or in collaboration with other healthcare professionals. The Regulation differs from other states where APRNs have full practice authority, allowing them to practice independently without needing a collaborative agreement with a physician.

Another regulation that may differ in Texas is the prescriptive authority for APRNs. In Texas, APRNs have limited prescriptive authority, which means they can prescribe medications but with certain restrictions. APRNs can prescribe controlled substances, but they are subject to additional requirements and limitations compared to physicians. For example, APRNs can only prescribe Schedule II controlled substances under a delegated prescriptive authority agreement with a collaborating physician, and they must follow specific protocols and regulations for prescribing such medications. This Regulation may differ from other states where APRNs have full prescriptive authority, allowing them to independently prescribe all categories of drugs, including controlled substances, without needing a collaborative agreement with a physician.

Online Nursing Essays

Struggling to Meet Your Deadline?

Get your assignment on PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050 done on time by medical experts. Don’t wait – ORDER NOW!

One state that grants full autonomy to Advanced Practice Registered Nurses (APRNs) in prescribing medication, including narcotics, is the state of Colorado.

In Colorado, APRNs are authorized to prescribe medications, including controlled substances such as narcotics, independently and without the need for physician supervision or collaboration. This means that APRNs in Colorado can assess patients, diagnose conditions, and prescribe medications, including narcotics, without any restrictions or limitations.

This full autonomy granted to APRNs in Colorado aims to improve access to healthcare, especially in underserved areas where physician shortages may exist. It allows APRNs to practice to the full extent of their education and training, providing timely and efficient care to needy patients.

Meanwhile, It’s crucial to remember that the exact range of work and prerequisites for Advanced Practice Registered Nurses (APRNs) might differ from one state to another, even if they have full authority to practice. It’s necessary to thoroughly examine the rules and regulations of each state to comprehend the complete scope of practice for APRNs in that specific state.

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050

The regulations governing Advanced Practice Registered Nurses (APRNs) play a crucial role in shaping their practice and scope of authority. I just want to inform everyone the difference of their regulations between California and Virginia. Since I came from California and moved into Virginia. With example how these regulations apply to APRNs with legal authority to practice within the full scope of their education and experience.

 In California, APRNs have restricted practice authority and must work under standardized procedures developed collaboratively with physicians. These standardized procedures define the specific scope of practice and patient management. Secondly, APRNs to obtain a furnishing license to prescribe medication independently.

In Virginia has granted full practice authority to APRNs. This means that APRNs in Virginia can practice independently, without the need for standardized procedures or physician collaboration, within their defined scope of practice. And also APRNs to maintain national certification in their specialized area of practice.

In accordance with application of regulations to APRNs 

an APRN in California, specialized as a nurse practitioner. The APRN collaborates with a physician to develop standardized procedures that outline the scope of their practice. These procedures may include guidelines for diagnosing and treating specific conditions, ordering diagnostic tests, and prescribing medications within the designated formulary. The APRN adheres to these standardized procedures, ensuring safe and effective patient care.

On the other hand, In Virginia, where APRNs have full practice authority due to regulation, a nurse midwife can independently provide comprehensive prenatal care and attend births without the need for standardized procedures or physician collaboration. The nurse midwife applies their education, skills, and experience to assess and manage the health of pregnant individuals, provide prenatal counseling, monitor fetal development, and facilitate safe deliveries.

Lastly, APRN board of nursing regulations between California and Virginia reveals significant differences in practice authority and collaboration requirements. California emphasizes collaborative practice with physicians through standardized procedures, whereas Virginia grants APRNs full practice authority. APRNs in California adhere to the standardized procedures developed in collaboration with physicians, ensuring high-quality care within the defined scope. Conversely, APRNs in Virginia practice independently, utilizing their education, experience, and national certification to deliver comprehensive care. Understanding these regulations is crucial for APRNs to navigate their practice environment effectively, provide patient-centered care, and contribute to improving healthcare outcomes in their respective states.

Reference:

https://www.rn.ca.gov/applicants/ad-pract.shtml

Links to an external site.

http://www.dhp.virginia.gov/Boards/Nursing/ApplicantResources/ApplyforLicense/NursePractitioner/index.html

Links to an external site.

https://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf

Links to an external site.

https://www.nursinglicensure.org/np-state/virginia-nurse-practitioner/

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.

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.

