Discussion: Professional Nursing and State-Level Regulations NURS 6050

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Discussion: Professional Nursing and State-Level Regulations NURS 6050

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT:    Discussion: Professional Nursing and State-Level Regulations NURS 6050 

Discussion: Professional Nursing and State-Level Regulations NURS 6050

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

Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Professional Nursing and State-Level Regulations NURS 6050
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.

RE: Discussion – Week 5

Advanced practice registered nurses (APRN) are an essential tool in health care systems today for a variety of reasons. They offer more access to primary health care as primary health care providers (this varies state to state as licensing is different), they offer care at lower prices (Laureate, 2018) and in more settings, such as a quick clinic (Laureate, 2018). There are issues, though, with how different states regulate APRNs, and there is a lack of cohesiveness between states and territories (not the fault of nurses).

In Michigan, where I am licensed, APRNs, nurse practitioners in particular, are not considered to be “primary care providers” by regulation (Scope of Practice Policy, 2020). They also lack the ability to prescribe Schedule II-V medications, unless delegated by a supervising physician. By contrast, in North Carolina (where I am in the process of moving to), APRNs are considered to be primary healthcare providers, as recognized by state policy (Scope of Practice, 2020). APRNs also are able to enter into a collaborative practice agreement with a physician, and that allows for more autonomy compared to APRNs licensed in the state of Michigan.

APRNs with more autonomy have the ability to be cost saving to the healthcare system and more efficient as well (Bosse, J., & et. al., 2017). APRNs tend to be limited by state policies and regulations, and the lack of federal oversight and the inconsistent regulations from state to state tends to hinder care and cause an increase in costs. According to the National Counsel of State Boards of Nursing (NCSBN), there is a movement underway in which APRNs can carry over their autonomy and practice skill levels from one state to another; the APRN Consensus Model provides guidance to states for adopting a regulation uniformity so APRNs can move from one state to another and continue with the same scope of practice (APRN Consensus Model, n.d.). This would be a huge advance for nursing in general in the United States. If all the states could get on board and adopt a uniform scope of practice, there could be growth and advancement in both practice and cost savings for the health care system.

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.

Laureate Education (Producer). (2018). Healthcare economics and financing [Video file]. Baltimore, MD: Author.

National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved December 28, 2020, from https://www.ncsbn.org/aprn-consensus.htm

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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DISCUSSION-WEEK 5

Module 3

Lendiane Halftown

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

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)

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

https://www.MidlevelU>blog

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

https://www.chcf.org>2018/09

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

https://www.ncbi,nlh.gov>pub
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
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. doi:10.1016/j.outlook.2017.10.002

Note: You will access this article from the Walden Library databases.
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

Note: You will access this article from the Walden Library databases.
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.
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.

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.

The laws of the nursing profession can only function properly if nurses know the current laws governing practice in their state (Howard, 2011).

Because of the United States Constitution does not include provisions to regulate the practice of nursing, the responsibility falls on the state. Under a state’s police powers, it has the authority to make laws to maintain public order, health safety, and welfare (Guido, 2010). In addition to the state’s need to protect the public, nursing leaders wanted to legitimize the profession in the eyes of the public, limit the number of people who hired out as nurses, raise the quality of professional nurses, and improve education standards in school (Penn Nursing Science, 2012).

All states and territories have enhanced a nurse practice act (NPA). Each state’s NPA is passed by the state’s legislature. But the NPA itself is insufficient in providing the necessary guidance for the nursing profession. Therefore, each NPA establishes a board of nursing (BON) that has the authority to develop administrative rules or regulations to clarify or make the law more specific. These rules and regulations undergo a process of public review before enactment (NCSBN, 2020).

It is the Nurse Practice Act that gives authority to regulate the practice of nursing and enforcement of law to an administrative agency or BON that is in charge with maintaining the balance between the rights of the nurse to practice nursing, and the responsibility to protect the public health, safety, and welfare of its citizens (Brous, 2012). How the membership of the BON is constituted depends on the state statute. Some states give the governor authority to appoint members to the BON, and other states require nominations from professional organizations with appointment by the director of head of the regulatory agency.

Do you know if NYS gives the governor authority to appoint members to the BON after receiving suggestions from professional nursing organizations such as the Nurse Practitioner Association you mentioned, or does NYS require 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

https://NCSBN>2012_JNR_NPA_G

National Council of State Boards of Nursing (2020). About U.S. Nursing Regulatory Bodies. Retrieved March 23, 2020, from

https://about-nursing-regulatory

Rubric Detail

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Content
Name: NURS_6050_Module03_Week05_Discussion_Rubric

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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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