NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations

            I am currently a Florida resident, which is state where APRNs can practice autonomously under most conditions. Fl statute 464.0123 allows APRNs with a minimum of 3,000 hours of post-graduate clinical experience who have passed a national licensure exam and meet state requirements to practice within the full scope of their education without the requirement of an overseeing physician in the medical practice (The Florida State Legislature, 2021). I have chosen to compare some legal differences in professional APRN governance between the states of Virginia and Florida. In Virginia, APRNs must operate under a practice agreement with a physician in order to prescribe medications and otherwise work up to the full scope of their education under Va statute 54.1-2957 (Virginia General Assembly, 2021) NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations. Although there are significant difference in practice autonomy between the VA and FL rules for APRNs, there are some regulations that are similar between the two states. Fl. Statute 624.09 requires that all independently practicing APRNs must hold professional liability insurance coverage for malpractice/negligence claims up to $100,000 in order to practice (The Florida State Legislature, 2021). In Virginia, although APRNs are required to practice under the license of a physician, they are still required to hold professional liability insurance under Va statute 8.01-581.15 (Virginia General Assembly, 2021).        

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 In order for APRNs nationwide to be able to practice autonomously, in line with the scope of their education and experience, the National Council of State Boards of Nursing supports the APRN consensus model (NCSBN, 2021). In my review of the differences in legal autonomy for APRNs between Florida and Virginia, I can see how such a model is necessary moving forward. The APRN consensus model would establish a single, national set of guidelines and regulations that would allow APRNS to practice at their maximum scope in every state (NCSBN, 2021). Being a military spouse, I am frequently forced to relocate and obtain new state licensure due to my husband’s orders, and can clearly see the benefits of such a model to allow APRNs to make significant contributions to their organizations no matter where they live. 

 

 

References:

The Florida State Legislature. (2021). Regulation of Professions and Occupations. The Official Internet Site of the Florida Legislature. Retrieved from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499%2F0464%2FSections%2F0464.0123.html 

NCSBN. (2021). Campaign for consensus. National Council of State Boards of Nursing. Retrieved from https://www.ncsbn.org/campaign-for-consensus.htm 

Virginia General Assembly. (2021). Title 54.1. professions and occupations. § 54.1-2957. (Effective July 1, 2022) Licensure and practice of nurse practitioners. Retrieved from https://law.lis.virginia.gov/vacode/title54.1/chapter29/section54.1-2957/ 

 

 

One of the new focuses for nurse educators in the university setting is community and public health. They are attempting to effectively prepare students to care for the populations they will serve. Different states, different communities have different health care needs. How can boards of nursing, regulating agencies like the AACN, and schools of nursing prepare students to take care of anyone, anywhere if the health care needs are so drastically different?

Dr. Mooring

That is a great question, Dr. Mooring. The Institute of Medicine (1970), predicted the expanding scope of the APRN role in today’s world of healthcare. Their suggestion for properly preparing APRNs to enter the workforce was to expand competencies about genetics, geriatrics, and regional health issues as part of obtaining an MSN or DNP. Also, in my personal experience there is so much training thatoccurs on the job after graduation that I think any APRN who was able to successfully graduate and pass a national board exam should be able to quickly adjust to treating patients in a certain geographical area.

Reference:

Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (1970, January 1). Transforming education. The Future of Nursing: Leading Change, Advancing Health. Retrieved December 30, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK209885/ 

Andrea,

I enjoyed reading your post. It is has been very informative to see how each state differs for APRN’s. Although I currently live in North Carolina, my family and I will soon be moving to Florida. Florida and North Carolina differ drastically for APRN’s. APRN’shave a lot more freedom when it comes to practice in the state of Florida, where in the state of North Carolina it is a bit more strict. It is important as future APRN’s that we educate ourselves on the requirements that we need to maintain our licenses. Do you ever think that there will be universal laws and policys for APRN’s within the country?

The Florida State Legislature. (2021). Regulation of Professions and Occupations. The Official Internet Site of the Florida Legislature. Retrieved from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499%2F0464%2FSections%2F0464.0123.html 

 

Limitations on nurse practitioners. North Carolina General Assembly. (n.d.). Retrieved December 29, 2021, from https://www.ncleg.net/enactedlegislation/statutes/html/bysection/chapter_90/gs_90-18.2.html

Advanced Practice Nurse regulations are state regulated, and regulations vary from state to state. The State Board of Nursing in each state is responsible for all administrative tasks for licensure; state boards also work with the Nurse Practice Act (NPA) by enforcing rules and regulations state-specific for licensure and scope of practice in exact areas (NurseJournal, 2021). It is important for nurses to understand the regulations in their residing state or for those they may potentially reside in the future.

I currently reside as a Registered Nurse in Tennessee. I chose to compare regulations between Tennessee and the state of Washington. Tennessee is part of the Nurse Licensure Compact (NLC) for Registered Nurses. States with nurse licensure compacts allow nurses to provide care to patients located across the country, without being required to obtain additional licenses (Nurse Licensure Compact, n.d.). Washington state currently has no pending NLC legislation. Unfortunately, APNs in either state are not allowed to practice within the nurse licensure compact in any of the 50 states currently, except for North Dakota. The APRN compact was adopted August 12, 2020 allowing advanced practice registered nurses to hold one multistate license and practice in other compact states (National Council of State Boards of Nursing, n.d.). The APRN Compact will be implemented when 7 states choose to enact the legislation.

A difference between nursing regulations in Tennessee versus Washington is regarding full practicing authority. Advanced Registered Nurse Practitioners (ARNP) in Washington state have full practicing authority. According to the American Association of Nurse Practitioners (n.d.), state practice and licensure laws allow NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances. Tennessee APNs do not. In Tennessee, NPs have restricted practice. In restricted practice states, the law requires career-long supervision, delegation or team management by another health provider for the NP to provide patient care (AANP, n.d.).

I believe Nurse Practitioners should be allowed to have nurse licensure compacts and full practice authority in every state, after an appropriate residency period with a Licensed physician or experienced Nurse Practitioner. Highly prepared NPs with full practice authority can help alleviate load from Physicians and improve staffing shortages. “Relaxing restrictions on ARNP scope of practice may also expand the capacity of primary care services in rural areas” (Ortiz, et. al., 2018). Expanding the APRN compact to every state will also allow APNs to cross state lines and have less restrictions to practice where needed. Nurses should continue to advocate for these measures. “Familiarity with the regulatory process will give nurses and APRNs the tools needed to navigate this dynamic environment with confidence” (Milstead & Short, 2019).

 

References

American Association of Nurse Practitioners (n.d.). State Practice Environment.

https://www.aanp.org/advocacy/state/state-practice-environment

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th

ed.). Burlington, MA: Jones & Bartlett Learning.

National Council of State Boards of Nursing. (n.d.). APRN compact.

https://www.ncsbn.org/aprn-compact.htm

NurseJournal. (2021, November 11). What Is the Role of the State Board of Nursing?

https://nursejournal.org/resources/what-is-the-role-of-the-state-board-of-nursing/

Nurse Licensure Compact. (n.d.). About the NLC. https://www.nursecompact.com/about.htm

Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of Nurse

Practitioner Practice Regulations on Rural Population Health Outcomes. Healthcare (Basel), 6(2), 65. https://doi.org/10.3390/healthcare6020065

One of the new focuses for nurse educators in the university setting is community and public health. They are attempting to effectively prepare students to care for the populations they will serve. Different states, different communities have different health care needs. How can boards of nursing, regulating agencies like the AACN, and schools of nursing prepare students to take care of anyone, anywhere if the health care needs are so drastically different?

