Discussion: Professional Nursing and State-Level Regulations NURS 6050
Discussion: Professional Nursing and State-Level Regulations NURS 6050
It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so in your Discussion: Professional Nursing and State-Level Regulations NURS 6050 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 NURS 6050
1 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)
2 http://www.nursingworld.org/
3Bosse, 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. doi:10.1016/j.outlook.2017.10.002
Note: You will access this article from the Walden Library databases.
4 https://class.waldenu.edu/bbcswebdav/institution/USW1/202050_27/MS_NURS/NURS_6050/artifacts/USW1_NURS_6050_Halm_2018.pdf
5 https://www.ncsbn.org/index.htm
6 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
Note: You will access this article from the Walden Library databases.
7 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
Note: You will access this article from the Walden Library databases.
Hello Colleague
Thank you for sharing your post on discussing professional and state-level regulations. You mentioned the Nurse Practitioner Association New York State (NPA), which you say is an organization that empowers nurse practitioners and professionals to comply with the legal requirements, as well as provide inputs into policy formulation processes. The NPA is a nursing organization that promotes high standards through the empowerment of nurse practitioners (NP’s), and the profession as you stated throughout New York State (NYS). The NPA is a nursing organization. Statutes (a written law) are passed by a legislative body. Each state has a nurse practice act (NPA), that establishes a board of nursing (BON) panel of nursing professionals in health care. These two bodies work together to enforce rules and regulations for all nurses in each state.
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Nursing laws can only function properly if nurses are aware of the current laws governing practice in their state (Howard, 2011).
The responsibility falls on the state because the United States Constitution does not include provisions to regulate the practice of nursing. A state has the authority to make laws to maintain public order, health, safety, and welfare under its police powers (Guido, 2010). Nursing leaders wanted to legitimize the profession in the eyes of the public, limit the number of people hired out as nurses, raise the quality of professional nurses, and improve education standards in schools, in addition to the state’s need to protect the public (Penn Nursing Science, 2012).
A nurse practice act has been strengthened in all states and territories (NPA). The legislature of each state passes the NPA. However, the NPA is insufficient in providing the nursing profession with the necessary guidance. As a result, each NPA creates a board of nursing (BON) with the authority to create administrative rules or regulations to clarify or narrow the scope of the law. Before they are enacted, these rules and regulations are subjected to public scrutiny (NCSBN, 2020).
The Nurse Practice Act delegated authority to an administrative agency or BON to regulate the practice of nursing and enforce the law, with the goal of maintaining a balance between the nurse’s right to practice nursing and the responsibility to protect the public health, safety, and welfare of its citizens (Brous, 2012). The composition of the BON is determined by the state statute. Some states delegate authority to the governor to appoint members to the BON, while others require nominations from professional organizations and appointment by the director or head of the regulatory agency.
Do you know if New York State gives the governor the authority to appoint members to the BON based on suggestions from professional nursing organizations such as the Nurse Practitioner Association you mentioned, or if New York State requires nominations from professional organizations with appointment by a director or head of a regulatory agency?
REFERENCES
Brous, E. (2012). Nursing licensure and regulations. In D.J. Mason, J. K. Leavitt, & M. W. Chaffee (eds). Policy and politics in nursing and health (6th ed). St. Louis, MO Saunders. Retrieved March 23, 2020, from
https://www.nursing/regulations>politcs
Guido, G. W. (2010). Legal & ethical issues in nursing (5th ed). Boston, MA: Pearson. Retrieved March 23, 2020, from
https://wwwlegal/ethical/issues/regulations
Howard, P.K. (2011). The death of common sense: How law is suffocating America. Retrieved March 23, 2020, from
https://www.free.org>articles>death
Penn Nursing Science. (2012). History of Nursing Timeline. Retrieved March 23, 2020, from
www.nursing.upenn.cdu/nhhc/pages/timeline
Kathleen A. Russell, JD, MN, RN (2012). Nurse Practice Acts Guide and Govern Nursing Practice. Retrieved March 23, 2020, from
National Council of State Boards of Nursing (2020). About U.S. Nursing Regulatory Bodies. Retrieved March 23, 2020, from
https://about-nursing-regulatory
Discussion: A Comparison of Advanced Practice Registered Nurse (APRN) within my current state versus another.
