Professional Nursing and State-Level Regulations Discussion Essay
RE: Discussion – Week 5
It is paramount that the Advanced Practice Registered Nurses (APRN) have a succinct knowledge and understanding of their scope of practice in their specialty in the state they chose to practice. (Milstead,2019). Therefore, I would like to compare Kansas and Washington State. Professional Nursing and State-Level Regulations Discussion Essay.
Practice Authority:
Kansas and Washington State have different practice authorities. Kansas state practices reduced Authority while Washington practices full practice.
Kansas State Practices reduced Practice Under Kan. Admin Regs. s60-11-101, an APRN has to practice under collaborative practice and laid down protocol and plan of care under the supervision of a physician. The Physician does not need to be present in person during the care. In addition, the APRN has to ren Professional Nursing and State-Level Regulations Discussion Essayew their certification every two years, and it requires 30 hours of continuing education.
Washington State. Under Wash. Admin Code s246-840-300, APRNs have full independent Authority to practice on their own under the scope of their practice. Therefore, APRNs in this state should renew their licenses every two years having practiced at least 250 hours and 30 hours of continuing education. In addition, Washington State requires all license applicant to have completed seven hours of HIV/AIDS training.
Therefore, Kansas State APRNs have to work under a physician, making it difficult to own their practice. Meanwhile, Washington State APRNs can own their practices.
Prescriptive Authority
Kansas APRN must register with the U.S Drug Enforcement administration before prescribing controlled substances and be under a Physician DEA. Additionally, APRNs must notify the State Board of Nursing of the name and address of the foresing Physician. Washington State, on the other hand, APRN has full prescription authority for their APRN. Therefore, it is within the scope of practice for Washington State APRNs to prescribe drugs and schedule II-IV controlled substances. To main the prescription Authority, they must have 15 hours of pharmacotherapeutics course renewal every two years.
APRN as Primary Care Provider
In Kansas, APRNs are not referred to as Primary Care Provider; therefore, they neither sign the Do Not Resuscitate form nor sign a death certificate.
In Washington State, the state policy accepts the APRNs as Primary Care Providers, which gives them Authority to sign both Do Not Resuscitate forms and death certificates.
References
https://scopeofpracticepolicy.org/states/ks/
https://www.aanp.org/advocacy/state/state-practice-environment
https://www.nursinglicensure.org/np-state/washington-nurse-practitioner/
http://apps.leg.wa.gov/wac/default.aspx?cite=246-840-300
http://www.sos.ks.gov/pubs/kar/2015/060_60-Board of Nursing, 2015 KAR Supp.pdf
Milstead, J. A. & Short N.M (2019). Health Policy and Politics: A Nurse’s Guide. (6th ed).
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5 months ago
Afanwi Ntumngia
RE: Discussion – Week 5
Interesting post-Lucy. I agree with you. The Advanced Practice Registered Nurses (APRN) must have a concise knowledge and understanding of their scope of practice in their specialty in the state they chose to practice. (Milstead,2019). It is essential for Nurses and Advance Nurse Practitioners to adhere to the regulations by fully completing the mandatory education levels to become nurse specialists. Compliance with rules helps them identify the specific area of professional engagement and the boundary of their operations.
Moreover, APRNs have the education, knowledge, skills, and experience necessary to provide essential and comprehensive primary care services. They consist of a workforce ideally positioned to improve access to care, contribute to health disparities reduction efforts, and lower the cost of providing such care (Bosse. J et al. 2017) Professional Nursing and State-Level Regulations Discussion Essay.
However, barriers at the state and national levels seem to prevent these highly qualified health care providers from practicing to the full extent to which their education and training have prepared them. The American Academy of Nursing (Academy) position that the FPA of APRNs is essential to achieving health equity. Restriction of full practice authority (FPA) for advanced practice registered nurses (APRNs) is a barrier to providing efficient, cost-effective, high-quality, and comprehensive health care services for some of our most vulnerable citizens.
Reference;
About U.S. nursing regulatory bodies. NCSBN. (2021). Retrieved September 29, 2021, from https://www.ncsbn.org/about-nursing-regulatory-bodies.htm.
National Council of State Boards of Nursing | NCSBN (n.d) Retrieved from https://www.ncsbn.org/index.htm
The impact of nurse practitioner regulations on population access to care – Nursing Outlook.https://www.nursingoutlook.org/article/S0029-6554(17)30616-4https://doi.org/10.1016/j.outlook.2017.10.002.