Dr. Mooring

Dr. Mooring:

You bring a good point regarding nurses being prepared for community and public health. I currently work in a community health setting. I feel it is important to prepare nursing students for working in various environments, including outpatient and home health. One practice nursing educational institutes and state nursing boards can better prepare nursing students for community health is incorporating required clinical hours in public/community health settings, in addition to acute care. “While efforts are being made to expand placements in the community and more care is being delivered in community settings, the bulk of clinical education for students still occurs in acute care settings” (Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, 2011). The need for nurses in the community health system continues to grow. Between 1996-2008, the total of registered nurses in community health settings, including home health care increased to 14.2 percent (American Association of Colleges of Nursing (2021). Increased clinical hours will allow nurses to have experience in all the various options the nursing field encompasses.

 

References

 American Association of Colleges of Nursing. (2021). Your Nursing Career: A Look at

the Facts. https://www.aacnnursing.org/Students/Your-Nursing-Career-A-Look-at-the-Facts

Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative

on the Future of Nursing, at the Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK209885/

Main Post

 

As nurses, it is our responsibility to be knowledgeable and understand the nursing practice act for the state in which we practice. Licensure is governed by the State Board of Nursing, which sets their education and practice regulations. The state must protect the public and does so by the written law that adheres to the state regulations (Milstead & Short, 2019).  Educating oneself in the guidelines allows the Nurse Practitioner to practice at the full scope and extent of their education and training (Bosse & Simmonds, n.d.).  Effectively, this will enable them to operate within their scope of practice.  This discussion will look at the nursing state boards of Tennessee and Alaska.

 

In Tennessee (restricted practice state for APRN), the requirements for the APRN are as follows: active registered nurse license in good standing, graduate degree, official transcript, national certification, proof of citizenship, completed mandatory profile, and 500 hours of clinical hours in the practice area. Also, there must be advanced pharmacology for prescriptive authority, and 5 CEU’s if practicing and 10 CEU’s if not practicing (TN Board of Nursing, 2016).  In Alaska (independent practice state for APRN), the requirements are similar, good standing as a registered nurse, graduate degree, official transcript ( advanced pathophysiology, advanced physical assessment, advanced pharmacology, national certification, professional reference letter, and ( 60 hours of CEU), prescriptive authority requires 15 contact hours in advance pharmacology/clinical management of drug therapy and DEA requires two contact hours in pain management and opioid use/addiction and 500 hours in clinical hours in the practice area (Alaska, n.d.).

Differing requirements between the two states is that Alaska requires its prospective APRNs to have a professional reference that can attest to the applicant’s competency to practice as an APRN. Alaska does not require oversight by another provider for the nurse practitioner to provide patient care. Alaska also allows the full authority to prescribe medications, including schedule II and schedule III-controlled substances. Tennessee also requires that prospective APRNs will need to be a member of a nursing board, have career-long supervision with delegation or team management by another health care provider for nurse practitioners to provide patient care. APRNs can’t write schedule II or schedule III drugs without physician supervision.

A comparison of a few regulations of the APRN that practices in a restricted authority state vs. the independent entire scope authority state. The restrictive condition the rules placed on the individual affects their practice in various ways. One significant course aspect involved is the increased cost of care (Bosse & Simmonds, 2019). The increased cost results from the physician billing at a 100% reimbursement rate as opposed to the 80-85% reimbursement rate of APRN.  The restrictive authority provides geographical challenges in providing care to underserved inner-city communities and rural areas. Physicians are not locating themselves to provide for these populations and locations. In a restricted practice state, the APRNs will stay within the covering authorities’ location for the supervision aspect, limiting health care utilization.  APRN’s in restricted authority states are at the mercy of the area of physicians.

As an APRN that practices in an independent authority state, one is free to practice away from the supervision of a physician, allowing more comprehensive coverage for primary care and preventative care services. The APRN approach is more holistic hence significantly lower hospitalization rates, fewer ER visits, fewer prescription drugs, and more of a collaborative interdisciplinary approach to patient care.  The second regulation is the prescriptive authority of the APRN. The independent APRN will address the entirety of the patient’s health complaint or problem because of the unrestricted power to prescribe, including schedule II and schedule III-controlled substances. The APRN is a restricted state cannot freely prescribe to address the patient’s needs, requiring the patient to seek care with another provider. This is ineffective care delivery (Bosse & Simmonds, n.d.). As advanced practice nurses, we must continue to push full scope authority and take our place as independent care providers that can revolutionize health care delivery.

 

Reference

Bosse, jordon, & Simmonds, katherine. (n.d.). ScienceDirect. Retrieved December 29, 2021, from sciencedirect.com/science/artic le/ii/S0029655417305584

 

Milstead, J. A., & short, N. M. (2019). health policy and politics: A nurse™S guide (6th – nursing papers. Nursing Papers – Academic writing services. (2021, June 9). Retrieved December 30, 2021, from https://graduatednurses.org/2021/06/09/milstead-j-a-short-n-m-2019-health-policy-and-politics-a-nurse%C2%99s-guide-6th-2/

 

National Coalition of State Boards of Nursing, 2008

National Coalition of State Boards of Nursing. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Chicago, IL: APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Chicago, IL: Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf

TN Board of Nursing: Everything About Licensure, License Verification, education. intersection. (2016, June 8). Retrieved December 30, 2021, from https://nursection.com/tn-board-nursing-licensure-license-verification-education/

One of the new focuses for nurse educators in the university setting is community and public health. They are attempting to effectively prepare students to care for the populations they will serve. Different states, different communities have different health care needs. How can boards of nursing, regulating agencies like the AACN, and schools of nursing prepare students to take care of anyone, anywhere if the health care needs are so drastically different?

Dr. Mooring

Dr. Mooring

The NCSBN is pushing for the Consensus Model, if all of the states choose to adopt this model the regulatory requirements will be uniform for licensure, accreditation, certification and education (NCSBN, 2008).  I don’t believe that the health care needs are so drastically different from state to state or communities, rather the availability of  resources, personnel, providers and authority of the provider is what the significant difference is from state to state. Nurses are the most prudent patient advocates and deliver the most personalized care among our health care professionals. Our credentials are more than adequate to care for patients as independent providers , improve access to care, delivery of care, and lower the cost of care  (Bosse & Simmonds, 2019) . This will ease the needs of the communities and provide an option for patients who need care.

Reference

Bosse, jordon, & Simmonds, katherine. (n.d.). ScienceDirect. Retrieved December 29, 2021, from sciencedirect.com/science/artic le/ii/S0029655417305584

National Coalition of State Boards of Nursing, 2008

National Coalition of State Boards of Nursing. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Chicago, IL: APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Chicago, IL: Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf

Discussion – Week 5

 

 

Precious Dixon

Walden University

NURS 6050

Dr. Mooring

December 29, 2021

 

Discussion – Week 5

Each state has a board of nursing (BON) that licenses and regulates the activities of nurses, including advanced practice registered nurses, within its jurisdiction. The BON also determines the nurses’ scope of practice and handles disciplinary issues associated with nursing practice violations (Huynh & Haddad, 2021). However, BON in each state has diverse regulations from other states. For instance, my state’s (Georgia) APRN BON regulations differ from Maryland’s BON regulations.