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

Health care regulations protect public safety. These regulations provide the standard of practice and licensure/credentialing rules. Requirements to practice vary from state to state and create obstacles for Advanced Practice Registered Nurses trying to practice in other areas (Milstead & Short, 2019). In the state of Georgia, the requirements for practices differ between specialties. A Certified Nurse Midwife needs to provide evidence of a Georgia state registered nurse license, transcript verifying graduation from an accredited post-graduate program, and certification from the American College of Nurse-Midwife Certification Council (Rules and Regulations of the State of Georgia, n.d.). In Kentucky, requirements are similar by requiring a copy of an active registered nurse license, completion of an accredited certified nurse-midwife education program, and certification with the national certification organization (Kentucky General Assembly, n.d.).

Even though the requirements are the same, receiving a new license takes time. The Nurse License Compact model allows nurses to practices within multiple states with one license. Until recently, APRNs did not have the same privilege (Milstead & Short, 2019). The National Council of State Boards of Nursing adopted the APRN compact model on August 12, 2020. For the model to be enacted, seven states must implement the legislation. Delaware is the only state with the legislation pending (National Council of State Board of Nursing, 2020). It is the responsibility of ARPNs desiring to practice in multiple states to be aware of the different state laws.

APRN’s scope of practice change across states. They continue to work to remove practice barriers (Milstead & Short, 2019). Georgia requires APRNs to adhere to a nursing protocol agreement with a physician (Rules and Regulations of the State of Georgia, n.d.). APRNs only practice within the parameters set by the delegating physician. In Kentucky, APRNs must collaborate with a physician when performing tasks outside their scope of practice. This includes prescribing controlled substances. Kentucky also limits the amount days and refills APRNs can prescribe (Kentucky General Assembly, n.d.).

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050 References

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050

Milstead, J.A., & Short, N.M. (2019) Health Policy and Politics: A Nurse’s Guide (6th ed.).

Jones & Bartlett Learning

Rules and Regulations of the State of Georgia (n.d.). Regulations of Advanced Practice

Registered Nurses. Retrieved December 30, 2020, from https://rules.sos.ga.gov/gac/410

11

Kentucky General Assembly (n.d.). Kentucky Administrative Regulations. Retrieved December 30, 20, from

https://apps.legislature.ky.go/law/kar/TITLE201.HTM

National Council of States Board of Nursing (n.d.) APRN Compact.

Professional Nursing and State-Level Regulations

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.

To Prepare:

  • Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
  • Consider how key regulations may impact nursing practice.
  • Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.

By Day 3 of Week 5

Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

Each state has its own Board of Nursing that all nurses have to abide by. The California Board of Registered Nursing (BRN) requires APRNs to hold a license, pay licensing fees, pay renewal fees, and graduate from a state-approved educational program (California Board of Nursing, n.d.). An NP may order durable medical equipment, prescribe medications, certify a person to be disabled, and create a plan of treatment for home health services as long as there is a collaborating or supervising physician (California Board of Nursing, n.d.). 

          Each state has its own regulations which APRNs have to follow in order to practice. Nurse practitioner scopes of practice vary by state. Some states are very similar, and some are different. There are three levels of practice authority: full practice, reduced practice, and restricted practice (Clarke, 2023). Reduced practice states allow NPs to perform some of their scope of practice without a supervising physician (Clarke, 2023). The restrictions are usually regarding running an independent practice and prescribing certain medications. There are 12 restricted practice states (Clarke, 2023). 

           Kansas is a full practice state. There are 27 full practice states (Clarke, 2023). Full practice authority means that nurse practitioners can perform the full scope of practice without a supervising physician. NPs are allowed to make diagnoses, order tests, prescribe medication, and run an independent practice (Clarke, 2023). There may be additional training or years of experience required before they can practice independently. California is a restricted practice state. There are 11 restricted practice states (Clarke, 2023). Restricted practice states require NPs to work under the supervision of a physician for all of their scope of practice (Clarke, 2023).

Scope of practice refers to the activities that nurses or clinical staff are allowed to do authorized by the state (Clarke, 2023). The main difference between Kansas’ and California’s APRN regulations is that California requires the NP to work under or be supervised by a physician, and Kansas allows NPs to prescribe medications, and make/treat diagnoses independently. APRNs can prescribe durable medical equipment, any drug that is consistent with the APRN’s title and population focus, and prescribe controlled substances (Kansas State Board of Nursing, 2022).

