Discussion: Professional Nursing and State-Level Regulations NURS 6050

Discussion: Professional Nursing and State-Level Regulations NURS 6050

APRNs in Missouri are subject to stringent supervision laws. An APRN and their collaborating physician are still required to work within a specific geographic proximity, even after the initial thirty days, according to Missouri APRN regulations (Sommer et al., n.d.). To practice legally, an APRN must be within a 30-mile radius of their collaborating physician in a non-Health professional shortage area (non-HPSA) or a 50-mile radius in an HPSA (ThriveAPb, 2013). An APRN can only practice outside of those 30 miles if they use telehealthcare, and they must obtain patient consent before telehealth services are initiated. Although APRNs are required to have a practice agreement with a physician, they are not required to meet. Another rule that APRNs in Missouri must abide by is that they are not permitted to sign death certificates or declare someone deceased. Illinois APRNs, like Missouri APRNs, have a practice agreement in place with a collaborating physician; however, Illinois APRNs must meet with their collaborating physician on a monthly basis (ThriveAPa, 2013). Illinois APRNs are also not permitted to sign death certificates or pronounce someone dead.

To comply with these regulations, APRNs must find a collaborating physician and establish a collaborative practice agreement. Collaborative practice agreements are written agreements that must establish guidelines for consultation and referral to collaborating physician or health facility, agreement of protocols and standing orders, must be signed and dated by both APRN and collaborating physician before the APRN can start practicing, must identify the process for reviewing and managing abnormal test results, the scope of practice, physicia (Missouri Division of Professional Registration, n.d.). Maintaining a professional and respected relationship with the physicians with whom you collaborate will assist APRNs in adhering to their regulations.

APRNs who have full practice authority allow APRNs the full ability to utilize knowledge, skills, and judgment to practice to the full extent of their education and training (American Nurses Association, n.d.). APRNs allowed to full practice authority have advantages such as reduction in health care costs, expansion of care to rural or underserved areas, and efficient and effective care as they do not have to wait for directions from their collaborating physician (Bradley University, n.d.). APRNs who are allowed full authority practice would function as a primary care physician. They would be allowed to make decisions as a physician and practice to their full extent. They would be unaffected by the regulations I selected; they would be allowed to make these decisions without breaking the law.

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American Nurses Association. (n.d.). Advanced Practice Registration Nurses (APRN). https://www.nursingworld.org/practice-policy/aprn/

Bradley University. (n.d.). What is Full Practice Authority for Nurse Practitioners? https://onlinedegrees.bradley.edu/nursing/msn-fnp/resources/understanding-regulations-what-is-full-practice-authority/#:~:text=According%20to%20the%20American%20Association%20of%20Nurse%20Practitioners,nursing%20board%20%28a%20definition%20last%20updated%20in%202015%29.

Missouri Division of Professional Registration. (n.d.). Nursing & Collaborative Practice. https://pr.mo.gov/nursing-advanced-practice-nursing-collaborative.asp

ThriveAP. (2013). Nurse Practitioner Scope of Practice: Illinois. https://thriveap.com/blog/nurse-practitioner-scope-practice-illinois

ThriveAP. (2013). Nurse Practitioner Scope of Practice: Missouri. https://thriveap.com/blog/nurse-practitioner-scope-practice-missouri

Sommer, C., Franklin, D., Kelly, H., Neely, J., Peters, J., and Smith, C. (n.d.). Current Practice of Advanced Practice Registered Nurses. https://house.mo.gov/Billtracking/bills171/commit/rpt1510/Scope%20of%20Practice%20Report.pdf#:~:text=To%20be%20recognized%20as%20an%20APRN%20in%20Missouri,obtained%20in%20the%20advanced%20practice%20nursing%20education%20program.

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

Main post

To be recognized as a professional, a person must meet the standards of his or her discipline and follow the laws and regulations that are in place to ensure competence and the safety of the individual and the public (National Commission on Correctional Health Care, n.d.). Because the Advanced Practice Registered Nurse (APRN) designation is extremely state-specific, the APRN scope of practice and regulatory requirements differ for nurses with the same designation in each state (Milstead & Short, 2019, p. 65). These are some of the differences in nursing rules between Michigan and Maryland nurse practitioners. Nurse Practitioners in Michigan are governed by the Public Health Code rather than the Nurse Practice Act. They can prescribe non-scheduled medications on their own, but they must have a physician cosign the prescription for schedules 2-5 substances. “A nurse practitioner cannot sign a death certificate or a workers’ compensation claim, but they can complete hospital rounds, make independent house calls, and request physical or speech therapy without the collaboration of a physician.” n.d. (School of Nurse Practitioners) The Nurse Practice Act governs Nurse Practitioners in Maryland. NPs must register with the Prescription Drug Monitoring Program (PDMP) and, once registered, they have the authority to prescribe schedule 2-5 substances and sign death certificates if the decedent was under their care (Nurse Practitioner School, n.d.).

