Professional Nursing and State-Level Regulations Discussion Essay

Regarding the Discussion for Week 5

Table of Contents

It is of utmost importance that Advanced Practice Registered Nurses (APRNs) possess a comprehensive understanding of the scope of their practice within their chosen state of practice (Milstead, 2019). Therefore, I would like to draw a comparison between the states of Kansas and Washington concerning professional nursing and state-level regulations.

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Practice Authority:

Kansas and Washington State differ significantly in terms of practice authority. Kansas practices limited authority, whereas Washington practices full authority.

In Kansas, APRNs are required to practice under collaborative agreements, following specific protocols and care plans under the supervision of a physician. It’s worth noting that the physician need not be physically present during the care. Additionally, Kansas APRNs must renew their certification every two years and complete 30 hours of continuing education.

Conversely, in Washington State, APRNs enjoy full independent authority to practice within the scope of their profession. Consequently, APRNs in Washington must renew their licenses biennially, having completed at least 250 hours of practice and 30 hours of continuing education. Furthermore, Washington State mandates that all license applicants must have undergone seven hours of HIV/AIDS training. This distinction allows APRNs in Washington State to establish their practices, which is not the case for their counterparts in Kansas.

Prescriptive Authority:

In Kansas, APRNs must register with the U.S Drug Enforcement Administration to prescribe controlled substances and work under a physician’s DEA. Additionally, they must inform the State Board of Nursing about the prescribing physician’s name and address. In contrast, Washington State provides APRNs with full prescription authority, encompassing the prescription of drugs and Schedule II-IV controlled substances. To maintain this authority, they must complete a 15-hour pharmacotherapeutics course every two years.

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APRN as Primary Care Provider:

Kansas does not recognize APRNs as Primary Care Providers, and therefore, they cannot sign Do Not Resuscitate (DNR) forms or death certificates. Conversely, in Washington State, state policy acknowledges APRNs as Primary Care Providers, granting them the authority to sign both DNR forms and death certificates.

Reference;

About U.S. nursing regulatory bodies. NCSBN. (2021). Retrieved September 29, 2021, from https://www.ncsbn.org/about-nursing-regulatory-bodies.htm.

National Council of State Boards of Nursing | NCSBN (n.d) Retrieved from https://www.ncsbn.org/index.htm

The impact of nurse practitioner regulations on population access to care – Nursing Outlook.https://www.nursingoutlook.org/article/S0029-6554(17)30616-4https://doi.org/10.1016/j.outlook.2017.10.002.

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5 months ago

Roseline Evans

RE: Discussion – Week 5

COLLAPSE

Hello Afanwi

I agree with your point regarding the barriers at the state and national levels that prevent APRNs from practicing to the full extent of their training. In doing more research, I found that alleviating provider shortage can be achieved by expanding APRN practice, especially in primary care, in medically underserved areas, and for medically underserved populations (AANP, n.d.). Imposing greater restrictions on APRNs will only exacerbate existing and projected health care workforce shortages by limiting the ability of APRNs to fill gaps in patients’ access to primary care services.The U.S primary care delivery system is ever changing, therefore it only makes sense to evaluate and modernize existing policy and legislation pertaining to NP scope of practice (Neff et al., 2018).

Presently, there also remains a gap in the NP scope of practice because of variations in each state’s NP legislation. Within the more restrictive NP policy states, NPs face legislation that limits their full scope of practice. For example, states with a more restrictive NP practice policy do not allow NP certification of home health-care visits and patient stays in skilled nursing facilities or hospice care, limit ordering durable equipment, and block general hospital privileges for patient admissions while increasing the oversight of care by collaborators, usually MDs. However, widening the NP scope of practice to the full extent of their knowledge, skills, and competencies could be an important intervention for potentially closing the patient access gap to primary care (Neff et al., 2018).

References

AANP. (n.d.). State Practice Environment. American Association of Nurse Practitioners. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment

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 Outlook, 66(4), 379–385. https://doi.org/10.1016/j.outlook.2018.03.001

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5 months ago

Michael Collins

Initial Post: Discussion – Week 5

COLLAPSE

The scope of practice when it comes to Advanced Practice Registered Nurses (APRNs) varies greatly from state to state. Before I even begin with the comparison of my state to another state, I will voice that is is ridiculous that states within the same country borders are going to have completely different rules and regulations for these APRN positions and limit what some can do. There needs to be a nation wide regulation that allows for APRNs to have full scope of practice. Without this, a barrier to cost effective, high-quality, and efficient health care services to citizens in need of care (Bosse, Simmonds, Hanson, Dunphy, Vonhook, & Poghosyan, 2017).