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5 months ago
Roseline Evans
RE: Discussion – Week 5
Hello Afanwi
I agree with your point regarding the barriers at the state and national levels that prevent APRNs from practicing to the full extent of their training. In doing more research, I found that alleviating provider shortage can be achieved by expanding APRN practice, especially in primary care, in medically underserved areas, and for medically underserved populations (AANP, n.d.). Imposing greater restrictions on APRNs will only exacerbate existing and projected health care workforce shortages by limiting the ability of APRNs to fill gaps in patients’ access to primary care services.The U.S primary care delivery system is ever changing, therefore it only makes sense to evaluate and modernize existing policy and legislation pertaining to NP scope of practice (Neff et al., 2018).
Presently, there also remains a gap in the NP scope of practice because of variations in each state’s NP legislation. Within the more restrictive NP policy states, NPs face legislation that limits their full scope of practice. For example, states with a more restrictive NP practice policy do not allow NP certification of home health-care visits and patient stays in skilled nursing facilities or hospice care, limit ordering durable equipment, and block general hospital privileges for patient admissions while increasing the oversight of care by collaborators, usually MDs. However, widening the NP scope of practice to the full extent of their knowledge, skills, and competencies could be an important intervention for potentially closing the patient access gap to primary care (Neff et al., 2018).
References
AANP. (n.d.). State Practice Environment. American Association of Nurse Practitioners. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment
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 Outlook, 66(4), 379–385. https://doi.org/10.1016/j.outlook.2018.03.001
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5 months ago
Michael Collins
Initial Post: Discussion – Week 5
The scope of practice when it comes to Advanced Practice Registered Nurses (APRNs) varies greatly from state to state. Before I even begin with the comparison of my state to another state, I will voice that is is ridiculous that states within the same country borders are going to have completely different rules and regulations for these APRN positions and limit what some can do. There needs to be a nation wide regulation that allows for APRNs to have full scope of practice. Without this, a barrier to cost effective, high-quality, and efficient health care services to citizens in need of care (Bosse, Simmonds, Hanson, Dunphy, Vonhook, & Poghosyan, 2017).
My state of residence in Pennsylvania. Pennsylvania is a state that does limit the scope of practice of APRNs unfortunately. In the state of Pennsylvania, Nurse Practitioners have the ability to diagnose medical conditions, develop treatment plans, and order and perform diagnostic tests (Pennsylvania Coalition of Nurse Practitioners, (n.d.). However this must be done under collaboration agreement with a licensed physician. Nurse Practitioners are considered primary care providers in my state. Another regulation that Pennsylvania APRNs must abide by is their prescriptive authority. Similarly to the scope of practice restrictions regarding care, APRNs must have collaboration with a licensed physician in order to prescribe medications and therapeutic measures (Pennsylvania Coalition of Nurse Practitioners, (n.d.).
In comparison, in the state of Maryland, APRNs are also considered primary care providers. While this was also the case in Pennsylvania, the difference between the two states is that Maryland allows full reign on providing care. This means that nurse practitioners in Maryland are not permitted to work in a collaborative effort with a licensed physician overseeing them (Maryland.Gov, 2020). Within the state of Maryland which borders Pennsylvania, the scope of practice allows completely different privileges and responsibilities. APRNs in Maryland can freely treat, diagnose, develop treatment plans, and perform and order diagnostic tests all without the overseeing of a licensed physicians. This is the same instance for their prescriptive authority. There is no need for a licensed physicians to be involved in the scope of practice APRNs have in Maryland.
Being in school for an APRN program, it certainly feels degrading knowing that the state I live in does not allow the scope of practice to fully encompass the skills and education I will gain through this challenging program. I will be a licensed professional with the ability to complete these tasks and work independently, but will be withheld from this privilege due to the regulations of my specific state. There are currently only 15 states that allow APRNs full practice authority of their abilities. There are ten other states that require post-licensure or certifications following school or the collaboration with a physician. The remaining 25 states all still currently require the collaborative agreement with a physician (Milstead & Short, 2019).
APRNs are forced to adhere to these regulations within whatever state they are practicing in. This is part of being a licensed professional and provider. There are rules that must be followed. As stated in the first paragraph, limiting the abilities of these APRNs in some states is creating a barrier to care for populations that would greatly benefit from APRNs having full indecent practice abilities. Now in these states that limit the full practice authority, this doesn’t mean there aren’t still numerous APRNs with their own practices providing affordable and quality care. They are just under a physicians agreement. If these limitations weren’t a thing, I am certain that more and more APRNs would be pulling from overstaffed hospitals and doctors offices where they are currently employed and creating their own private practices in order to bring quality care to the community.
References
Bosse, J., Simmonds, K., Hanson, C., Dunphy, L., Vanhook, P., Poghosyan, L. (2017, November 1). Position statement: Full practice authority for advanced practice register nurses is necessary to transform primary care. Volume 65, Issue 6, pp. 761-765. https://doi.org/10.1016/j.outlook.2017.10.002
Maryland.Gov. (2020, December 9). Advanced Practice Registered Nursing: Nurse Practitioners. Maryland Board of Nursing. Retrieved from, https://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx
Milstead, J. A., & Short, N. M. (2019) Health Policy and Politics; A Nurse’s Guide (6th Ed.). Jones & Bartlett Learning.
Pennsylvania Coalition of Nurse Practitioners (n.d.). Scope of Practice. Retrieved from, https://www.pacnp.org/page/ScopeofPractice
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5 months ago
Idowu Oshokoya
RE: Initial Post: Discussion – Week 5
Michael,
I do like your discussion post, and I do agree with you that it is unfortunate that the scope of practice for Advanced Practice Registered Nurses in Maryland is different from Pennsylvania. You are correct that Nurse practitioners in Maryland does need collaborative agreement with doctors and they can diagnose, treat, and prescribe medications without any overseeing of a medical doctor (Maryland.Gov, 2020).
In the United States, only limited nations have permitted APRNs to fully practice without any collaboration agreement. While some other states still require post-licensure or certifications following school. The rest of the 25 states mandates a collaboration agreement with doctors before practice (Milstead & Short, 2019).
References
Maryland.Gov. (2020, December 9). Advanced Practice Registered Nursing: Nurse
Practitioners. Maryland Board of Nursing. Retrieved
https://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx
Milstead, J. A., & Short, N. M. (2019) Health Policy and Politics; A Nurse’s Guide
(6th Ed.). Jones & Bartlett Learning.
Pennsylvania Coalition of Nurse Practitioners (n.d.). Scope of Practice. Retrieved
https://www.pacnp.org/page/ScopeofPractice
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5 months ago
Michael Collins
RE: Initial Post: Discussion – Week 5
Thank you for your response! It is ashame that many states don’t allow APRNs to practice to their fullest independent potential.
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5 months ago
Roseline Evans
RE: Initial Post: Discussion – Week 5
Hello Michael,
I enjoyed reading your post and found it to be very informative. You made some valid points about feeling disheartened knowing that even after graduating as NPs, the states we live in still limit what we can do with our licenses. For example, my state Virginia falls under “restricted practice” According to AANP (n.d.) “State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care”
In your post, you mentioned that “limiting the abilities of these APRNs in some states is creating a barrier to care for populations that would greatly benefit from APRNs having full indecent practice abilities.” Research does indeed support this statement as we see that the growth of nurse practitioners (NPs) across all 50 states is unsurprising given the current landscape of health care, yet barriers that limit practice need action at both the state and national levels. Access to care is a significant challenge for patients. This access is negatively impacted when qualified NPs are willing and able to deliver quality, cost-effective care, yet governmental bodies continue to ignore legislation that would update the laws and modernize health care (Peterson, 2017). The study further suggests that full practice authority of NPs leads to more office-based primary care visits and checkups and fewer ACS emergency visits (Peterson, 2017). There is definitely great benefit to allowing NPs to practice independently as shown by this research.
References
AANP. (n.d.). State Practice Environment. American Association of Nurse Practitioners. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment
Peterson, M. E. (2017, January 1). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/
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5 months ago
Michael Collins
RE: Initial Post: Discussion – Week 5
Thank you for your response. This barrier to quality health care across the United States by not letting APRNs practice independently is unfair to citizens in areas where care is scarce from a physician. Something needs done and allowing APRNs full practice authority nation wide would be a huge step forward.
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5 months ago
Misty Williams
RE: Initial Post: Discussion – Week 5
Hi Michael. I completely agree with you in your statement that it is ridiculous that states within the same country borders have different rules and regulations for APRN (Advanced Practice Registered Nurses) positions. As I can see from our discussion posts, it is evident that most of us live in different states within the United States. We are advancing our careers and depending on the program of study we will be completing the same courses for that degree. However, depending on the state we live in some of us will not be able to operate within our full scope of practice. There are many benefits of allowing APRN’s ability to work without restrictions. According to an article in our assigned readings states that allow APRN’s to work without a restriction receive fewer emergency room visits, lower hospitalization rates, and the care provided by APRN’s comes at a lower cost than that of physicians ((Bosse et al., 2017). There is also a reduction of prescriptions written for drugs commonly linked to overdose and death.
