Discussion: Policy and State Boards of Nursing

NURS 8100 Discussion: Policy and State Boards of Nursing

Discussion: Policy and State Boards of Nursing

Obtaining a license is just the beginning of any nurse’s career. Just as medical technology is evolving, so must we. Most state boards of nursing require the ongoing safe and competent practice of licensees. Texas Board of Nursing has identified specialty nursing certification as one method of demonstrating continuing competency in the nurse’s specialty or area of practice (Texas Board of Nursing – Laws & Rules – Nursing Practice Act, n.d.). Both professional and practicing nurses are affected by the rule changes.

Continuing education is essential to maintain patient safety by keeping knowledge, skills, and abilities. Forty-two state boards require national nursing certification to practice as an advanced practice nurse (Watson & Hillman, 2010). Houston Methodist hospital regulates advanced practice registered nurses (APRNs) by providing written verification of recertification to continue practicing.

One of the most significant issues is that state boards of nursing are held to legislative mandates that vary from state to state—determining who should be held responsible in payment for certification and renewal. For example, should the public/organization be obliged to fund regulation to implement measures for individual nurses (Thomas, Benbow, & Ayars, 2010)? For some, this may cause an additional financial burden.


Texas Board of Nursing – Laws & Rules – Nursing Practice Act. (n.d.). Retrieved April 26, 2022, from https://www.bon.texas.gov/laws_and_rules_nursing_practice_act.asp

Thomas MB, Benbow DA, & Ayars VD. (2010). Continued Competency and Board Regulation: One State Expands Options. Journal of Continuing Education in Nursing41(11), 524–528. https://doi.org/10.3928/00220124-20100701-04

Watson E, & Hillman H. (2010). Advanced practice registered nursing: licensure, education, scope of practice, and liability issues. Journal of Legal Nurse Consulting21(3), 25–29.

By Day 3

Post a cohesive response that addresses the following:

  • What are the most recent regulations promulgated through your state board of nursing for advanced practice?
  • How are the state regulations supported within your place of employment?
  • How do the states differ in terms of scope of practice? What impact does this have on professional nurses across the United States?

Read a selection of your colleagues’ postings.

Regulations Promulgated through Maryland Board of Nursing.

In the state of Maryland some of the advanced practice registered nurses (APRNs) include certified midwives, nurse anesthetist, certified nurse practioner (NP) and a clinical nurse specialist. This should be similar to other states too. At a minimum and from personal experience Maryland board of nursing has to give permission to practice as an NP and there are basic requirements that have to be met to qualify to be certified. Not all the regulations that are set forth by the state of Maryland for APRN to practice are recent but they are however all currently used.

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Code of Maryland regulations (COMAR) are the compilation of the state of Maryland regulations that help govern the state,

Discussion Policy and State Boards of Nursing
Discussion Policy and State Boards of Nursing

(Maryland.org, n.d). Health care is not an exception and APRNP have to abide by the COMAR regulations. According to COMAR, (2020), APRNs can perform multiple functions independently. These include comprehensive assessments, complete a death certificate, do not resuscitate orders, interpret diagnostic and laboratory tests, prescribe medications, provide care and give referrals to other providers. An NP can also practice as a registered nurse and for those who have certifications for mental health, they can admit a client on an involuntary basis for treatment.

How State Regulations Are Supported within Place of Employment

The place of employment has set standards at the same level of practice as expected by the state but for some treatment approaches the expectation is to defer to the primary physician or the medical director.  Establishing this baseline helps achieve the expected standards and also remain in compliance with the COMAR and federal regulations. The place is very supportive that when the NP completes an admission assessment, the doctor does not have to double check unless there is a concern.

As a nurse practioner, at the place of work there are multiple activities that can be performed independently. These tasks include but not limited to giving orders for medications and treatment, reviewing diagnostic tests, and responding to families as required. One task that is permitted by the state of Maryland but not encouraged at the place of work is signing of certificates of incapacity. (A. Speer, personal communication, July 26, 2021). The primary physician and the psychiatrist sign the Maryland order for life sustaining treatment (MOLST) also and only encourage the NP to sign it if they are not available. This is a task that is authorized by COMAR regulations.

How States Differ in Terms of Scope of Practice

Different states have different prescriptive authorities and conditions that they give to their APRNs. There are those states that are referred to as independent states which allow APRN independent prescribing and there are those which do not, (Schirle & McCabe, 2016).  Barriers to practice are not uncommon even when the states are flexible, health care settings can still impose different strict policies and procedures. This leads to restriction of some aspects of patient care and limited access to providers despite the states having full practice authority, (Schorn, Myers, Barroso, Hande, Hudson, Kim & Kleinpell 2022).

Impact on Professional Nurses across the United States.

Some nurses have opted to relocate or work where there is more prescriptive authority. Some nurses also have opted not to relocate but get licensures in neighboring states that can give them more autonomy. There are also nurses who have opted to work in other areas where they are needed. These areas include working as lobbyists, researchers, nurse educators and consultants. In this aspect their full potential is more effectively utilized.


COMAR (2020) Practice of the Nurse Practitioner​ , http://www.dsd.state.md.us/comar/comarhtml/10/

Maryland.org (n.d), Division of state documents. http://www.dsd.state.md.us/COMAR/ComarHome.html

Schirle, L., & McCabe, B. E. (2016). State variation in opioid and benzodiazepine prescriptions between independent and nonindependent advanced practice registered nurse prescribing states. Nursing Outlook64(1), 86–93. https://doi.org/10.1016/j.outlook.2015.10.003

Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a National Survey: Ongoing Barriers to APRN Practice in the United States. Policy, Politics & Nursing Practice23(2), 118–129. https://doi.org/10.1177/1527154422107652

Thank you for your insight. It is upsetting to learn that the work and sacrifice made to pursue an advanced practice degree will be restricted. Full Practice Authority (FPA) creates greater access to care in underserved urban and rural areas. States with FPA are more likely to have nurse practitioners (NP) working in rural and underserved areas and NP practices than states with more restrictive licensure models. NP that can practice independently can provide patients with complete and direct access to the NP services at the point of care. The most significant barrier to the lack of the ability to practice is delaying patient care. In return, greater use of NPs equals $16 billion in immediate savings would increase over time (American Association of Nurse Practitioners, 2013). Avoiding duplication in services, unnecessary billing costs, and office visits are associated with savings.


American Association of Nurse Practitioners. (2013). Nurse practitioner cost effectiveness. https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioner-cost-effectiveness