My state of residence in Pennsylvania. Pennsylvania is a state that does limit the scope of practice of APRNs unfortunately. In the state of Pennsylvania, Nurse Practitioners have the ability to diagnose medical conditions, develop treatment plans, and order and perform diagnostic tests (Pennsylvania Coalition of Nurse Practitioners, (n.d.). However this must be done under collaboration agreement with a licensed physician. Nurse Practitioners are considered primary care providers in my state. Another regulation that Pennsylvania APRNs must abide by is their prescriptive authority. Similarly to the scope of practice restrictions regarding care, APRNs must have collaboration with a licensed physician in order to prescribe medications and therapeutic measures (Pennsylvania Coalition of Nurse Practitioners, (n.d.).

In comparison, in the state of Maryland, APRNs are also considered primary care providers. While this was also the case in Pennsylvania, the difference between the two states is that Maryland allows full reign on providing care. This means that nurse practitioners in Maryland are not permitted to work in a collaborative effort with a licensed physician overseeing them (Maryland.Gov, 2020). Within the state of Maryland which borders Pennsylvania, the scope of practice allows completely different privileges and responsibilities. APRNs in Maryland can freely treat, diagnose, develop treatment plans, and perform and order diagnostic tests all without the overseeing of a licensed physicians. This is the same instance for their prescriptive authority. There is no need for a licensed physicians to be involved in the scope of practice APRNs have in Maryland.

Being in school for an APRN program, it certainly feels degrading knowing that the state I live in does not allow the scope of practice to fully encompass the skills and education I will gain through this challenging program. I will be a licensed professional with the ability to complete these tasks and work independently, but will be withheld from this privilege due to the regulations of my specific state. There are currently only 15 states that allow APRNs full practice authority of their abilities. There are ten other states that require post-licensure or certifications following school or the collaboration with a physician. The remaining 25 states all still currently require the collaborative agreement with a physician (Milstead & Short, 2019).

APRNs are forced to adhere to these regulations within whatever state they are practicing in. This is part of being a licensed professional and provider. There are rules that must be followed. As stated in the first paragraph, limiting the abilities of these APRNs in some states is creating a barrier to care for populations that would greatly benefit from APRNs having full indecent practice abilities. Now in these states that limit the full practice authority, this doesn’t mean there aren’t still numerous APRNs with their own practices providing affordable and quality care. They are just under a physicians agreement. If these limitations weren’t a thing, I am certain that more and more APRNs would be pulling from overstaffed hospitals and doctors offices where they are currently employed and creating their own private practices in order to bring quality care to the community.

References

Bosse, J., Simmonds, K., Hanson, C., Dunphy, L., Vanhook, P., Poghosyan, L. (2017, November 1). Position statement: Full practice authority for advanced practice register nurses is necessary to transform primary care. Volume 65, Issue 6, pp. 761-765. https://doi.org/10.1016/j.outlook.2017.10.002

Maryland.Gov. (2020, December 9). Advanced Practice Registered Nursing: Nurse Practitioners. Maryland Board of Nursing. Retrieved from, https://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx

Milstead, J. A., & Short, N. M. (2019) Health Policy and Politics; A Nurse’s Guide (6^th Ed.). Jones & Bartlett Learning.

Pennsylvania Coalition of Nurse Practitioners (n.d.). Scope of Practice. Retrieved from, https://www.pacnp.org/page/ScopeofPractice

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5 months ago

Idowu Oshokoya

RE: Initial Post: Discussion – Week 5

COLLAPSE

Michael,

I do like your discussion post, and I do agree with you that it is unfortunate that the scope of practice for Advanced Practice Registered Nurses in Maryland is different from Pennsylvania. You are correct that Nurse practitioners in Maryland does need collaborative agreement with doctors and they can diagnose, treat, and prescribe medications without any overseeing of a medical doctor (Maryland.Gov, 2020).

In the United States, only limited nations have permitted APRNs to fully practice without any collaboration agreement. While some other states still require post-licensure or certifications following school. The rest of the 25 states mandates a collaboration agreement with doctors before practice (Milstead & Short, 2019).

References

Maryland.Gov. (2020, December 9). Advanced Practice Registered Nursing: Nurse

Practitioners. Maryland Board of Nursing. Retrieved

https://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx

Milstead, J. A., & Short, N. M. (2019) Health Policy and Politics; A Nurse’s Guide

(6^th Ed.). Jones & Bartlett Learning.

Pennsylvania Coalition of Nurse Practitioners (n.d.). Scope of Practice. Retrieved

https://www.pacnp.org/page/ScopeofPractice

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5 months ago

Michael Collins