Professional Nursing and State-Level Regulations NRSE 6050

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Professional Nursing and State-Level Regulations NRSE 6050

Professional Nursing and State-Level Regulations NRSE 6050

Every State has different laws and regulations that impact APRNs practice, determined by individual state legislation and specific agency (Milstead & Short, 2019). The Nurse Practice Act (NPA) defines the regulation of nursing practice, which varies by State, and is governed by its state Board of Nursing (BON) to regulate the practice of nursing with the primary focus to protect the public health, safety, and welfare of its citizens.

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The American Nurses Association (ANA) represents all APRNs’ interest and believes that patients’ interests are best served by a health care system in which many different types of qualified professionals are available, accessible, and working together – collaboratively. Therefore, the scope of practice needs to reflect a professional’s true expertise (American Nurses Association, n.d.).

Starting July 2020, APRNs in Florida were able to practice independently, without a physician’s supervision, and to operate primary care practice in family medicine, general pediatrics, and general internal medicine. To qualify, the APRN needs to accumulate 3,000 hours of experience under physician supervision. APRNs have to complete minimum graduate-level course work in differential diagnosis and pharmacology and have not been subject to disciplinary action within the past five years (Florida Board of Nursing, n.d.).

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The passage of the bill demonstrates a commitment to the modernization of the way health care is delivered. APRNs can practice to the full extent of their education and abilities to provide the most efficient quality care to patients (American Nurses Association, n.d.). With this passage, people from Florida will have more access to health care, particularly in rural areas that are often underserved.

In contrast, although Texas recently eliminated the requirement of on-site physician supervision for Nurse Practitioners, they remained under restricted practice. State law requires a physician to provide continuous supervision, but the constant physical presence is not needed (Nurse Practitioner Schools, 2019). APRNs provide patient care by delegation from physicians.

A physician must delegate the prescriptive authority through a written document prescribed by law, and certain limitations apply to prescribing Controlled Substances (CSs), as schedules III-V. Schedule II may also be delegated depending on the patient’s pressing needs (Coalition for Nurses in Advanced Practice, n.d.). Supervising physicians are mandated to track prescriptions written by APRNs, perform chart reviews, and meet monthly.

To continue practicing as an APRN in Florida and Texas, one must maintain the State required continuing education courses and an additional three contact hours related to prescribing controlled substances. Texas requires practicing a minimum of 400 hours in their role and population focus area and shall attest to completing additional five contact hours in pharmacotherapeutics (“Texas Board of Nursing – Nurses,” n.d.). To continue practicing as an APRN in Texas, they should maintain and renew their RN and APRN licensed at the same time.

Florida and Texas are just one example of different States with different regulations. Every State has specific laws.  An APRN needs to understand the rules for the State that they are interested in practicing in. One must always ensure that you are practicing within your scope to protect the patients you are caring for and safeguard your license that you worked so hard to obtain.

Professional Nursing and State-Level Regulations NRSE 6050 References

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.

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.

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RE: Discussion – Week 9

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 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.

Professional Nursing and State-Level Regulations NRSE 6050 References

  • 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 research, 9, 457. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935027/
  • 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 psychiatry, 17(1), 30-38. Retrieved from: https://doi.org/10.1002/wps.20482
  • Dixit, S. K., & Sambasivan, M. (2018). A review of the Australian healthcare system: A policy perspective. SAGE open medicine, 6, 2050312118769211. Retrieved from: https://doi.org/10.1177/2050312118769211

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.

For California, which is the state I currently reside in, NPs have restricted practice. According to the American Association of Nurse Practitioners (2022), there are three practice environments for NPs: full practice, reduce practice, and restricted practice. There are currently 11 states including California who are restricted practice.

Restricted practice means that during the NPs career they must be supervised by a physician to be able to practice and the physicians must agree with the NPs assessment and approve the care plan and prescriptions associated with that assessment (American Association of Nurse Practitioners, 2022).

Recently, the California governor signed AB 890 which provides two different routes an NP can take to independently practice. One route taken effect since January 2021 allows NPs to continue to practice in any healthcare facility as long as there is one or two physicians employed there but does not have to be directly supervised while the other NP route which will take effect in January 2023 allows NPs to practice independently and open their own clinic, but they would have to be in good standing and have practiced three plus years (Montague, 2020). Even with this information, the AANP still shows California as being a restricted practice state maybe the official change won’t occur until 2023.

For Minnesota, where Walden University is located, NPs have full practice. This means that NPs can diagnose, prescribe medications including controlled substances, order and interpret diagnostic tests, and initiate and manage treatments based on the licensure of the state board of nursing (American Association of Nurse Practitioners, 2020).

However, new NPs must work 2,080 hours under what Minnesota calls a collaborative management in which the NP must work collaboratively with a physician (Minnesota Board of Nursing, 2022).

To my understanding since the California governor signed the AB 890, this allows NPs in California to practice to their full scope independently just like a full practice state so APRNs in both California and Minnesota can practice fully if they are in good standing with the board and continue to meet the requirements to keep their license.

Professional Nursing and State-Level Regulations NRSE 6050 References

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. 

RE: Discussion – Week 5-Main Post

 
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It is every nurses’ responsibility to know and understand the regulations of their state in accordance with their specific area of interest. Each state has their separate distinct regulations which will vary as will the scope of practice. In this post I will list the differences of two nursing regulations between my home state of Missouri and Mississippi.

