NURS 6050 Professional Nursing and State-Level Regulations 

Sample Answer for NURS 6050 Professional Nursing and State-Level Regulations  Included After Question

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.

A Sample Answer For the Assignment: NURS 6050 Professional Nursing and State-Level Regulations 

Title: NURS 6050 Professional Nursing and State-Level Regulations 

For a person to be considered a professional, they must meet the minimum requirements of that profession and follow the regulations that govern the profession. Regulation of Advanced Practice Registered Nurses (APRN) varies from state to state. The scope of practice also differs from state to state. There are some differences in regulations between the state of Michigan and Maryland. The Public Health Code regulates APRNs in Michigan. They can independently prescribe non-scheduled medications but require a doctor to cosign for the prescription of schedule 2-5 medications (Michigan Board of Nursing, 2021).

APRNs cannot sign a death certificate but can participate in ward rounds, perform house call visits without a collaborating doctor (Michigan Board of Nursing, 2021). The Nurse Practice Act governs APRNs in Maryland. They can sign a death certificate. They have to register with the Prescription Drug Monitoring Program to be allowed to prescribe schedule 2-5 drugs (Maryland Board of Nursing, 2021). In Michigan, certified nurse-midwives must partner with physicians to offer care to patients, while in Maryland, they are allowed to practice independently without entering into a physician collaboration.

APRNs have the skills, education, and clinical knowledge to offer specialized care to their patients. Complying with these regulations will allow them to identify and beware of their practice areas and the boundaries of their operations. The regulation stipulates the necessary certifications required for an individual to practice. An example is all APRNs must obtain certification from the Maryland Board of Nursing before being allowed to practice. Nurses can adhere to these regulations by finishing the mandatory course hours to become APRNs. They can also ensure that their license is updated, participate in continuous education programs to ensure they are up to date with new nursing knowledge

References

Maryland Board of Nursing. (2021). Pages – Advanced practice registered nursinghttps://mbon.maryland.gov/Pages/advanced-practice-index.aspx

Michigan Board of Nursing. (2021). Michigan board of nursing. SOM – State of Michigan. https://www.michigan.gov/lara/0,4601,7-154-89334_72600_72603_27529_27542_91265-59003–,00.html

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A Sample Answer 2 For the Assignment: NURS 6050 Professional Nursing and State-Level Regulations 

Title: NURS 6050 Professional Nursing and State-Level Regulations 

I concur with the concept that the state laws and regulations between Michigan and Maryland differ in several capacities. In Michigan, under the Public Act 499, An APRN that is registered under the Michigan health professional licensure is permitted to prescribe a non-scheduled prescription drug and a controlled substance. The APRN is expected to prescribe in schedules of 2 to 5 as a delegated act of a supervising physician. Notably, APRNs are also permitted to conduct the ordering, receipt, and dispensing of complimentary starter dose drugs under specified conditions.

On the other hand, in Maryland, APRNs are permitted to practice independently without or with limited supervision of the physician. Furthermore, the measure also allows the APRN to prescribe medication and controlled substances without having an attestation agreement with a physician (Rubenfire, 2015). Succinctly, an APRN might directly dispense a controlled dangerous substance listed in Schedules III, IV, or V. In this manner, the prescription drug must be established under the Federal Food, Drug, and Cosmetic Act, or state law.

NURS 6050 Professional Nursing and State-Level Regulations 
NURS 6050 Professional Nursing and State-Level Regulations 

References

Rubenfire, A. (2015). Maryland allows nurse practitioners to practice independently of a physician. Modern Healthcare. Retrieved from https://www.modernhealthcare.com/article/20150514/NEWS/150519928/maryland-allows-nurse-practitioners-to-practice-independently-of-a-physician

Sheehan, A., Jones, A., McNerlin, C., Iseler, J., & Dove-Medows, E. (2021). How advanced practice registered nurse practice barriers impact health care access in Michigan. Journal of the American Association of Nurse Practitioners33(9), 739-745. https://doi.org/10.1097/jxx.0000000000000443 

A Sample Answer 3 For the Assignment: NURS 6050 Professional Nursing and State-Level Regulations 