James,
I truly enjoy learning about other States’ regulations regarding our future career. I feel like the regulation put into place from the Virginia Board of Nursing, regarding two years or 4000 hours of clinical practice isn’t a terrible regulation before being able to work independently but I do feel like increasing that to a five-year requirement (2021), may be a little excessive. Living in California and learning about our regulations, I have learned that at this time, we are unable to practice or furnish drugs independently without physician supervision. According to the California Nurse Practioners: Laws and Regulations, “the furnishing or ordering of drugs or devices by nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician but does include (1) collaboration on the development of standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner (BRN, 2019). I can only hope the regulations will allow for more autonomy for future APRNs, especially in a time where more health care workers are needed.
References
Board of Registered Nursing. (2019). Nurse Practitioners: Laws & Regulations. Sacramento, California; State of California Department of Consumer Affairs – Board of Registered Nursing. https://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf
Regulations governing the licensure of Nurse Practitioners, (2021).
https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePractitioners.pdf
CALIFORNIA STATE/REGION REGULATIONS
In 2017, over 20 states passed legislation that emphatically impacted access to and delivery of healthcare to patients nationwide. As in previous years, professional advanced registered nurses (APRN) organizations and Boards of Nursing (BON) have worked indefatigably in their respective legislative sessions to ensure patients had access to high-quality healthcare in their states.
I currently work and live in the State of California. In this discussion, I will explain the differences in legislative law and the scope of practice of APRNs within California and Alaska.
APRN’s are registered nurses who have completed further education to prepare them to convey a broad range of services including diagnosis and treatment of acute and chronic illnesses.
California up until recently was 1 of 22 states that restricted APRN’s by requiring them to work with physician oversight (Joanne Spetz, 2018).
On October 12, 2019, Senate Bill number 323 (SB 323), chapter 848 was authorized by Senator Edward Hernandez, and assembly member Susan Eggman and approved by our Governor, which granted over 18,000 California nurse practitioners full practice authority (CANP, 2020).
Full Practice Authority is the authorization of NP’s to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments, including prescribing medications under the exclusive licensure authority of state board of nursing (BON) (CANP, 2020).
Even though APRN’s in California have been given the privilege to full practice authority, under the scope of practice for California APRN’s they must have a standardized procedure or protocol that must be developed and approved by a supervising physician.
According to Ed Hernandez, SB 323 has been a fight for some time. Senator Ed Hernandez felt SB 323 was a necessary law that needed to be passed related to the 2.5 million previously uninsured Californians receiving health coverage under the Affordable Care Act, to ensure more trained health care professionals (CANP, 2020).
APRN’s in California also have the prescriptive authority which means, drugs or devices furnished by the APRN must be ordered in accordance with the policies and protocols set forth in the agreement with the supervising physician. The APRN may furnish drugs and devices within the APRN’s area of practice. Physician involvement is required when an APRN is furnishing schedule ll or lll controlled substances, and a patient-specific protocol is required (California Scope of Practice Policy: State Profile, 2020).
APRN as a primary care provider is recognized in state policy as primary care providers. This means a person responsible for coordinating and providing primary care to members, within the scope of practice of their license to practice, for initiating referrals and maintaining continuity of care. A primary care provider may be a primary care physician or nonphysician medical practitioner including a nurse practitioner, certified nurse-midwife or physician assistant (California Scope of Practice Policy: State Profile, 2020).
APRN’s in California and under the legislative SB 323 to summarize are given the privileges to full practice authority and have prescriptive authority, while under physician authority.
But as California continues to face a growing shortage of primary care physicians, the Legislature is considering allowing NP’s who get additional training and certification to work independently (Aguilera, 2020). According to author Elizabeth Aguilera, the State Assembly passed Assemble Bill 890, which would free many NP’s from needing to operate under a supervising physician’s agreement (Aguilera, 2020). Assembly Bill 890 will create a path for NP’s who want to work independently by opening their own practice. The bill, carried by Santa Rosa Democratic Assemblyman Jim Wood, now goes to the Senate (Aguilera, 2020).
The California Board of Nursing (BRN) grants legal authority to practice and regulate/issues separate certification to APRN. Defined in statute APRN includes certified nurse practitioner (CNP), NP (in statute), clinical nurse specialist (CNS), Certified Nurse Midwife (CNM), and, certified registered nurse anesthetist (CRNA) roles. NP’s function under standardized procedures or protocol when performing medical functions, collaboratively developed and approved by the NP, physician, and the administration in the organized healthcare facility in which they work (Philips DNP, APRN, FNP-BC, FAANP, 2018)).
NP standard of procedure (SOP), is defined within the standardized procedures commensurate with the NP’s education and training, not in statute or regulation (Philips DNP, APRN, FNP-BC, FAANP, 2018).
APRN’s are not legally in California authorized to admit patients to the hospital; however, individual hospitals may grant APRN’s hospital privileges (Philips DNP, APRN, FNP-BC, FAANP, 2018). Also, APRN’s do not require in California national certification to enter practice (Philips DNP, APRN, FNP-BC, FAANP, 2018).
APRN’s in California are regulated by a BON or a combination of a BON and BOM (the board of medicine) oversight exists, requirement or attestation for physician supervisors, delegation, consultation or collaboration for authority to practice and/or prescriptive authority (Phillips, DNP, APRN, FNP-BC-FAANP, 2018).
APRN certification in California requires completion of a master’s, postgraduate, or doctorate degree from an accredited NP program, and then a certification from a nationally recognized certifying body such as the American Academy of Nurse Practitioners or the American Nurse Credentialing Center (California Health Care Foundation, 2018). NP certification in Californian can be obtained by the successful completion of an NP education program that meets BRN standards or by certification through a national organization whose standards are equivalent to those of the BRN (California Health Care Foundation, 2018). There are 23 approved NP programs in California (California Health Care Foundation, 2018). Since January 2008, California requires NP applicants who have not been qualified or certified as an NP in California or any other state possess a master’s degree in nursing, or a graduate degree in nursing, and complete an NP program approved by the board. An NP must have BRN certification to practice in California, but certification from a national professional association is not required California Health Care Foundation, 2018 (California Health Care Foundation, 2018).
In California, NP practice is governed by the state nurse practice act California Health Care Foundation, 2018 (California Health Care Foundation, 2018). The Board of Registered Nursing has promulgated regulations that require NP to work under standardized procedures for authorization to perform medical functions (California Health Care Foundation, 2018). This means that NP’s work under collaboration with a physician and adhere to standardized procedures developed through collaboration among administrators and health professionals. There are no rules regarding the proximity of the physician to the NP, meaning a physician can provide supervision from hundreds of miles away.
State regulations regarding APRN scope of practice varies from state to state. The Model Act defines the scope of practice for APRN’s to include conducting assessments, ordering and interpreting diagnostic procedures, establishing diagnoses, prescribing, ordering, administering, dispensing, and furnishing therapeutic measures, delegating to assistive personnel, and consulting with other disciplines and providing referrals (California Health Care Foundation, 2018). The Model Act recommends that APRN’s be licensed independent practitioners. (California Health Care Foundation, 2018).