I have learned throughout my years of practice that not every state allows advanced practice registered nurses to practice to the fully extent of their license. “Barriers at the state and national levels continue to prevent these highly qualified health care providers from practicing to the full extent to which their education and training have prepared them” (Position Statement: Full Practice Authority for Advanced Practice Registered Nurses in Necessary to Transform Primary Care, 2017).

According to NursingLicensure.org (2020b), in Missouri an APRN who wishes to prescribe controlled substances must have recent three semester hour advanced pharmacology course that is offered by their accredited school or 45 hours of recent continuing education, 3000 hours of preceptorship training with medicines, drugs, and therapeutic devices, and enter into an agreement with a physician who has an unrestricted DEA number who is engaged in a similar practice.

Professional Nursing and State-Level Regulations NRSE 6050

While in Mississippi the APRN must have all the training and collaboration that Missouri requires plus an additional 720 hours of supervised practice plus an additional requirement such as being able to document education and training in pharmacology which can be met through pharmacology coursework integrated into the advanced practice program.

In research from NursingLicenesure.org (2020a), in Mississippi an APRN must earn a degree at the master’s level which includes clinical experience and be nationally accredited through an agency approved by the Board and pass national certification examination. The program must be designed to prepare nurses for intended role, however those who graduated by the end of 1998 will not necessarily have degrees at the graduate level while those who graduated post-1993 will need to demonstrate that they completed programs that include concentrations in the specialties for which they are seeking.

APRNs graduating by the end of 1993 will not have completed programs specific to their role and will need to show that they have completed accredited APRN programs. Meanwhile in Missouri, according NursingLicensure.org (2020b), an APRN is a licensed RN with a qualifying Document of Recognition. These APRNs are recognized based on national advanced practice certification specific to the desired population focus and must meet educational requirements set by the agency. The nurse must complete an advanced nursing program which includes 500 hours of supervised clinical practice.

It is the accountability of the APRN to make sure they are aware of the regulations according to the state in which they are gaining certification and employment. For instance, Missouri and Mississippi are both either restricted or reduced in the APRNs ability to practice. If they could have full practicing power, they would be able to fully prescribe any medication needed for their patients without having to have their hands held by the collaborating physician.

“Restricted NP practice limits their ability to provide care in areas that lack access to primary health-care providers” (The impact of Nurse Practitioner Regulations on Population Access to Care, 2018). It would make treating patients easier when they are not seeking approval. In either state, it would be wise for the APRN to review and become familiar with the regulating board for the practicing state and to read the Nurse Practice Act within that state.

Professional Nursing and State-Level Regulations NRSE 6050 References:

Position statement: Full practice authority for advanced practice registered nurse/s is necessary to transform primary care. (November 2017). ScienceDirect. https://linkinghub.elsevier.com/retrieve/pii/S002965541730554

The impact of nurse practitioner regulations on population access to care. (2018). ScienceDirect. https://linkinghub.elsevier.com/retrieve/pii/S00296554173061664

READINGS

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)

2 http://www.nursingworld.org/

3Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761–765. doi:10.1016/j.outlook.2017.10.002

Note: You will access this article from the Walden Library databases.

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

5 https://www.ncsbn.org/index.htm

6 Neff, D. F., Yoon, S. H., Steiner, R. L., Bumbach, M. D., Everhart, D., & Harman J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379–385. doi:10.1016/j.outlook.2018.03.001

Note: You will access this article from the Walden Library databases.

7 Peterson, C., Adams, S. A., & DeMuro, P. R. (2015). mHealth: Don’t forget all the stakeholders in the business case. Medicine 2.0, 4(2), e4. doi:10.2196/med20.4349

Note: You will access this article from the Walden Library databases.

Also Read:

NURS 6050 Discussion: Presidential Agendas

NURS 6050 Assignment: Agenda Comparison Grid and Fact 

NURS 6050 Discussion: Politics and the Patient Protection and Affordable Care Act

NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement

Professional Nursing and State-Level Regulations NRSE 6050 SAMPLE

Different states tend to have unique regulations for the Advance Practice Registered Nurse but all aims at securing the interest of the public health safety by regulating the activities of the health care professionals (Milstead, 2019). The board of nursing of a state acts on the power derived from the Nurse Practice Act passage that allows them to set and regulate standard for safe nursing practice within its jurisdiction for nurses that have the qualification and for advanced practice including licensure requirements and license renewal as well as any necessary disciplinary actions (Milstead, 2019).

Comparing the State of Georgia, my home state APRN board of nursing regulation to that of the State of Nebraska; the first thing I noticed is that Georgia state regulatory body is the board of nursing while that of Nebraska is the Department of Health and Human Services. The credentialing criteria are similar, but there are some differences in the scope of practice.

Georgia state practice regulation has a restrictive tendency; the practice authority allows limited actions for APRN practice requiring supervision by 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).

In the state of Georgia, the practice authority requires a written protocol between the NP and the overseeing physician which specifies medical acts delegated by the physician and demands an instant session with the physician (Scope of Practice Policy, 2019). No wonder at my practice setting an NP is not allowed to initiate care nor partake in a patient discharge process.

On the other hand, Nebraska state and licensure law permit all NPs to exercise autonomy in practice such that they can assess patients, diagnose, order diagnostic tests, initiate and manage treatments, prescribe all medications including control substances without a provider’s supervision after fulfilling the criteria for doing so (Nebraska legislature, n.d).

Allowing APRNs to have full practice access will enable an increase in experience and expand the talents inherent in the nurse practitioners and encourage significant innovations in the nursing profession; also motivates other NPs to spring up in filling 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 prac

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