Title: NURS 6050 Professional Nursing and State-Level Regulations 

In terms of controlled substances, I agree that the rules and regulations in California are geared towards preventing the misuse and abuse of drugs within the healthcare context. According to state laws, a prescription for a controlled substance shall solely be issued in scenarios where the medical purpose is legitimate and by an individual practitioner that is acting in his or her usual course of professional practice (California Law, 2021). An order for an addict or habitual user of controlled substances which is issued as part of an authorized narcotic treatment program and an order purporting to be a prescription issued under legitimate research or treatment are considered as legal prescriptions. On the other hand, In Maryland, an oral prescription for a Schedule II controlled substance may only be dispensed in an emergency as allowed under state laws (Davis et al., 2019). Schedule III and IV controlled substances cannot be refilled or filled more than 5 times or more than 6 months after the date the prescription was issued. Moreover, Schedule II prescriptions have no expiration and cannot be refilled.

References

California Law. (2021). California Legislative Information. Retrieved from https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=HSC&division=10.&title=&part=&chapter=4.&article=1.

Davis, C. S., Lieberman, A. J., Hernandez-Delgado, H., & Suba, C. (2019). Laws limiting the prescribing or dispensing of opioids for acute pain in the United States: A national systematic legal review. Drug and alcohol dependence194, 166-172. https://doi.org/10.1016/j.drugalcdep.2018.09.022 

A Sample Answer 4 For the Assignment: NURS 6050 Professional Nursing and State-Level Regulations 

Title: NURS 6050 Professional Nursing and State-Level Regulations 

According to the state of Maryland, an APRN or advanced practice nurse means a registered nurse who is certified by the board as a certified nurse-midwife, a certified registered nurse anesthetist, a certified nurse practitioner, or a clinical nurse specialist. As in Georgia, Maryland APRN’s must also hold a current Maryland license in good standing to practice registered nursing, have graduated from a board-approved graduate-level program for nurse practitioners, and hold current national certification for each specialization that the nurse practice in according to The State of Maryland (n.d.).  

An APRN can only practice in the area of specialty that certification was gained in. In Maryland, APRNs do have full practice authority. With full practice authority nurse practitioners can independently do comprehensive physical examinations, evaluate patients, diagnose, and order labs, treatments, and prescribe medications to the full extent under the licensure of the state board of Maryland.  According to Rubenfire (2015) Gov. Larry Hogan signed the Nurse Practitioner Full Practice Authority Act. This act also allows nurse practitioners to prescribe certain drugs without having an “attestation agreement” with a physician. 

References

Rubenfire, A. (2015, May 14). Modern Healthcare. Maryland allows nurse practitioners to practice

                independently of a physician.

https://www.modernhealthcare.com/article/20150514/NEWS/150519928/maryland-allows-nurse- practitioners-to-practice-independently-of-a-physician

Maryland Board of Nursing. (n.d.). Advanced practice registered nursing: nurse practitioners.

                http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.03.htm

A Sample Answer 5 For the Assignment: NURS 6050 Professional Nursing and State-Level Regulations 

Title: NURS 6050 Professional Nursing and State-Level Regulations 

Advanced practice registered nurses (APRNs) possess the education, knowledge, skills, and experience necessary to practice and prescribe with full authority (Bosse et al., 2017). When APRNs are allowed to practice within the full scope of their education and experience, the quality and ability to access healthcare improves. This is especially essential in the area of mental health and substance abuse, as treatment deserts present barriers to the accessibility to appropriate care. As nurse practitioners gain full practice authority, they can reduce the burden that is present within the healthcare system (Neff et al., 2018).

Prescriptive Authority Educational Requirements in Ohio and Arizona

In the state of Ohio, the prescriptive authority of APRNs is regulated by The Ohio Board of Nursing. The Ohio Board of Nursing has created a regulation that requires a course of study in advanced pharmacology (Ohio Board of Nursing, 2017). This course of study must consist of a minimum of 45 contact hours, content specific to a nurse’s specialty, 36 hours of training obtained by a single provider, and completion of a comprehensive written examination (Ohio Board of Nursing, 2017). Additionally, the course must cover the fiscal and ethical implications of prescribing drugs, descriptions of applicable state and federal laws, detailed prevention plans for abuse/diversion for schedule II substances, and recommendations for alternative pain management therapies (Ohio Board of Nursing, 2017). These requirements were developed to ensure that APRNs who are prescribing medications do so in an educated and safe manner. APRNs can ensure patient safety and quality of care by adhering to this guideline through taking the appropriate educational courses.

