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Discussion: Professional Nursing and State-Level Regulations NURS 6050

Discussion: Professional Nursing and State-Level Regulations NURS 6050

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

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)

 

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 Practitioners14(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.

WEEKLY 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.