6050 NURS Week 5 Discussion: Professional Nursing and State-Level Regulations

6050 NURS Week 5 Discussion

6050 NURS Week 5 Discussion: Professional Nursing and State-Level Regulations

                                                                               Discussion Post

Milstead and Short (2019) share that boards of nursing write rules with criteria that applicants must meet to be eligible to sit for licensure examinations and for issuing licenses.“Applicants for licensure must pass an initial licensing examination, then comply with continuing education requirements or undergo competency assessment by the regulatory body that provides oversight for that profession (Milstead & Short, 2019).

The College of Nurses of Ontario (CNO) is the regulatory board of nursing in the province I live, that provides licensure and establishes education requirements for Advanced Practice Registered Nurses (APRN).  APRN’s bring a holistic as well as patient-centered and family-centered approaches to the prevention and management of complex health and behavioral issues addressed in various care settings across the life span (Bosse et al., 2017).

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Within the category of APRN, are Nurse Practitioners (NP). NP’s provide primary, acute, and specialty health care across the lifespan through assessment, diagnosis, and treatment of illnesses and injuries (American Nurses Association).
Within Ontario, CNO defines NP’s as “registered nurses who have met additional education, experience and exam requirements set by the College. They are authorized to diagnose, order and interpret diagnostic tests, and prescribe medication and other treatment” (College of Nurses of Ontario, 2020). CNO has outlined regulations for NP’s.  One regulation the board has outlined for NP’s is in regards to medication administration. Only NP’s who have successfully completed approved additional education are authorized to prescribe controlled substances.
There are also prescription regulations for NP’s in the state of New York. The board of nursing in New York states the “law authorizes nurse practitioners (NPs) to order, prescribe or dispense medications (including controlled substances) for the treatment of their patients. After completing New York State Education Department approved pharmacology coursework and being certified by the New York State Education Department to prescribe, most nurse practitioners must obtain additional government approvals and meet other criteria in order to prescribe medications” (New York State Education Department, 2019).
Both the boards of nursing in Ontario and New York require additional education requirements prior to NP’s being able to prescribe medications. Ontario will allow NP’s after obtaining licensure to prescribe medications, but not controlled substances. To be able to prescribe controlled substances additional education will be needed.The New York State requires all NP’s to have an additional pharmacology coursework prior to having the ability to prescribe any medications.
The New York State board also allows nurses to practice independently and not under the supervision of Physicians (New York State Education Department, 2019). CNO also consider NP’s as independent Practitioners who also do not need to work under the supervision of a Physician (College of Nurses of Ontario, 2020).
The Texas Board of Nursing (2018) differs from New York and Ontario where NP’s must practice under the supervision of a Physician.

Bosse et al. (2017) share that APRNs who are able to work to the full extent of their education and training have greater potential to identify creative approaches for solving problems within these systems, which will benefit nursing as a discipline, the larger health care community, and most importantly the community they serve.

APRNs such as NP’s adhere to the regulations of their regulatory body by maintaining their educational requirements and license requirements. As Bosse et al. (2017) mentioned it is important that NP’s are able to work to the full extent of their education and training. As mentioned above some states still have not allowed NPs to work independently, such as Texas. It would benefit the community served if NP’s in all states and provinces had the ability to practice independently.

                                                                               References

American Nurses Association. (n.d.). ANA enterprse. Retrived December 29, 2020, from https://www.nursingworld.org/
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.ezp.waldenulibrary.org/10.1016/j.outlook.2017.10.002
College of Nurses of Ontario. (2020). Nurse Practitioners. https://www.cno.org/en/learn-about-standards-guidelines/educational-tools/nurse-practitioners/
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning
New York State Education Department. (2019). Nursing Prescription Privileges. http://www.op.nysed.gov/prof/nurse/np-ppep.htm
Texas Board of Nursing. (2018). Advance Practice Registered Nurse.https://www.bon.texas.gov/applications_advanced_practice_registered_nurse.asp

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.
It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so 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.
To Prepare:

  • Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
  • Consider how key regulations may impact nursing practice.
  • Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion..

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.