The first difference involves practice authority. While Georgia’s BON regulations require APRNs to have a protocol agreement with a supervising physician and additional supervision requirements (Georgia Department of Public Health [GDPH], 2018), Maryland’s BON regulations allow APRNs full practice authority and independence. According to Brom et al. (2018), full practice authority denotes medical doctor or physician involvement not being needed for the APRN to practice, and the APRN practice being the BON’s primary authority. The second difference entails prescriptive authority. Currently, Georgia requires APRNs’ prescriptive ability to be indicated in the nurse protocol agreement with the medical doctors. Irrespective of the terms defined in the nurse protocol agreement, APRNs in Georgia are prohibited from prescribing Schedule II controlled substances. Conversely, Maryland’s BON gives APRNs prescriptive authority.

The regulations may apply to APRNs with legal authority to practice within the full scope of their education and experience differently. For example, the regulations would allow the APRNs in Maryland to perform all the practice and prescribe medication or drugs, while in Georgia, the APRNs have limited practice roles. The regulations also enable the APRNs in Maryland to prescribe medications independently but require APRNs in Georgia to obtain a nurse protocol agreement before they can prescribe. Besides, APRNs may adhere to the chosen regulations by ensuring and attaining the required continuing education training each licensing year and guaranteeing that their practice licenses are up to date.

 

References

Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120–130. https://doi.org/10.1097/JXX.0000000000000023

Georgia Department of Public Health. (2018, June). Georgia Department of Public Health Prescriptive Authority for Advanced Practice Registered Nurses Toolkit. https://dph.georgia.gov/sites/dph.georgia.gov/files/APRN%20Prescriptive%20Authority%20Guidelines%206.2018.pdf

Huynh, A. P., & Haddad, L. M. (2021, July 22). Nursing Practice Act. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK559012/

 

Providing APRNs with full practice authority will help improve access to primary care for so many patients,  and as you say, it is also beneficial to have a physician readily available to discuss complicated cases. What do you think it will take to get prescriptive authority for all APRNs in the country? How can we get legislators to understand how important that is?

Dr. Mooring

Precious

I read your post comparing Georgia and Maryland and the full scope authority and prescriptive authority. The NCSBN launched their campaign in 2008 and then launched the Maps Project in 2011 with intended implementation in 2015. I looked at the scoring grid and Georgia is 50-71% (NCSBN, 2008).  Georgia, Tennessee and Alabama are a few of the most restrictive states regarding authority . The South East Region of the United States tend to be behind in the progression. Is Georgia governed by the BON and the BOM?

We need to make an effort as APRN’s to continue to support the ANA for regulatory consistency amongst the states. Many physicians are against the full scope of authority  regardless of the education or training.  Many agencies have substantiated the evidence that  allowing APRN’s full scope authority would help resolve the issue of the shortage of physicians in primary care and ease the demand that Covid-19 has placed on the health care system (Sofer, 2018).

National Coalition of State Boards of Nursing, 2008

National Coalition of State Boards of Nursing. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Chicago, IL: APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Chicago, IL: Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf

Sofer,  D.  (2018).  AMA resolution opposes independent practice by APRNs.  American Journal of Nursing, 118(3), 12. https:// doi: 10.1097/01.NAJ.0000530922.33715.46

I live in the State of Florida. On March 11, 2020, Governor Ron DeSantis signed a bill allowing nurse practitioners to practice autonomously without the supervision of a physician (Florida Board of Nursing, 2021) . This law went into effect on February 25, 2021 . (Florida Board of Nursing, 2021).

In opposition, APRN in New York are not allowed to practice autonomously and must still practice under the supervision of a physician (NYS Nursing, 2021). New York law allows a nurse practitioner to work a little more independently such as collaborating with a physician through the phone but does not grant full independent practice (NYS Nursing, 2021).

In the State of Florida, nurse practitioners can only sign a death certificate if they have applied and been approved for autonomous practice (Florida Board of Nursing, 2021).

On the contrary, in New York State nurse practitioners are allowed to sign death certificates and do not have to work independently as they are allowed in Florida (NY State Senate, 2019).

In order to practice independently in Florida, a APRN must apply to the program and have a total of 3,000 clinical hours under the supervision of a physician among other regulations over the past five years. (Florida Board of Nursing, 2021). Many NPs who have the experience can take full advantage of this new law. For example, NPs who have worked with a specific clinical setting can open up their own practice and subject to pay liability and insurance just like doctors do.

 

 

 

Reference

Florida Board of Nursing. (2021). Can an APRN sign death certificates? Retrieved December 30, 2021, from https://floridasnursing.gov/help-center/can-an-aprn-sign-death-certificates/

Florida Board of Nursing. (2021.). HB 607 passes legislature – impact to RNS, CNAS, and APRNs. Retrieved December 30, 2021, from https://floridasnursing.gov/hb-607-passes-legislature/

NY State Senate. (2019). Legislation. Retrieved December 30, 2021, from https://www.nysenate.gov/legislation/laws/PBH/4141

NYS Nursing: Practice Information: Practice Requirements for Nurse Practitioners. (2021). Office of the professions. Retrieved December 30, 2021, from http://www.op.nysed.gov/prof/nurse/np-prfnp.htm

Providing APRNs with full practice authority will help improve access to primary care for so many patients,  and as you say, it is also beneficial to have a physician readily available to discuss complicated cases. What do you think it will take to get prescriptive authority for all APRNs in the country? How can we get legislators to understand how important that is?

Dr. Mooring

Hi Claudia,

I found your article interesting regarding NPs signing death certificates. This is a part of full practice authority I did not consider but exists in many states. NPs are fully authorized to sign death certificates in 26 states, with NPs only being able to sign under special conditions in the states of Alaska, Arkansas, and New Jersey (Cavanaugh, 2017). In a research article I found from the Journal of Nurse Practitioners (2010), arguments were made both in favor and in opposition of NPs being allowed to sign death certificates. A few of the arguments in favor of NPs signing death certificates are that NPs are increasingly the primary care provider and are most knowledgeable about the patient’s medical conditions to determine the cause of death; a fewer number of primary care physicians and physician care medical residents being available causes delays in completion of death certificates (Selway, 2010). Arguments against NPs signing death certificates include that the NP’s educational process does not develop the sufficient knowledge or skills to complete certain portions regarding cause of death; death certificates require special skill and knowledge to be accurately completed (Selway, 2010). I personally believe NPs should be allowed to sign death certificates and seek out experienced physicians when needed for additional opinions of cause of death. What are your thoughts on these arguments?

 

References

 Cavanaugh, C. (2017, November 15). A Guide to the NP Wheel: Nurse Practitioner

Scope of Practice Laws. Barton Associates.  https://www.bartonassociates.com/blog/a-guide-to-the-np-wheel-   

nurse-practitioner-scope-of-practice-laws

Selway, J. (2010). Should APRNs Be Allowed to Pronounce Death or Certify Cause of

Death? The Journal for Nurse Practitioners, (6)2, 124-125.

https://www.sciencedirect.com/science/article/pii/S1555415509006874

Hello Claudia,

Unlike in the state of Florida, nurses in Georgia must work under a physician’s supervision (Georgia SOS,2021). Besides that, both of these states have a lot in common, including the similarity of consequences for unlicensed practices. Georgia’s Regulations state that “An applicant for licensure who has practiced as a licensed practical nurse or registered professional nurse in the State of Georgia while not holding an active license issued by the board shall be subject to disciplinary action by the Board which may include: a private or public reprimand; a find of $50.00 per month for up to six months of unlicensed practice, etc…” (Georgia SOS, 2021) while the 2021 Florida similarly says, in Chapter 465.016, that the act of ‘”…obtaining a license by misrepresentation or fraud or through an error of the department or board” will be disciplined’ (The 2021 Florida Statutes, 2021).