References

California Board of Nursing. (n.d.). Nurse practitioners: Laws & regulations. California Board of Registered Nursing. https://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf

Clarke, E. M. (2023, March 31). Nurse practitioner practice authority: A state-by-state guide. NurseJournal. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/

Links to an external site.

Kansas State Board of Nursing. (2022). Nurse practice act: Statutes & administrative regulations. Kansas State Board of Nursing. https://ksbn.kansas.gov/wp-content/uploads/NPA/npa.pdf

By Day 6 of Week 5

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

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

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

Discussion Week 5 

Every state develops and employs unique nursing regulations. At the same time, the Board of Nursing (BON) helps formulate care standards and provides practice licenses consistent with the existing nursing practice laws. It also guides licensure, nursing education, and practice. The BON regulations for New Jersey and New York differ in several respects.

Usually, the BON regulations for New Jersey and New York require advanced practice registered nurses (APRNs) to have a master’s degree but differ in their licensure requirements. New Jersey demands that these nurses have a registered nurse (RN) license, graduate education, and national certification to qualify for licensure as APRNs (NursingLicensure.org, n.d.-a). However, New York only requires that they have an RN license and either a national certification or a master’s degree. On this note, as long as APRNs satisfy the state educational requirements, they do not need national certification to get their practice license. The state deems those that completed graduate education to be nationally certified (NursingLicensure.org, n.d.-b). These licensure requirements reflect the difference in rules and guidelines across these states.

BON regulations for New York also confer full practice authority, contrary to New Jersey, where there is a reduced practice environment. This fact suggests that APRNs in the former can work independently. Those working in the latter can equally execute advanced practice roles but must work per the terms stipulated in a collaborative agreement (NursingLicensure.org, n.d.-a). Even though APRNs in New York can prescribe medications, they must have adequate pharmacology competence, which they can achieve by graduating from a registered program or taking an additional three-semester course (NursingLicensure.org, n.d.-b). Currently, APRNs in this state do not need to enter into a practice agreement to exercise their prescriptive authority following a recent removal of this requirement (Brusie, 2022). Thus, APRNs in these two states work in different practice environments.

States employ unique nursing laws that shape BON regulations. In this regard, New Jersey and New York approach licensure and practice differently. For instance, APRNs in the latter exercise complete practice authority, unlike those in the former who work in a reduced practice environment. Even so, nurses with the full power to deliver care must adhere to state-specific rules to be eligible to perform all advanced roles.

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050 References

Brusie, C. (2022, April 19). New York nurse practitioners get full practice authority. Nurse.org.

https://nurse.org/articles/new-york-full-practice-nurse-practitioner/

NursingLicensure.org. (n.d.-a). Advanced practice nurse license requirements in New Jersey:      Nurse practitioner, clinical nurse specialist, nurse anesthetist.

New Jersey APN License Requirements | Become a Nurse Practitioner in NJ

NursingLicensure.org. (n.d.-b). Advanced practice nurse requirements in New York.

Become a Nurse Practitioner in New York | APN License Requirements in NY

Peterson, M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner

focus. Journal of the Advanced Practitioner in Oncology8(1), 74–81.

I enjoyed reading your post and like that your state New York is more favorable for practicing as Nurse practitioners as it gives the more scope of practice. In California, it is required to be RN License  and Master’s degree just like New york , but also required or have graduate degree in nursing and required a board shall also issue a certificate after determined requirements has meant by the individual (Nurse practitioner: Laws and regulations). Also, In California, if one wants to hold a license or holding a license they need to submit, their credentials includes “previous license, education, experience and other credentials and information board required and used to qualify on to hold the title Nurse practitioner” (Nurse practitioner: Laws and regulations).

“The Legislature finds that various and conflicting definitions of the nurse practitioner are being created by state agencies and private organizations within California”. The Legislature also depicts that people or patients may get confused or “harmed” by this kind of confusion so they decided to establish certain  requirements and officially determine the qualifications before “use of title of Nurse practitioner” by someone (California legislature information).

In California, to prescribe medications or device nurse practitioners need to undergo supervised physician or surgeon, also for controlled substances prescriptions need 24 hours training and registration under safety act.

Furthermore, “Drug order” or “order” for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to “prescription” in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code” (California legislative information).

