Discussion: Professional Nursing and State-Level Regulations

Discussion: Professional Nursing and State-Level Regulations
In Pennsylvania, nurse practitioners are considered primary care providers. They can diagnose, treat, order, and perform tests and prescribe medications. However, they must have a written collaboration with a physician (Pennsylvania Coalition of Nurse Practitioners, n.d.). A federal waiver to dispense buprenorphine-containing products is obtainable through proper training and physician oversight (Pennsylvania Coalition of Nurse Practitioners, n.d.) Discussion: Professional Nursing and State-Level Regulations.
In contrast, Washington D.C. allows nurse practitioners to function independently without physician oversight, including prescribing controlled substances under the state board of nursing authority (American Association of Nurse Practitioners, n.d.). Allowing nurse practitioners to practice within their education’s full scope helps expand the community’s medical resources. Every state should implement this idea to provide greater access to primary care.
For nurse practitioners in Pennsylvania to adhere to these regulations, they can not open a primary care practice. Instead, they must join a team that operates with a physician at the team’s head. The physician provides oversight of the nurse practitioner and their practice. If the physician manages those with opioid addictions, the nurse practitioner working with them can become trained and eligible to prescribe buprenorphine under the physician’s guidance. To do so, a nurse practitioner must complete 24 hours of training, demonstrate the ability to treat and manage opiate use disorder, and be licensed to prescribe Schedule III, IV, or V medications for pain (American Society of Addiction Medicine, n.d.) Discussion: Professional Nursing and State-Level Regulations.
References
American Association of Nurse Practitioners. (n.d.).  State practice environment.  https://www.aanp.org/advocacy/state/state-practice-environment
American Society of Addiction Medicine. (n.d.).  Buprenorphine waiver management.  https://www.asam.org/advocacy/practice-resources/buprenorphine-waiver-management
Pennsylvania Coalition of Nurse Practitioners. (n.d.).  Scope of practice.  https://www.pacnp.org/page/ScopeofPractic e
sample response

I agree with your statement on all states needing to allow APRNs to practice without a collaborating physician. As you stated above , it will provide greater access to health care. According to Neff et. al, allowing NPs full autonomy to practice may be a relatively simple policy mechanism for states to improve access to primary care (2018). This statement shows that research has been done and studies have shown this to be factual. In Pennsylvania , APRNs practice regulations are much like those of South Carolina. The scope of practice in South Carolina is delegated and APRNs can prescribe legend drugs and schedule II controlled substances by a certain amount and time frame (NCSBN,n.d) Discussion: Professional Nursing and State-Level Regulations. Overall, I believe states should look into how to align the regulations and scopes of practices to be alike,hence; APRNs could easily practice in any state and it will help to improve access to health care. Thank you for the knowledge of what regulations are for Pennsylvania and Washington, DC.

References

National Council of State Boards of Nursing (NCSBN). (n.d). Retrieved April 2, 2021, from https.//www/ncsbn.org/index.htm

Neff, D.F, Yoon, S.H., Steiner, R.L., Bumbach, M.D., Everhrt, 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.208.03.001

response 2

I agree that nurse practitioners should be given the opportunity to practice independently if they choose. Many states have placed restriction on NP in there prescriptive authority and practice. The medical associations are the leading proponents of restricting NP prescriptive and practice, they believe the NP and physician should work together to provide safe and quality healthcare (Park et al., 2018) Discussion: Professional Nursing and State-Level Regulations. Many physicians I have spoken too have said they are not comfortable with all NP practicing independently. The other side of the coin is that there are many NP that do not want to work independent and feel more comfortable with assistance from a physician. Primary care providers are in demand as many physicians have chosen other career pathways. Nurse practitioners have been shown to have less malpractice lawsuits and improved patient satisfaction (Kraus and DuBois, 2016). At the end of the day it really depends on the nurse practitioners comfort level to work independently.