References

Florida Legislature (n.d.). The 2021 Florida statutes. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=456.072&URL=0400-0499/0465/Sections/0465.016.html

Georgia SOS. (n.d.). Chapter 410-7 unlicensed practice. https://rules.sos.ga.gov/gac/410-7

Georgia SOS. (n.d.). Chapter 410-11 regulation of advanced nursing practice. https://rules.sos.ga.gov/gac/410-7

Advanced practice registered nurses, or APRN, regulations are defined by the Nurse Practice Act and overseen by a Board of Nursing. The main purpose of these rules are to determine and define the credentials needed to be considered an APRN, controlling licensure for nurses. These regulations are influenced by state law as well so each state may have different rules. In order to become an APRN one must obtain a master degree along with educational and clinical experience (Russel, 2017).

Florida has quite strict APRN regulations and is described as having “restrictive NP practice regulatory environments” (Neff, 2018, p. 382). In Florida APRN’s must be under MD supervision. The strict limitations placed on Florida APRN’s has been point for tension as many call for more autonomy. Especially since the start of the COVID pandemic there is a need for more responsibility due to the lack of physicians (Bachtel, 2020). Florida APRN’s are not considered primary care providers in policy. Montana has less restrictive regulations, allowing APRN’s to practice independently. The state does not mandate physician supervision for APRNs therefore they can open their own practice and are considered primary care providers in policy. Being recognized as a PCP can provide more duties for an APRN.

Since Florida APRN’s are not PCPs in policy there is a barrier on the scope of practice in comparison with an APRN from Montana with the same educational and clinical experience. A Montana APRN would be able to practice independently allowing them to take on duties like signing death certificates. A Florida APRN would be required to have a minimum of three thousand hours of physician supervised experienced to gain the right to practice independently and have access to the same level as the Montana APRN.

References:

Bachtel, M. K., Hayes, R., & Nelson, M. A. (2020). The push to modernize nursing regulations during the pandemic. Nursing Outlook, 68(5), 545.

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.

Russell, K. A. (2017). Nurse practice acts guide and govern: Update 2017. Journal of Nursing Regulation, 8(3), 18-25.

One of the new focuses for nurse educators in the university setting is community and public health. They are attempting to effectively prepare students to care for the populations they will serve. Different states, different communities have different health care needs. How can boards of nursing, regulating agencies like the AACN, and schools of nursing prepare students to take care of anyone, anywhere if the health care needs are so drastically different?

Dr. Mooring

Chris-Paul,

I also chose to investigate the APRN regulations for the state of Florida because this is where I currently live and will likely practice as an APRN. I was unfamiliar with Montana’s regulations prior to reading your post. Florida has made some progress in recent years, allowing APRNs to utilize their education and skills, but there is still room for improvements.

In your post you also mentioned the strain that the COVID-19 crisis put on health care providers and certain state practice restrictions created barriers to APRNs assisting with this tremendous need. These restrictions were highlighted during the pandemic and led to executive orders in five states to temporarily suspended all APRN physician collaboration/supervision requirements, select practice requirements were waived in 16 additional states, and n action was taken in the seven remaining reduced or restricted states (Kleinpell, Myers, Schorn, & Likes, 2021). The response to the national COVID-19 pandemic revealed the value of APRNs being allowed to practice to the full extent of their practice. According to Bachtel, Hayes, and Nelson (2020), the Southeastern United States remains the most restricted area for APRNs. Now is the time to advocate for change on removing APRN practice barriers.

References

Bachtel, M. K., Hayes, R., & Nelson, M. A. (2020). The push to modernize nursing regulations during the pandemic. Nursing Outlook, 68(5), 545–547. https://doi.org/10.1016/j.outlook.2020.05.006

Kleinpell, R., Myers, C. R., Schorn, M. N., & Likes, W. (2021). Impact of COVID-19 pandemic on APRN practice: Results from a national survey. Nursing Outlook, 69(5), 783–792. https://doi.org/10.1016/j.outlook.2021.05.002

Hi Chris,

Prior to reading your discussion post, I was unaware of the limitations APRNs face in the state of Florida. It surprised me that APRNs in Florida are not considered primary care providers. In my home state of Missouri, it is relatively common for APRNs to be PCPs; in fact, my own personal PCP is an FNP.

As you mentioned, the COVID pandemic may lead to a call for less restrictive APRN practices in the future. Like Florida, Georgia is another state known for its limitations on APRN practice and is considered the most restrictive. The Federal Health and Human Services secretary recommended that states relax the restrictions on APRNs (Bachtel, 2020). So far, 22 states have enacted full practice authority for APRNs expanding their scope of practice and responsibility.

References

Ashcroft, J. R. (2021). Division 2200—State Board of Nursing. In Code of State Regulations (pp. 10–13).

Bachtel, M. K., Hayes, R., & Nelson, M. A. (2020). The push to modernize nursing regulations during the pandemic. Nursing Outlook, 68(5), 545.

In every profession, there are some rules and regulations that govern the professionals. The nursing profession has its rules and regulations too and as nurses it is important that we learn about our board of nursing’s rules and regulations. The APRN profession has its regulations and each state has its own, but they are all for the better good which is safety of the general population health.

I reside in the state of Georgia and I used to live in the state of New Jersey so I will be comparing two APRN boards of nursing regulations in Georgia to that of New Jersey. First, both of these states are regulated by the board of nursing. Also, taking the scope of practice, there are some restrictions in both Georgia and New Jersey State. When it comes to practicing. The APRN requires supervision of a doctor before he or she can administer care to patients (American association of nurse practitioners, 2021). Georgia requires an APRN to be a graduate of an APRN school within four years and with 500 hours of practice within those four hours when applying to practice (Georgia board of Nursing, 2020). With New Jersey, besides graduating with APRN degree, the APRN also requires a “graduate level 3-credit pharmacology course completed within five (5) years” (New Jersey division of consumer affairs, 2015).

Secondly, when it comes to prescribing controlled medicines, in the state of Georgia, the APRN can only prescribe schedule III to V after providing written agreement to the physician he or she works under and getting approval, but not scheduled II meds. New Jersey on the other hand, the APRN can prescribe all the controlled medicines from II-V provided they have collective written agreement with the physician (American medical association, 2017).

Being that the APRNs who have legal authority to practice within the full scope of their education and experience have already completed the program, they have met the requirements. The only thing is to find a practitioner she can work under. With the amount of patients providers see, most providers are usually rushing out to see other patients while attending to another. Its obvious more providers are needed. With the kind and amount of education and training APRNs receive, I think they qualify enough to provide care to patients without the supervision of providers. Providers work will be less, patients will have quality of care, if APRNs are given full authority to practice on their own; thus, there will be more providers which will reduce shortage of providers, reduce the time patients spend waiting to be seen and they can bring out their concerns and problems when being attended to without being rushed.

 

References

American medical association. (2017). https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-prescriptive-authority.pdf

 

Georgia board of Nursing-Initial authorization as an advanced practice registered nurse. (2020).

https://sos.ga.gov/PLB/acrobat/Forms/38%20Application%20-%20Initial%20Authorization%20%28APRN%29.pdf

New Jersey division of consumer affairs. (2015). https://www.njconsumeraffairs.gov/nur/Pages/APN-Certification.aspx

State Practice Environment. (2021). American association of nurse practitioners.   https://www.aanp.org/advocacy/state/state-practice-environment

Hello Yvonne, I enjoyed reading your post this week. I live in Florida, a state where APRNs can practice autonomously. However, I was surprised, when reading through my colleague’s posts from this week, at the number of states where APRNs have to practice under a supervising physician. I agree with your point that with the amount of education and licensure requirements for APRNs should allow them to practice autonomously after graduation, no matter in which state they reside. That is the whole idea behind the APRN consensus model. Similarly structured to the state nursing licensure compact, the APRN consensus model lays out a way that APRN certification can be honored across state lines so that APRNs can practice anywhere in the U.S. (NCSBON, 2021). There are 4 APRN roles that are included in the consensus model for APRN regulation, and those include certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP) (American Association of Colleges of Nursing, n.d.)