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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.
*Note: Throughout this program, your fellow students are referred to as colleagues.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 5 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 5
To participate in this Discussion:
Week 5 Discussion
Module 3: Regulation (Weeks 5-6)
Laureate Education (Producer). (2018). Regulation [Video file]. Baltimore, MD: Author.
Learning Objectives
Students will:
Compare state/regional board of nursing regulations
Compare boards of nursing and professional nurse associations
Analyze members of boards of nursing
Analyze state regulations for healthcare
Due By
Assignment
Week 5, Days 1–2
Read/Watch/Listen to the Learning Resources.
Compose your initial Discussion post.
Week 5, Day 3
Post your initial Discussion post.
Begin to compose your Assignment.
Week 5, Days 4-5
Review peer Discussion posts.
Compose your peer Discussion responses.
Continue to compose your Assignment.
Week 5, Day 6
Post at least two peer Discussion responses on two different days (and not the same day as the initial post).
Week 5, Day 7
Wrap-up Discussion.
Week 6, Days 1-6
Continue to compose your Assignment.
Week 6, Day 7
Deadline to submit your Assignment.
Learning Resources
Required Readings
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)
American Nurses Association. (n.d.). ANA enterprise. Retrieved September 20, 2018, from http://www.nursingworld.org
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.
Halm, M. A. (2018). Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing. Worldviews on Evidence-Based Nursing, 15(4), 272–280. doi:10.1111/wvn.12291
National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved September 20, 2018, from https://www.ncsbn.org/index.htm
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
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.
Required Media
Laureate Education (Producer). (2018). The Regulatory Process [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2018). Healthcare economics and financing [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2018). Quality improvement and safety [Video file]. Baltimore, MD: Author.
Discussion: Professional Nursing and State-Level Regulations
Boards of Nursing (BON) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of the nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.
It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so 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.
To Prepare:
Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of the nursing practice.
Consider how key regulations may impact nursing practice.
Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion..
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.
*Note: Throughout this program, your fellow students are referred to as colleagues.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 5 Discussion Rubric
Post by Day 3 and Respond by Day 6 of Week 5
To participate in this Discussion:
Week 5 Discussion

RE: Discussion – Week 5
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Week 5 Discussion

            My husband and I have recently moved from Colorado to North Carolina, and I was disheartened to find out that we had moved from a state that allows APRNs to practice unrestricted to a more rigidly restricted state. In Colorado, newly graduated nurse practitioners must complete an 1800-hour preceptorship with a physician, and they have to be able to meet and collaborate weekly. Following this preceptorship, the nurse practitioner and physician will then enter into a 1800 hours mentorship which has to be outlined with a plan for continued collaboration. (Nurse Practitioner Scope of Practice: Colorado | Thriveap, 2013)

            In North Carolina, APRNs must enter into a collaborative practice agreement with a physician. This agreement will outline the exact drugs and devices the APRN will be allowed to prescribe. Within the first six months, the APRN and physician will meet each month to discuss the agreement’s revisions or quality improvement measures. Once the first six months are complete, the APRN and physician will review the collaborative practice agreement annually. The burden seems to fall on the APRN to pay for a collaborative practice agreement with the physician, and a financial contract for the physician’s services must be drawn up. (North Carolina Scope of Practice Policy – State Profile, 2020)

In February 2019, legislators in North Carolina introduced the SAVE act with the hopes of removing outdated restrictions on APRNs and give them full practice authority. The act had a lot of support, and the North Carolina Nurses Association was hopeful that it would be passed by the end of 2020, but when COVID, the act was placed on the backburner.(Legislative Update 6/26/2020, 2020) It is still eligible to be brought up and voted on anytime this year, but with elections coming up in November, it seems like it will have to be refiled for next year. I hope that amid this pandemic, legislators will realize that allowing APRNs to practice fully could save money and, more importantly, save lives.

            I have found that the VA has nurse practitioner residency programs in most states for FNPs and PMHNPs, and there is one here in Durham, North Carolina. These programs are for one year, and they are paid internships. In 2016, the VA announced that it would recognize full practice authority for NPs, clinical nurse specialists, and nurse-midwives despite certain state restrictions.  (Livanos, 2016)

References

Legislative update 6/26/2020. (2020, June 26). North Carolina Nurses Association. https://ncnurses.org/advocacy/legislative/legislative-update-6-26-2020/

Livanos, N. (2016). Increasing avenues to care: Department of veterans affairs makes move to grant aprns full practice authority. Journal of Nursing Regulation, 7(3), 58–62. https://doi.org/10.1016/s2155-8256(16)32322-5

North carolina scope of practice policy – state profile. (2020). Scope of Practice Policy. http://dev.scopeofpracticepolicy.org/states/nc/

Nurse practitioner scope of practice: Colorado | thriveap. (2013, November 19). ThriveAP. https://thriveap.com/blog/nurse-practitioner-scope-practice-colorado

