Pennsylvania nursing Certification and Licensure

Pennsylvania nursing Certification and Licensure

Pennsylvania is considered a reduced practice state, which means that a nurse practitioner must practice under a physician with a collaboration agreement outlining their joint practice (ANA,2021). Under a collaboration agreement, a nurse practitioner can deliver many health care services such as diagnose medical conditions, develop and implement treatment plans, order and perform diagnostic tests, and order and manage medications (Pennsylvania Coalition of Nurse Practitioners, 2021). Physician availability must be also outlined in the agreement. However, recently the PA senate passed bill 717 trying to change current practice. The proposed bill would allow nurse practitioner’s the ability to practice independently in the state after participating in at least a 3-year collaboration agreement with a physician (Phillips, 2019). This bill has a lot of support but has also met resistance by the house and is still in process of potentially becoming Pennsylvania law. Although nurse practitioners cannot practice independently currently, they are recognized in the state as primary care providers Pennsylvania nursing Certification and Licensure.

A nurse practitioner in Pennsylvania must have an RN license, successfully complete a master’s degree or post master’s certificate nurse practitioner program, and obtain national certification before applying for a Pennsylvania state license (Nursinglicensure.org, 2020). Application can be completed online with the Pennsylvania licensing system (PALS) and is approved by the state board of nursing. License renewal is every two years with a 30 continuing education hours requirement (AANP, n.d.).

A nurse practitioner in Pennsylvania can prescribe drugs, devices and Schedule II-V controlled substances (Pennsylvania Coalition of Nurse Practitioners, 2021). Buprenorphine-containing products can be administered by a nurse practitioner if both the nurse practitioner and collaborating physician are certified and trained accordingly (Pennsylvania Coalition of Nurse Practitioners, 2021). Prescriptive authority must also be outlined in the collaboration agreement between the physician and nurse practitioner. To obtain a DEA number, one must apply online through the U.S. Department of Justice, Drug Enforcement agency. Once issued, it will need renewed every three years.

There are multiple nurse practitioner organizations specific to Pennsylvania. Some are location specific within the state but share similar goals and mission statements. These organizations are there to support and promote practice through legislative and regulatory processes, provide continuing education, and advocate the roles of nurse practitioners in today’s health care (Pennsylvania Coalition of Nurse Practitioners, 2021).  The Pennsylvania Coalition of Nurse Practitioners (PCNP), Nurse Practitioner Assoc of Southwestern Pennsylvania (NPASP), Nurse Practitioners of Central Pennsylvania (NPCP), and Nurse Practitioners of Northeastern Pennsylvania (NEPA) are just some examples of the organizations available to Pennsylvania nurse practitioners Pennsylvania nursing Certification and Licensure.

References

AANP. (n.d.). Pennsylvania State Policy Fact Sheet. American association of nurse practitioners. Retrieved August 31, 2021, from https://www.aanp.org/advocacy/state/state-practice-environment/state-policy-fact-sheets/pennsylvania-state-policy-fact-sheet

AANP. (2021). State practice environment. American Association of Nurse Practitioners. Retrieved August 31, 2021, from https://www.aanp.org/advocacy/state/state-practice-environment

U.S. Department of Justice- Diversion control division. (n.d.). General information. Registration Procedures. Retrieved August 31, 2021, from https://www.deadiversion.usdoj.gov/drugreg/index.html

Nursinglicensure.org. (2020, November 4). Pennsylvania crnp requirements – how to become a nurse practitioner in pa. NursingLicensure.org – A more efficient way to find nursing license requirements in your state. Retrieved August 31, 2021, from https://www.nursinglicensure.org/np-state/pennsylvania-nurse-practitioner/

Pennsylvania Coalition of Nurse Practitioners. (2021). Scope of practice. Retrieved August 31, 2021, from https://www.pacnp.org/page/ScopeofPractice

Phillips, J. (2019, June 13). Pa senate bill to expand role of nurse practitioners – rcpa. RCPA. https://www.paproviders.org/pa-senate-bill-to-expand-role-of-nurse-practitioners/ Pennsylvania nursing Certification and Licensure

Discussion: Certification and Licensure

Now that you are in your final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass a national AGPCNP certification exam.  Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.

Photo Credit: Getty Images/iStockphoto

Although there is a movement called the APRN Consensus Model to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement Pennsylvania nursing Certification and Licensure.

Another important area to consider and plan for is prescriptive authority. Prescriptive authority is granted under state law by the appropriate board. The board granting prescriptive authority may be the medical board, state board of pharmacy, or nursing board for the appropriate state licensure being pursued. The authority to write for a controlled substance is granted at a federal level and is verified through the Drug Enforcement Administration (DEA) by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.

Finally, the legal landscape for NPs is constantly changing as the status of NPs as providers improves on a national level. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes will significantly impact your scope of practice as a nurse practitioner.

For this Discussion, you examine professional issues for your state, including certification and licensure, scope of practice, independent practice, prescriptive authority, and legislative activities.

To prepare:

  • Review practice agreements in your state.
  • Identify whether your state requires physician collaboration or supervision for nurse practitioners and, if so, what those requirements are.
  • Research the following:
    • How do you get certified and licensed in your state?
    • What is the application process for certification in your state?
    • What is the primary nurse licensure office resource website in your state?Pennsylvania nursing Certification and Licensure
    • How does your state define the scope of practice of a nurse practitioner?
    • What is included in your state’s practice agreement?
    • How do you get a Drug Enforcement Agency (DEA) license?
    • How does your state describe a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
    • In what legislative and advocacy activities are your state nurse practitioner organization(s) involved?

By Day 3

Post a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.

Read
a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on 2 different days in one or more of the ways listed below.

  • Share an insight from having viewed your colleagues’ posts.
  • Suggest additional actions or perspectives.
  • Share insights after comparing state processes, roles, and limitations.
  • Suggest a way to advocate for the profession.
  • Share resources with those who are in your state.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

 

In the state of Pennsylvania, nurse practitioners are recognized as Certified Registered Nurse Practitioners (CRNPs) once licensed. CRNPs must have a master’s degree as well as have passed the certification exam. Once licensed, CRNPs must renew their license biannually (Pennsylvania Department of State, 2021) Pennsylvania nursing Certification and Licensure.

In order to become certified as a CRNP in the state of Pennsylvania, the student must apply through the Pennsylvania State Board of Nursing. The Pennsylvania State Board of Nursing is the entity responsible for all nursing licensing in Pennsylvania. Once the student has completed all of their MSN coursework, official transcripts must be sent to the state BON. The student must also have current standing as a licensed registered nurse in the state. Finally, prescriptive authority approval must be obtained by completing required pharmaceutical education and submitting a separate application to the board (Buppert, 2021). Additional steps to the application process include child abuse clearance, criminal history check, educational verification and national certification.

Pennsylvania is a restricted practice state in that it does require collaboration with a supervising physician (Pennsylvania Coalition of Nurse Practitioners, 2021). CRNPs are also required to have a collaborative agreement in order to prescribe. CRNPs may prescribe schedule II-V controlled substances as outlined in the prescribing agreement with the supervising physician.

In Pennsylvania, a CRNP is defined as,

 “A professional nurse licensed in this Commonwealth who is certified by the Board in a specialty and who, while functioning in the expanded role as a professional nurse, performs acts of medical diagnosis or prescription of medical therapeutic or corrective measures in collaboration with a physician licensed to practice in this Commonwealth and in accordance with the act and this subchapter. Nothing in this subchapter is to be deemed to limit or prohibit a professional nurse from engaging in those activities which constitute the practice of professional nursing as defined in section 2 of the act (63 P.S. § 212). (Buppert, 2021) Pennsylvania nursing Certification and Licensure. 

One of the biggest barriers to being a CRNP in PA, as in many other states, is the requirement to collaborate with a physician. I grew up in MA where NPs can practice independently of physicians. Massachusetts is one of twenty-three states to enforce this regulation. The requirement of nurse practitioners to work with collaborating physicians is beneficial, especially as a new nurse practitioner, to provide a resource to the new CRNP. However, this can limit patient access to care, especially in rural areas. Nurse practitioners who wish to branch out on their own are unable to do so without having standing practice agreements with a collaborating physician.

References

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett.

Pennsylvania Department of State. (2021). Board of Nursing. Retrieved from https://www.dos.pa.gov

Pennsylvania Coalition of Nurse Practitioners. (2021). Scope of Practice Pennsylvania nursing Certification and Licensure. Retrieved from https://www.pacnp.org

NRNP_6565_Week1_Discussion_Rubric

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Excellent
Point range: 90–100
Good
Point range: 80–89
Fair
Point range: 70–79
Poor
Point range: 0–69
Main Posting:

Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

Points Range: 40 (40%) – 44 (44%)

Thoroughly responds to the discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least 3 current credible sources.

Points Range: 35 (35%) – 39 (39%)

Responds to most of the discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least 3 credible references.

Points Range: 31 (31%) – 34 (34%)

Responds to some of the discussion question(s).

One to 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 fewer than 2 credible references.

Points Range: 0 (0%) – 30 (30%)

Does not respond to the discussion question(s).

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 1 or no credible references.

Main Posting:

Writing

Points Range: 6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Further adheres to current APA manual writing rules and style.

Points Range: 5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range: 4 (4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 3 (3%)

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 Posting:

Timely and full participation

Points Range: 9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main discussion by due date.

Points Range: 8 (8%) – 8 (8%)

Posts main discussion by due date.

Meets requirements for full participation.

Points Range: 7 (7%) – 7 (7%)
Posts main discussion by due date.
Points Range: 0 (0%) – 6 (6%)

Does not meet requirements for full participation.

Does not post main discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

Points Range: 8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
Points Range: 7 (7%) – 7 (7%)
Response is on topic, may have some depth.
Points Range: 0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
First Response:

Writing

Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully 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: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.

Points Range: 4 (4%) – 4 (4%)

Response posed in the discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range: 0 (0%) – 3 (3%)

Responses posted in the discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:

Timely and full participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range: 4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

Points Range: 3 (3%) – 3 (3%)
Posts by due date.
Points Range: 0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:

Post to colleague’s main post that is reflective and justified with credible sources.

Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectivesPennsylvania nursing Certification and Licensure.

Points Range: 8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
Points Range: 7 (7%) – 7 (7%)
Response is on topic, may have some depth.
Points Range: 0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
Second Response:

Writing

Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully 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: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.

Points Range: 4 (4%) – 4 (4%)

Response posed in the discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range: 0 (0%) – 3 (3%)

Responses posted in the discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:
Timely and full participation
Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range: 4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

Points Range: 3 (3%) – 3 (3%)
Posts by due date.
Points Range: 0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

 

Nurse Practitioner Practice Agreement, Certification, and Licensure in Pennsylvania

In the state of Pennsylvania (PA), advanced practice registered nurses are given the title certified registered nurse practitioner [CRNP] (Buppert, 2021). CRNPs in PA practice under a reduced practice agreement; state practice and licensure laws require them to have a collaborative agreement with a physician who holds a current license to practice in PA, to provide patient care, and prescribe medications (American Association of Nurse Practitioners, 2019). This collaborative agreement must outline the availability of the physician to the CRNP directly or by phone, an emergency services plan, and the regular review of the CRNP’s patient charts by the physician (Buppert, 2021).

To obtain CRNP certification in PA, students must graduate from an accredited, Board-approved master’s or postmaster’s nurse practitioner program and meet the minimum clinical hour requirement of 500 hours (Pennsylvania Department of State, 2021). CRNP students then must pass a Board-recognized national certification exam in their given specialty (Pennsylvania Department of State, 2021). Applicants must complete at least 45 hours of advanced pharmacology coursework within five years before applying for prescriptive authority (Buppert, 2021). To obtain licensure, the student must pay a $100 licensing fee for in-state schools or a $140 fee for an out-of-state education and pay a $50 application fee for prescriptive authority (Pennsylvania Department of State, 2021). Applicants then must complete three hours of child abuse recognition and reporting continuing education for initial licensure (Pennsylvania Department of State, 2021). Established CRNPs must complete 30 hours of continuing education every two years, consisting of at least 16 hours of pharmacology and two hours of child abuse education (Pennsylvania Department of State, 2021). They also have to pay a biennial renewal fee of $81 along with a $41 biennial prescriptive authority renewal fee (Pennsylvania Department of State, 2021).The primary nurse licensure office resource for CRNPs is the Pennsylvania Department of State website, which provides comprehensive details and resources about PA’s State Board of Nursing requirements Pennsylvania nursing Certification and Licensure.

Nurse Practitioner Scope of Practice in PA

When collaborating with a licensed physician in the Commonwealth of Pennsylvania, CRNPs may perform comprehensive patient assessments and establish medical diagnoses, order and perform diagnostic testing, initiate patient referrals to other licensed healthcare professionals, develop and implement treatment plans, implement pharmaceutical treatments if they have prescriptive authority, and complete admission and discharge summaries (Buppert, 2021). Also, CRNPs may order blood products, dietary plans, home health and hospice care, and durable medical equipment for patients (Buppert, 2021). CRNPs can refer patients for physical, occupational, respiratory, and dietary therapies (Buppert, 2021). Lastly, the scope of practice for a CRNP in PA includes performing disability assessments, making initial methadone treatment assessments, issuing homebound schooling certifications, and issuing verbal orders to the extent allowed by a healthcare facility’s policies (Buppert, 2021). CRNPs have a broad scope of practice in the state of PA; however, they are restricted by needing to have a collaborative agreement with a physician to carry out their scope of practice Pennsylvania nursing Certification and Licensure.