Every state has their different regulations based on their laws and policies made by lawmakers, some influenced by nursing leaders and administrators . Though nursing associations and organizations always try to bring new policies and try to fight for nursing rights for their scope of practice within their field of knowledge and experience. We as nurses need to participate more in research and administrations, as nurses spend more time while giving care to patients. So, nurses need to  present their thoughts for practice as they know better about quality care and evidence based practice , and what are some changes needed to bring and how they can benefit patients. Cause it will impact and influence lawmakers when nurses present real life situations with real examples they face day to day in their experiences.

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050 References

AANP (2013). Nurse practitioner cost effectiveness. Retrieved Sept 26, 2022 from

                https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioner-cost-effectiveness

California legislative information ( n.d.) Business and professions code – bpc , division 2, Chapter 6, nursing, article nurse practitioners (2834-2837). Retrieved Sept 26, 2022 from

               https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml? lawCode=BPC&division=2.&title=&part=&chapter=6.&article=8.

Nurse practitioner: Laws and regulations (2013). Board of registered nursing , business and professions code. Retrieved Sept 26, 2022 from

              https://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf

NursingLicensure.org. (n.d.-b). Advanced practice nurse requirements in New York. Retrieved Sept 28, 2022 from

             https://www.nursinglicensure.org/np-state/new-york-nurse-practitioner/

As I researched more about this week’s topic of APRN regulations, I

discovered that each state has distinct restrictions regarding how Nurse

Practitioners can do their duties. It is both surprising and frustrating that there

are still many restrictions on NP practice in several jurisdictions, including my

own, Pennsylvania. The AANP has broad definitions for practice authority

statuses (Carthon, et al., 2018). Full Practice, Reduced Practice, and Restricted

Practice are the three options. Each state’s State Board of Nursing (BON) has

its own set of regulations. Each state has a website devoted to their specific

BON outlining the laws and regulations that are necessary in that state. I reside

in Pennsylvania (PA), where the State Board of Nursing is responsible for

ensuring the health and safety of all residents of the state by regulating the

practice of professional and practical nursing, dietetics, and nutrition and

granting licenses to clinical nurse specialists, dietitians, graduate nurses,

registered nurses, practical nurses, and certified registered nurse practitioners

(Carthon, et al., 2018).

A Certified Registered Nurse Practitioner (CNP) in Pennsylvania 14

required to fulfill needs for ongoing education on a biennial cycle of renewal.

These requirements include completing a minimum of 30 continuing education

credits, of which 16 hours must be in pharmacology (Kandrack, et al., 2021).

Additionally, PA mandates that at least two hours of ongoing education in pain

management, identifying addiction, or the practices of prescribing or

distributing opioids be completed by all certified registered nurse practitioners

(CRNP) and dispensers (Carthon, et al., 2018),

Because I lived  so close to the PA and West Virginia (WV) line while   I

was in nursing school, and I completed my clinical rotations there. Several of my

classmates had licenses from both West Virginia and Pennsylvania, allowing

them to work in either state. The main distinction I discovered in WV

regulation during my investigation was that it is a state that is part of the NLC

multi-state nursing license. There are total of 26 states that take part in the

Nursing Compact States (NLC). Being able to practice in numerous states

while paying different license fees and renewal fees every two years is quite

advantageous. I believe that NLC has advantages and disadvantages. The NLC

helps traveling nurses since it eliminates the need for several licenses.

Additionally, since there are more traveling nurses, it might make it harder for

nurses to get jobs close to where they live in states that take part in the NLC. In

West Virginia, you must renew your license each year and complete twelve

contact hours (Peterson, 2017).

Any professional whose license has expired is prohibited from

practicing until it is reinstated. Your license may be revoked, or you may be

required to attend the appropriate lessons or training if you do not fully adhere

to your state’s laws and regulations. The expectations of the profession before

earning that license have been explained to us as we become ready to receive a

license. The American Nurses Association (ANA) supports high standards of

nursing practice, promotes the economic and general welfare of nurses in the

workplace, projects a positive and realistic view of nursing, and advocates

before Concerning medical issues that affect nurses and the general population,

congress and regulatory bodies (Kandrack, et al., 2021). Never forgetting the

need of safe practice, I will always conduct my business as a medical  professional.