The licensure requirements of APRNs differ between states due to differing regulatory boards. Education for prescriptive differs in Arizona, as the Arizona State Board of Nursing specifies that 45 contact hours of education must occur in the three years preceding an application for prescribing and dispensing privileges (Arizona State Board of Nursing, 2019). These hours of education need to only contain education on pharmacology or the clinical management of drug therapy (Arizona State Board of Nursing, 2019). While the Arizona State Board of Nursing requires the same amount of contact hours as the Ohio Board of Nursing, their requirements surrounding the requirements of study are less rigorous and allow for more flexibility.  

Prescribing of Naloxone in Ohio and Arizona

The ongoing drug epidemic has made it vital for nursing regulatory boards to create guidelines surrounding the prescription of opioids and naloxone. According to the Ohio Board of Nursing, an APRN can legally prescribe naloxone. Prescriptions may be written for an at-risk individual, and/or friend or family member who may be in the position to help an individual who is actively overdosing on opioids (Ohio Board of Nursing, 2015). Additionally, this regulation has led to the removal of healthcare providers’ civil, criminal, and professional liability in regards to prescribing naloxone to a patient. However, to prescribe naloxone, following prescription regulations and patient-training protocols are required (Ohio Board of Nursing, 2015). APRNs can utilize this regulation as a prevention mechanism within a care plan that relates to substance abuse.

Similarly in the state of Arizona, the Arizona State Board of Nursing has given APRNs prescriptive authority over naloxone. While a prescription can be written for an at-risk individual, and/or friend or family member, like in Ohio, it may also be given to a community organization that provides services to at-risk individuals (Arizona State Board of Nursing, 2017). Arizona has, also, removed professional liability and criminal prosecution for APRNs who prescribe naloxone in “good faith”.  In addition, Arizona requires APRNs to co-prescribe naloxone when a patient is issued a new prescription for a schedule II opioid, dispensed outside of a health care institution, that is greater than 90 morphine milligram equivalents per day (Arizona State Board of Nursing, 2017).

References

Arizona State Board of Nursing. (2017). The use of controlled substances for the treatment

of chronic pain. Retrieved from https://www.azbn.gov/sites/default/files/advisory-opinions/ao-controlled-substances-for-the-treatment-of-chronic-pain.pdf

 Arizona State Board of Nursing. (2019). Rules of the state board of nursing. Retrieved from https://www.azbn.gov/sites/default/files/2020-03/RULES.Effective.June3_.2019.pdf

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

A Sample Answer 6 For the Assignment: NURS 6050 Professional Nursing and State-Level Regulations 

Title: NURS 6050 Professional Nursing and State-Level Regulations 

Comparison of Board of Nursing Regulations in Two States

An APRN in Pennsylvania and an APRN in Maryland do not have identical board of nursing regulations to follow. The American Association of Nurse Practitioners (2021) show how the US differs from state to state regarding if an APRN has full, reduced, or restricted practice. Much like in Maryland, a nurse practitioner (NP) in Pennsylvania can diagnose a patient, begin a care plan, order tests, and prescribe medication but in Pennsylvania an NP requires a written agreement with a licensed physician (Pennsylvania Coalition of Nurse Practitioners, n.d.). This agreement includes oversight of the NP, availability of the doctor, emergency planning, and NP chart review. While an NP in Pa cannot over practice independently, an NP in Md can earn the ability to practice independently once they have at least 18 months collaborating with a physician (NCSL Scope of Practice, 2021). Practicing and prescribing authority are two regulations that differ between Pennsylvania and Maryland APRNs.

According to Milstead & Short (2019) APRN practice is not consistent across the country because each state has the constitutional right “to establish laws governing professions and occupations” (p. 65). This is why is it essential for every APRN to be fully educated on their states’ regulation. Anytime an APRN is considering a relocation it is also important to learn the state nursing regulations of the proposed relocation. Being able to adhere to practice and prescribing authority requires research to see what that state requires and allows. I would personally like to someday practice independent of physician oversight, but unless Pennsylvania regulations are changed, I will have to relocate to a full practice state. As seen in Maryland, there may still be time regulations prior to being able to practice independently. While APRNs being able to practice at the full scope of their practice is ideal for most, there is no consistency across the country when it comes to scope of practice.