References:

American Association of Colleges of Nursing. (n.d.). APRN Consensus Model. American Association of Colleges of Nursing: The Voice of Academic Nursing. Retrieved December 30, 2021, from https://www.aacnnursing.org/Education-Resources/APRN-Education/APRN-Consensus-Model 

NCSBON. (2021). Campaign for consensus. National Council of State Boards of Nursing. Retrieved from https://www.ncsbn.org/campaign-for-consensus.htm 

 

Providing APRNs with full practice authority will help improve access to primary care for so many patients,  and as you say, it is also beneficial to have a physician readily available to discuss complicated cases. What do you think it will take to get prescriptive authority for all APRNs in the country? How can we get legislators to understand how important that is?

Dr. Mooring

Reply to Yvonne,I used to work in a hospital where some physicians did not approve nurse practitioners in a hospital setting. A petition was signed by several physicians not to allow NPs to practice in hospitals and they refused to have a NP work with them. I believe that there will be a lot of opposition once more and more NPs start to have a autonomous practice. Some physicians think that nurse practitioners can not perform at the same level of service as they can (Sofer, 2018). Many agencies such as the Kaiser Family Foundation  believe that NPs can help ease the burden on overwhelmed physicians especially because of the rise in the elderly population (Sofer, 2018).

Supporters of NP independent practices believe that NPs are able to fill the physician shortage because it takes a NP approxiamtely six years to graduate as oppose to a physician that has 11-12 years of studying and residency programs (Cabbabe, 2016). Studies also show that NP and physicians continue to work in the same metropolitan area still leaving a shortage in the rural areas (Cabbabe, 2016).

Nurse Practitioners are trained individuals who in an opposing challenge need to prove themselves twice as hard to those who do not believe they have the expertise to take care of patients.  As nurses, we work harder to keep our patients safe in the hospital setting and as APRNs we will continue to do the same.

Reference

Cabbabe, S. (2016). Should Nurse Practitioners be allowed to work independently?  The Journal of the Missouri State Medical Association,  113(6): 436–437. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139780/

Sofer,  D.  (2018).  AMA resolution opposes independent practice by APRNs.  American Journal of Nursing, 118(3), 12. https:// doi: 10.1097/01.NAJ.0000530922.33715.46

In order to protect public safety, health professions regulation is necessary, in forms of licensing and credentialing, and it required ongoing maintenance of acceptable standards of practice (Milstead & Short, 2019). NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations Practice acts very by state and titles, definitions, criteria for entrance into practice, scopes of practice, reimbursement policies, and models of regulation are state specific (Milstead & Short, 2019).

I’ve held an RN license in the state of Florida and in the states of Virginia, and in noticing some differences in RN regulations, I decided to compare regulations and scope of practice surrounding the APRN. In 2020, Florida changed the law to allow APRNs who meet certain criteria to practice primary care or midwifery without physician supervision (Florida Department of Health, 2020).  To practice as an autonomous APRN in the state of Florida, one must follow the scope of practice, which include engaging in autonomous practice only in a primary care practice, perform the general functions of the advanced practice nurse related to primary care, admit, manage, and discharge patient from a facility, and a certified nurse midwife and APRN must follow guidelines established under the law (Florida Department of Health, 2020).  In Florida, the Psychiatric Mental Health Nurse Practitioner (PMHNP) meeting the requirements in s. 394.455(35), within an established protocol with a psychiatrist, may prescribe psychotropic controlled substances for the treatment of mental disorders (Florida Department of Health, 2020).

In the state of Virginia, a prescription for a controlled substance may be issued only by a licensed nurse practitioner pursuant to § 54.1-2957.01 (Virginia Department of Health Professionals, 2021). Virginia regulations surrounding ARNPs practicing autonomously is like that which the state of Florida currently follows.  An APRN can practice independently if they have met requirements of subsection I and they may practice without a written or electronic practice agreement. Otherwise, they must maintain appropriate collaboration and consultation, as evidenced in a written or electronic practice agreement, with at least one patient care team physician (Virginia Department of Health, 2021).

Allowing APRNs to practice to the full extent of their training can provide many benefits to patients and health care systems, such as greater access to care, particularly in areas of lower socioeconomic status, but state regulations continue to limit APRN practice in much of the United States (Phoenix & Chapman, 2020). Regulations that govern nursing practice can be implemented by a number of agencies, and it is important as an APRN to track these agencies, including health professions licensing boards, states agencies that govern licensing and certification, agencies that deliver public health services, and agencies that govern federal/state contribution program reimbursement (Milstead & Short, 2019).  We are in a period of rapid change in the way health car is delivered and the APRN should advocate for policies that improve patient’s access to affordable and quality health care.

References

Florida Department of Health. (2020). Nurse practice act. https://www.fadona.org/2020/Nurse-Practice-Act-Florida.pdf

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

Phoenix, B. J., & Chapman, S. A. (2020). Effect of state regulatory environments on advanced psychiatric nursing practice. Archives of Psychiatric Nursing, 34(5), 370–376. https://doi.org/10.1016/j.apnu.2020.07.001

Virginia Department of Health Professions. (2021). Board of Nursing. Laws and regulations. http://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/LawsRegulations/index.html

One of the new focuses for nurse educators in the university setting is community and public health. They are attempting to effectively prepare students to care for the populations they will serve. Different states, different communities have different health care needs. How can boards of nursing, regulating agencies like the AACN, and schools of nursing prepare students to take care of anyone, anywhere if the health care needs are so drastically different?

Dr. Mooring

 

According to the West Virginia Board of Examiners for Registered Professional Nurses, an “Advanced Practice Registered nurse is a registered nurse who has acquired advanced clinical knowledge and skills preparing [them] to provide correct and indirect care to patients as a certified nurse practitioner [etc]… who has completed a board approved graduate-level education program and who has passed a board-approved national certification examination” (West Virginia Code 30-7-1, 2019) NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations. In the state that I reside, APRN’s are governed by the Georgia Board of Nursing which determines the rules and requirements needed by [them] to practice in the state of Georgia. These regulation are very crucial to the health care system and are built to protect both the patient and worker.

A great example of this can be see in Rule 410-7-.01 of the Rules and Regulations of the State of Georgia which discuses the consequences of unlicensed practice and although many other states don’t directly state it, some states like Florida, similarly quote that the act of ‘”obtaining a license by misrepresentation or fraud or through an error of the department or board” will be disciplined’ (Chapter 465.016, The 2021 Florida Statutes, 2021).

Another regulation that has proven to be needed is the disciplinary actions of one “permitting any person not licensed as a pharmacist in this state or not registered as an intern in this state, or permitting a registered inter who is not acting under the direct and immediate personal supervision of a licensed pharmacist, to fill, compound, or dispense any prescriptions in a pharmacy owned and operated by such or in a pharmacy where such pharmacist is employed or on duty” (Chapter 465.016d The 2021 Florida Statutes, 2021); We also see a similar rule displayed in the Rules and Regulations of the state of Georgia (Rule 480-15-.03, 2021). Although these states, do not state the same rules word for word, a common denominator between these all the state and their rules is that they were issued for the safety of their patient; in this case, protecting them from inexperienced and unregistered nurses and pharmacy technicians.