Obtaining a Drug Enforcement Agency License and PA Regulations

To prescribe and dispense controlled substances, CRNPs must register with the United States Department of Justice Drug Enforcement Administration (DEA) as a mid-level practitioner and obtain a DEA number (Pennsylvania State Board of Nursing, 2019). Pennsylvania does not require a separate state registration for prescribing controlled substances (Pennsylvania State Board of Nursing, 2019). In PA, CRNPs can prescribe a Schedule II controlled substance for up to a 30-day supply and a Schedule III or IV controlled substance for up to a 90-day supply, as identified in their collaborative agreement (Buppert, 2021). CRNPs cannot prescribe or dispense gold compounds, heavy metal antagonists, radioactive agents, oxytocics, and Schedule I controlled substances (Buppert, 2021).

Legislative and Advocacy Activities

The Pennsylvania Coalition of Nurse Practitioners (PCNP) is a state organization that protects and advocates for the practice of CRNPs in PA (Pennsylvania Coalition of Nurse Practitioners [PCNP], n.d.). PCNP is currently advocating to make PA a full-practice authority state for CRNPs (PCNP, n.d.). Senate Bill 25 and House Bill 100 have passed legislation in the Senate and are now undergoing evaluation in the House (PCNP, n.d.). These bills would grant CRNPs full practice authority after completing 3,600 hours and three years in a collaborative agreement (PCNP, n.d.). Advocating for CRNP full-practice authority legislation will help solve the primary care provider shortage in PA, expand services to areas with limited access to healthcare in the state, and help reduce the cost of healthcare for patients (PCNP n.d.) Pennsylvania nursing Certification and Licensure.

Restrictions and Barriers Impacting Nurse Practitioner Independent Practice in PA

The nurse practitioner workforce is the most rapidly growing primary care provider workforce in the United States, potentially reducing healthcare costs and improving patient access to quality healthcare services in Pennsylvania (Poghosyan, 2018). However, reduced practice constraints in PA leads to less efficient and more expensive patient care (Ortiz et al., 2018). Restrictions impede patient access to healthcare in medically underserved urban and rural areas of the state and the three million PA residents with Medicaid insurance (PCNP, n.d.). Additionally, with COVID-19 increasing the demand for healthcare services, restricted practice authority limits the ability of the PA healthcare system to respond to and meet patient needs (Moore et al., 2020). My research surprised me to discover that 2.5 million PA residents, or 22% of the PA population, live in a designated medically underserved area (PCNP, n.d.). Also, research by the PCNP demonstrates that Medicare and Medicaid patients experience 50% more unnecessary hospitalizations in a restricted practice state like PA, compared to states with full practice authority (PNCP, n.d.). Although CRNPs in PA have the practice authority to provide quality care to patients, healthcare policy reform is necessary to grant CRNPs full practice authority and subsequently expand patient access to affordable, quality care throughout the entire state of PA (Poghosyan, 2018).

References

American Association of Nurse Practitioners. (2019). State practice environment.

https://www.aanp.org/advocacy/state/state-practice-environment

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones &

Bartlett.

Moore, C., Kabbe, A., Gibson, T.S., & Letvak, S. (2020). The pursuit of nurse practitioner

practice legislation: a case study. Policy, Politics, & Nursing Practice, 21(4), 222-232. https://doi.org/10.1177/1527154420957259

Ortiz, J., Hofler, R., Bushy, A., Lin, Y.L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse

practitioner practice regulations on rural population health outcomes. Healthcare, 6(2), 65. https://doi.org/10.3390/healthcare602065

Pennsylvania Coalition of Nurse Practitioners (PCNP). (n.d.). Full practice authority for nurse Pennsylvania nursing Certification and Licensure

practitioners expands care for PA. https://careforpa.com/improving-care

Pennsylvania Department of State. (2021). Certified registered nurse practitioner Pennsylvania

licensure requirements. Commonwealth of Pennsylvania. https://dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Pages/Certified-Registered-Nurse-Practitioner-Licensure-Requirements-Snapshot.aspx

Pennsylvania State Board of Nursing. (2019, July). Instructions for certified registered nurse

practitioner (CRNP) prescriptive authority application. https://dos.pa.gov/ProfessionalLicensing/BoardsCommisions/Nursing/Documents/Applications%20and%20Forms/Prescriptive-Authority-Application.pdf

Poghosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioner

workforce and practice. Nursing Economics, 36(1), 43-45 Pennsylvania nursing Certification and Licensure.