Certified Nurse-Midwives are another APRN specialty where regulations differ from state to state; in this case, I will compare nurse midwives’ regulations in Michigan to those in Maryland. Midwives in Michigan must work in collaboration with physicians when providing care to patients, whereas nurse midwives in Maryland are allowed to practice independently of a physician.

These regulations apply to APRNs who have legal authority to practice within the full scope of their education and experience. These regulations serve as guidelines for those practicing within the discipline in order to protect their title as well as the public. APRNs follow these regulations by keeping their license current, completing the required continuing education training each licensing year, and ensuring safety and competence in practice (National Commission on Correctional Health Care, n.d.).

Discussion: Professional Nursing and State-Level Regulations NURS 6050

Professional Nursing and State-Level Regulations

Both the state and federal governments place a high premium on providing high-quality clinical services. Disease surveillance and public health protection are the responsibility of the government. It is equally important for legislators to set policies and allocate resources to improve healthcare infrastructure so that services are more reliable and effective. Regulations governing the healthcare system in the United States of America protect the general public’s safety (Milstead & Short, 2019). A set of legislation governing the professional activity of Advanced Practice Registered Nurses is implemented by practice-specific authorities like the New Jersey Board of Nursing and The Nurse Practitioner Association of New York State (APRN).

Regulations for New York’s Advanced Practice Registered Nurses

An APRN’s professional actions are governed by state-specific policies. In addition, the APRN’s educational qualifications and licensing procedures are addressed in the legislation. Under the New York State Education Department’s Division of Nursing, the New York State Board of Nursing sets standards for certification and practice opportunities for practitioners in many disciplines, including palliative care, obstetrics and gynecology, psychiatry, and pediatrics. Additionally, the Nurse Practitioner Association New York State (NPA), a non-profit organization, is dedicated to promoting high-quality healthcare. Nurse practitioners and other health care workers can rely on the organization to ensure that they meet all legal standards (The Nurse Practitioner Association New York State, n.d). In addition, the NPA contributes to policy development and fosters nurse networking.

Advanced practice registered nurse regulations in New Jersey

To practice as an Advanced Practice Nurse in New Jersey, one must be certified by the state’s Board of Nursing. It also has a shared protocol with the doctors and guarantees that they conform to the legal criteria of practice. APRNs of New Jersey is a group of nurses, APRNs, and people who have a common goal of eliminating barriers to practice (Advanced Practice Nurses of New Jersey APN-NJ, n.d). In order to improve access to care, foster professional teamwork, and cultivate effective leadership, the group fosters awareness-creation (Advanced Practice Nurses of New Jersey APN-NJ, n.d). Patients’ welfare is also a top priority, as evidence-based practice is mandated by federal government law.

New York and New Jersey Have Their Own Unique Set of Issues

There are extensive systems in place to ensure that nurses in New York and New Jersey are properly registered and licensed. It is the responsibility of both states’ comprehensive authorities to draft and implement regulations that specify the rights and responsibilities of nurses. Disease diagnosis, counseling, and health education are all responsibilities that fall to the practitioners in this field. New York State Education Law also provides recommendations for the APRN’s educational requirements. However, the rules are different depending on where you live. In New Jersey, a diverse group of healthcare professionals and patients advocate for new rules, but in New York, state agencies are in charge of enforcing existing rules.


APRNs have advanced clinical knowledge, education, and skills to provide specialized care to the community. Therefore, compliance with the regulations will enable them to identify the specific area of professional engagement and the boundary of their operations. Moreover, the regulations stipulate the years of experience and necessary certifications before enrolling for an advanced degree in nursing. For instance, every nurse practitioner must obtain certification by the New Jersey Board of Nursing before becoming an APRN. The nurses can adhere to the regulations by completing the mandatory education levels to become nurse specialists.

Discussion: Professional Nursing and State-Level Regulations NURS 6050 References

Advanced Practice Nurses of New Jersey APN-NJ. (n.d). State Legislative and Regulatory Information. Retrieved from http://enp-network.s3.amazonaws.com/APNNJ/students/New%20Jersey%20APNs.pdf

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.The Nurse Practitioner Association New York State. (n.d).  About Us. Retrieved from  https://apnnj.enpnetwork.com/page/30121-about-us

The Nurse Practitioner Association New York State. (n.d).  About Us. Retrieved from  https://apnnj.enpnetwork.com/page/30121-about-us

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?