 

References

Georgia Secretary of State. (2021). Chapter 410-7 unlicensed practice. https://rules.sos.ga.gov/gac/410-7

Georgia Secretary of State (n.d.)Chapter 480-15 Pharmacy Technicians and other pharmacy personel.http://rules.sos.ga.gov/gac/480-15

Florida Legislature (2021, Dec 30). The 2021 Florida statutes. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=456.072&URL=0400-0499/0465/Sections/0465.016.html

The West Virginia Board of Examiners for Registered Professional Nurses and The West Virginia State Board of Examiners for Licensed Practical Nurses (2019, Oct.) Criteria for determining scope of practice for licensed nurses and guidelines for determining acts that may be delegated or assigned by licensed nurses.https://wvrnboard.wv.gov/lawandscope/Documents/Scope%20of%20Practice%20%20Document%2010-25-19.pdf

 

One of the new focuses for nurse educators in the university setting is community and public health. They are attempting to effectively prepare students to care for the populations they will serve. Different states, different communities have different health care needs. How can boards of nursing, regulating agencies like the AACN, and schools of nursing prepare students to take care of anyone, anywhere if the health care needs are so drastically different? NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations

Dr. Mooring

Comparison of Georgia and Florida APRN regulations

When comparing Florida and Georgia’s APRN regulations, it is clear that Georgia is more specific in regards to prescribing authority priviledges. Georgia clearly gives guidelines for  no prescriptions for scheduled 1 or 2 controlled substances. This is a regulation put in place to protect the public. According to the (Diversion Control Division, 2021), drugs that fall into these two categories contain “a lack of accepted safety for use under medical supervision, and a high potential for abuse,  which may lead to severe psychological or physical dependence”. An APRN can prescribe most medications in collaboration with their delegating physician. Florida’s APRN prescription regulations also have a governed controlled substance committee that will review an APRN’s use of prescribing schedule 2 controlled substances longer than seven days, with the exception of some of the other controlled psychiatric medications that can be prescribed by a mental health nurse practioner. Georgia follows this same rule, however, it is not stated in the rules and regulations.

Georgia has a set standard of no more than four nurse practitioners to one delegating physician. Florida rules are similar and states the APRN “must enter into a supervisory protocol with at least one physician” when practicing (Florida Statutes, 2021). In both states, APRN’s must “collaborate” with a physician regarding patient care.

 

Application of APRN regulation adherence

 

In the state of Arizona, APRN’s or (RNP’s) have full legal authority to practice within the scope of their education, certification, and experience. According to the state of Arizona  rules of nurse practice act, section R4-19-512, “An RNP with a DEA registration number may prescribe:  A Schedule II controlled substance as defined in the federal Controlled Substances Act, 21 U.S.C. § 801 et seq., or Arizona’s Uniform Controlled Substances Act, A.R.S. Title 36, Chapter 27, but shall not prescribe refills of the prescription”. The nurse practitioner can prescribe a schedule 2 controlled substance, however she cannot prescribe a refill. This is a safeguard regulation. APRN’s must apply for prescribing rights to the nursing board, and also for a DEA number for any controlled substances.

Advanced nurse practitioners in the state of Arizona can practice independently. They are not mandated to “consult or collaborate” with a physician in order to give patient care. They may “consult with the public and professionals in health care, business, and industry in the areas of research, case management, education, and administration (rules of the nurse practice act, 2021). APRN’s have the choice of which health care professional they consult with and when.

 

Georgia 2021 Regulations for APRN’s

1. An APRN may practice under a nurse protocol agreement authorized by O.C.G.A. § 43-34-25 if the nurse protocol agreement adheres to the following criteria:

Shall comply with the provisions of O.C.G.A. § 43-34-25 regarding prescription drug orders placed by an APRN for a drug or medical device including, but not limited to, the following: a. No prescription drug orders submitted by an APRN for Schedule I or II controlled substances;   b. No refills of any drug for more than 12 months from the date of the original Order, except in the case of oral contraceptives, hormone replacement therapy, or prenatal vitamins, which may be refilled for a period of 24 months;  NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations   c. No drug order or medical device that may result in the performance or occurrence of an abortion, including the administration, prescription or issuance of a drug order that is intended to cause an abortion to occur pharmacologically;   d. Written prescription drug orders shall be signed by the APRN, be written on forms that comply with the nurse protocol agreement, and such forms shall contain the information required by paragraph (d) of O.C.G.A. § 43-34-25;   e. A written provision in the nurse protocol agreement authorizing the APRN to request, receive, and sign for professional samples, and to distribute them to patients in accordance with a list of professional samples approved by the delegating physician that is maintained by the office or facility where the APRN works and that requires the documentation of each sample received and dispensed; and   f. Compliance with applicable state and federal laws and regulations pertaining to the ordering, maintenance, and dispensing of drugs (GA R&R, 2021).

 

2. Only four (4) advanced practice registered nurses may enter into a nurse protocol agreement with a delegating physician at any one time under O.C.G.A § 43-34-25, except this limitation shall not apply to an APRN that is practicing in the following settings:

(a)	In a hospital licensed under Title 31;

 

(b)	In any college or university as defined in Code Section 20-8-1;

 

(c)	In the Department of Public Health;

 

(d)	In any county board of health;

 

(e)	In any free health clinic;

 

(f)	In a birthing center;

 

(g)

In any entity: 1. Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal Revenue Code, as defined in Code Section 48-1-2, and primarily serves uninsured or indigent Medicaid and Medicare patients; or   2. Which has been established under the authority of or is receiving funds pursuant to 42 U.S.C. Section 254 b or 254c of the United States Public Health Service Act;

 

(h)	In any local board of education which has a school nurse program; or

 

(i)	In a health maintenance organization that has an exclusive contract with a medical group practice and arranges for the provision of substantially all physician services to enrollees in health benefits of the health maintenance organization (GA R&R, 2021).

Florida 2021 Regulations for APRN’s

1. An advanced practice registered nurse shall perform those functions authorized in this section within the framework of an established protocol that must be maintained on site at the location or locations at which an advanced practice registered nurse practices, unless the advanced practice registered nurse is registered and practicing under s. 464.0123. In the case of multiple supervising physicians in the same group, an advanced practice registered nurse must enter into a supervisory protocol with at least one physician within the physician group practice. A practitioner currently licensed under chapter 458, chapter 459, or chapter 466 shall maintain supervision for directing the specific course of medical treatment (Florida Statutes, 2021).
2. The board shall establish a committee to recommend a formulary of controlled substances that an advanced practice registered nurse may not prescribe or may prescribe only for specific uses or in limited quantities. The committee must consist of three advanced practice registered nurses licensed under this section, recommended by the board; three physicians licensed under chapter 458 or chapter 459 who have work experience with advanced practice registered nurses, recommended by the Board of Medicine; and a pharmacist licensed under chapter 465 who is a doctor of pharmacy, recommended by the Board of Pharmacy. The committee may recommend an evidence-based formulary applicable to all advanced practice registered nurses which is limited by specialty certification, is limited to approved uses of controlled substances, or is subject to other similar restrictions the committee finds are necessary to protect the health, safety, and welfare of the public. The formulary must restrict the prescribing of psychiatric mental health controlled substances for children younger than 18 years of age to advanced practice registered nurses who also are psychiatric nurses as defined in s. 394.455. The formulary must also limit the prescribing of Schedule II controlled substances as listed in s. 893.03 to a 7-day supply, except that such restriction does not apply to controlled substances that are psychiatric medications prescribed by psychiatric nurses as defined in s. 394.455. (Florida Statutes, 2021).