References
Bosse, 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. https://doi.org/10.1016/j.outlook.2017.10.002
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5 months ago
Michael Collins
RE: Initial Post: Discussion – Week 5
Thank you for your response. That is very interesting that there is a direct link to less prescription drugs being prescribed that are linked to overdoses and deaths. These limitations to practice must be fixed because the health care system would Benefit drastically.
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5 months ago
Scott Lamprecht
RE: Initial Post: Discussion – Week 5
The AMA has a very well funded lobby program with lots of political power. They battle this on a State to State level. Professional Nursing and State-Level Regulations Discussion Essay.
REPLY QUOTE
5 months ago
Angela Sullivan
RE: Discussion – Week 5
APRNs is a broad definition which encompasses clinical nurse specialists (CNS), clinical nurse practitioners CNP) and clinical nurse anesthetists (CRNA). “APRNs are often primary care providers and are at the forefront of providing preventive care services to the public” (APRN ANA, n.d.). Each state has their own regulating body of nursing with their own scope of practice for APRNs. I chose my home state of Ohio and then, where I would like to move one day, Arizona.
OHIO
Ohio has a reduced practice environment which means that “state law requires career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice” (State Practice Environment, n.d.) The physician must enter in to a standard care agreement with the APRN. “A Standard Care Agreement (SCA) is a written, formal guide to planning and evaluating a patient’s health care” (SCA, n.d.) and it must be in place before an APRN enters into practice.
APRNs have prescriptive authority. The APRN must complete 45 hours of advanced pharmacology within their previous five years, including “legal, ethical, and fiscal implications of prescribing in Ohio as well as specific instruction related to schedule II controlled substances” (Prescriptive authority, n.d.). NPs may only prescribe medications after obtaining a thorough patient history and physical assessment to establish a diagnosis of the patient’s medical condition (Nurse Practitioner Scope of Practice Ohio, 2013).
ARIZONA
Arizona has a full practice environment. “State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing” (State Practice Environment, n.d.). Though NPs in Arizona can practice freely without supervision, Arizona state law requires that the NP refer patients to other health care providers or consult another provider if the patient’s care requires something out of the NPs knowledge and experience (Nurse Practitioner Scope of Practice Arizona, 2014).
With being a full practice environment, APRNs in Arizona may prescribe medications without the collaboration or supervision of another health care provider. NPs must apply for prescriptive authority through the Arizona Board of Nursing and have completed 45 hours of education in pharmacology in the preceding three years. The NP “must apply for a DEA number if he/she wishes to prescribe controlled substances” where it can only be used in the state of Arizona (Nurse Practitioner Scope of Practice Arizona, 2014). NPs can prescribe nonrefillable prescriptions for schedule II controlled substances.
When I complete my NP program, I will still be a resident of Ohio. Therefore, I will have to work in collaboration with another physician and will need to complete the requirements necessary for prescriptive authority. I have already been informed that if there is a position where I work now when I graduate, that I can become employed there. The NPs assess and obtain history of the patient either physically or virtually. The NP then collaborates with the provider in house or on call before they are able to prescribe medications or admit the patient. Hopefully, in a few years I will move to Arizona. It will be nice to be able to apply for my own DEA number and to work and prescribe autonomously. I think getting the experience from working collaboratively with another health care provider would benefit me the most to later work freely in another state Professional Nursing and State-Level Regulations Discussion Essay.
Advanced practice registered nurses (APRN): American Nurses Association. ANA. (n.d.). Retrieved September 29, 2021, from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/.
Nurse practitioner scope of practice: Arizona. ThriveAP. (2014, May 7). Retrieved September 30, 2021, from https://thriveap.com/blog/nurse-practitioner-scope-practice-arizona.
Nurse practitioner scope of practice: Ohio. ThriveAP. (2013, October 30). Retrieved September 30, 2021, from https://thriveap.com/blog/nurse-practitioner-scope-practice-ohio.
Prescriptive authority. www.OhioAPRN.com. (n.d.). Retrieved September 30, 2021, from http://www.ohioaprn.com/prescriptive-authority.html.
SCA (Standard Care Arrangement). www.OhioAPRN.com. (n.d.). Retrieved September 30, 2021, from http://www.ohioaprn.com/sca—standard-care-arrangement.html.
State practice environment. American Association of Nurse Practitioners. (n.d.). Retrieved September 30, 2021, from https://www.aanp.org/advocacy/state/state-practice-environment.
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5 months ago
Michael Collins
RE: Discussion – Week 5
Hello Angela,
The reason I chose to respond to you was because I saw you mentioned you were from Ohio which neighbors my state of Pennsylvania. I wanted to see if states in such close proximity would have any differences when it comes to the scope of practice and regulations. I did see that Ohio requires the collaboration with a physician. Like Ohio, the Pennsylvania board of nursing requires nurse practitioners to collaborate and work under a physician to diagnose medical conditions, develop and implement treatment plans, and order and perform diagnostic tests (Pennsylvania Coalition of Nurse Practitioners, (n.d.). However, unlike Ohio as you mentioned, regardless of the pharmacology training, APRNs in Pennsylvania still must have a collaborative agreement with a licensed physician in order to have prescriptive authority.
The other state I chose was Maryland is completely opposite just like your choice of Arizona. I didn’t chose Maryland for any specific reason like planning to move there, I just knew their regulations differed from my state. In Maryland, APRNs are allowed full reign on their practice authority and are not permitted to work under the supervision of a physician similarly to Arizona (Maryland.Gov, 2020). Upon researching in our course workbook, I found that only 15 states in the United States allow APRNs to have full practice authority independent of a physician (Milstead & Short, 2019).
I agree with you about it being beneficial upon completing this program to remain in my current state and work under the supervision of a physician to test the waters and gain experience. Similarly to you, I have already been offered a job upon completing school at my current place of employment and have a very good rapport with the physician that I will ideally be working under. Once I gain the experience doing this for some time, I likely will try to move my family to a state where I can have the full authority that I will have earned through this program.
References
Maryland.Gov. (2020, December 9). Advanced Practice Registered Nursing: Nurse Practitioners. Maryland Board of Nursing. Retrieved from, https://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx
Milstead, J. A., & Short, N. M. (2019) Health Policy and Politics; A Nurse’s Guide (6th Ed.). Jones & Bartlett Learning. Professional Nursing and State-Level Regulations Discussion Essay
Pennsylvania Coalition of Nurse Practitioners (n.d.). Scope of Practice. Retrieved from, https://www.pacnp.org/page/ScopeofPractice
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5 months ago
Andrea Cholagh
Response #2
Hi Angela, great post !
Nursing regulatory bodies assure that safe and competent nursing care is provided by licensed nurses (NCSBN, n.d.). It is important to know the regulatory bodies in which state you work in. It’s great that Arizona enables full practice authority! As stated in your post, NPs can practice freely without supervision if it is in their scope of practice (Advanced Practice Legal Issues, 2014). In comparison, Ohio requires a career-long regulated collaboration with another health care provider for an NP to provide patient care (AANP, 2021). These regulations are like the regulatory bodies I discussed – CNO in Ontario, and LARA in Michigan where Ontario allows full practice authority and Michigan does not. How do you think these regulations apply to a APRNs ability to practice to their full extent of their education and experience?
References
Advanced Practice Legal Issues. (2014, May 7). Nurse practitioner scope of practice: Arizona. ThriveAP. https://thriveap.com/blog/nurse-practitioner-scope-practice-arizona
American Association of Nurse Practitioners (AANP). (2021, August 4). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment
National Council of State Boards of Nursing (NCSBN). (n.d.). https://www.ncsbn.org/index.htm
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5 months ago
Idowu Oshokoya
RE: Discussion – Week 5
Hello Angela,
Thank you for sharing the post. You are correct that the scope of practice of APRNs varies from each state, and it depend on the regulating bodies. Since Ohio is difference from Arizona, the guidelines and duties of APRNs are not the same. The fact remains that the state of Ohio has a reduced practice for nurse practitioners and that , “state law requires career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice” (State Practice Environment, n.d.).
Professional Nursing and State-Level Regulations Discussion Essay. However, the State of Arizona has granted APRNs full practice Arizona and that, “State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing” (State Practice Environment, n.d.). More so, any nurse practitioners that wishes to practice or write schedule II prescription in the State of Arizona , “must apply for a DEA number if he/she wishes to prescribe controlled substances” (Nurse Practitioner Scope of Practice Arizona, 2014).
References
Thrive AP. (2014). Nurse practitioner scope of practice: Arizona. Retrieved from https://thriveap.com/blog/nurse-practitioner-scope-practice-arizona.
American Association of Nurse Practitioners. (n.d.). State practice environment. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment.
REPLY QUOTE EMAIL AUTHOR
5 months ago
Scott Lamprecht
RE: Discussion – Week 5
Great discussion! The AMA has a lot of money and political power which allows them to control nursing practice through legislation. Professional Nursing and State-Level Regulations Discussion Essay