NURS 6050 Discussion: Professional Nursing and State-Level Regulations

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

APRN Prescriptive Authority for Arkansas and Texas

Prescriptive authority in Arkansas for APRNs necessitates the APRN to be licensed in Arkansas with prescribing privileges within the scope of their certification. After completing an APRN level pharmacology course within a year, the practitioner must gain 300 hours of experience with a qualified preceptor and establish a collaborative practice agreement with an Arkansas licensed physician holding an unrestricted DEA registration number. Only then can an APRN prescribe legend drugs and medicines or therapeutic devices specific to their area of practice. For controlled drugs, only Schedule III through V may be prescribed by an APRN, with the exception of hydrocodone combination products. Schedule I and II controlled substances cannot be prescribed by an APRN (Arkansas Department of Health, 2018).

In Texas, APRNs must complete graduate-level pharmacotherapeutics, advanced pathophysiology, and advanced health assessment and finish 45 hours of preceptor experience per course. If an APRN has prescriptive authority in another state, they must meet Texas’s education requirements before gaining prescriptive authority. Unlike Arkansas, APRNs in Texas can prescribe Schedule II controlled substances but only in a hospital setting. Additionally, APRNs can authorize or prevent generic substitutions for prescription drugs (Texas Board of Nursing, 2019).

APRN Delegation Regulations for Arkansas and Texas

In Arkansas, APRNs can delegate specific tasks to nurses and unlicensed staff, including noninvasive treatments, data collection, ambulation, positioning, personal hygiene, but not physical assessments, formulating patient care plans, transmitting verbal or telephone orders, and calling in prescriptions to the pharmacy (Arkansas Department of Health, 2018).

In Texas, medication administration can be delegated to a medication aide in correctional health, long-term care facilities, and home health agencies. Other delegation criteria apply in Texas, with the delegating APRN responsible for assessing the delegate’s competence (Texas Board of Nursing, 2019).

Prescriptive Authority and Delegation for APRNs with Full Practice Authority

Regulations for prescriptive authority and delegation for APRNs with full practice authority can be influenced by various state and national barriers. Overcoming these barriers can enable APRNs to provide services to underserved populations, such as minorities and the uninsured (Bosse et al., 2017).

References

Arkansas Department of Health. (2018, December 29). Arkansas State Board of Nursing. https://www.healthy.arkansas.gov/programs-services/topics/arsbn-adv.-practice.

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

Texas Board of Nursing. (2019). Texas Board of Nursing – Practice – APRN Scope of Practice. https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp.

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

In New Jersey, advanced practice nurses (APNs) or nurse practitioners (NPs) cannot practice independently and require collaboration with a physician. This collaboration involves a written protocol with a physician when prescribing medications. All prescriptions are written under the physician’s name and NPI number (NCSLSOP Scope of Practice Policy, 2021). This collaboration extends to prescription writing for all medications (The State of New Jersey, n.d.).

In contrast, Florida allows all advanced practice nurses to practice autonomously, including prescription writing for any drug. An autonomous practice bill (HB 607) passed in 2020, granting APNs the ability to practice independently. Those who choose to practice autonomously must meet specific education requirements, including graduate-level courses in differential diagnosis and pharmacology. They also need 3,000 hours of supervision. APNs who continue to collaborate with a physician do not have the authority to prescribe controlled substances (FLANP).

While I support the idea of APNs practicing independently, I believe that mandatory supervision hours are crucial to ensure that nurses maintain their clinical competence and critical thinking abilities. Balancing education with hands-on clinical experience is vital to produce competent and safe healthcare providers. State boards of nursing have a responsibility to protect the public from potential harm, and the regulatory requirements in Florida reflect this commitment to patient safety.

References

FLANP. (n.d.). Florida Association of Nurse Practitioners. https://www.flanp.org/page/AutonomousPractice

NCSLSOP Scope of Practice Policy. (2021). National Organizations for State and Local Officials. https://scopeofpracticepolicy.org/states/nj/

The State of New Jersey. (n.d.). New Jersey Division of Consumer Affairs. https://www.njconsumeraffairs.gov/nur/Pages/APN-Certification

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp.

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.

By Day 3 of Week 5

By Day 6 of Week 5

In New Jersey, while an advanced practice nurse (APN) or nurse practitioner (NP) cannot practice independently, they are recognized as primary care providers.  Otherwise known as a joint protocol, they require “collaboration, and a written protocol with a physician is required when prescribing medications” (NCSLSOP Scope of Practice Policy, 2021).  This collaboration also extends to prescription writing for all medications (The State of New Jersey, n.d.).    The APNs that I have worked with, prescription pads have a medical doctor’s name and NPI number written on them.  When the APNs introduce themselves, they inform the staff of the name of which doctor they are collaborating with.

In comparison, all advanced practice nurses in Florida do not require collaboration.  HB 607 (Autonomous Practice) is a bill that was passed on March 11, 2020, allowing APNs to be autonomous (FLANP).  They can practice independently, including prescription writing of any drug (NCSLSOP Scope of Practice Policy, 2021). Every nurse practitioner does not have to be autonomous, as it is a choice to be independent or collaborate.   Those who choose to practice autonomously will require additional continuing education hours that include “three graduate-level semester classes in differential diagnosis, three graduate-level semester classes in pharmacology” (FLANP), and 3,000 hours of supervision.   The APNs who choose to continue to collaborate will do so under the supervision of a doctor and cannot prescribe control substances NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

While I agree that APNs should practice independently, I agree with the mandatory supervision hours.  Even though nurses are encouraged to advance their education, the balance requires hands-on care and practice.  We do not want book competent nurses that are deficient in critical thinking due to a lack of clinical exposure. The job of the state board of nursing and as a regulatory body is to protect the public from harm.  Florida’s board of nursing made great strife in going from a restricted status of APN licensure to independent status, yet put the correct stipulations in place to protect the public.

References

FLANP. (n.d.). Retrieved from Florida Association of Nurse Practitioners: https://www.flanp.org/page/AutonomousPractice

NCSLSOP Scope of Practice Policy. (2021). Retrieved from National Organizations for State and Local Officials: https://scopeofpracticepolicy.org/states/nj/

The State of New Jersey. (n.d.). Retrieved from New Jersey Division of Consumer Affairs: https://www.njconsumeraffairs.gov/nur/Pages/APN-Certification NURS 6050 Discussion: Professional Nursing and State-Level Regulations