 

References

 

(SOS) Secretary of State of Georgia. (2021). Rules and regulations of the state of Georgia.

https://rules.sos.ga.gov/gac/410-11

 

U.S. Department of Justice (2021). Diversion control division.

https://www.deadiversion.usdoj.gov/schedules/

 

Online Sunshine. (2021). The 2021 Florida Statutes.

http://www.leg.state.fl.us/statutes/

 

The Arizona State board of Nursing. (2021). Rules of the Nurse Practice act.

https://www.azbn.gov/licenses-and-certifications/advanced-practice-resources

 

Providing APRNs with full practice authority will help improve access to primary care for so many patients,  and as you say, it is also beneficial to have a physician readily available to discuss complicated cases. What do you think it will take to get prescriptive authority for all APRNs in the country? How can we get legislators to understand how important that is?

Dr. Mooring

Advocacy by professional nursing organizations such as the American Nurses Association and the American Association of Nurse Practitioners will be necessary for APRNs to gain complete prescriptive authority across the country. As our country faces future difficulties such as an aging population, rising health-care expenditures, and an increasing burden of chronic disease, APRN’s strengthen the health-care workforce and maximize our available potential to address these issues. According to the (AANP, 2013) “there is a critical need for all primary care providers to practice to the full extent of their scope of practice”. For patients in rural communities, where there is a shortage of primary care providers, APRN’s must have the ability to practice within their full scope of practice. In addition, barriers for APRNs must be addressed in order to enhance patient outcomes and provide the necessary care.

It is especially beneficial to join specialized professional nurse groups. Participation creates a membership base, which is the foundation for forming powerful coalitions and gaining power in the political and regulatory spheres (Milstead & Short, 2019). For example, the ANA and AANP both have (PACs) Political Action Committees. PAC’s have rules to follow regarding how contributions are made (by only organization members) and function by supporting or opposing a candidate for election based on support for the AANP legislative agenda, the likelihood of electoral success, and the committee’s recommendations, not on political party affiliation (AANP, 2021).

Action is being taken for rights for Nurse Practitioners at a Federal and State level, with letters of support addressed to state legislators for specific bills that directly affect the future of how APRNs practice (AANP, 2021) NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.

 

References

 

(AANP) American Association of Nurse Practitioners. (2013). Nurse practitioners in primary care. AANP Position Paper.

https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioners-in-primary-care

(AANP) American Association of Nurse Practitioners. (2021). Federal Advocacy. Bringing the voice of the nurse practitioner to Capital Hill.

https://www.aanp.org/advocacy/federal

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

Daphne,

As you mentioned in your post, Florida, Georgia, and Arizona all differ in the regulations outlining the scope of practice for APRNs.  Because states have the authority to establish laws governing professions and occupations, APRN practice is unique to each state. In 2000, the NCSBN along with the AACN created a Consensus Model for Regulation: Licensure, Accreditation, Certification, and Education (LACE), which served as the basis of BON regulation of advanced practice nurses (Milstead & Short, 2019). More than 10 years after the introduction of the Consensus Model, 8 states still do not recognize the title APRN, a small amount allows independent prescribing or practice, and mandatory, supervised transition-to-practice hours are increasingly common as a pathway to Full Practice Authority (Gonzalez & Gigli, 2021). The good news is that state-by-state efforts to implement the Consensus Model have been a significant focus of APRN legislative efforts across the country and would promote uniformity of state laws.

References

Gonzalez, J., & Gigli, K. (2021). Navigating Population Foci and Implications for Nurse Practitioner Scope of Practice. The Journal for Nurse Practitioners, 17(7), 846–850. https://doi.org/10.1016/j.nurpra.2021.04.008

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

 

 

Hi Tricia,

 

Thanks for your response to my post. I agree with you that the regulations from the remaining restricted NP practice states are slowly headed in the direction for full practice authority. Florida is a success story with a new law that was signed in 2020 by Governor DeSantis. The law allows for NP licensure to practice independently. Requirements must be met for the application process to start. The requirements include the NP completing three grad-level semester hours with the addition of pharmacology, along with 3000 hours of clinical hours, (this can include hours obtained while still in NP program), professional liability insurance coverage, and CNM’s will need to provide a wtiiten agreement with a hospitial and physician authorization in regards to patient transfer (FLANP, 2021).

This landmark law can be viewed at Florida Statutes, Rule 64B9-4.021, effective 10/26/2021: “Advanced practice registered nurses who are registered pursuant to Section 464.0123, F.S., shall engage in autonomous practice only in a manner that meets the General Standard of Practice. The General Standard of Practice shall be that standard of practice, care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similarly situated, educated, and licensed Advanced Practice Registered Nurses”.

 

 

References

 

(FLANP) Florida Association of Nurse Practitioners. (2021). Autonomous Practice.

https://www.flanp.org/page/AutonomousPractice

Online Sunshine. (2021). The 2021 Florida Statutes.

http://www.leg.state.fl.us/statutes/

 

The board of nursing is a state level government that is responsible for enforcing regulations for nursing practice in order to protect the public. The board makes sure that nurses are receiving the correct credentialing and certifications to keep the healthcare professionals license up to date. (Milstead & Short, 2019)

During my research, I found that a collaborative practice agreement (CPA) with a supervising physician licensed by the North Carolina Medical Board is required for Nurse Practitioner approval to practice in North Carolina. The supervising physician must provide to the nurse practitioner written instructions about indications and contraindications for prescribing drugs and a written policy for periodic review by the physician of the drugs prescribed (North Carolina General Assembly, 2021.) In the state of Florida, APRNs can practice autonomously under most conditions. Florida statute 464.0123 allows APRNs with a minimum of 3,000 hours of post-graduate clinical experience who have passed a national licensure exam and meet state requirements to practice within the full scope of their education without the requirement of an overseeing physician in the medical practice (The Florida State Legislature, 2021).

I chose these two states because I currently live in the State of North Carolina and my family and I will be moving to the state of Florida within the next 6 months. While researching this topic I was slightly surprised at some of the major differences among the different states for APRNs. As a military family, this will be something that I will have to put more research into in the future. It is important as future APRN’s that we educate ourselves on the requirements that we need to maintain our licenses. We need to keep our licenses active and provide safe patient care.

References:

 

The Florida State Legislature. (2021). Regulation of Professions and Occupations. The Official Internet Site of the Florida Legislature. Retrieved from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499%2F0464%2FSections%2F0464.0123.html 

 

Limitations on nurse practitioners. North Carolina General Assembly. (n.d.). Retrieved December 29, 2021, from https://www.ncleg.net/enactedlegislation/statutes/html/bysection/chapter_90/gs_90-18.2.html

Providing APRNs with full practice authority will help improve access to primary care for so many patients,  and as you say, it is also beneficial to have a physician readily available to discuss complicated cases. What do you think it will take to get prescriptive authority for all APRNs in the country? How can we get legislators to understand how important that is?

Dr. Mooring

Hi Gabriel,

It was also surprising to me how differently each state board operates regarding nursing licensures. The differences make it even more necessary for every state to join the Advanced Practice Registered Nurse Compact (APRN Compact). Some of the benefits of the APRN Compact include APRNs are allowed to practice freely among other member states, improves access to APRNs during disasters or other times of need, benefits military spouses with APRN licenses who often relocate every two years, and eliminates redundant regulatory processes and fees (National Council of State Boards of Nursing, 2021). A few of the disadvantages of the compact proponents argue is the lack of patient safety and the concern of decision-making being taken away from the State Board of Nursing and given to the NCSBN via the compact (Everything CRNA, 2021). I personally believe the benefits of the APRN compact outweigh any disadvantages.

