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NRNP 6675 Discussion: Certification and Licensure Plan

How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in Washington?

In order to obtain a license in Washington State as an Advanced Practice Registered Nurse one must first hold a license as a registered nurse, have completed a master’s degree from an accredited education program, and complete the required amount of supervised hours of patient care (American Nurses Credentialing Center, 2022). You must then register at https://www.nursingworld.org/ancc/, and then take—and pass—the psychiatric-mental health nurse practitioner exam administered by the American Nursing Credentialing Center (ANCC) (ANCC, 2022).

What is the application process for certification in Washington?

Once this is completed in Washington State, create an account with Secure Access Washington(SAW) and sign in to the Department of Health Online Application Portal (Secure Access Washington, 2022). Through this website, you can complete the application, upload transcripts, and pay the required fees. You may then re

NRNP 6675 Discussion Certification and Licensure Plan
NRNP 6675 Discussion Certification and Licensure Plan

ceive your provisional license number while your application is in process.

What is Washington state’s board of nursing website?

You can find all the required information for how to become and obtain your nurse practitioner license as well as apply for and renew your license at https://secureaccess.wa.gov/myAccess/ saw/select.do (Secure Access Washington, 2022).

How does Washington state define the scope of practice of a nurse practitioner and what is included in your state practice agreement?

The Washington state legislature defines the scope of practice of a nurse practitioner under the WAC 246-840-300

NRNP 6675 Discussion Certification and Licensure Plan
NRNP 6675 Discussion Certification and Licensure Plan

and RCW 18.79.250 and does not require a collaborative agreement with a physician making it a full practice state for nurse practitioners (Washington State Legislature, n.d.). This means ARNPs have full autonomy to practice within their scope to the extent of their level of education, training, and licensure, and without physician oversight, are able to prescribe medication and treatment.

How do you get a DEA license?

For all qualified practitioners who write prescriptions for controlled substances, a federal Drug Enforcement Administration (DEA) certificate is a legal requirement (Drug Enforcement Division Registration, 2021). Many individual states including Washington also require a practitioner to hold a Controlled Dangerous Substances (CDS) certificate in addition to a DEA certificate. All registration applications and renewals for a DEA license must be completed and submitted online. Renewals are due every 5 years (DEA, 2021).

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Does Washington have a prescription monitoring program (PMP)?

Washington State does have a prescription monitoring program (PMP). It is defined under RCW 70.225 and is responsible for the creation of Washington’s PMP also known as Prescription Review. By making dispensing records and other information for Schedule II, III, IV, and V drugs, available to medical providers and pharmacists as a patient care tool, practitioners could improve patient care and stop prescription drug misuse (Washington State Legislature, 2011).  Program rules, WAC 246-470, took effect on August 27, 2011. The program started data collection from all dispensers on October 7, 2011 (Washington State Legislature, 2011).

Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state.

In Washington state nurse practitioners have full practice authority meaning if qualified, are authorized to prescribe all drug schedules. This allows nurse practitioners full practice authority without barriers to providing patient care. Nurse Practitioners may prescribe, diagnose, and create a plan of care independent from a physician as long as they remain within their scope of practice as defined by WAC 246-840-300 and RCW 18.79.250 (Washington State Legislature, n.d.). This increases the ability of nurse practitioners to broaden access to care within the community.

References

Drug Enforcement Division Registration. (2021). Retrieved June 1, 2022, from https://www.deadiversion.usdoj.gov/drugreg/index.html

Secure Access Washington. (2022). Retrieved June 3, 2022, from

https://secureaccess.wa.gov/myAccess/saw/select.do.

American Nurses Credentialing Service. (2022). Retrieved June 3, 2022, from

https://www.nursingworld.org/ancc/

Washington State Legislature. (n.d.). Retrieved June 2, 2022, from

https://apps.leg.wa.gov/wac/default.aspx?cite=246-840-300

Washington State Legislature. (2011). Retrieved June 2, 2022, from

https://app.leg.wa.gov/rcw/default.aspx?cite=70.225

Week 1 PMHNP Professional Issues

What surprised me in my research is that while an NP can work independently, the must have physician oversite for the first 18 months related to prescriptive authority. This can be a barrier for the NP and may delay practice. However, I believe this to be the safest route.

Additionally, according to Nursing Administrator Quarterly, (2022), failure to understand the role of the  of APRN , limited professional recognition, poor admin and physician relations, restrictions consisting of physician cosignature and the inability of the NP to be listed as a provider are additional barriers.