RE: Discussion – Week 5
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Response#1
Hi Shelley,
I enjoyed reading your post. It’s so interesting how different states have such drastically different rules for advanced practice nurses. One would think that during a pandemic, it would be obvious that the need for advanced practice nurses is great, however, it does seem to have put a hold on a lot of things. According to the North Carolina Nurses Association, they remained very confident, naming this act as one of the highest priorities for the 2020 legislative session (NCNA, 2020).  I do agree with you, however, that there may be a hold up due to the presidential election season. Hopefully, though, those in healthcare can continue to advocate for the dire need of advanced practice nurses being able to operate to their full capacity. You mentioned the VA NP residency programs, are you interested in working for the VA? Just curious as to how those programs are. It might be a good option to try; it seems as though it is a great way to incorporate NP’S in utilizing their full practice authority.
One of my good friends that I met along my travel nursing experiences recently moved to Colorado specifically because NP’s are able to work independently. Her goal is to open her own practice and with Colorado’s laws for NP’s, it would allow her, essentially, to be her own medical director. It seems as though, as of 2010, NP’s in Colorado are not required to practice under the supervision of an MD, although, when it comes to prescribing medications there are some limitations early on in their career as an advanced practice nurse (ThriveAP, 2013).
After reading and researching through different state mandates, it’ll be interesting to see what will happen with regards to the independence of NP’s in the coming years. I do hope that North Carolina is finally able to pass the SAVE act!
References:
Nurse Practitioner Scope of Practice: Colorado. (2020, July 22). Retrieved October 02, 2020, from https://thriveap.com/blog/nurse-practitioner-scope-practice-colorado
SAVE Act. (n.d.). Retrieved October 02, 2020, from https://ncnurses.org/advocacy/legislative/save-act/

RE: Discussion – Week 5
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Professional Nursing and State-Level Regulations
The state boards of nursing protect the public through controlling the nursing practice. The regulations indicate the level of education and scope of practice required to provide safe and cost-effective care. They vary from one state to another but aim to make sure nurses’ access growing evidence to provide effective care. There are important differences relating to education and renewal of licenses in Maryland and Idaho’s Boards of Nursing.
As mentioned, Maryland and Idaho’s Boards of Nursing have different regulations relating to education and renewal of licenses. In Maryland, the Board of Nursing approves licenses for APRNs upon obtaining a master’s degree or higher in an approved nurse practitioner program (NCSBN, 2020). On the other hand, in Idaho, an APRN only provide evidence of a graduate or post-graduate nursing program degree. Moreover, the nursing license is renewed after a specific period. In the state of Maryland, the renewal of licenses is done annually, and APRNs must provide active national certification and transcripts of refresher courses undertaken during the period of practice (NCSBN, 2020). In Idaho, APRN licenses are renewed after two years, and APRNs must undergo a 10-hour course on pharmacology (NCSBN, 2020). The education and training impart knowledge and skills to support nurses to practice at the advanced level.
Graduate or post-graduate degree, refresher courses, and continuous education required for renewal of APRN license apply to APRN’s scope of practice. Education and license renewal requirements support the provision of safe and cost-effective care by the APRNs (Nursing Licensure, 2020). According to Bosse et al. (2017), continuous education and refresher courses allow nurses to access a growing body of evidence essential in the execution of APRN roles. Per Halm (2018), attaining a graduate or post-graduate degree program and engaging in continuous nursing education helps APRNs to utilize their knowledge and skills to the full extent of their training. Importantly, APRNs must adhere to the education and licensure stipulations. For example, a nurse needs to hold RN and APRN credentials concurrently because RN licensure is a precondition to APRN. The two licensure credentials facilitate a nurse’s licensing process.
The license requirements vary from one state to another. Apart from the required educational qualification, different states require additional training to help APRNs address changes in the ever-changing healthcare sector. The education and renewal of license provisions help nurses with a growing body of evidence to competently provide care to patients
References
Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761-765.
Halm, M. (2018). Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing. Worldviews on Evidence-Based Nursing, 15(4), 272–280.
NCSBN. (2020). Board of Nursing professional licensure requirements. National Council of State Boards of Nursing. https://www.ncsbn.org/14730.htm.
Nursing Licensure. (2020). Nurse Practitioner license requirements: Change is in the air. Nursing Licensure. https://www.nursinglicensure.org/articles/nurse-practitioner-license.html
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Content
Name: NURS_6050_Module03_Week05_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range: 40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range: 35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
Points Range: 0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
Points Range: 15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
Points Range: 13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range: 0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response
Points Range: 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
Points Range: 14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
Points Range: 12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range: 0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6050_Module03_Week05_Discussion_Rubric

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