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


Guido, G. W. (2010). Legal & ethical issues in nursing (5th ed). Boston, MA: Pearson. Retrieved March 23, 2020, from


Howard, P.K. (2011). The death of common sense: How law is suffocating America. Retrieved March 23, 2020, from


Penn Nursing Science. (2012). History of Nursing Timeline. Retrieved March 23, 2020, from


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


Discussion:  A Comparison of Advanced Practice Registered Nurse (APRN) within my current state versus another.


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.


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).



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 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


California Association for Nurse Practitioner (2013). New Full Practice Authority Bill Introduced. Retrieved March 21, 2020, from


Joanne Spetz (May 2, 2019). California’s Nurse Practitioners: How Scope of Practice Laws Impact Care. Retrieved March 21, 2020, from


Elizabeth Aguilera (February 13, 2020). Facing doctor shortage, will California give nurse practitioners more authority to treat patients? Retrieved March 21, 2020, from


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


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


The healthcare team must work collaboratively to accomplish high-quality care and positive outcomes. Each role in the healthcare team has a specific scope of practice and is based on their educational preparation and triaging, allowing them to contribute to primary care (Bosse et al., 2017). APRNs will focus on bringing a holistic, patient-centered, and family-centered approach to prevent and manage complex health and behavioral issues (Bosse et al., 2017).

Some examples of APRNs are nurse practitioners (NP) and certified nurse-midwife (CNM). Nurse practitioners provide comprehensive care services to address physical and mental health needs. While CNMs offer services focusing on primary sexual and reproductive health services and postpartum care, childbirth, and care of newborns (Bosse et al., 2017).

Healthcare professionals must practice within their scope of practice, or consequences could follow. Living in Pennsylvania, in 2004, Governor Rendell introduced the proposed legislation known as Prescription of Pennsylvania (Rx4PA), which sought to increase access to health care, control spiraling state healthcare costs, and improve quality (Carthon et al., 2016)—allowing for APRNs to order medical equipment, signing disability forms, and prescriptive authorities (Carthon et al., 2016). Pennsylvanians were 11% more likely to use the emergency room than all other Americans (Carthon et al., 2016).

State to state regulations varies regarding the prescriptive authority. Revealing in 2017 Florida legislature expanded APRN prescribing controlled substances, such as opioids and stimulants, reported earlier that Florida physicians were dispensing oxycodone five times more than the national average (Reynolds, Reynolds, & Craig-Rodriguez, 2021). Comparing to Pennsylvania, the Governor allowed APRNs to prescribe medications in 2004. Florida was the last state to rant controlled substances prescriptive authority (Reynolds, Reynolds, & Craig-Rodriguez, 2021).

In 1985, The Medical Practice Act imposed strict requirements on CNMs to legally practice in Pennsylvania (Levinson, 2018). Pennsylvania legislators made unsuccessful attempts in the early 1990s to legalize non-nurse midwifery practice. Pennsylvania has a high home birth rate, and non-nurse midwives attend (Levinson, 2018). Their attempts were supported by the Amish community and opposed by CNMs and medical groups (Levinson, 2018). The non-nurse midwives practiced illegally because the Midwife regulation Law proscribes midwifery practice without a license, and Pennsylvania currently provides no path to licensure for non-nurse midwives (Levinson, 2018). In Pennsylvania, to certify, the individual must be licensed by the board, have the minimum education requirements, can practice without a physician, and lastly be required to carry malpractice insurance (Levinson, 2018).

According to the Florida state website, the requirements need to practice midwifery are they must have a high school diploma, 21 years of age, completion of an approved midwifery program for a minimum of 3 years, if an RN or LPN a reduction in clinical training if qualified (2021). Students must observe additional 25 women before allowing for a license. Once completed, the student will test their proficiency in core competencies that are required (Statutes &Constitution). The difference between the states is Pennsylvania allows for non-nurse midwives due to the Amish community.

In conclusion, regulations apply to APRNs and must be followed to practice within the scope of practice. The rules set guidelines and standards for professionals. APRNs must continue to meet the credited education required to keep their license up to date to ensure safety and competence in their chosen practice.


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 Outlook65 (6), 761-765.

Carthon, J. M. B., Wiltse Nicely, K., Altares Sarik, D., & Fairman, J. (2016). Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania. Policy, Politics & Nursing Practice17(2), 99–109. https://doi-org.ezp.waldenulibrary.org/10.1177/1527154416660700

Levinson, L. (2018). Solving the Modern “Midwife Problem”: The Case for Non-Nurse Midwifery Legislation in Pennsylvania. Temple Law Review91(1), 139.

Reynolds, A. M., Reynolds, C. J. & Craig-Rodriguez, A. (2021). APRNs’ controlled substance prescribing and readiness following Florida legislative changes. The Nurse Practitioner, 46 (6), 48-55. doi: 10.1097/01.NPR.0000751796.01625.17.