References

American Association of Nurse Practitioners (AANP). (2021, August 4). State Practice

Environment. Retrieved on December 28, 2021 from https://www.aanp.org/advocacy/state/state-practice-environment

Milstead, J.A., & Short, N.M. (2019). Health Policy and politics: A nurse’s guide (6th ed).

Burlington, MA: Jones & Bartlett Learning

NCSL Scope of Practice. (2021). State Overview: Maryland. Retrieved on December

28, 2021 from https://scopeofpracticepolicy.org/states/md/

Pennsylvania Coalition of Nurse Practitioners. (n.d.). Scope of Practice. Retrieved on

December 28, 2021 from https://www.pacnp.org/page/ScopeofPractice

A Sample Answer 7 For the Assignment: NURS 6050 Professional Nursing and State-Level Regulations 

Title: NURS 6050 Professional Nursing and State-Level Regulations 

I compared the two states of Texas and New Mexico, and just like your discussion on Pennsylvania and Maryland Boards of Nursing, they differed significantly. I live in Texas, and it is very similar to the same legislative restrictions of APRNs, where they may only practice under the supervision of a delegating physician (Texas Board of Nursing, n.d.). As a Registered Nurse in various Emergency Departments, I have noticed that Nurse Practitioners must work under an assigned Physician’s license. Before completing this assignment, I did not know that state regulation requires APRNs to have Physician oversight, but instead mistakenly thought that that was facility-specific policy. 

It is compelling that Maryland allows APRNs to practice independently of a supervising physician after having 18 months of experience working with one. That sounds like an intelligent compromise to enable independent practice after somewhat of a pre-determined residency period. In comparison, the other state that I researched was New Mexico, and there APRNs can legally practice independently, to the full scope of their abilities, without physician oversight. New Mexico allows this to respond to the state’s lack of accessible health care (New Mexico Board of Nursing, n.d.). According to Neff et al. (2018), APRNs can effectively ease the strain between stretched physicians and their communities. Still, I think a designated time of experience alongside a physician would only benefit both APRNs and the communities they serve that much more. 

References

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. https://doi.org/10.1016/j.outlook.2018.03.001

New Mexico Board of Nursing. (n.d.). Rules and regulations.  https://nmbon.sks.com/rules-regulations.aspx

Texas Board of Nursing. (n.d.). Advanced practice information. https://www.bon.texas.gov/practice_nursing_practice_aprninfo.asp

A Sample Answer 8 For the Assignment: NURS 6050 Professional Nursing and State-Level Regulations 

Title: NURS 6050 Professional Nursing and State-Level Regulations 

Boards of Nursing (BONs) are regulatory bodies that focus on protecting the public’s welfare and health by ensuring that quality, safe, and competent nursing care is provided by licensed and qualified nurses. In Maryland, the Maryland Board of Nursing presides over regulations that guide applicants and APRNs in practicing within the state. On the other hand, the regulatory body for nursing practice in Florida is the Florida Board of Nursing which ensures safe practice within the state. Notably, it is imperative for nurse practitioners to adhere to the set regulations and guidelines for safe and sanctioned practice within ethical principles.

APRN board of nursing regulations in Maryland

In Maryland, the preparing and dispensing regulation states that a nurse practitioner may personally prepare and dispense any drug that is authorized to prescribe by the Board of Nursing when it comes to treating a patient at different sectors or institutions. The sectors or facilities that are expected to handle preparing and dispensing include a clinic or medical facility that is operated on a nonprofit basis, and a clinic or medical facility that specializes in the treatment of medical cases reimbursable through workers’ compensation insurance (Maryland, 2021). Nevertheless, health centers that operate on a campus of an institution of higher education can also qualify as appropriate centers for preparing and dispensing drugs. For APRNs to prepare and dispense medications in Maryland, they must follow protocol and obtain a dispensing permit from the Maryland Board of Physicians and pay a specific fee.

In another aspect, under the scope of practice for Nursing Practitioners, APRNs are given the right and obligation to refuse to perform any delegated act, whether written or oral. In a scenario in which an APRN’s judgment deems a specific delegated act to be unsafe or invalidly prescribed, he or she is obligated to refuse to perform the act (Maryland Board of Nursing, 2021). Moreover, APRNs can also refuse to perform a specific act or assignment that presents a significant risk of harm to either the patient or themselves. For instance, an APRN might refuse to treat a patient as a result of a crossing of nurse-to-patient professional boundaries or a conflict of interest.

APRN board of nursing regulations in Florida

According to the 2021 Florida Statutes, an individual can only dispense medicinal drugs if licensed as a pharmacist or otherwise by the Florida Board of Medicine. In this case, a licensed pharmacist or physician authorized by law to prescribe drugs might dispense such drugs to his or her patients in accordance with prescription guidelines in the state (The Florida Senate, 2021). In the process of addressing the issue of prescription drug abuse, the Florida legislature adopted a new law to counteract Florida’s growing issue with prescription drug abuse and diversion. The State Legislature also approved the establishment and use of a Prescription Drug Monitoring Program database that takes up the role of collecting controlled substance prescription records from dispensers. This program helps in boosting the guidelines for physicians and pharmacists in operating pain management.

In Florida, nursing responsibilities and issues are not addressed in the Florida Nurse Practice Act or the Rules of the Florida Board of Nursing. In this aspect, nurses are given the option of filing a Petition for Declaratory Statement when they feel the need to present issues or complaints of specific responsibilities, laws, or acts (Florida Department of Health, 2021). Succinctly, an APRN can use the petition as an appropriate means to address doubts or questions and resolve controversies that are associated with the applicability of rules, statutes, and guidelines.

References

Florida Department of Health. (2021). Declaratory statements. Retrieved from https://www.floridahealth.gov/licensing-and-regulation/public-records/declaratory/index.html

Maryland (2021). Division of State Documents. Retrieved from https://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.07.htm

Maryland Board of Nursing (2021). Advanced practice registered nursing: Nurse practitioners. Retrieved from https://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx

The Florida Senate. (2021). 2021 Florida Statutes (Including 2021B Session). Retrieved from https://www.flsenate.gov/Laws/Statutes/2021/465.0276

Ohio Board of Nursing

The Ohio Board of Nursing (OBN) regulates over 300,000 licenses and certificates in the state of Ohio; OBN licenses and regulates not only Registered Nurses (RNs), Licensed Practical Nurses, and Advanced Practice Registered Nurses (APRNs) but also Dialysis Technicians (DTs) and Medication Aides (MA-Cs) (OBN, n.d.). The primary goal of OBN is to license nurses and to efficiently remove unsafe healthcare providers from practice to protect Ohio patients (OBN, n.d.).

Regulations Comparison

APRN licensure regulations in Ohio consist of having an active Ohio RN license, earning a master’s or a doctoral degree in a nursing specialty that qualifies you to sit for your board examination, proof of a minimum of 45 contact hours in advanced pharmacology that are no older than five years, and one current national certification in a nursing specialty or population focus (OBN, 2022). When comparing Ohio’s neighboring state, Pennsylvania’s APRN license regulations, I only saw one similarity: the master’s degree requirement (Pennsylvania Department of State, 2023). Pennsylvania requires proof of 500 hours of clinical experience, three hours of continuing education in child abuse recognition, and liability insurance before licensure (Pennsylvania Department of State, 2023).

In Ohio, APRNs work in collaboration with one or more physicians; they “may provide preventive and primary care services, provide services for acute illnesses, and evaluate and promote patient wellness within the nurse’s nursing specialty, consistent with the nurse’s education and certification, and in accordance with rules adopted by the board” (OBN, 2022, para. 8). In Pennsylvania, APRNs also work collaboratively with physicians and “may diagnose medical conditions, develop and implement treatment plans, order and perform diagnostic tests, and deliver other health care services” (PCNP, n.d., para. 1). Ohio and Pennsylvania share similar scopes of practice; both require collaboration with a physician, and APRNs have the authority to diagnose and treat patients as primary care providers.

