Discussion: Professional Nursing and State-Level Regulations
PEER 1
Christina Bradford
Discussion: Professional Nursing and State-Level Regulations
The nurse practitioner’s role in healthcare is crucial in today’s healthcare system. The first nurse practitioner role began in the 1960s when a shortage of primary care physicians was predicted in rural areas. This goal was to increase access to primary care in this area, where physicians were less likely to practice (Milstead & Short, 2017, p. 62). Health care in the United States is necessary; allowing advanced practice registered nurses to have full practice authority (FPA) produces many benefits. “Allowing APRNs to have FPA can improve health equity while providing care that costs patients, health care systems, and payers less money” (Bosse et al., 2017). Each state has set forth its scope of practice, so many advanced practice registered nurses are not allowed to practice to their full extent.
I reside in Georgia and plan to work in the emergency department as a nurse practitioner upon graduation. Georgia is a restricted practice state regulated by the GA Board of Nursing and the Medical Board, meaning that I would be required to practice under the nursing protocols of the supervising physician. Georgia licensure requires a graduate degree and national certification upon graduation. Nurse Practitioners in Georgia are allowed to write prescriptions for drugs that fall under the schedule III-V categories. Working in the emergency department this can cause a strain on the physicians as they would have to agree to prescribe more potent narcotics such as Norco and Percocet for traumatic injuries. I often see that the nurse practitioner may treat the patient and print out any narcotic prescriptions needed, and then the supervising physician will sign the printed prescription. Since the nurse practitioner is following a nurse protocol in the emergency room, the APRN can also order tests such as CT scans or MRIs to rule out a life-threatening emergency. In Georgia, if the APRN is practicing in a physician’s office, those particular scans would have to be ordered by the physician. These steps can be time-consuming for the APRN and the patient. Another example in my setting is when a patient comes in with an obvious deformity to the wrist. The NP may start the treatment for the fracture by ordering x-rays and medications for pain. Still, if the x-ray report shows that the wrist fracture is displaced, the physician would take over care of the patient to reduce the wrist under conscious sedation. In my department, there is a lot of care collaboration among the team.
Colorado is a full practice state regulated by the Colorado Board of Nursing. Being in a full practice state means that the nurse practitioner can diagnose, treat, and manage patients without the supervision of a physician, along with prescribing medications (Medsource Consultants, 2017). Being able to prescribe schedule II-V medications does not come without additional education; however, APNs must complete 1000 hours of prescribing mentorship with a physician or another APRN and register with the DEA (Medsource Consultants, 2017).
Nurse practitioners are an integral part of the healthcare workforce. With nurse practitioners’ authority to practice being restricted or limited in many states, it becomes difficult to practice to full abilities and causes inefficiencies in care. Studies have also shown that relaxing scope of practice restrictions allows nurse practitioners to practice without oversight which reduces health care spending but was also done without harming patients (Smith, 2021).
References
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
Medsource Consultants. (2017). A state-by-state scope of practice guide for nurse practitioners. https://www.medsourceconsultants.com
Milstead, J. A., & Short, N. M. (2017). Health policy and politics (6th ed.). Jones & Bartlett Learning.
Smith, L. (2021). The effect of nurse practitioner scope of practice laws on primary care delivery. Health Economics, 31(1), 21–41. https://doi.org/10.1002/hec.4438
Rodney Wike
Comparison of Board of Nursing Regulations in Two States
For this discussion, I will analyze the Board of Nursing Regulations for North Carolina and Montana. North Carolina currently requires all advanced practice registered nurses (APRNs) to have a supervising physician which limits their ability to practice to the full extent of their abilities (“Collaborative practice guidelines”, n.d.). Montana, on the other hand, grants APRNs the ability to practice to the full scope of their practice without a supervising physician (“Montana,” n.d.).
Application to Advanced Practice Registered Nurses
This difference in full practice authority leads to a great deal of variances in access to care based on research. Although I listed North Carolina and Montana as the states to compare, I did find a great article about the financial benefits of allowing APRNs full practice authority in Tennessee. Myers et al. (2020) state “from a 2017 baseline, the cumulative impact of granting Tennessee APRNs full practice authority is a net gain of 25,536 jobs and $3.2 billion in economic impact” (p. 155). Although the financial benefits are great, providing access to more patients and producing jobs is more impactful on the community.
Examples of How APRNs Adhere to Regulations
APRNs must adhere to the regulations set forth by their legislature, board of nursing, and medical board. In North Carolina for example, APRNs must have an agreement with a supervising physician to oversee their clinical interactions. APRNs in Montana are also regulated by their legislature and board of nursing but are free to practice independently. A APRN in North Carolina may need a physician to sign off on prescribing a certain medication. APRNs must meet the minimum requirements set forth by the entities listed above in order to be granted their license. These nurses must also continue to meet the education and practice requirements to have their licenses renewed. These rules and regulations help to keep patients safe and protect providers from malpractice.
References
Collaborative practice guidelines: North Carolina Board of Nursing. Collaborative Practice Guidelines
North Carolina Board of Nursing. Retrieved June 28, 2022, from https://www.ncbon.com/
practice-nurse-practitioner-collaborative-practice-guidelines
Montana. American Association of Nurse Practitioners. (n.d.). Retrieved June 28, 2022, from
https://www.aanp.org/advocacy/montana
Myers, C. R., Chang, C., Mirvis, D., & Stansberry, T. (2020). The macroeconomic benefits of Tennessee
Aprns having Full Practice Authority. Nursing Outlook, 68(2), 155–161.
https://doi.org/10.1016/j.outlook.2019.09.003
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