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050 Reference

Peterson, M. E. (2017). Barriers to practice and the impact on Health Care: A nurse

practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1),

322-330. https://doi.org/10.6004/jadpro.2017.8.1.6

Kandrack, R., Barnes, H., & Martsolf, G. R. (2021). Nurse practitioner scope of

practice regulations and nurse practitioner supply. Medical Care Research and

Review, 78(3), 208-217. https://doi.org/10.1177/1077558719888424

Carthon, J. M., Nicely, K. W., Sarik, D. A., & Fairman, J. (2018). Effective strategies

for achieving scope of practice reform in Pennsylvania. Policy, Politics, and

Nursing Practice, 17(2), 99-109. https://doi.org/10.1177/1527154416660700

Your write-up is very enlightening. It is fascinating to know that one does not necessarily need the national certification to practice as an APRN in New York if one has an RN license and master’s degree. It is also fantastic to know that ARRN graduates from New York can practice independently. I almost doubted the authenticity of care in this area, but when I did more research and saw that APRNs in New York will still practice according to a written protocol agreement with the physician they are collaborating with. This means that working independently as NP, one still must have collaborated with one or two providers. And this makes perfect sense.

This ultimately means the patients need not worry about any alteration in their care since the NPs are still working under providers’ guidance. However, in the eyes of some others, by completely removing the limitation of having a written protocol with a physician, the provider scarcity will be eliminated, and The NPs will practice freely (Poghosyan et al., 2018).  Consequently, this will lead to improved accessibility of care for patients and improved patient outcome (Neff et al., 2018). I cannot ignore the fact that the new Nurse practitioners can also look for jobs as soon as they graduate.

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050 References

Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., Bumbach, M. D., Everhart, D., & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook66(4), 379-385.

Poghosyan, L., Norful, A. A., & Laugesen, M. J. (2018). Removing restrictions on nurse practitioners’ scope of practice in New York State: Physicians’ and nurse practitioners’ perspectives. Journal of the American Association of Nurse Practitioners30(6), 354-360.

REPLY

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.

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/

RE: Response to your Discussion – Week 5 Main Post

In terms of the scope of practice, New York is the latest state to pass legislation granting nurse practitioners full practice authority, signed by New York Governor Kathy Hochul on April 11, 2022.  With full practice authority, nurse practitioners in New York will now be able to evaluate, test, diagnose, manage treatment, and prescribe medications for patients without having to sign a contract agreement with a supervising physician.

However in New Jersey, nurse practitioners has reduced practice and require having a joint protocol, by statutory law in New Jersey, the collaborating agreement requires the APN and the physician to review one patient case per year. In New Jersey, nurse practitioners are regulated and licensed by the board of nursing. Nurse practitioners may practice following completion of their nurse practitioner program but before passing the national NP certification exam.

In New York requires individuals to be active registered nurses and have completed a nurse practitioner program approved by the NYSED with an MSN or a higher degree before they can become licensed nurse practitioners. While it isn’t necessary to become nationally certified in a specific specialty, it can be a useful way to meet the New York State Board of Nursing’s eligibility requirements for practitioners. Regardless of the certifying agency that you decide to use to pursue your preferred specialty, it’s important to ensure that you meet the minimum education and experience standards.

To become a certified nurse practitioner, you have the choice between taking two primary exams. The American Nurses Credentialing Center (ANCC) offers a 175-question exam that focuses on the clinical role of a nurse practitioner. In contrast, the American Association of Nurse Practitioners (AANP) offers a 150-question competency-based exam that assesses skills and individual abilities. After earning your certification, the state requires you to update it every five years through additional training and education. It additionally requires active practitioners to re-license every three years.

While the education requirements set by the New Jersey Board of Nursing to the applicants for certification shall be graduation from a master’s-level program designed to educate and prepare nurse practitioners/clinical nurse specialists and completion of a graduate level 3-credit course in Pharmacology from a school duly accredited by a national accrediting agency approved by the Board; or a pharmacology course of at least 45 hours integrated into the Master’s in Nursing program. New Jersey law also requires biennial certificate renewal which coincides with registered professional nurse licensure renewal.

For both states, respective Boards of Nursing require nurse practitioners to hold a registered professional nurse license in good standing in the ir specific states but can also provide certification by endorsement for NPs certified from other states. In my situation, I got an RN license for both New Jersey and New York.

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS NURS 6050 References

  1. P. Newhouse et al., “Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review,” Nursing Economics 29, no. 5 (Sept.–Oct. 2011): 230–50.
  2. Stanik-Hutt et al., “The Quality and Effectiveness of Care Provided by Nurse Practitioners,” Journal for Nurse Practitioners 9, no. 8 (2013): 492–500.

Martiniano R, Wang S, Moore J. A Profile of New York State Nurse Practitioners, 2017. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany; October 2017.