APRNs Practicing and Adhering to Regulations

It is important to understand your state’s regulations to know the proper steps to become a licensed APRN and be prepared, especially when practicing with full legal authority within your scope. Knowing your scope of practice and whether you need to collaborate with a licensed physician or not, as well as knowing prescribing privileges and other essential information about your licensing limits and expectations, is vital. The laws and regulations are put in place to ensure there are guidelines to keep nurses and advanced practice nurses practicing to the best of their abilities and, most importantly, to keep their patients safe.

References

Pennsylvania Coalition of Nurse Practitioners (PCNP). (n.d.). Scope of practice. Retrieved June 26, 2023, from https://www.pacnp.org/page/ScopeofPractice

Links to an external site.

Pennsylvania Department of State. (2023). Certified registered nurse practitioner Pennsylvania licensure requirements. Retrieved June 26, 2023, from https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Pages/Certified-Registered-Nurse-Practitioner-Licensure-Requirements-Snapshot.aspx

Links to an external site.

Ohio Board of Nursing (OBN). (n.d.). About us. Retrieved June 26, 2023, from https://nursing.ohio.gov/about-us

Links to an external site.

Ohio Board of Nursing (OBN). (2022, January). APRN licensure and practice in Ohio. Retrieved June 26, 2023, from https://nursing.ohio.gov/wps/wcm/connect/gov/4c0c1a57-f45f-4427-9dc9-d152d4c02cd4/APRN-Licensure-and-Practice-in-Ohio.January-2022.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-4c0c1a57-f45f-4427-9dc9-d152d4c02cd4-oqTl6KV

I agree with your point of view; it is sad and frustrating when two neighboring states (Kentucky and Iowa) have different laws governing the same group of practitioners with the same level of education and licensure. According to a recent AANP article, the regulation of nurse practitioners and their scope of practice varies greatly across states, with some states allowing nurse practitioners to practice independently while others requiring physician supervision or collaboration (American Association of Nurse Practitioners, 2021).

The article also mentions that state boards of nursing license and regulate nurse practitioners, and these boards set the requirements for nurse practitioner education, certification, and licensure, as well as the scope of practice and prescriptive authority for nurse practitioners in their respective states. Furthermore, according to a study published in the Journal of Nursing Regulation, state boards of nursing play an important role in ensuring the quality of nursing education programs by establishing minimum accreditation, licensure, and certification standards (Heinrich, 2021). The study also emphasized the importance of continuing to evaluate and revise nursing regulations in order to keep up with the changing healthcare landscape and ensure that nursing practice remains safe, effective, and patient-centered.

Professional Nursing and Level Regulations

The nursing profession enjoys the highest level of public confidence. Their work is crucial to the health and well-being of their patients, and it covers a wide range of responsibilities. Because of the gravity of their position, nurses are subject to oversight by a Board of Nursing (BON). A body of law governs the profession of nursing in each state. The Nursing Practice Act (NPA) is the law governing the practice of nursing in the United States (Yang et al., 2021). The NPA ensures that all registered nurses are not only capable of doing their jobs but that they do it to the best of their abilities. In addition, the NPA creates the BON. The BON issues nursing licenses and oversees the licensing of nurses within the state. Qualified nurses receive licenses from the board, and the profession’s boundaries and expectations for care are defined (Fitzgerald, 2020). Since each state has its own NPA and BON, the rules governing this subject matter also differ. This paper will analyze the Board of Nursing regulations for Advanced Practice Registered Nurses (APRNs) in California and Maryland.

The APRN regulations in California do not have full independence in the workplace. In addition, they are limited to only the areas of expertise they have studied. In California, a doctor must oversee an APRN before the nurse can do a full physical examination, request diagnostic tests, make a diagnosis, or write a prescription. On the other hand, Maryland allows nurse practitioners to perform independent practices. APRNs in this state are authorized by the Board of Nursing to conduct initial patient assessments, order and interpret diagnostic tests, prescribe medications, and oversee ongoing treatment plans (Bradley et al., 2019). The difference in the nursing practice regulations in the two states definitely impacts the quality of patient care. In a state like Maryland, where full practice authority in nursing is allowed, there is a decrease in the cost of care because duplication of services is avoided, and patients are allowed to see healthcare providers of their choice. APRNs can adhere to the above regulations by making appropriate examinations, assessments, prescriptions, and treatments as required by their state.