References

Everything CRNA (2021). APRN Compact.

https://www.everythingcrna.com/aprn-compact/#:~:text=Since%202002%2C%20the%20APRN%20Compact%20was%20proposed%20to,clinical%20nurse%20specialists%2C%20nurse%20anesthetists%2C%20and%20nurse%20midwives.

National Council of State Boards of Nursing. (2021). About the APRN Compact.

https://www.aprncompact.com/about.htm

Hi Gabriel,

I enjoyed reading your post, Very informative! while reading your post I was surprised to see how different each state board operates in regards to nursing licensure, required hours for APRN practice and required physician supervision. Hopefully in the next few years all states will join the Advanced Practice Registered Nurse Compact and make it less difficult for practitioners. i am from Florida where APRN are allowed to practice with autonomy and independently, but I live in Georgia where rules and regulations are much different. Gabriel what are your thoughts about all states joining the APRN compact?

References:

Georgia board of Nursing-Initial authorization as an advanced practice registered nurse. (2020).

https://sos.ga.gov/PLB/acrobat/Forms/38%20Application%20-%20Initial%20Authorization%20%28APRN%29.pdf

 

 

Georgia board of Nursing-Initial authorization as an advanced practice registered nurse. (2020).

https://sos.ga.gov/PLB/acrobat/Forms/38%20Application%20-%20Initial%20Authorization%20%28APRN%29.pdf

 

Hi Monique,

Your discussion is blank. I wonder if there was an issue with the copy and paste?

Dr. Mooring

Week 5 Discussion

 

The State Regulatory Process has a purpose and allows powers to establish and ensure the established laws are held up within the nursing practice. In each healthcare setting, each discipline is responsible for carrying its own set of rules and regulations. (Mistead, 2017). Advanced Practice Registered Nurses in Missouri and Nevada can practice in an office setting. An example would be an NP practicing in an office setting and practicing with a collaborating Physician. In Missouri, NPS has a restricted practice that allows supervision and delegation to a Physician. ( American Association of Nurse Practitioners, 2021). The regulation of having Missouri require a collaborating physician highlights the possible limitation of an NP in the office setting. Barriers may include a delay in care which may depend on whether a Physician is readily available to clear specific treatments.One marked difference between Missouri and Colorado is that Missouri’s NPS must practice with a Collaborating Physician. According to a state advocacy reference, the NP has Full Practice Authority in Colorado. ( American Association of Nurse Practitioners, 2021).

 

An APRN article discussed how In Colorado, NP’s could fully Practice, which includes evaluating, diagnosing, treating, and much more ( National Council of State Boards of Nursing, 2021). The NPS has a drastic possibility of a delay in initiating treatment plans in Colorado. APRNs can adhere to guidelines to practicing within an office setting. NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations An APRN from Missouri must be informed of their scope of practice at all times. The power of being reported is that they may have possible delays in the initiation while collaborating with a physician. This is a practice that APRNS in both states can utilize. The prescribing of Controlled Substances is an excellent example of how both APRNs can get certain medications added to their treatment. The nurse with the Missouri License may not specify a controlled substance independently, but with their collaborating physician, they could.

 

 

References:

 

American Association of Nurse Practitioners (2021). State Practice Environment.https://www.aanp.org/advocacy/state/state-practice-environment

 

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

 

National Council of State Boards of Nursing. (2021). APRN compact. https://www.ncsbn.org/aprn-compact.htm

 

 

 

 

 

 

 

 

 

 

Hi Monique!

In my home state of Florida, APRNs are mandated to be monitored by a physician and have an agreement in writing (ThriveAP, 2013).

That makes me sad that some states are not gaining benefit from physicians and APRNs collaborating with one another. It is proven that the team effort reflects a stronger bond between patient and health care workers and a lower mortality rate in the ICU. A good relationship between the two should not promote a delay in care and show an increase of medical knowledge (Miller, n.d.).

References

Miller, B. (n.d.). Physicians benefit from collaboration with NPs and PAs. Retrieved on January 1, 2022,

from https://medsourceconsultants.com/physicians-benefit-from-collaboration-with-nps-and-pas/

ThriveAP. (2013). Nurse practitioner scope of practice: Florida. Retrieved on January 1, 2022,

from https://thriveap.com/blog/nurse-practitioner-scope-practice-florida

One of the new focuses for nurse educators in the university setting is community and public health. They are attempting to effectively prepare students to care for the populations they will serve. Different states, different communities have different health care needs. How can boards of nursing, regulating agencies like the AACN, and schools of nursing prepare students to take care of anyone, anywhere if the health care needs are so drastically different?

Dr. Mooring

Jamie, it is different that Aparna are not allowed to sign for disabled parking signs. It is an ongoing journey to expand or enable APRNs to care for patients in certain capacities. This issue can cause a delay in treatment and inconvenience for our patients who could be working on other tasks .(Summers, 2018).

Summers L, The American nurse [Am Nurse], ISSN: 0098-1486, 2016 May-Jun; Vol. 48 (3), pp. 11; Publisher: American Nurses’ Assn; PMID: 27439244

 

 

References

Georgia Board of Nursing. (n.d.). 

Emergency Rules Adopted by the Georgia Board of Nursing in Response to the Public Health Emergency. sos.ga.gov. Retrieved September 29, 2021, from https://sos.ga.gov/plb/acrobat/forms/38%20Reference%20-%20GBON%20Emergency%20Rules.pdf.pdf

NC Board of Nursing. (2020, April 9). THE NORTH CAROLINA BOARD OF NURSING ORDER REGARDING THE REASSIGNMENT OF NURSE PRACTITIONERS TO A NEW PRACTICE AREA OR POPULATION FOCUS TO MEET CRITICAL NEEDS DURING THE COVID-19 EMERGENCY. ncbon.com. Retrieved September 29, 2021, from https://www.ncbon.com/myfiles/downloads/coronavirus/nurse-practitioner-order-to-relax-scope-requirements.pdf

Phillips, S. J. (2021). 33rd Annual APRN Legislative Update. The Nurse Practitioner, 46(1), 27-55. https://doi.org/10.1097/01.npr.0000724504.39836.69

Tamisha,
I agree that it is the responsibility of the APRNs to understand the rules and regulations of the state and how that they are in. Having knowledge of state regulations can allow someone to see if they would like to be part of a active passage or not. In some states, it requires more than time to become a member

Module 3 Main Discussion

In the state of Georgia, where I live, the Georgia Board of Nursing regulates all license for nursing including License practitioner, Registered nurse, Nurse Practitioner, and any level of nursing. Georgia is also part of the AANP (American Association of Nurse Practitioners) Region 11 along with Alabama, Florida, Missouri, and the U.S. Virgin Islands. Unfortunately, the practice laws in Georgia are some of the most restrictive in the nation. Georgia law mandated that nurse practitioners have a protocol agreement with a supervising physician and some extra additional supervision although some of those restrictions have been lifted temporarily during the COVID pandemic. California also has supervision requirements for nurse practitioners and although their state board of nursing have requested these limitations be lifted as well, the California Medical Association argues that the state already has enough providers especially to cover the pandemic at hand.

I have worked hand in hand with physicians, nurse practitioners, and physician assistants throughout the years of working in the healthcare and I have to say that I’ve know many nurses who know more than some of the physicians. I think the nation should come into agreement as a whole and have the same laws into place. Those states that don’t have limits on what nurse practitioners can do are becoming more appealing to some who want to be able to practice without any restrictions.

References

(n.d.). Nursing licensure. Retrieved January 12, 2022, from https://www.nursinglicensure.org

(n.d.). www.aanp.org. Retrieved January 10, 2022, from http://www.aanp.org  NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations