NURS 6050 Professional Nursing And State-Level Regulations
NURS 6050 Professional Nursing and State-Level Regulations
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APRN practice is typically governed by the Board of Nursing and defined by the Nursing Practice Act. Besides, the method is impacted by various laws and regulations. According to Neff et al. (2018), although the rules may vary from one state to another, they all aim at securing the interest of the public health safety by regulating activities of APRNs health care professionals. They explicitly state that the variation existing between APRNs and related state rules and regulations brings the need for nurses to explicitly understand their scope of practice as defined by the laws and regulations of the said state. In light of this, the paper delves into giving an in-depth explanation of Georgia APRN Board of Nursing regulations, while comparing and contrasting with Ontario’s laws.
In Georgia, the Board of Nursing is the regulatory body for APRNs. These boards are responsible for evaluating applications for nurse licensure, disciplinary actions, issuance, and renewal of nursing licenses. On the other hand, the College of Nurses of Ontario is the governing and regulatory body for APRNs. Although the criteria the two organizations use to give credentials are similar, there are significant differences in the scope of practice in Georgia and Ontario. APRN practice laws in Georgia are the most restrictive in the whole of U.S. The regulations in Georgia require an APRNs to engage in a protocol agreement with a supervising physician actively, so that other supervision requirements are comprehensively mandated. Besides, the regulations do not allow APRNs to write prescriptions for schedule II medications, which lowers the ability of the nurse to order diagnostic tests (Bosse et al., 2017). The prescription laws and regulations in Ontario contradict the ones in Georgia. It is common to find an APRNs in Ontario prescribing medications to patients. The state laws of Ontario allow nurses to pre
NURS 6050 Professional Nursing and State Level Regulations
scribe controlled substances provided they have completed approved substance education. The government of Ontario in 2017 recommended changes to the regulations under the Nursing Act 1991 that gave power to APRNs to expand their scope of practice. In essence, the Nursing Act of 1991 is one example of a law that regulates the magnitude of APRNs in Ontario.
The Georgia Board of Nursing through its licensure laws and regulations requires APRNs to hold an active Georgia registered nursing license before an individual can practice as a certified nurse practitioner in the state. On the other hand, APRNs that are considered independently licensed providers are supposed to work under protocol agreements, and Georgia Composite Medical Board controls their prescriptive authority. On the contrary, Ontario state licensure laws and regulations permit all NPs to exercise autonomy in practice. The nurse can assess patients, diagnose, order diagnostic tests, initiate and manage treatments, prescribe all medications, including control substances without a provider’s supervision after qualifying in Approved Substance Education. Allowing APRNs to have full practice access will enable an increase in experience and expand the talents inherent in nurse practitioners. Besides, it will encourage significant innovations in the nursing profession; it also motivates other NPs to spring up in filling the gap created by the shortage of providers in Canada.
In my practice, which is in Georgia, the state practice and licensure laws and regulations are restricting our ability as nurses to engage in at least one element of APRN practice. Besides, this regulation will ensure that all nurse in practice gets certification to practice as an APRN in Georgia. Moreover, the demand of Georgia states laws and regulations will ensure I appreciate career-long supervision, team management, and delegation to another health care provider so that as an APRN, I provide patients with quality care (Milstead & Short, 2019). In my practice, restriction of prescribing schedule III to V drug and substances is limiting the scope of practice of nurses. The prescriptive authority of a supervising physician by submitting a written protocol to the supervising physician and permission is granted, ensuring that nurse managers in my practice engage in supervision mandate. Georgia prescription laws and regulation demands are applicable in my training in the sense that we, the nurses, are required to prescribe both legend drug and Schedules II-V controlled drugs only after certification.
APRNs in Georgia can adhere to licensure laws and regulations by visiting the Georgia Composite Medical Board website after being authorized to complete licensure requirements. Besides, after graduating from a nursing education program, a nurse should look for licensure by endorsement as a registered nurse (Peterson et al., 2015). Further, a nurse should apply to evaluation. The Georgia Board of Nursing is responsible for evaluating applications for nurse licenses. In regards to prescription laws and regulations, Peterson et al. (2015) assert that APRNs can adhere to this regulation by ensuring that Schedule III and IV controlled substances cannot be filled or refilled more than five times or more than six months after the date the prescription was issued, whichever occurs first. Besides, a nurse should ensure that Schedule II prescriptions cannot be refilled. Under the Georgia State law, there is no expiration for a Schedule II prescription.
References
Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761–765. doi:10.1016/j.outlook.2017.10.002
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Neff, D. F., Yoon, S. H., Steiner, R. L., Bumbach, M. D., Everhart, D., & Harman J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379–385. doi:10.1016/j.outlook.2018.03.001
Peterson, C., Adams, S. A., & DeMuro, P. R. (2015). mHealth: Don’t forget all the stakeholders in the business case. Medicine 2.0, 4(2), e4. doi:10.2196/med20.4349
RE: Discussion – Week 5
Thank you for pointing out the differences between nursing board regulations in Iowa and Illinois. I wanted to understand why some states allow ARNPs the liberty to practice independently but in other states, they are not allowed. I wondered if the more rural states tended to give more liberty to the nursing profession in this regard. According to the online Family Nurse Practitioner (FNP) program from the Simmons School of Nursing (n.d.), lawmakers are working on expanding the nurse practitioner’s (NP) role to underserved areas because primary care physicians are in such short supply in these areas. More importantly, studies show that when the scope of practice for NPs is expanded, the quality of patient outcomes is not reduced (Ortiz et al., 2018).
