NURS 6050: Professional Nursing and State-Level Regulations Discussion
Comparison of Advanced Practice Registered Nurse Board of Nursing
State boards of nursing regulate the licensure and practice of American advanced practice registered nurses (APRN’s). Milstead and Short (2019) explain that these boards of nursing are legally obliged to protect the public through nurse practice regulation. A comparison of full practice authority and licensure regulations reveals variations and similarities between California and Arizona.
The board of nursing in Arizona permits full practice authority (FPA) for APRN’s unlike in California that adopts restricted practice. Peterson (2017) explains that restricted practice limits the ability of APRN’s to work independently by requiring them to execute one or more elements of their practice under physician supervision or through collaborative agreements. The board of nursing in Arizona permits APRN’s to diagnose and evaluate patients, initiate, and manage treatments, and order and interpret diagnostic tests under its exclusive authority (Bosse et al., 2017). Conversely, the Californian board of nursing leaves room for physicians to supervise its APRN’s. In California, APRN’s can only practice with standardized procedures contrary to their colleagues in Arizona whose board of nursing allows practice without these procedures.
Further, the state boards of nursing in California and Arizona have similar regulations on APRN licensure. According to Milstead and Short (2019), APRN’s should complete graduate education within their area of specialization before sitting for respective national certification examinations. After these examinations, the boards require APRN’s to apply and get a state-specific license for practice. The regulations of these boards on APRN licensure and FPA or restricted practice influence whether these nurses can practice independently to the full extent of their competencies, education, and experience. One should acquire the specialty licensure before practicing as an APRN within the area of specialization. For example, a registered nurse can only experience a wider scope of practice to prescribe medications with or without physician supervision only after getting APRN licensure.
Overall, the board of nursing in California restricts APRN practice unlike that of Arizona that guarantees FPA despite both of them sharing a similar regulatory approach for licensure. APRN’s can comply with these regulations by practicing within the limits of their scope of practice and getting APRN licensure after graduate education and national examination. For example, a nurse practitioner should complete specialty graduate education, pass national certification examinations, and get state licensure before practicing based on what is prescribed by state practice laws.
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. https://doi.org/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.
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://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/
response 1
Michigan is like California in the fact that it they are both somewhat restricted. However, California recognizes nurse practitioners as primary care providers and Michigan does not. “NPs are recognized in state policy as primary care providers. Primary care provider means a person responsible for coordinating and providing primary care to members, within the scope of their license to practice, for initiating referrals and for maintaining continuity of care” (California scope of practice policy – State profile, n.d.). This bothers me about the State of Michigan. Legislators need to look and educate themselves on what we as practitioners are educated to do in our profession to treat and diagnose patients.
There is a huge demand to lower the cost of healthcare over the past 10 years. One way of doing so is to utilize nurse practitioners as unrestricted nurse practitioners. “Utilizing nurse practitioners properly will increase access to health care and create a substantial cost-savings to the health care system” (Imgrund, 2008). Nurse practitioners are cheaper than seeing a physician and this would cut down on the cost not only for the patients, but with Medicare and Medicaid as well.
References
Imgrund R. (2008). Meet your nurse practitioner: improving access to health care, offering cost effective health care, and high quality health care. Colorado Nurse, 108(1), 14.
California scope of practice policy – state profile. (n.d.). Scope of practice policy. Retrieved April 1, 2021, from https://scopeofpracticepolicy.org/states/ca/
response 2
I do agree with you. These regulations do restrict nurse practitioners to practice independently to the full extent. While nurses go through the same curriculum and sit for the same board exam, but each state continues to have different regulations relating to advanced nursing practice. These regulations may be essential but seem to restrict nurse practitioners from practicing to their total capacity, for example, a nurse practitioner from California will have to find a collaborating physician to cosign or supervise them before they can treat, diagnose or even prescribe some medications. The need for NP has become more eminent due to the shortage of primary care providers, especially in rural areas (Ortiz et al., 2018). Nurses make up the largest part of healthcare, and they play a vital role in healthcare. Even though the Affordable Care Act brought about some changes, there is still a lot to be done. These regulations intend to make sure healthcare is delivered safely, but there needs to be a form of uniformity across state lines. How do these changes take effect? The answer lies in the involvement of politically savvy nurses in politics to make changes for nurses (Milstead 2019).
References
Milstead, J A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).
Burlington, MA: Jones & Bartlett Learning.
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, 6(2), 65. https://doi.org/10.3390/healthcare6020065
Discussion: 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.
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.
State BONs have a significant impact on nurses, APRNs, and the general public. Each state has a Board of Nursing (BON) that helps implement regulations and protect patients. One thing that a BON can do is open the scope of practice for APRNs. This has been accomplished in several states, but over half of the states still are without full practice APRNs (Milestead and Short, 2019). This harms the public because full practice APRNs increase access to healthcare, especially in rural settings. NP programs were created to improve access to care, specifically primary care in rural areas throughout the United States in the 1960s when there was a shortage of physicians (Milestead and Short, 2019). Not having APRNs practice with their full scope leads to decreased access, higher costs, and lower quality care for patients (Milestead & Short, 2019). BONs can also create compact agreements, similar to how some states allow compact licensure for RNs. Compact agreements between states would require that states work together to revise Nurse Practice Acts (NPAs) to include the Uniform APRN requirements (Milestead and Short, 2019, p. 80). In 2015, an APRN compact model was approved, but currently, no states have worked together to implement compact legislation. The lack of multistate registration makes moving to new states more difficult for APRNs, if only for political reasons.