How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?

According to COMAR 10.27.07.02:

After attending an approved RN program, you must

An applicant for certification as a nurse practitioner shall obtain certification from the Board before commencing practice. An applicant for certification as a nurse practitioner must:

Have current Maryland license in good standing to practice registered nursing or a multistate licensure privilege to practice registered nursing;

Have graduated from a Board-approved accredited graduate level program for nurse practitioners at the Masters’ level or higher that meets the requirements of the state regulations.

Hold a current national certification for each area of specialization from a national certifying body recognized by the board of nursing.  Submit the proper completed application to the board. Comply with all the requirements set forth in COMAR 10.27.01.04; demonstrate competency in English.  The nurse must pay all associated fees.

 

What is the application process for certification in your state?

In the state of MD if the nurse has a compact license:

Certification application

• Copy of Compact license

• Declaration of residence form

• Sealed official transcript(s)

• Copy of current national

certification OR letter of

eligibility to take the

certification exam

Complete the NP certification application (see pages 4, 5 & 6 of this document) in its entirety.

If currently licensed in a Compact State, attach a copy of your current registered nurse license.

 

What is your state’s board of nursing website?

https://mbon.maryland.gov/

How does your state define the scope of practice of a nurse practitioner?

A psychiatric nurse practitioner together with a physician is authorized to sign applications:

(1) In accordance with Health-General Article, §10-615, Annotated Code of Maryland, to admit a minor to a facility for treatment of a mental disorder; and

(2) In accordance with Health-General Article, §10-616, Annotated Code of Maryland, to admit an individual on an involuntary basis to a facility for treatment of a mental disorder.

C. A nurse practitioner may practice only in the area of specialization in which certified.

D. Nothing in this chapter limits or prohibits a registered nurse from performing those functions which constitute the practice of registered nursing as defined by law.

E. A nurse practitioner has a right and obligation to refuse to perform any delegated act, oral or written, if in the nurse practitioner’s judgment it is unsafe or an invalidly prescribed medical act.

F. An individual certified under this chapter shall be subject to disciplinary sanctions set forth in Health Occupations Article, §8-316, Annotated Code of Maryland.

 

What is included in your state practice agreement?

Practice Before Maryland Certification.

 

A. A registered nurse who has completed a Board-approved educational program for nurse practitioners and who has applied to take a Board-approved national certifying examination, may practice as a nurse practitioner graduate before certification in this State upon approval of the Board if the nurse has:

Presented evidence of submission of an application to take a Board-approved national certification examination; and

Provided the name of a certified nurse practitioner, who has an active unencumbered Maryland or compact RN State license, who will directly supervise the nurse practitioner graduate.

“Nurse practitioner” means an individual who is licensed, certified and can practice as an NP which means to work independently as described by COMAR.

 

How do you get a DEA license?

Apply for a Maryland State Controlled Dangerous Substances Registration (CDS) with the Office of Controlled Substances Administration (OCSA).

  1. Register with PDMP
  • All practitioners who prescribe or dispense controlled dangerous substances must attest to the completion of the 2-hour Continuing Education on the initial and renewal CDS application.
  1. Complete the 3-year practitioner application form

    • provide physical address where drugs will be used
    • fill out all other requested information
    • Register with PDMP

Step Two:

Once approved, apply for a Federal DEA license (you will need your state license number)

 

 

Does your state have a prescription monitoring program (PMP)? Yes, PDMP

How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

According to 10.27.07

For the first 18 months the NP must have physician oversight. A nurse practitioner may personally prepare and dispense any drug that a nurse practitioner is authorized to prescribe in the course of treating a patient at:

 

(1) A medical facility or clinic that specializes in the treatment of medical cases reimbursable through workers’ compensation insurance;

 

(2) A medical facility or clinic that is operated on a nonprofit basis;

 

(3) A health center that operates on a campus of an institution of higher education;

 

(4) A public health facility, a medical facility under contract with a State or local health department, or a facility funded with public funds; or

 

(5) A nonprofit hospital or a nonprofit hospital out-patient facility as authorized under the policies established by the hospital.

An NP cannot prescribe Schedule I drugs.

 

 

References:

 

Justia US Law. (2022). 2016 Maryland Code. Health Occupations. Title 8 – Nurses. MD Health Occ Code.

https://law.justia.com/codes/maryland/2016/health-occupations/title-8/subtitle-1/section-8-101/

Maryland Dept. of Health. CDS Application. OCSA. https://health.maryland.gov/ocsa/Pages/CDS-Application.aspx

MD.Gov. (2022). Division of State Documents. Preparing and Dispensing. http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.07.htm

 

Kleinpell, R., Myers, C. R., Likes, W., & Schorn, M. N. (2022). Breaking Down Institutional Barriers to Advanced Practice Registered Nurse Practice. Nursing administration

quarterly, 46(2), 137–143. https://doi.org/10.1097/NAQ.0000000000000518

Licensure

The process of obtaining licensure in the states of Texas starts with prerequisite bachelor’s degree then successful completion of a master’s degree nursing program from an accredited school of nursing. Once the board exam on the area of study has been completed, licensure process through the Texas board of nursing can commerce.

Application process

The application process for certification is done through the Texas Board of Nursing website

Website

https://www.bon.texas.gov

Scope of practice

Advance practice nurses need to follow guiding principles, rules and standard when practicing to maintain licensure, credentialing and maintain standards of care (Keber & Ledbetter, 2017). These include the type of patient to see and method of care delivery. Each state has their own of practice and it is the responsibility of the individual advance practice nurse to understand and practice within the jurisdiction of the content of their state’s scope of practice. The Texas Board of Nursing explains that the advance practice nurse role continues to evolve based on advancement to treatment options and technological input, hence the need for the advance practice nurse to continue improve knowledge by having ongoing assessment and obtaining the requisite knowledge as needed for practice growth. Texas only allows a restricted scope for practice for APRN.

 

Practice agreement

The Advance nurse practice agreements provides details on every aspect of the advance nurse practice. Guidelines that cover prescription process, authority, and patient treatment.

DEA license

Advance practice nurses who have successfully completed the requirement to prescribe controlled medications are eligible and required to register with the Drug Enforcement Agency (DEA). To obtain this number. The APRN needs to apply with the Department of Justice website if this is a first-time application. Application can also be done using the required form which has to be mailed directly from the DEA Headquarters registration unit when subsequent application is needed.

Prescription Monitoring Program (PMP)

The state of Texas has a prescription monitoring program. Since March 1st 2022, Advance practice nurses need to check to prescription monitoring program before prescribing opiates, benzodiazepines, barbiturates, or carisoprodol.

Prescriptive Authority

An APRN who has full licensure and a valid prescriptive authorization number if the APRN   holds an active license without any disciplinary action.  In addition, the prescriptive authority must be written and signed, contain the name, address, professional license, practice location, practice setting, types of medication to be provided and not to be provided. This prescriptive agreement must be renewed annually by the APRN and the collaborating physician.

An APRN can prescribe controlled substances in scheduled III through V if prescription does not exceed a 90-day supply. If more than 90 days’ supply is required a physician needs to consult with the patient. Children less than age two must have a consultation by a physician before administration on schedules III through V.

Summary of findings

The process of obtaining eligibility to practice in the state of Texas is a rigorous one. Registered nurses who are eligible for licensure need to first complete the board certification exam successfully for their desired specialization.

Barriers to Independent practice

The demand for Primary Care Clinicians continues to increase as delivery to access of care improves and population of the aging also increases. States like Texas that restrict APRN limit care delivery access. In situations where there is no collaborating physician to partner with the APRN, access to care is delayed.

Research Thoughts

The process and licensure and certification can be challenging. There are no guidelines that assist a student who has completed all required coursework required for licensure and credentialing. It would be beneficial to have a list of everything required and timelines to note.

References

Kerber, A. S., & Ledbetter, N. J. (2017). Scope and Standards: Defining the advanced practice role in genetics. Clinical Journal of Oncology Nursing, 21(3), 309–313. https://doi.org/10.1188/17.CJON.309-313

Poghosyan, L., Kueakomoldej, S., Liu, J., & Martsolf, G. (2022). Advanced practice nurse work environments and job satisfaction and intent to leave: Six‐state cross sectional and observational study. Journal of Advanced Nursing (John Wiley & Sons, Inc.), 1. https://doi.org/10.1111/jan.15176

King WK 1 Initial Post-Arkansas

Arkansas Board of Nursing Licensing and Practice information

  • How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?

Complete a graduate degree nurse practitioner program, pass the national certification exam associated with the degree focus, apply for state licensure online and submit all required documentation (Healthy.arkansas.gov, 2022a).

 

  • What is the application process for certification in your state?

Create a user profile, if you do not already have one, on the Arkansas Nurse Portal using a personal email address. Complete an application for APRN licensure and upload all required documentation. Obtain a full license history report from nursys.com. Obtain a notarized statement attesting to practicing as a nurse for a minimum of 2,000 hours. Submit national certification documentation once exam is passed. Complete a background check utilizing the number obtained on payment page of application. Submit official transcripts and proof of Arkansas RN licensure. (Healthy.arkansas.gov, 2022c)

 

 

  • What is your state’s board of nursing website?

https://arsbn.boardsofnursing.org/arsbn

 

  • How does your state define the scope of practice of a nurse practitioner?

Arkansas is a reduced practice state, requiring APRN’s to practice with a collaborative practice agreement with a physician, also limited Schedule II prescribing with strict guidelines in place (Healthy.arkansas.gov, 2022d). Recently they have allowed for independent practice authority to be granted to APRN’s that have demonstrated 6,250 hours of practice, however Schedule II privileges are still restricted with the practice authority .

 

  • What is included in your state practice agreement?

Scope of practice relating to collaborative practice agreements, licensing and education, independent practice requirements and restrictions (Healthy.arkansas.gov, 2022d).

 

 

  • How do you get a DEA license?

You must apply for prescriptive authority through the Arkansas State Board of Nursing at the end of the APRN application or at another time. The prescriptive authority may only be obtained with a collaborative practice agreement and quality assurance plan (Healthy.arkansas.gov, 2022c). The prescriptive authority must have prescriptive protocols (Healthy.arkansas.gov, 2022b). Once prescriptive authority is obtained and a certificate number is issued then you apply for a DEA certificate through the Arkansas Nurse Portal. Submit DEA certificate number to ASBN once received.

 

  • Does your state have a prescription monitoring program (PMP)?

Arkansas does have a prescription drug monitoring program. This program requires APRN’s who hold a DEA registration to register with the PMP and review that PMP with every Schedule II and III opioid prescription and with the initial prescription for benzodiazepines and every 6 months therafter (Healthy.arkansas.gov. 2022a).

 

  • How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

Advanced practice registered nurses may prescribe Schedule III-V and hydrocodone products reclassified as Schedule II from Schedule III as of 2014 and only if authorized by the CPA and in accordance with the specific area of practice (Healthy.arkansas.gov, 2022. Schedule II may be prescribed if one of the following apply: for a period of 5 days or less; or if it is a stimulant meeting specific criteria.

 

References

Healthy.arkansas.gov. (2022a). ASBN – Adv. Practice. Retrieved from https://www.healthy.arkansas.gov/programs-services/topics/arsbn-adv.-practice

 

Healthy.arkansas.gov. (2022b). ASBN – Collaborative Practice. Retrieved from https://www.healthy.arkansas.gov/programs-services/topics/arsbn-collaborative-practice

Healthy.arkansas.gov. (2022c). ASBN – Laws & Rules Arkansas Department of Health. Retrieved from https://www.healthy.arkansas.gov/programs-services/topics/arsbn-laws-rules

Healthy.arkansas.gov. (2022d). Nurse Practice Act of the State of Arkansas. Retrieved from https://www.healthy.arkansas.gov/images/uploads/pdf/NURSEPRACTICEACT.pdf.

Hello Robyn

Very Informative post!  As you mentioned Arkansas is currently a reduced practice authority state but with the Act 412, nurse practitioners in Arkansas will soon be able to practice independently when eligible (Kilhore-Hill, 2021). A minimum of three years of practice under the collaboration of physician is needed to acquire practice authority. I believe the NPs to be giving a chance to practice to the full extent of their training and education. Across the United Stated, ARNPs received the same training, education, and certification. Therefore, I find it concepts of full, reduced or restricted authority very frustrating. I think that relaxing the ARNPs scope of practice across the States will help achieve better results for both health care professionals and patients. In a research study, the Institute of Medicine “ The IOM recommends that the nursing community, other health professions groups, and policy makers, establish a common ground to remove scope of practice restrictions and increase interprofessional collaboration.” (Ortiz et al., 2018)  I believe that this is necessary to avoid ARNPs to start moving massively from restricted states to reduced and full practice authority states.

Reference

Kilgore-Hill, M (2021). Arkansas Nurse Practitioners: Moving Toward Independence. https://www.arkansasmedicalnews.com/arkansas-nurse-practitioners—moving-toward-independence–cms-811

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