NURS 6003 Discussion: Professional Nursing and State- Level Regulations
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.
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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.
*Note: Throughout this program, your fellow students are referred to as colleagues.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 5 Discussion Rubric
Post by Day 3 and Respond by Day 6 of Week 5
To participate in this Discussion:
Week 5 Discussion
Learning Resources
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.org
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.
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.12291
National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved September 20, 2018,
from https://www.ncsbn.org/index.htm
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
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.
Required Media
Laureate Education (Producer). (2018). The Regulatory Process [Video file]. Baltimore, MD:
Author.
Laureate Education (Producer). (2018). Healthcare economics and financing [Video file].
Baltimore, MD: Author.
Laureate Education (Producer). (2018). Quality improvement and safety [Video file]. Baltimore,
MD: Author.
Week 5 Discussion: Compare two APRN board of Nursing Regulations
Every state has outlined laws and rules for Advanced Practice Registered Nurses (APRN) to follow which guide their practice. “There are four main categories of APRN providers, which are listed as nurse practitioners, nurse midwives, nurse anesthetists, and the clinical nurse specialists” (Ungvarsky, 2019). In the state of Maryland, where I reside there is a fifth APRN role recognized, which is nurse psychotherapists” (NursingLicensure.org, 2013-2020). APRN can be defined as a medical professional who has completed training at a master’s level or above. Different states have different laws in place. It is important that the APRN understand and comply with their state laws, which guide their practice. Within this discussion I will compare the states of Maryland and Texas.
“Maryland became the 21st state to allow nurse practitioners to practice autonomy from physicians” (Modern Healthcare, 2015). Governor Larry Hogan, who is the present governor of Maryland signed the Nurse Practitioner Full Practice Authority Act into legislation in May of 2015. Full autonomy includes prescribing and dispensing drugs, devices and schedule II-V controlled substances. Although nurse practitioners have been allowed to practice independently, they are required to name a mentor upon licensure who will serve as a mentor for at least 18 months. This only applies if the certified registered nurse practitioner (CRNP) is a first- time applicant. The named mentor can be either a CRNP or a licensed Maryland Physician
In the state of Texas CRNPs are still fighting for full practice authority. “Currently NPs must practice under a physician within a 75-mile radius, NP’s are not allowed to prescribe schedule II drugs, NPs are not allowed to sign death certificates or handicap permits. Under the proposed bill 1792 NPs with at least 2,080 hours under a physician, would allow them to practice independently” (Wofford, 2019). Although, it seems the nurse practitioners are serving as physicians, they remain limited in their practice.
Limiting the CRNPs practice puts a restriction on the amount of care they can provide patients. Providing full autonomy to NPs would allow more efficient care and quicker turn around times for treatment. Having nurse practitioners as providers could also result in lower healthcare costs.
References
Modern Healthcare. (2015). Maryland allows nurse practitioners to practice independently of a physician. Retrieved from https://www.modernhealthcare.com/article/20150514/NEWS/150519928/maryland-allows-nurse-practitioners-to-practice-independently-of-a-physician
NursingLicensure.org. (2013-2020). Advanced Practice Registered Nurse License Requirements in Maryland. A More Efficient Way to Find Nursing Licensure Requirements in Your State. Retrieved from https://www.nursinglicensure.org/np-state/maryland-nurse-practitioner.html
Ungvarsky, J. (2019). Advanced practice registered nurse (APRN). Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&bquery=APRN&cli0=FT1&clv0=Y&type=1&searchMode=Standard&site=eds-live&scope=site
Wofford, P. (2019). Texas Nurse Practitioners Fight for Full Practice Authority. Retrieved from https://nurse.org/articles/texas-nurse-practitioners-fight-for-practice/
Hi A….,
Thank you for your post and the explicit explanation you put together between the states of Maryland and Texas. I agree with you that limiting CRNPs practice will put a restriction on the care of patients that need it which has become obvious in a time like this worldwide corona virus pandemic. As rightly stated by Ken Miller, president of the American Association of Nurse Practitioners, States that give nurse practitioners more authority are improving access to healthcare as a result and he also urged all states in the nation to follow the same pattern as Maryland ( Modern Healthcare, 2015).
In Indiana State where I live, CRNPs can open their own practices, diagnose and treat patients but are required by state law to have a collaborative agreement in place with a physician in order to prescribe medications (Martsolf, Grant, & Ryan, 2017). Due to the restrictions placed on CRNPs in the state, there are many physician offices that cannot readily accommodate patients in a timely manner thereby resulting in delay of care with sometimes increased morbidity and mortality over this waiting period. On the continued restriction, experts warned could result in decrease access to healthcare services, and reduced quality of care (Milstead & Short, (2019).
Thanks, Angenette, for your informative post and teaching me about CRNP laws in Texas and Maryland.
References
Martsolf, Grant, & Ryan. (2017, March 22). Expanding the Scope of Practice of Indiana’s Nurses. Retrieved from
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Rubenfire, A. (2015, May 14). Maryland allows nurse practitioners to practice independently of a physician. Retrieved from https://www.modernhealthcare.com/article/20150514/NEWS/150519928/maryland-allows-nurse-practitioners-to-practice-independently-of-a-physician