I currently live in Wisconsin, but I am from Iowa. Both states have very different regulations in regards to APRNs. Wisconsin is not a full practice state, meaning that APRNs must work in collaboration with a physician (Wisconsin State Legislature, 2019). They are allowed to write prescriptions for medications, but they cannot write scripts for any Class I controlled substances. Additionally, APRNs are not recognized as primary care providers in the state of Wisconsin.
In Iowa, APRNs have full, independent practice (Scope of Practice Policy, 2021). They are allowed to write prescriptions for all medications, and they are recognized as primary care providers by the state (Scope of Practice Policy, 2021). This is excellent news for the residents of Iowa. Many parts of Iowa are rural with poor access to care. For example, my grandparents live far from any large towns that have great options for clinics. Their small town has a clinic with one NP who can provide urgent care and serve as a primary care provider. Through Iowa’s regulations, this NP can help the residents in her surrounding area. She increases their access to high-quality, efficient care.
Milstead, J. A., & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones Bartlett Learning.
Scope of Practice Policy. (2021). State overview: Iowa. Retrieved from https://scopeofpracticepolicy.org/states/ia/
Wisconsin State Legislature. (2019). Chapter N 8: Certification of advance practice nurse practitioners. Retrieved from https://docs.legis.wisconsin.gov/code/admin_code/n/8/10
3rd post
Professional Nursing and State-Level Regulations
The level of practice authority that Advanced Practice Registered Nurses (APRN) can exercise varies from state to state. As of 2017, there are only twenty-two states that have granted full practice authority to APRNs. Full practice authority allows APRNs to practice to the full extent of their training and experience (Bosse et al., 2017). The remaining states and United States territories require APRNs to have a signed collaborative agreement with a physician. The collaborative agreement indicates that an APRN has a physician who has agreed to supervise their practice. This barrier to APRN practice is based on each state’s laws and regulations (Milstead & Short, 2019). Laws and regulations in individual states can significantly affect someone’s access to care. This is because populations in more rural areas of the country have difficulty accessing primary care services due to their location (Neff et al., 2018). Because the United States Constitution gives the states power to establish their laws and regulations, most professional licensure issues are decided at the state level (Milstead & Short, 2019). It is essential to understand other states’ laws and regulations when looking to practice elsewhere.
I live in Pennsylvania, and APRNs must collaborate with a physician to practice (49 Pa. Code § 21.251. Definitions., 2009). Requirements of the collaborative agreement include ensuring that the physician is available to the APRN. A plan is established for emergencies and that they meet regularly to go over prescription protocols, referrals, and standards of medical practice (49 Pa. Code § 21.251. Definitions., 2009). This agreement can be a barrier to practice because it does not allow the APRN to have complete autonomy in their practice (Neff et al., 2018). Pennsylvania allows APRNs to prescribe Schedule II to V medications; however, this needs to be specifically outlined in the collaboration agreement (49 Pa. Code § 21.251. Definitions., 2009). Pennsylvania also states that an APRN can have their license suspended or revoked if they perform outside their scope of practice (49 Pa. Code § 21.351. Penalties for violation., 2009). The Board of Nursing in Pennsylvania has the power to investigate these violations and issue punishment if deemed necessary.
A dream of mine has always been to move to Tennessee and have similar regulations for APRN practice. Tennesse is considered more restrictive than Pennsylvania but is still managed by the State Board of Nursing. The physician must supervise the APRN and sign off on their charts within thirty days (Rules of the Tennessee board of nursing chapter 1000-04 advanced practices nurses and certificates of fitness to prescribe, 2019). The APRN can prescribe drugs that fall on the Schedule II to V categories (Rules of the Tennessee board of nursing chapter 1000-04 advanced practices nurses and certificates of fitness to prescribe, 2019).
APRNs must practice to their full practice authority to serve better their communities (Bosse et al., 2017). The question has come forward whether or not the Federal government should step up and pass legislation related to this issue. However, it brings into question if this is a Constitutional move due to the states having their power to set laws and regulations (Milstead & Short, 2019). It is an issue that deserves a spotlight within local government. APRNs deserve to be able to practice to their full authority and training and to be reimbursed for those services by insurance companies appropriately (Milstead & Short, 2019).
References
49 Pa. Code § 21.251. Definitions. (2009). Www.pacodeandbulletin.gov. http://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter21/s21.251.html&d=reduce
49 Pa. Code § 21.351. Penalties for violation. (2009). Www.pacodeandbulletin.gov. http://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter21/s21.351.html&d=reduce
Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Van-hook, 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.
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