ALASKA STATE/REGION REGULATIONS
Alaska is one of the first states to embrace the role of the APRN. Alaska began to adapt state laws giving NPs more freedom as early as the 1980s. On July 21, 1984, Eileen Mountano RN, Chairperson of the Alaska Board of Nursing signed an adoption order for new regulations regarding ANPs in Alaska. ANPs at the time included Certified Nurse Practitioners, and Certified Nurse-Midwives (Hartz MSN, FNP, 2014). The new regulations would repeal a requirement for a signed collaborative agreement between a physician and ANP that also had to be approved by the Alaska Medical Board (). In 1987, additional regulations gave ANPs independent authority to prescribe controlled drugs Scheduled ll-lV (Hartz MSN, FNP, 2014). According to the author, Alaska was one of the first states to adopt broader licensing authority in the 1960s and remains one of the only 19 states along with the District of Columbia that allows NP’s to practice with full autonomy (Hartz MSN, FNP, 2014).
The nursing statutes in Alaska are the result of legislation passed by the legislature. They are what gives the Board of Nursing its powers and authority to regulate nurses for the protection of the public (Hartz MSN, FNP, 2014).
In 1981 SB 238 was introduced to update the nursing statutes. It included the current definition of “advanced nurse practitioner” and “nurse anesthetist” and gave the BON authority to regulate the groups. (Hartz MSN, FNP, 2014).
The bill was passed in 1982 and by 1983 work had begun on new ANP regulations, and in 1984 was passed (Hartz MSN, FNP, 2014).
Currently, APRNs working in Alaska have the freedom to practice independently, with the supervision of a physician. Physician involvement is not necessary for diagnosing, treating, or prescribing for patients in anyway. Alaska’s laws for APRNs are some of the most liberal in the nation (Nurse Practitioner Scope of Practice: Alaska, 2014).
Prescribing laws allow APRNs freedom in their practice. Again, physician involvement is not necessary for the NP to prescribe. In order, though for NPs to write prescriptions an NP must submit an application to the state board of nursing as well as complete 15 contact hours of education in advanced pharmacology and clinical management within the two-year period immediately before the date of the initial application (Nurse Practitioner Scope of Practice: Alaska, 2014). NP’s in Alaska must also renew their authority to prescribe every two years, and in order to renew their prescribed privileges the NP has to take 12 hours of continuing education in advanced pharmacotherapeutics and 12 hours of continuing education in clinical management (Nurse Practitioner Scope of Practice: Alaska, 2014).
APRNs in Alaska are regulated by a BON and have full, autonomous practice and prescriptive authority without a requirement or attestation for physician supervision, delegation, consultation, or collaboration (Nurse Practitioner Scope of Practice: Alaska, 2014).
Discussion Professional Nursing and State-Level Regulations NURS 6050 REFERENCES
California Scope of Practice Policy: State Profile (2020). Retrieved March 21, 2020, from
www.httpps://scopeofpracticepolicy.org>states>ca
California Association for Nurse Practitioner (2013). New Full Practice Authority Bill Introduced. Retrieved March 21, 2020, from
www.https://canpweb.org>press-releases
Joanne Spetz (May 2, 2019). California’s Nurse Practitioners: How Scope of Practice Laws Impact Care. Retrieved March 21, 2020, from
https://www.chcf.org>publication
Elizabeth Aguilera (February 13, 2020). Facing doctor shortage, will California give nurse practitioners more authority to treat patients? Retrieved March 21, 2020, from
https://www.CaliMatters<projects>doctors-short
Nurse Practitioner Scope of Practice: Alaska (May 23, 2014). Retrieved from
Lynn Hartz MSN, FNP (June 2014). Alaska Nursing Today vol 2. Retrieved March 22, 2020, from
Https://www.NursingALD.com>pdf>Ala
California Health Care Foundation. California’s Nurse Practitioners: How Scope of Practice Laws Impact Care (September 2018). Retrieved from
Susanne J. Philips, DNP, APRN, FNP-BC-FAANP (January 2018). 30th Annual APRN Legislative Update. Improving Access to healthcare one time at a time. Retrieved from