Statutes & constitution: view statutes : Online sunshine. (2021, September 25). Retrieved September 25, 2021, from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499%2F0467%2F0467.html.

A Comparison of APRN Illinois Board of Nursing and Iowa Board of Nursing.

I will be comparing the two states where I have practiced.

Firstly, Nurse practitioner is a registered nurse educated in the disciplines of nursing who has advanced knowledge of nursing, physical and psychological assessment, appropriate interventions, and management of health care, and who possesses evidence of current certification by a national professional nursing certifying body approved by the board (AANP, 2021).

The difference between APRN in Illinois and Iowa is that a nurse practitioner in Illinois requires physician involvement for diagnosis and treatment. In contrast, a nurse practitioner in Iowa does not need a physician involvement in this decision making. In Illinois, a collaborative practice agreement is required for all clinical practice, except for practice within a hospital or ambulatory surgical treatment center.

In Illinois, APRN must consult with their collaborating physician at least once a month, but this doesn’t happen in Iowa.

For example, a mental health nurse practitioner in the state of Iowa has an autonomy to diagnose a psychiatric condition and prescribe medications for these set of patients, including controlled substances.


AANP. (2021). What’s a nurse practitioner (NP)? American Association of Nurse Practitioners. https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner

Advanced registered nurse practitioner – Role & scope. (2020, October 10). Iowa Board of Nursing | Kathleen R. Weinberg, MSN, RN, Executive Director. https://nursing.iowa.gov/practice/advanced-registered-nurse-practitioner-role-scope

Advocacy Resource Center. (2017). Nurse Practitioner Practice Authority. American Medical Association. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-practice-authority.pdf

Illinois Nursing Workforce Center. (2019). Illinois General Assembly. https://www.ilga.gov/commission/jcar/admincode/068/068013000D04400R.html

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


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.htm

Each state has a board of nursing that develop regulations and guidelines that must be followed in order to legally practice. There are 3 different practice environments for APRNs and the details of what is allowed in practice varies with each state. The first practice environment is restricted with 11 states following those guidelines. 16 states and territories have reduced practice regulations. 29 states and territories have full practice authority for APRNs. Full practice authority is defied as “NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.” (AANP, 2022) and is the recommended model of care by the National Academy of Medicine.

As of April 19th, 2022, Kansas, which is my home state, passed a full practice authority (FPA) act giving APRNs the ability to practice without being under supervision by a physician. This means that APRNs who practice in the state of KS are no longer required to have supervision of a physician. APRNs are now able to register for a DEA number and prescribe controlled substances. APRNs in KS are required to have advanced pharmacology education in order to register for a DEA number. Jon Fanning the CEO of AANP states that “This law is a necessary step toward eliminating health care disparities, managing costs and building the health care workforce for Kansas. States that have adopted Full Practice Authority are better positioned to address these critical issues.” (Fanning, 2022). I am eager to see the results of APRNs having FPA in my home state. When APRNs are entrusted with full practice authority, they can use their skills and knowledge to provide the best care to their patients. I look forward to working as a full practice APRN after passing boards and having the ability to prescribe and manage my patients care independently.

In Oklahoma APRNs do not have to practice under the supervision of a physician but in order to prescribe, APRNs must be under the supervision of a physician. That is commonly done in a written agreement. APRN in Oklahoma are not able to prescribe schedule II drugs or sign death certificates. These limitations to the scope of practice for APRN are referred to as restrictive and have potential complications for APRNs working in a rural community. “States that restrict or reduce NPs’ ability to practice by limiting licensure authority are more closely associated with geographic health care disparities, higher chronic disease burden, primary care shortages, higher costs of care and lower standing on national health rankings.” (AANP, 2022). Having these limitations for APRNs who are practicing in rural communities contributes to the current health disparity and limits accessible care.

Erin Tolbert, M. S. N. (2022, May 5). Nurse practitioner scope of practice: Oklahoma. ThriveAP. Retrieved September 28, 2022, from https://www.thriveap.com/blog/nurse-practitioner-scope-practice-oklahoma#:~:text=Nurse%20practitioners%20practicing%20in%20Oklahoma,the%20supervision%20of%20an%20MD.

Issues at a glance: Full Practice Authority. American Association of Nurse Practitioners. (n.d.). Retrieved September 28, 2022, from https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief

Nurse practice act statutes & administrative regulations – kansas.gov. (n.d.). Retrieved September 28, 2022, from https://ksbn.kansas.gov/wp-content/uploads/NPA/npa.pdf

State practice environment. American Association of Nurse Practitioners. (n.d.). Retrieved September 28, 2022, from https://www.aanp.org/advocacy/state/state-practice-environment

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