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.

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.

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

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.

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 Medicine33(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/

Money and power can be great motivators. As you previously stated, politicians use the polarizing nature of the many issues facing healthcare in order to gain votes, not evaluate the  best solution for the welfare of the population. The United States has been tauted to have the “best healthcare in the world”. It certainly could be argued that the care in the U.S. is superior. However, our healthcare system is not without its issues.

The Affordable Care Act was an attempt to correct the disparities in healthcare in an effort to insurance access to the uninsured by expanding Medicaid, creating sliding scale insurance prices, insurance rate restrictions, and by allowing children to stay on their parent’s insurance until age 26 (Campbell and Shepard, 2020). Unfortuneately, the perspective of some constituents and politicians was that we are throwing money into a broken system. Additionally, some people would prefer limited government interference in daily living, so the Affordable Care Act represented a step closer to socialized medicine.

In truth, health coverage is very complex with many different factors to consider. According to Campbell and Shepard (2020), social scientists are exploring it’s origins and effects including important but not fully understood long term changes in the ACA and may have been affected by it in ways that are difficult to disentangle. For the average U.S. citizen, reading and understanding the Affordable Care Act would be tedious and quite a feat in itself. Therefore, many Americans rely on politicians and the media to understand and interpret the complex policies, and this leaves the citizens vulnerable to manipulation.

Consider the perspective on the Affordable Care Act taken by our current president. According to the White House (2022), President Biden stated, “Over the last 12 years, Republicans in Congress have voted over 70 times to repeal the ACA with no real plan to replace it, and just this year a Republican revealed a plan to strip protections from 100 million Americans with pre-existing conditions and jack up premiums.” However, upon researching the  issue, I discovered that there is in fact an executive order from the Administration of Donald Trump called “An America First Healthcare Plan”.

The same set of facts and circumstances are present, except this order states, “On December 22, 2017, I signed into law the repeal of the burdensome individual-mandate penalty (of the ACA), liberating millions of low-income Americans from a tax that penalized them for not purchasing health-insurance coverage they did not want or could not afford. Through Executive Order 13813 of October 12, 2017 (Promoting Healthcare Choice and Competition Across the United States), my Administration has expanded coverage options for millions of Americans in several ways…” (The Administration of Donald J. Trump, 2020).

These two statements contradict each other. One states that there was no plan, however the other goes on to describe what the plan was in detail. This is a falacy of incomplete comparison. Not all of the necessary information was present to evaluate the premises. Additionally, the language used is highly emotionally charged and seems intended to illicit fear, anger, or victimization – words like burdensome, “no real plan”, and jacked up premiums. Additionally, the word “liberated” ellicits positive feelings that  would make the listener more likely to allign with the  speaker.

As stated in the original post, a politician’s goal is to stay in office. Therefore, not every statement can be taken at face value, especially without doing one’s due diligence and researching the topic. After researching this topic, it appears that ethics and politics do not go hand in hand. One must observe for the implicit bias in any argument, but especially arguments that affect policies in healthcare. As a profession, we are trained to distinguish between fact and extraneous materials. It appears that taking an active role in researching both sides of the issues and comparing them with reliable sources while being alert for implicit biases and logical falacies is yet another way we can be advocates for our patients. Certainly, the politicians are not altruistically taking positions on policies. 

The regulations governing Advanced Practice Registered Nurses (APRNs) play a crucial role in shaping their practice and scope of authority. I just want to inform everyone the difference of their regulations between California and Virginia. Since I came from California and moved into Virginia. With example how these regulations apply to APRNs with legal authority to practice within the full scope of their education and experience.

 In California, APRNs have restricted practice authority and must work under standardized procedures developed collaboratively with physicians. These standardized procedures define the specific scope of practice and patient management. Secondly, APRNs to obtain a furnishing license to prescribe medication independently.

In Virginia has granted full practice authority to APRNs. This means that APRNs in Virginia can practice independently, without the need for standardized procedures or physician collaboration, within their defined scope of practice. And also APRNs to maintain national certification in their specialized area of practice.

In accordance with application of regulations to APRNs 

an APRN in California, specialized as a nurse practitioner. The APRN collaborates with a physician to develop standardized procedures that outline the scope of their practice. These procedures may include guidelines for diagnosing and treating specific conditions, ordering diagnostic tests, and prescribing medications within the designated formulary. The APRN adheres to these standardized procedures, ensuring safe and effective patient care.