References:
Ortiz, J., Hofler, R., Bushy, A., Lin, Y., Khanijahani, A., & Bitney, A. (2018, June 15). Impact of nurse practitioner practice regulations on rural population health outcomes. Healthcare (Basel, Switzerland), 6(2), 65. https://doi.org/10.3390/healthcare6020065
Simmons School of Nursing. (n.d.). Where can nurse practitioners work without physician supervision? Retrieved from https://online.simmons.edu/blog/nurse-practitioners-scope-of-practice-map/
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An Advanced Registered Nurse Practitioner (ARNP) is a certified registered nurse who has completed national certification for a specialized area (Arizona Board of Nursing, 2020) such as Psychiatric Mental Health Nurse Practitioner (PMHNP). This nurse will compare the regulations from two of the places she has lived in, Alaska and Arizona
According to Ariz. Rev. Ann § 32-1601(20) (ARNP) has full independent authority and practice under licensure authority of the State Board of Nursing instead of a licensed physician (NCSL Scope of Practice Policy, 2021). The same is true in Alaska, (ARNP) have full independence to practice without the supervision of a physician according to Alaska Admin. Code §12-44.400. This means that both states allow (ARNP) to
1. Examine a patient and establish a medical diagnosis by client history, physical examination, and other criteria.
2. For a patient who requires the services of a health care facility: Order and interpret laboratory, radiographic, and other diagnostic tests, and perform those tests that the RNP is qualified to perform.
1. Admit the patient to the facility,
2. Manage the care the patient receives in the facility, and
3. Discharge the patient from the facility.
3.
4. Prescribe, order, administer and dispense therapeutic measures including pharmacologic agents and devices if authorized under R4-19-511, and non-pharmacological interventions including, but not limited to, durable medical equipment, nutrition, home health care, hospice, physical therapy, and occupational therapy.
5. Identify, develop, implement, and evaluate a plan of care for a patient to promote, maintain, and restore health.
6. Perform therapeutic procedures that the RNP is qualified to perform.
7. Delegate therapeutic measures to qualified assistive personnel including medical assistants under R4-19-509.
8. Perform additional acts that the RNP is qualified to perform and that are generally recognized as being within the role and population focus of certification. (ARIZONA STATE BOARD OF NURSING, 2017)
One key difference is in the prescribing and dispensing authority within each state. Arizona requires that evidence of a minimum of 45 contact hours of education within the three years immediately preceding the application be submitted, covering one or both of the following topics consistent with the population focus of education and certification: Pharmacology, or Clinical management of drug therapy (ARIZONA STATE BOARD OF NURSING, 2017). While Alaska requires the applicant to provide evidence of completion of 15 contact hours of education in advanced pharmacology and clinical management of drug therapy within the two-year period immediately before the date of application (DIVISION OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING, 2021)
NURS 6050 Professional Nursing and State-Level Regulations
References:
Arizona Board of Nursing. (2020, July 24). Arizona Board of Nursing Scope of Practice APRN Questions & Answers SCOPE OF PRACTICE Nurse Practitioners. Retrieved from Arizona Board of Nursing: https://www.azbn.gov/sites/default/files/2020-11/FAQs%20Final%20Questions-%20NP%207.24.20%20%281%29.pdf
ARIZONA STATE BOARD OF NURSING. (2017, July 1). RULES OF THE STATE BOARD OF NURSING. Retrieved from ARIZONA STATE BOARD OF NURSING: https://www.azbn.gov/sites/default/files/2018-12/rulesjuly12017final.pdf
DIVISION OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING. (2021). Statutes and Regulations Nursing Nursing. DEPARTMENT OF COMMERCE, COMMUNITY, AND ECONOMIC DEVELOPMENT (p. 23). State of Alaska.
NCSL Scope of Practice Policy. (2021). State Overview: Arizona. Retrieved from NCSL Scope of Practice Policy: https://scopeofpracticepolicy.org/states/az/
Advanced practice registered nurses practice is distinct state by state and the APRN scope of practice and regulative criteria vary from nurses with same qualifications and titles in each state (Milstead & Short, 2019). In comparing APRNs in Texas and New Mexico, there are differences in regulations based on the respective nursing boards and the scope of practice authority. In Texas, the APRN board of nursing regulations mandates nurse practitioners to restricted practice. The NPs can only engage in one element of practice and should be on career-long supervision of a physician. APRNs should also have registered nurse license, graduate degree and have national certification. The Texas Board of Nursing also mandates APRNs to meet the Nurse Practice Act and all its requirements (Texas Board of Nursing, 2021). In New Mexico, Nurse practitioners are under the Nurse Practice Act and must register with the Prescription Monitoring Unit. The APRNs have full practice authority and can prescribe drugs and controlled substances. The APRNs are also regulated by the state Board of Nursing and should have national certification and graduate degree qualification (NMNPC, 2020). The implication is that certified family nurse practitioners (FNPs) as a specialty in APRN may also have variations based on states. In Texas, family nurse practitioners must have supervising physicians to provide patient care. However, in New Mexico FNPs are allowed to practice independently to the full extent of their training and education.
The regulations impact APRNs who have legal authority to practice to the full level of their education and experience as they set guidelines for those practicing with the profession to protect their titles and the public (Laureate Education, 2018). APRNs comply with the regulations by ensuring that they update their licenses, meet the requirements for continuing education and training and enhancing patient safety and competence in their nursing practice.
References
Laureate Education (Producer). (2018). The Regulatory Process [Video file]. Baltimore, MD:
Author.
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).
Burlington, MA: Jones & Bartlett Learning.
New Mexico Nurse Practitioner Council (2020). Practice Regulations.
https://www.nmnpc.org/page/PracticeRegs
Texas Board of Nursing. (2021) Practice-APRN Scope of Practice.
https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp