Discussion: Professional Nursing and State-Level Regulations NURS 6050
Walden University Discussion: Professional Nursing and State-Level Regulations NURS 6050– Step-By-Step Guide
This guide will demonstrate how to complete the Walden University Discussion: Professional Nursing and State-Level Regulations NURS 6050 assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for Discussion: Professional Nursing and State-Level Regulations NURS 6050
Whether one passes or fails an academic assignment such as the Walden University Discussion: Professional Nursing and State-Level Regulations NURS 6050 depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for Discussion: Professional Nursing and State-Level Regulations NURS 6050
The introduction for the Walden University Discussion: Professional Nursing and State-Level Regulations NURS 6050 is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for Discussion: Professional Nursing and State-Level Regulations NURS 6050
After the introduction, move into the main part of the Discussion: Professional Nursing and State-Level Regulations NURS 6050 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.
How to Write the Conclusion for Discussion: Professional Nursing and State-Level Regulations NURS 6050
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for Discussion: Professional Nursing and State-Level Regulations NURS 6050
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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Professional Nursing and State-Level Regulations
According to NCSBN (2021b), nursing regulatory body (NRB) was developed to protect the safety, health, and welfare of the public regarding nursing practice. The Advanced Practice Registered Nurse (APRN) scope of practice is defined by the Nurse Practice Act, state regulations, and statutes overseen by the state board of nursing. The board of nursing holds APRNs accountable for conduct regarding ethical, legal, and standards of professionalism. In 2008 the Consensus Model was developed, and the goal was to have all states follow the same model for APRNs. The focus of the Consensus Model was on developing consistency in education, certification, licensure, accreditation, independent practice, and independent prescribing for the APRN (NCSBN, 2021a).
According to Mark (2018), in 2018, 23 states had adopted the consensus model allowing APRNs to practice independently while other states still require supervision or collaboration with a physician. Since 2018 additional states have followed suit and are now full practice states for APRNs, but still other states are reduced or restrictive practice. Having variations in regulations and scope of practice is why the APRN must understand these variations from state to state. In this discussion, a comparison grid of Minnesota and Texas Board of Nursing’s regulations regarding prescribing of drugs and therapeutic devices and the authority to pronounce death and provide the cause of death for the death certificate will be highlighted.
MN Board of Nursing |
Tx Board of Nursing |
|
| Prescribing authority on drugs and therapeutic devices. | Under 148.235, APRN has full independent practice to:
Diagnosis, order therapy, and give referrals to other health care facilities and providers.
Prescribe, dispense, obtain, sign for, administer, and document over the counter, legend, and controlled substances, including sample medications, but must abide by Drug Enforcement Administration (DEA) requirements regarding controlled substances.
Must file all DEA registrations and numbers with the board, and the board will maintain current records.
Plan, order, and initiate a treatment including medical devices and equipment, nutrition, diagnostic services, and supportive services.
Above points cited in: (Minnesota Board of Nursing, 2020).
|
Under Chapter 222 (19 & 20), the APRN has restrictive practice to:
Must have a prescriptive authority agreement between the APRN and a physician where the physician delegates to the APRN the act of prescribing or ordering a drug (legend, over-the-counter or drug sample) or device.
Controlled Substances may be ordered under the prescription agreement but cannot exceed 90 days. If a renewal is needed beyond 90, days the delegated physician needs to be consulted or needs to do a chart review if unable to see the patient in person. In addition, APRNs cannot order controlled substances for a patient under two years of age without in- person or chart consult.
The prescriptive authority agreement may reference or include the terms of a protocol or other written authorization between the APRN and physician.
The APRN must apply for prescriptive authority and renew every two years, including having documentation of five hours of continuing education in pharmacotherapeutics.
APRN’s works off protocols or other written authorization from a delegating physician to provide medical interventions of patient care. The protocols are signed by the APRN and delegating physician, reviewed annually, and maintained in the practice setting. Protocols or other written authorization are designed to promote professional judgment by the APRN. Therefore, the protocol or written authorization does not need to detail the precise steps in the treatments plan. Instead, the protocol may indicate types or classifications of drugs or devices that may or may not be prescribed by the APRN. The APRN must have a monthly meeting with the delegating physician face-to-face or telecommunication to keep prescription authority agreement and protocols active.
Above points cited in: (Texas Board of Nursing, 2021)
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| Authority to pronounce death and provide the cause of death for the death certificate. | MN Rule part 4601.1800 states that an APRN can pronounce and sign the death certificate if they were present at the time of death, or provided medical care to the patient before death, or had direct knowledge of the circumstances of the cause of death and has access to the medical record (Minnesota Board of Nursing, 2020). | Tx Chapter 671 states an APRN may pronounce death and provide the cause of death only if artificial means of support did not precede death (Texas Board of Nursing, 2017). |
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Application of State Regulations for the APRN
As stated above, not all states have adopted the consensus model, and currently, some states are full, reduced, or restrictive authority practice for the APRN role. Unfortunately, this inconsistency can cause obstacles for the APRN to practice and reduces access to health care for the public. According to Peterson (2017), the Institute of Medicine’s future goal is to allow APRNs to practice within the full scope of their education and experience. APRN independence could allocate funding toward higher-value services. For example, full practice authority APRNs would lead to more primary care visits and fewer emergency room visits. By converting more states to full practice authority states such as Minnesota, the APRN can initiate and manage treatments, including independent prescribing under, the state board of nursing licensure. By increasing the APRN independence this would allow physicians the flexibility to provider care to patients that are outside the scope of the APRN. On the other end of the spectrum, in a restrictive practice authority state such as Texas, the APRN requires supervision from a physician and rigorous authority agreements and time-consuming consultation to keep the agreement active. Allowing the APRN to assist physicians in the death process documentation gives physicians more time to focus on patient care. With the rising cost of health care, limited physicians, aging population allowing all APRNs to practice independently would be a cost-saving to the economy and would increase health care access. The APRN can adhere to the above state regulations by maintaining their RN and APRN licensure, maintaining continuing education units and keeping authority agreements up to date so that they may practice under a delegated physician.
References
Mack, R. (2018). Increasing Access to Health Care by Implementing a Consensus Model for Advanced Practice Registered Nurse Practice. The Journal for Nurse Practitioners, 14(5), 419–424. https://doi.org/10.1016/j.nurpra.2018.02.008
Minnesota Board of Nursing. (2020). APRNs and authority to pronounce death and provide cause of death. https://mn.gov/boards/nursing/advanced-practice/advanced-practice-topics/aprns-authority-pronounce-death.jsp
NCSBN. (2021a). APRN campaign for consensus: Moving toward uniformity in state laws.
http://www.ncsbn.org/campaign-for-consensus.htm
NCSBN. (2021b). Guiding Principles. https://www.ncsbn.org/1325.htm
Peterson, M.E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74-81. https://doi.org/10.6004/jadpro.2017.8.1.6
Texas Board of Nursing. (2017) Health and safety code Chapter 671. Determination of death and autopsy report. https://statutes.capitol.texas.gov/Docs/HS/htm/HS.671.htm
Texas Board of Nursing. Rules and regulations related to nurse education, licensure, and practice. (2021). https://www.bon.texas.gov/pdfs/law_rules_pdfs/rules_regulations_pdfs/March%202021%20Rules%20and%20Regulations%203%204%2021.pdf
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
Professional Nursing and State-Level Regulations
Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.
It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To Prepare:
- Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
- Consider how key regulations may impact nursing practice.
- Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.
By Day 3 of Week 5
Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.
By Day 6 of Week 5
Respond to at least two of your colleagues* on two different days and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples.
*Note: Throughout this program, your fellow students are referred to as colleagues.
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Comparison of APRN Board of Nursing Regulations in Texas and Maryland
Advanced Practice Registered Nurses (APRNs) are highly trained nursing professionals who provide vital healthcare services throughout the United States. Each state’s board of nursing regulations govern APRN practice. The regulations of the Texas and Maryland Boards of Nursing will be compared in this post, with a focus on two key aspects: scope of practice and collaborative agreements. Furthermore, we will discuss how these regulations apply to APRNs and provide examples of compliance with each regulation.
Scope of Practice
The Texas Board of Nursing defines the scope of practice for APRNs, which is consistent with the national standards outlined by the APRN Consensus Model (Texas Board of Nursing, 2021). In Texas, APRNs are licensed to diagnose, treat, and manage acute and chronic health conditions, as well as to prescribe medications and order diagnostic tests (Texas Board of Nursing, 2021). The following APRN roles are recognized in Texas: nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, and certified nurse-midwife (Texas Board of Nursing, 2021).
Similarly, the APRN Consensus Model is used by the Maryland Board of Nursing to define the scope of practice for APRNs (Maryland Board of Nursing, 2021). Maryland, like Texas, recognizes the same four APRN roles and empowers them to diagnose, treat, and manage health conditions, prescribe medications, and order diagnostic tests (Maryland Board of Nursing, 2021).
Collaborative Agreements
The requirements for collaborative agreements differ significantly between the two states. To prescribe medication in Texas, APRNs must have a written prescriptive authority agreement with a collaborating physician (Texas Board of Nursing, 2021). This agreement specifies the physician’s supervision and the APRN’s scope of practice when it comes to medication prescriptions (Texas Board of Nursing, 2021).
In contrast, Maryland has removed the requirement for APRNs and physicians to enter into collaborative agreements, allowing APRNs to practice independently (Maryland Board of Nursing, 2021). This change allows APRNs in Maryland to provide comprehensive care without physician supervision, improving access to healthcare services, especially in underserved areas (Maryland Board of Nursing, 2021).
Application of Regulations to APRNs
The above-mentioned regulations apply to APRNs who have legal authority to practice within the scope of their education and experience. A Texas APRN, for example, must comply with the collaborative agreement requirement by creating and maintaining a written prescriptive authority agreement with a collaborating physician. This agreement ensures that the APRN works within their authority and receives appropriate oversight when prescribing medications.
In Maryland, an APRN can practice independently and comply with state regulations without the need for a collaborative agreement. Within their scope of practice, this allows the APRN to provide comprehensive care, including prescribing medications and ordering diagnostic tests.
Finally, both Texas and Maryland have APRN regulations that are consistent with the APRN Consensus Model, but their requirements for collaborative agreements differ. Understanding these distinctions is critical for APRNs to practice legally and provide high-quality healthcare services.
References
American Nurses Association. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Retrieved from https://www.nursingworld.org/~4af4f2/globalassets/practiceandpolicy/innovation–evidence/aprn-consensus-model-report.pdfLinks to an external site.
Maryland Board of Nursing. (2021). Advanced practice registered nursing. Retrieved from https://mbon.maryland.gov/Pages/aprn.aspxLinks to an external site.
Texas Board of Nursing. (2021). Advanced practice registered nurse (APRN) practice. Retrieved from https://www.bon.texas.gov/practice_aprn.aspLinks to an external site.
Regulations in the healthcare system are created to provide protection for the public and each state has different laws and regulations to follow (Milstead & Short, 2019). Advanced Registered Nurse Practitioner has been evolving for the past few years to provide the needs to the public. The scope of work is somehow different from being a registered nurse and it varies in every state. APRN are trained and educated to provide comprehensive care to the public with evidence-based practice that is high quality (Boehning & Punsalan, 2023).
In Texas, APRNs must only perform their practice scope of work that is within the Board authorized professional standards that are aligned to Nursing Practice Act, Board rules, and other regulations in Texas that are applicable to their scope of practice. The Texas Nurse Association (TNA) supports full practice. However, it does not allow full authority and only allows practice under the supervision of a physician where they made a contract with. Physicians are required to review the charts and sign a form to allow APRN to prescribe. APRN can order Physical therapy (PT), sign disabled person placard forms, sign Physician Orders for Life Sustaining Treatment (POLST) and sign other similar documentations. They are not allowed to sign a death certificate without being under primary care provider. Prescribing medications are allowed especially the schedule II drugs but must follow and maintain the protocol with the physician (Weisen, 2023).
In contrast to Illinois, full practice authority has been granted and was effective on June 14, 2019, for those who completed their education and training. It allows the APRNs to fully practice without the supervision of a physician. To obtain the full practice authority, they must apply to the Illinois Department of Financial and Professional Regulation (IDFPR) and notarized that they have completed at least 250 hours of continuing education or 4000 hours of clinical training after getting their national certification. The other advantages are there is no limitation when prescribing, administering, and dispensing drugs if APRN has licensed under the Illinois Controlled Substance Act. They can prescribe schedule II to through IV controlled substances without the physician’s approval. However, they need the collaboration of physician if they were to prescribed benzodiazepine and narcotic drugs. If APRN does not want to file for full authority to practice, then he/she must complete 45 hours of continuing education in pharmacology to obtain the authority to prescribe schedule II. There is a collaborative practice agreement between the APRN and physician to let the APRN prescribe schedule II, III, IV, and V. You are only allowed to prescribe 30 days supplies for uncontrolled substances.
To obey the regulations and rules, APRNs must be aware of our scope of practice and the limitations to avoid malpractice and it varies in every state and must apply these to show the adherence to the policy, regulations, and rules to provide public safety and appropriate healthcare needs. Learning is never ending, and it evolves as days go by. This indicates that even with the title of being Advanced Practice Registered nurse must continue to educate and train to acquire a new set of knowledge and skills to provide high quality of care and promote safety to the public. As APRNs, we can join different organizations to develop our growth as professionals and connecting with other APRNs because they can provide suggestions on choosing the right continuing education you need. One of the organizations that can help APRNs attain highest quality of education are Nurse Practitioner Associates for Continuing Education (NPACE) and the American Association of Nurse Practitioners (AANP). In addition to this, we can get certification. According to American Board of Nursing Specialties, being certified demonstrate your competence level and expertise and boost your confidence in decision making.