On the other hand, In Virginia, where APRNs have full practice authority due to regulation, a nurse midwife can independently provide comprehensive prenatal care and attend births without the need for standardized procedures or physician collaboration. The nurse midwife applies their education, skills, and experience to assess and manage the health of pregnant individuals, provide prenatal counseling, monitor fetal development, and facilitate safe deliveries.

Lastly, APRN board of nursing regulations between California and Virginia reveals significant differences in practice authority and collaboration requirements. California emphasizes collaborative practice with physicians through standardized procedures, whereas Virginia grants APRNs full practice authority. APRNs in California adhere to the standardized procedures developed in collaboration with physicians, ensuring high-quality care within the defined scope.

Conversely, APRNs in Virginia practice independently, utilizing their education, experience, and national certification to deliver comprehensive care. Understanding these regulations is crucial for APRNs to navigate their practice environment effectively, provide patient-centered care, and contribute to improving healthcare outcomes in their respective states.

Reference:

https://www.rn.ca.gov/applicants/ad-pract.shtml

Links to an external site.

http://www.dhp.virginia.gov/Boards/Nursing/ApplicantResources/ApplyforLicense/NursePractitioner/index.html

Links to an external site.

https://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf

Links to an external site.

https://www.nursinglicensure.org/np-state/virginia-nurse-practitioner/

Hello Class, 


 

As I researched more about this week’s topic of APRN regulations, I 

discovered that each state has distinct restrictions regarding how Nurse 

Practitioners can do their duties. It is both surprising and frustrating that there 

are still many restrictions on NP practice in several jurisdictions, including my 

own, Pennsylvania. The AANP has broad definitions for practice authority 

statuses (Carthon, et al., 2018). Full Practice, Reduced Practice, and Restricted 

Practice are the three options. Each state’s State Board of Nursing (BON) has 

its own set of regulations. Each state has a website devoted to their specific 

BON outlining the laws and regulations that are necessary in that state. I reside 

in Pennsylvania (PA), where the State Board of Nursing is responsible for 

ensuring the health and safety of all residents of the state by regulating the 

practice of professional and practical nursing, dietetics, and nutrition and 

granting licenses to clinical nurse specialists, dietitians, graduate nurses, 

registered nurses, practical nurses, and certified registered nurse practitioners 

(Carthon, et al., 2018). 


 

A Certified Registered Nurse Practitioner (CNP) in Pennsylvania 14 

required to fulfill needs for ongoing education on a biennial cycle of renewal. 

These requirements include completing a minimum of 30 continuing education 

credits, of which 16 hours must be in pharmacology (Kandrack, et al., 2021). 

Additionally, PA mandates that at least two hours of ongoing education in pain 

management, identifying addiction, or the practices of prescribing or 

distributing opioids be completed by all certified registered nurse practitioners 

(CRNP) and dispensers (Carthon, et al., 2018), 


 

Because I lived  so close to the PA and West Virginia (WV) line while   I 

was in nursing school, and I completed my clinical rotations there. Several of my 

classmates had licenses from both West Virginia and Pennsylvania, allowing 

them to work in either state. The main distinction I discovered in WV 

regulation during my investigation was that it is a state that is part of the NLC 

multi-state nursing license. There are total of 26 states that take part in the 

Nursing Compact States (NLC). Being able to practice in numerous states 

while paying different license fees and renewal fees every two years is quite 

advantageous. I believe that NLC has advantages and disadvantages. The NLC 

helps traveling nurses since it eliminates the need for several licenses. 

Additionally, since there are more traveling nurses, it might make it harder for 

nurses to get jobs close to where they live in states that take part in the NLC. In 

West Virginia, you must renew your license each year and complete twelve 

contact hours (Peterson, 2017). 


 

Any professional whose license has expired is prohibited from 

practicing until it is reinstated. Your license may be revoked, or you may be 

required to attend the appropriate lessons or training if you do not fully adhere 

to your state’s laws and regulations. The expectations of the profession before 

earning that license have been explained to us as we become ready to receive a 

license. The American Nurses Association (ANA) supports high standards of 

nursing practice, promotes the economic and general welfare of nurses in the 

workplace, projects a positive and realistic view of nursing, and advocates 

before Concerning medical issues that affect nurses and the general population, 

congress and regulatory bodies (Kandrack, et al., 2021). Never forgetting the 

need of safe practice, I will always conduct my business as a medical  professional.
 