Personally, I do not think that we will see a change in allowing all APRN’s in all states to have prescriber powers any time soon. I would be surprised if it even happened in our lifetime. Doctors have been around for hundreds to thousands of years. APRNS have only existed since the 1960s (Berg). How can we expect a long-standing attitude about the jobs of doctors and nurses to change in just a few terms? A few decades? As I said in my discussion post, APRNs don’t even automatically receive prescribing rights once they become APRNS in the state of Arkansas. They must apply for that “privilege.” If states are still slow to give basic prescribing rights, how are we to expect more. Legislation is slow and often very ineffectual. It is hard to get a consensus among parties. How can we hope to motivate legislators to change, regardless of what we do?

References

Arkansas Aprn Requirements: How to become a nurse practitioner in ar. NursingLicensure.org – A more efficient way to find nursing license requirements in your state. (2021, September 21). Retrieved from https://www.nursinglicensure.org/np-state/arkansas-nurse-practitioner/ 

Berg, J. (n.d.). The perils of not knowing the history of the nurse practitioner role. Journal of the American Association of Nurse Practitioners. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32890036/

Regulations in the healthcare system are created to provide protection for the public and each state has different laws and regulations to follow (Milstead & Short, 2019). Advanced Registered Nurse Practitioner has been evolving for the past few years to provide the needs to the public. The scope of work is somehow different from being a registered nurse and it varies in every state. APRN are trained and educated to provide comprehensive care to the public with evidence-based practice that is high quality (Boehning & Punsalan, 2023).

    In Texas, APRNs must only perform their practice scope of work that is within the Board authorized professional standards that are aligned to Nursing Practice Act, Board rules, and other regulations in Texas that are applicable to their scope of practice. The Texas Nurse Association (TNA) supports full practice. However, it does not allow full authority and only allows practice under the supervision of a physician where they made a contract with. Physicians are required to review the charts and sign a form to allow APRN to prescribe. APRN can order Physical therapy (PT), sign disabled person placard forms, sign Physician Orders for Life Sustaining Treatment (POLST) and sign other similar documentations. They are not allowed to sign a death certificate without being under primary care provider. Prescribing medications are allowed especially the schedule II drugs but must follow and maintain the protocol with the physician (Weisen, 2023).

     In contrast to Illinois, full practice authority has been granted and was effective on June 14, 2019, for those who completed their education and training. It allows the APRNs to fully practice without the supervision of a physician. To obtain the full practice authority, they must apply to the Illinois Department of Financial and Professional Regulation (IDFPR) and notarized that they have completed at least 250 hours of continuing education or 4000 hours of clinical training after getting their national certification. The other advantages are there is no limitation when prescribing, administering, and dispensing drugs if APRN has licensed under the Illinois Controlled Substance Act. They can prescribe schedule II to through IV controlled substances without the physician’s approval. However, they need the collaboration of physician if they were to prescribed benzodiazepine and narcotic drugs. If APRN does not want to file for full authority to practice, then he/she must complete 45 hours of continuing education in pharmacology to obtain the authority to prescribe schedule II. There is a collaborative practice agreement between the APRN and physician to let the APRN prescribe schedule II, III, IV, and V. You are only allowed to prescribe 30 days supplies for uncontrolled substances.

     To obey the regulations and rules, APRNs must be aware of our scope of practice and the limitations to avoid malpractice and it varies in every state and must apply these to show the adherence to the policy, regulations, and rules to provide public safety and appropriate healthcare needs. Learning is never ending, and it evolves as days go by. This indicates that even with the title of being Advanced Practice Registered nurse must continue to educate and train to acquire a new set of knowledge and skills to provide high quality of care and promote safety to the public. As APRNs, we can join different organizations to develop our growth as professionals and connecting with other APRNs because they can provide suggestions on choosing the right continuing education you need. One of the organizations that can help APRNs attain highest quality of education are Nurse Practitioner Associates for Continuing Education (NPACE) and the American Association of Nurse Practitioners (AANP). In addition to this, we can get certification. According to American Board of Nursing Specialties, being certified demonstrate your competence level and expertise and boost your confidence in decision making.