Discussion: Professional Nursing and State-Level Regulations

Discussion: Professional Nursing and State-Level Regulations

Discussion: Professional Nursing and State-Level Regulations

RE: Discussion – Week 5

Advanced Practice Registered Nurse (APRN) board of nursing regulations vary for each state in the United States of America. Given the differences between APRNs and the related state decrees, rules, and regulations, there is always the need for the APRNs to have a clear understanding on how the scope of healthcare practices are defined by such laws and regulations and any other opinion propagated by the regulation agencies for each state (Neff et al., 2018). In Georgia, the APRN Board of Nursing states that a nurse practitioner should be a registered professional nurse who is recognized by the board to get involved in the advanced practice registered nursing. Also, the board requires the nurse practitioner to practice in ways that are consistent with chapter 410-13 of the rule and regulations stipulated by the Georgia Board of Nursing (Phoenix & Chapman, 2020). For a professional nurse to be allowed to practice, they require the completion of a Georgia Board-approved advanced practice registered nurse reentry or the refresher program.

In California, there are differences in regulations compared to Georgia. While Georgia requires the completion of a Georgia Board-approved advanced practice registered nurse reentry or the refresher program, in California, federal certification or any other qualification from the recognized university is enough for nurses to practice in different healthcare institutions within the state (Phillips, 2015). Most regulations or the requirements between the two states are similar. For instance, for both the states, there is the need for healthcare professionals to acquire the certification for practice to be able to get involved in the healthcare processes.

The regulations selection can allow Advanced Practice Registered Nurses (APRNs) to operate within their scope of practice and exercise their educational achievements and experiences in enhancing the treatment processes (Sabo et al., 2017). APRNs may adhere to the two regulations through engaging in continuous training processes to gain insight into what is needed.

References

Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., Bumbach, M. D., Everhart, D., & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing outlook66(4), 379-385. Retrieved from: https://doi.org/10.1016/j.outlook.2018.03.001

Phillips, S. J. (2015). 27th Annual APRN legislative update: advancements continue for APRN practice. The Nurse Practitioner40(1), 16-42. Retrieved from:  10.1097/01.NPR.0000457433.04789.ec

Phoenix, B. J., & Chapman, S. A. (2020). Effect of state regulatory environments on advanced psychiatric nursing practice. Archives of psychiatric nursing34(5), 370-376. Retrieved from: https://doi.org/10.1016/j.apnu.2020.07.001

Sabo, J. A., Chesney, M., Tracy, M. F., & Sendelbach, S. (2017). APRN consensus model implementation: The Minnesota experience. Journal of Nursing Regulation8(2), 10-16. Retrieved from: https://doi.org/10.1016/S2155-8256(17)30093-5

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 5Post 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.Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.Chapter 4, “Government Response: Regulation” (pp. 57–84)American Nurses Association. (n.d.). ANA enterprise. Retrieved September 20, 2018, from http://www.nursingworld.orgBosse, 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.2017.10.002Note: You will access this article from the Walden Library databases.Halm, M. A. (2018). Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing. Worldviews on Evidence-Based Nursing, 15(4), 272–280. doi:10.1111/wvn.12291National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved September 20, 2018, from https://www.ncsbn.org/index.htmNeff, 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 Note: You will access this article from the Walden Library databases.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 Note: You will access this article from the Walden Library databases.Required MediaLaureate Education (Producer). (2018). The Regulatory Process [Video file]. Baltimore, MD: Author. Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018). Healthcare economics and financing [Video file]. Baltimore, MD: Author. Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018). Quality improvement and safety [Video file]. Baltimore, MD: Author.

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RE: Discussion – Week 5

Module 3- Discussion post

Across the United States there is an inconsistency in the scope of practice for Advance Practice Registered Nurses (APRN). Each state decides the level of autonomy and prescription authority of their advance practicing nurses. To understand the variety of regulations I researched my home state of Alaska and decided to compare it with Texas, a state with a similar political climate. The two regulations that I narrowed in on are, Practicing Authority and Persritption authority, and how they differ in the two areas. Also how this directly affects the APRN practice and patient access.

Discussion: Professional Nursing and State-Level Regulations

Practice Authority

In the state of Alaska,  according to Scope of Practice (2020), Nurse practitioners are not required to have a collaborative agreement and may practice independently, without a physician’s supervision in accordance with the rules of the Alaska Board of Nursing. “In Alaska, an advanced practice registered nurse is a licensed independent practitioner who is licensed to practice as a nurse-midwife, a clinical nurse specialist, a nurse practitioner, or a certified registered nurse anesthetist, or in more than one role” (ABON, 2020). This allows all different board certified APRN to work independently to the full scope of their training and license. From ambulatory to inpatient they are responsible for the planning, diagnosing, and implementation of care to their patients. In a remote area such as Alaska an APRN may be the only provider in a rural village, or working in a birthing center. There is a necessity to have APRNs working independently to deliver care with Alaska’s geographical limitations. APRN practicing authority differs greatly in Texas. According to the Texas Board of Nursing (2020) “Written agreement is required between the NP and the supervising physician. The protocols should be jointly developed and reviewed annually. Tex. Admin. Code §22-11-221.13”. This regulation removes the ability for the APRN to independently practice and requires them to be in collaboration with a physician or medical group to oversee their medical care. Working under a license of an MD will greatly reduce their ability to practice to the level of their education and to make autonomous decisions.

Prescriptive Authority

In Alaska “An NP may independently prescribe prescription drugs in accordance with state and federal laws. In addition to prescription drugs, an NP may prescribe Schedules II-V controlled substances. Alaska Admin. Code §12-44.440, Alaska Admin. Code §12-44.445” (ABON, 2020). When researching variation to prescriptive authority I looked directly at the differences of controlled substances. In the state of Alaska, APRN can prescribe independently Class scheduled 2-5. They have regulations the same as MD, to check the state-based dispense database every month for the first three months, and then every 90 days if the perception doesn’t change. In Texas prescriptive authority is a “Written agreement required between the physician and the NP.  The agreement must outline which drugs and devices may be prescribed among other items. Tex. Admin. Code §22-11-222.5” (Scope of Practice.org, 2020). This is applied to all medications, especially controlled substances. An APRN is unable to independently use their critical nursing judgment and prescribe how they determine, they are limited by the guidelines established by the supervising MD or medical group. Regulations limiting APRN to write for controlled substances is a barrier to care in the fight against the opioid pandemic.

Discussion: Professional Nursing and State-Level Regulations

Regulation Effects on APRN practices:

In researching this discussion I quickly became aware of the difference in regulations of APRN throughout the Unites States. “With over 267,000 advanced practice registered nurses (APRNs) in the U.S, APRNs represent a powerful force in the health care system…As long as regulatory requirements differ from state to state, each state border represents an obstacle to portability—potentially preventing access to professionals and access to care” (National Council of State Board of Nursing, 2020). This issue became apparent when our nation was faced with an Opioid Epidemic, and the inability to properly treat the patients due to regulations on APRN. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) ACT for patients and communities, signed into law in 2018 allowed APRN to prescribe buprenorphine for opioid use disorder (Moore, 2019). ”This legislation offers NPs a chance to play a pivotal role in reversing the opioid epidemic’s rising rates of addiction and overdose death in the United States” (Moore, 2019). The limitation of APRN prescribing Buprenorphine is one example of how it’s ultimately limiting patient care. Nurses when moving to a new state have to check each board of nursing guidelines to how they can practice. There is a push nationwide referred to as the Consensus Model, which provides guidance for states to adopt uniformity in the regulations of APRN roles (National Council of State Board of Nursing, 2020). A national standard would allow the general public to have a better understanding of APRN, and allow increase access to care in more remote areas of the country.

References

Alaska Board of Nursing (ABON). (n.d.). Retrieved December 27th, 2020. commerce.alaska.gov

Moore, D. J., (2019). Nurse Practitioners’ Pivotal Role in Ending the Opioid Epidemic. The Journal for Nurse Practitioners Vol 15 p.323-327.  www.npjournal.org

National Council of State Board of Nursing (NCSBN). (n.d.). Retrieved December 28th, 2020.

https://www.ncsbn.org/boards.htm

Scope of Practice. (n.d.). Retrieved December 28th, 2020. https://scopeofpracticepolicy.org

Texas Board of Nursing (TBON). (n.d.). Retrieved December 27th, 2020. https://www.bon.texas.gov

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

Discussion: Professional Nursing and State-Level Regulations

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

Discussion: Professional Nursing and State-Level Regulations

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

Discussion: Professional Nursing and State-Level Regulations

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Discussion: Professional Nursing and State-Level Regulations
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Rubric Detail

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Content
Name: NURS_6050_Module03_Week05_Discussion_Rubric

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List View

Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)
Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
Points Range: 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6050_Module03_Week05_Discussion_Rubric

RE: Discussion – Week 5- Response

Kimberly, I agree that the scope of practice for APRNs comes down to their Practicing authority and Prescription authority. The area of practice determines what kind, if any, physician supervision is needed. The scope of practice then defines what type of health care setting they will be able to practice in. As you stated in an example in Alaska, APRNs can legally practice as Primary Care Providers (PCP). Allowing non-physician professionals, such as APRNs, to practice to the full extent of their education and training gives patients more options and more types of services (American Nurses Association, n.d.). They can also assist with the shortage of primary care providers and the needed services in underserved areas. Many non-physician health care providers are trained and willing to help meet this shortage but are not permitted to do so because of limitations in their scope of practice (American Nurses Association, n.d.).

Just like Alaska, Florida APRNs can now practice autonomously. To do so, they need at least 3,000 clinical practice hours under the supervision of a physician within the past five years and three graduate-level semester hours in differential diagnosis and pharmacology. They cannot have been subject to disciplinary action in any state within the past five years (Florida Board of Nursing, n.d.). To continue their practice, they need to maintain their national certification with the required CE courses in addition to the three hours of Safe and Effective Prescription of Controlled Substances requirement.

References

American Nurses Association. (n.d.). Scope of practice. ANA. https://www.nursingworld.org/practice-policy/scope-of-practice/

American Nurses Association. (n.d.). Aprn. ANA. https://www.nursingworld.org/practice-policy/aprn/

Florida Board of Nursing. (n.d.). HB 607 passes legislature – Impact to RNs, CNAs, and APRNs. Florida Board of Nursing – Licensing, Renewals & Information. https://floridasnursing.gov/hb-607-passes-legislature/