 

Reference  

Peterson, M. E. (2017). Barriers to practice and the impact on Health Care: A nurse 

practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 

322-330. https://doi.org/10.6004/jadpro.2017.8.1.6 


 

Kandrack, R., Barnes, H., & Martsolf, G. R. (2021). Nurse practitioner scope of 

practice regulations and nurse practitioner supply. Medical Care Research and 

Review, 78(3), 208-217. https://doi.org/10.1177/1077558719888424 


 

Carthon, J. M., Nicely, K. W., Sarik, D. A., & Fairman, J. (2018). Effective strategies 

for achieving scope of practice reform in Pennsylvania. Policy, Politics, and 

Nursing Practice, 17(2), 99-109. https://doi.org/10.1177/1527154416660700 

Full and Restricted Practice in the APRN Role

The Advanced Practicing Registered Nurse (APRN) has full practice authority in New Hampshire. Allowing the APRN to treat, diagnose, and prescribe without the oversight of a physician. However, places of employment are allowed to limit the scope of practice that an APRN is granted within the Nurse Practice Act (New Hampshire Board of Nursing, 2023). This is evident at the organization where I work because APRNs are required to have an attending physician. This only occurs at some healthcare facilities, and if APRNs want to open their own practice in New Hampshire, the scope of practice grants them that ability. The National Council of State Boards of Nursing (2022) shows that the Nurse Practice act in New Hampshire does not specify independent practice or prescribing authority for Clinical Nurse Specialists (CNS) and appears only to recognize the CNS role in psychiatric and mental health (New Hampshire Employment Security, Economic and Labor Market Information Bureau, 2021). 

The APRN’s scope of practice in Pennsylvania is restricted in two ways. Pennsylvania requires a written collaboration agreement with a physician and also limits the APRN’s prescriptive power. While the state of Pennsylvania recognizes APRNs as Primary Care providers, it also requires that a physician be available to the APRN “on a regularly scheduled basis” (commonwealth of Pennsylvania, 2009) to cosign records, review the medical practice standards, and update diagnosis. Based on the contract that the APRN must enter with the physician, their prescriptive authority can become more restricted than the state allows. Currently, APRNs’ prescriptive authority in Pennsylvania is limited regarding controlled substances. APRNs may not prescribe schedule III and IV drugs for more than 90 days and schedule II drugs for more than 30 days (Mitchell & Bhai, 2022). Then a physician must take over. Methadone is a schedule II substance, and Buprenorphine is a schedule III; both are used to treat opiate addiction. This can limit APRNs’ ability to treat opiate addiction even if they have specific training to do so.

            The regulations in Pennsylvania do not technically apply to APRNs in states where the full scope of practice is granted. As I explained earlier, employers may impose restrictions on APRNs that work within their organization, even in New Hampshire, where full practice authority exists. For APRNs to adhere to practice and prescriptive regulations in Pennsylvania or their state, APRNs should be familiar with their state practice act. They should follow the laws outlined for practice and prescribing and enter a collaborative contract with a physician in Pennsylvania. APRNs in states with a full scope of practice should recognize the limitations of their education. These APRNs’ should seek more information to show an excellent example of what an asset an APRN can be. Doing so may help other states improve their own laws on practice authority.

References

Commonwealth of Pennsylvania. Pa. Code §49.21.251 Links to an external site. (2009). https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter21/s21.251.html

Links to an external site.

Mitchell, D., & Bhai, M. (2022, December 5). The case for nurse practitioner reform: Full practice authority in Pennsylvania. Commonwealth Foundation. https://www.commonwealthfoundation.org/research/nurse-practitioner-reform-full-practice-authority-pennsylvania/#_edn15

Links to an external site.

National Council of State Boards of Nursing. (2022, September). APRN consensus model by state. https://www.ncsbn.org/public-files/aprn_consensus_model_by_state.pdf

Links to an external site.

New Hampshire Board of Nursing. (2023). Scope of practice. New Hampshire Office of Professional Licensure and Certification. https://www.oplc.nh.gov/scope-practice

Links to an external site.

New Hampshire Employment Security, Economic and Labor Market Information Bureau. (2021). Licensed, certified, and registered occupations in new Hampshire 2021. https://www.nhes.nh.gov/elmi/products/licertocc/documents/nursaprn.pdf

Don’t wait until the last minute

Fill in your requirements and let our experts deliver your work asap.