Dec 25, 2023 Dec 25, 2023 at 2:12pm
Greetings everyone,
In the United States, different states have APRN boards that are tasked with developing unique regulations to govern how nurse practitioners operate within clinical settings (Yang et al., 2021). Broadly, the regulations set by these boards fall under three broad categories full practice, reduced or restricted. This analysis compares the Practices of APRNS in the state of Maryland where I live, and to another state, North Carolina where practice restrictions differ. In Maryland, Nurse Practitioners have the authority to independently prescribe medications, diagnose conditions, and administer treatments, their counterparts in North Carolina do the same but under the keen supervision of physicians (McMichael & Markowitz, 2023). To demonstrate this by example, a Nurse practitioner in Maryland would be able to autonomously manage chronic conditions like diabetes. Quite the opposite, a Nurse Practitioner in North Carolina would require the oversight and close supervision of a physician to engage in activities such as making adjustments to insulin regimens.
Needless to say, these regulations by APRN boards impact nursing practice in several ways. According to McMichael & Markowitz (2023), in states where nurses have full practice authority for example in Maryland, these healthcare professionals are free to exercise their legal right of practicing autonomously. In their report on this, Alexander and Schnell (2019) wrote that in full practice states, these professionals are authorized to engage independently in activities such as prescribing medications, diagnosing medical conditions, and providing treatments. The benefit this authority has is allowing APRNs to optimize their skills. More importantly, this full practice authority demonstrates a commitment to recognizing the full scope of nursing practice expertise. Suffice it to say, that nurse practitioners must adhere to these stipulated regulations and a practical way in which they can do this is by ensuring that they fully understand the specific requirements that these regulations have. Secondly, they must appreciate the differences between different states, especially those planning to move from one state to another. These two approaches are necessary to ensure that these practitioners abide by the set practice regulations.
References
Alexander, D., & Schnell, M. (2019). Just what the nurse practitioner ordered: Independent prescriptive authority and population mental health. Journal of Health Economics, 66, 145-162. https://doi.org/10.1016/j.jhealeco.2019.04.004
McMichael, B. J., & Markowitz, S. (2023). Toward a uniform classification of nurse practitioner scope of practice laws. Medical Care Research and Review, 80(4), 444-454. https://doi.org/10.1177/10775587221126777
Milstead, J. & Short, N. (2019). Health Policy and Politics: A Nurse’s Guide (6th ed.). Jones & Bartlett Learning.
Yang, B. K., Johantgen, M. E., Trinkoff, A. M., Idzik, S. R., Wince, J., & Tomlinson, C. (2021). State nurse practitioner practice regulations and US health care delivery outcomes: a systematic review. Medical Care Research and Review, 78(3), 183-196. https://doi.org/10.1177/1077558719901216
Dec 26, 2023 Dec 26, 2023 at 11:46am
Hi Brendaline,
I agree with you that nurse practitioners should exercise their optimum level of practice without being supervised. Full Practice Authority is an authorization for the nurse practitioners to diagnose, evaluate, order treatment, interpret diagnostic test, and prescribe medications. Restricted or reduced states in FPA of nurse practice is associated with geographic health care disparities, higher chronic disease burden, primary care shortages, higher costs of care and lower standing on national health rankings. Adopting FPA will enhance access especially in rural or underserved areas, provide efficient care that prevents delays on delivering the care, decrease cost, and provide protection of patient’s choice of healthcare provider (AANP, 2022).
I currently live in Illinois now and I read that the state is also providing FPA for nurse practitioners. However, prior to transitioning to independent practitioner it needs a collaborative agreement and provide information on what treatment or procedures they are allowed to do. Same goes with prescriptive authority it needs collaborative agreement and may include schedule III to IV. Nurse practitioners are allowed to prescribe schedule II-controlled substances if it is delegated by the physician. Notarizing attestation is a must that the nurse practitioner had served 250 hours of continuing education and training and 4,000 hours of clinical experience after obtaining national certification.
Reference
American Association of Nurse Practitioners. (2022, April). Issues at a Glance: Full Practice Authority. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief
Illinois Scope of Practice Policy – State Profile. (n.d.). Scope of Practice Policy. https://scopeofpracticepolicy.org/states/il/