Kraus, E. & DuBois, J.M. (2016). Knowing your limits: A qualitative study of physicians and nurse practitioner perspectives on NP independence in primary care. Journal of General Internal Medicine, 32(3), 284-290. https://doi-org.ezp.waldenulibrary.org/10.1007/s11606-016-3896-7

Park, J., Athey, E., Pericak, A., Pulcini, J. & Greene, J. (2018). To what extent are state scopr of practice laws related to nurse practitioners’ day-to-day practice autonomy. Medical Care Research and Review, 75(1), 66-87. https://doi-org.ezp.waldenulibrary.org/10.1177%2F1077558716677826

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 Discussion: Professional Nursing and State-Level Regulations.

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..

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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 Discussion: Professional Nursing and State-Level Regulations.

Initial Discussion post

The mission of all boards of nursing (BON) is to protect the public. The BONs protect the public through regulatory processes. One regulatory practice used to ensure competency in a nurse is setting specific criteria to sit for a licensure examination (Milstead and Short, 2019). All BONs require new nurses to pass the National Council Licensure Examination (NCLEX) before they are given state licensure as a registered nurse. The BONs use Nurse Practice Acts to provide specific details of what a nurse can do or not do (Milstead and Short, 2019). Some nursing practice acts that the BON may provide requirements for licensure, educational standards, and scopes of practice (Milstead and Short, 2019). There are different regulations in each state, so it is essential to know the state regulations where you practice.

There are regulations in the state board of nursing that may affect the way nurses practice. The nurse practice acts that may restrict nurses from specific procedures are one-way BONs influence nurses’ care. Compact nursing licensure in several states helps nurses make smooth transitions from one state to another to provide care to patients. Sometimes the BONs’ repeal of regulations may also affect nurses’ care (Laureate Education, 2018). It is important to know current regulations and get involved in the regulatory process when it may affect our practice negatively Discussion: Professional Nursing and State-Level Regulations.

The states of Wyoming and Soth Carolina were used to compare Advanced Practice Registered Nurses (APRN) practice acts. In Wyoming, APRNs are allowed to function independently and, in South Carolina, must practice under a physician (AANP, n.d.). Nurse practitioners should have the right to practice independently and without oversite by physicians. Nurse practitioners provide care to underserved populations and rural areas (Bosse et al., 2017). The other regulation that affects APRN’s care is that they are not compensated 100% for Medicaid and Medicare patients. APRNs receive between 80% to 85% of the payment a physician would receive for the same care (Bosse et al., 2017). APRNs have made progress but still, need to be able to practice at the full scope of their education.

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

Bosse, J., Simmonds, K., Hansen, C., Pulcini, J., Dunphy, L. & Vanhook, P. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65, 761-765. https://www.nursingoutlook.org/action/showPdf?pii=S0029-6554%2817%2930558-4

Laureate Education (Producer). (2018). The Regulatory Process [Video file]. Baltimore, MD: Author.

Milstead, J.A. & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning Discussion: Professional Nursing and State-Level Regulations.

response

Travel nursing seems to be the popular choice lately. I never thought about how this would impact an advanced practice registered nurse (APRN) crossing state boundaries when each state has particular practice restrictions. Varying regulations make it nearly impossible for APRNs to practice in other states (Milstead & Short, 2019).

Pennsylvania is similar to South Carolina when it comes to APRN practice. All nurse practitioners must operate under a physician’s guidance, limiting access to quality healthcare for many Americans. I agree that nurse practitioners should be able to function as independent providers.

After reading your post, I did more research on Medicare payment policies and found some interesting facts. You describe an “incident to” billing, which leaves nurse practitioners’ quality care unrecognized (MedPAC, 2019). This issue occurs when patient care is billed under a supervising physician, even though a nurse practitioner managed the care. I would like to see all 50 states recognize nurse practitioners as independent providers and reimburse them accordingly.

References

MedPAC. (2019). Improving Medicare’s payment policies for advanced practice registered nurses and physician assistants. http://www.medpac.gov/-blog-/the-commission-recommends-aprns-and-pas-bill-medicare-directly-/2019/02/15/improving-medicare%27s-payment-policies-for-aprns-and-pas

Milstead, J., & Short, N. (2019). Health policy and politics: A nurse’s guide. Jones & Bartlett Discussion: Professional Nursing and State-Level Regulations.