NURS 8100 Discussion Policy and State Boards of Nursing
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After the introduction, move into the main part of the NURS 8100 Discussion Policy And State Boards Of Nursing assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
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How to Format the References List for NURS 8100 Discussion Policy And State Boards Of Nursing
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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NURS 8100 Discussion Policy and State Boards of Nursing
Within the far-reaching and multi-layered realm of policy and reform, government at the state level plays an essential role. Consider the federally enacted PPACA’s individual mandate which sought to increase the number of consumers who receive insurance coverage and, therefore, greater access to care. In a system that is already stretched beyond capacity and confronting a nursing shortage, how can the health care system meet this increased demand? Since state boards of nursing determine scope of practice, it is important to stay up to date and current with the policies and regulations that are created by the state board of nursing.
To prepare: Review the Thomas, Benbow, and Ayars article and the Watson and Hillman article focusing on how states regulate advanced nursing practice and how legislative changes are impacting scope of practice.
Visit your state board of nursing website and/or contact the board to determine how the state board controls advanced practice through regulations.
Determine if your state board has created any new policies or regulations that address changes to scope of practice in response to legislative changes.
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.
By Day 6
Respond to at least two of your colleagues selecting someone from a different state and comparing your state’s scope of practice with your colleague’s. Share any insights and implications for practice.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.
Return to this Discussion in a few days to read
the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 9 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Sample Answer for NURS 8100 Discussion Policy And State Boards Of Nursing
The Illinois state board of nursing has made several amendments to advanced nursing practice regulations. The board created a pathway for APRNs working in hospitals, hospital-affiliated settings, and ambulatory surgery centers to offer most advanced practice nursing care with no career-long collaborative agreement (Illinois General Assembly, n.d.). A written collaborative agreement is needed for all APRNs engaged in clinical practice, except those privileged to practice in a hospital, hospital affiliate, or ambulatory surgical treatment center. However, if an APRN engages in clinical practice outside of a hospital, hospital affiliate, or ambulatory surgical treatment center must have a written collaborative agreement (Illinois General Assembly, n.d.). Besides, APRNs must have an ongoing relationship with a physician to prescribe benzodiazepines and some other scheduled agents.
The state regulations are supported in my current place of employment since the organization’s leadership allows APRNs to practice within their full scope of education without a collaborative agreement with a physician. APRNs in our organization are authorized to: conduct patient assessment; diagnose; order, perform, and interpret diagnostic tests; order treatments; provide palliative and end-of-life care; provide advanced counseling, patient education, and patient advocacy.
The scope of APRN practice differs across various states in the US. Various states grant APRNs Full practice authority, while others have Reduced and Restricted practice. States with Full practice allow APRNs to practice within their full scope of education (Peterson, 2018). APRNs with Reduced practice are required to have a collaborative agreement with a physician to engage in the elements of APRN practice. Besides, states with restricted practice need supervision and delegation to practice. The APRN scope of practice disparity negatively affects APRN professional practice since APRNs in some states are not allowed to practice as their counterparts in other states. Patients in states with Full practice have more access to healthcare since APRNs act as primary care providers (Ortiz et al., 2018).
References
Illinois General Assembly. (n.d.). Nurse Practice Act. https://ilga.gov/legislation/ilcs/ilcs4
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, Switzerland), 6(2), 65. https://doi.org/10.3390/healthcare6020065
Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.
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Name: NURS_8100_Week9_Discussion_Rubric
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List View
Excellent Good Fair Poor
RESPONSIVENESS TO DISCUSSION QUESTION
Discussion post minimum requirements:
*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.
Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.
Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.
CONTENT KNOWLEDGE
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.
Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course
Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.
CONTRIBUTION TO THE DISCUSSION
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.
Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.
Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas
QUALITY OF WRITING
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.
Points Range: 5 (16.67%) – 5 (16.67%)
Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.
Points Range: 4 (13.33%) – 4 (13.33%)
Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.
Points Range: 0 (0%) – 3 (10%)
Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.
Total Points: 30
Name: NURS_8100_Week9_Discussion_Rubric
Sample Answer 2 for NURS 8100 Discussion Policy And State Boards Of Nursing
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.
Code of Maryland regulations (COMAR) are the compilation of the state of Maryland regulations that help govern the state, (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.
References
COMAR 10.27.07.00 (2020) Practice of the Nurse Practitioner , http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.03.htm
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 Outlook, 64(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 Practice, 23(2), 118–129. https://doi.org/10.1177/15271544221076524
Sample Answer 3 for NURS 8100 Discussion Policy And State Boards Of Nursing
For many years, as advanced as the State of Massachusetts was on many fronts, the profession of nursing was not one of them. Up until January 6, 2021, ARNP’s we had be given temporary (full) practice authority due to the Covid Pandemic. When signed in January 2021, we were the last New England State to give ARNP’s full practice authority, and the 23rd State to pass this regulation across the United States (Health Leaders, 2021).
The Health System I work for is woefully behind adjusting policies and procedures to reflect this new amendment to ARNP’s practice authority within the state. We have a significant need for primary care providers within the Commonwealth and with this change, ARNP’s can practice independently and as primary care providers with their own panel of patients (AANP, 2021, Mass.gov, 2021). Up until a few months ago, I had to have the physician I work with listed as my supervising provider. Other policies came to question as they were completely unnecessary. According to the medical groups administrative leadership, primary care panels by APRN’s is in the works, but likely won’t occur system wide for 18-24 months (Personal Communication, April 24, 2022).
There is significant variability across the United States regarding practice Authority. According to AANP (2021), 29* states (*including Guam, Northern Marina Islands and Washington, DC) have full practice authority, 16* states (*including American Samoa, Puerto Rico and US Virgin Islands) have reduced practice authority and 11 have restricted practice authority (Nurse Journal, 2022. Full practice authority is defined as an NP practicing to the full scope of licensure without a supervising physician. Reduced practice authority means NP’s can perform parts of their scope independently and parts with supervision. Rarely does this include diagnostic testing and diagnosis and treatment but more often medication oversight. Restricted practice authority states require NP’s to work solely under the supervision of a physician (AANP, 2021, Nurse Journal, 2022).
Professional nurses, regardless of area of practice, have demonstrated competencies to be able to practice in a full scope capacity without supervision. By minimizing scope across the United States, we are ultimately denying access to healthcare by a qualified provider (AANP, 2021). Most advanced practice nurses, especially if they have Doctorate level education, have more years of school and clinical than that of their physician colleagues (Nurse Journal, 2022). Lack of recognition and utilization of our extensive capabilities, may undermine the professions’ ability for growth and respect.
References
American Academy of Nurse Practitioners (AANP). (2021). Information and resources for Massachusetts NPs. https://www.aanp.org/advocacy/massachusetts
Health Leaders (2021). Massachusetts is the 23rd state to allow NPs to practice independently. https://www.healthleadersmedia.com/nursing/nurse-practitioners-massachusetts-granted-full-practice-authority
Mass.gov. (2022). 244 CMR 4.00: Advanced practice registered nursing. https://www.mass.gov/doc/244-cmr-4-advanced-practice-registered-nursing/download
Nurse Journal. (2022). Nurse practitioner practice authority: A state-by-state guide. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/
Sample Answer 4 for NURS 8100 Discussion Policy And State Boards Of Nursing
The Illinois state board of nursing has made several amendments to advanced nursing practice regulations. The board created a pathway for APRNs working in hospitals, hospital-affiliated settings, and ambulatory surgery centers to offer most advanced practice nursing care with no career-long collaborative agreement (Illinois General Assembly, n.d.). A written collaborative agreement is needed for all APRNs engaged in clinical practice, except those privileged to practice in a hospital, hospital affiliate, or ambulatory surgical treatment center. However, if an APRN engages in clinical practice outside of a hospital, hospital affiliate, or ambulatory surgical treatment center must have a written collaborative agreement (Illinois General Assembly, n.d.). Besides, APRNs must have an ongoing relationship with a physician to prescribe benzodiazepines and some other scheduled agents.
The state regulations are supported in my current place of employment since the organization’s leadership allows APRNs to practice within their full scope of education without a collaborative agreement with a physician. APRNs in our organization are authorized to: conduct patient assessment; diagnose; order, perform, and interpret diagnostic tests; order treatments; provide palliative and end-of-life care; provide advanced counseling, patient education, and patient advocacy.
The scope of APRN practice differs across various states in the US. Various states grant APRNs Full practice authority, while others have Reduced and Restricted practice. States with Full practice allow APRNs to practice within their full scope of education (Peterson, 2018). APRNs with Reduced practice are required to have a collaborative agreement with a physician to engage in the elements of APRN practice. Besides, states with restricted practice need supervision and delegation to practice. The APRN scope of practice disparity negatively affects APRN professional practice since APRNs in some states are not allowed to practice as their counterparts in other states. Patients in states with Full practice have more access to healthcare since APRNs act as primary care providers (Ortiz et al., 2018).
References
Illinois General Assembly. (n.d.). Nurse Practice Act. https://ilga.gov/legislation/ilcs/ilcs4
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, Switzerland), 6(2), 65. https://doi.org/10.3390/healthcare6020065
Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.
Sample Answer for NURS 8100 Discussion Policy And State Boards Of Nursing
The goal of the state boards of nursing is protect the safety of the community by ensuring nurses who practice are competent and have received the required training to provide care (Thomas, Benbow, & Ayars, 2010). Since this scope of practice is defined at the state level, there can be a discrepancy in what nurses are allowed to do state-to-state and the license needed to practice in that state. There has been tremendous effort to form legislature around the compact nursing license to allow nurses reciprocity in participating states. However, this is not the standard with advanced practice registered nurses (APRN) (Watson & Hillman, 2010). In the state of New Mexico, the board of nursing is actively involved in promoting and encouraging the expansion of the APRN Compact (New Mexico Board of Nursing, n.d.). Currently, the only two states involved in the APRN are Utah, North Dakota, and Delaware (APRN Compact, n.d.). States not involved in the APRN Compact can vary greatly in terms of scope of practice. For example, recently in Florida it was passed that nurse practitioners have full practice authority while in many other states that has been the norm for years. This type of discrepancy can disrupt the distribution of qualified providers across the country due to scope of practice limitations. Additionally, it can cause confusion among practitioners on what they can/can not do by law.
At my organization, the state regulations are supported within my place of employment through the Professional Nursing Practice Department who advocate for state and federal legislature involving nursing and support the state regulations around registered nurses and APRNs. This department looks at our nurse residency program, nursing credentials, nursing accreditations etc. for the academic hospital. This department works in collaboration with several other complimentary nursing departments and reports directly to our Chief Nursing Officer.
References
APRN Compact. (n.d.) https://aprncompact.com/about.htm
New Mexico Board of Nursing. (n.d.) https://www.ncsbn.org/policy-and-government.htm
Thomas, M. B., Benbow, D.A., & Ayars, V. D. (2010). Continued competency and board regulations: One state expands options. Journal of Continuing Education in Nursing, 41(11), 524-528.
Watson, E., & Hillman, H. (2010). Advanced practice registered nursing: Licensure, education, scope of practice, and liability issues. Journal of Legal Consulting, 21(3, 25-29.