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

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

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

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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..

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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Professional Nursing and State-Level Regulations SAMPLE

APRN practice is typically governed by the Board of Nursing and defined by the Nursing Practice Act. Besides, the method is impacted by various laws and regulations. According to Neff et al., (2018), although the rules may vary from one state to another, they all aim at securing the interest of public health safety by regulating activities of APRNs health care professionals. They explicitly state that the variation existing between APRNs and related state rules and regulations brings the need for nurses to explicitly understand their scope of practice as defined by the laws and regulations of the state. In light of this, the paper delves into giving an in-depth explanation of Georgia APRN Board of Nursing regulations, while comparing and contrasting with Ontario’s laws.

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

In Georgia, the Board of Nursing is the regulatory body for APRNs. These boards are responsible for evaluating applications for nurse licensure, disciplinary actions, issuance, and renewal of nursing licenses. On the other hand, the College of Nurses of Ontario is the governing and regulatory body for APRNs. Although the criteria the two organizations use to give credentials are similar, there a significant difference in the scope of practice in Georgia and Ontario. APRN practice laws in Georgia are the most restrictive in the whole U.S. The regulations in Georgia requires an APRNs to engage in a protocol agreement with a supervising physician actively, so that other supervision requirements are comprehensively mandated. Besides, the regulations do not allow APRNs to write prescriptions for schedule II medications, which lowers the ability of the nurse to order diagnostic tests (Bosse et al., 2017). The prescription laws and regulations in Ontario contradict the ones in Georgia. It is common to find an APRNs in Ontario prescribing medication to patients. The state laws of Ontario allow nurses to prescribe controlled substances provided they have completed approved substance education. The government of Ontario in 2017 recommended changes of the regulations under the Nursing Act 1991 that gave power to APRNs to expand their scope of practice. In essence, the Nursing Act of 1991 is one example of a law that regulates the magnitude of APRNs in Ontario.

Georgia Board of Nursing through the licensure laws and regulations requires APRNs to hold an active Georgia registered nursing license before an individual can practice as a certified nurse practitioner in the state. On the other hand, APRNs that are considered independently licensed providers are supposed to work under protocol agreements, and Georgia Composite Medical Board controls their prescriptive authority. On the contrary, Ontario state licensure laws and regulations permit all NPs to exercise autonomy in practice. The nurse can assess patients, diagnose, order diagnostic tests, initiate and manage treatments, prescribe all medications, including control substances without a provider’s supervision after qualifying in Approved Substance Education. Allowing APRNs to have full practice access will enable an increase in experience and expand the talents inherent in nurse practitioners. Besides, it will encourage significant innovations in the nursing profession; it also motivates other NPs to spring up in filling the gap created by the shortage of providers in Canada.

In my practice, which is in Georgia, the state practice and licensure laws and regulations are restricting our ability as nurses to engage in at least one element of APRN practice. Besides, this regulation will ensure that all nurse in practice gets certification to practice as an APRN in Georgia. Moreover, the demand of Georgia states laws and regulations will ensure I appreciate career-long supervision, team management, and delegation to another health care provider so that as an APRN, I provide patients with quality care (Milstead & Short, 2019). In my practice, restriction of prescribing schedule III to V drug and substances is limiting the scope of practice of nurses. The prescriptive authority of a supervising physician by submitting a written protocol to the supervising physician and permission is granted, ensuring that nurse managers in my practice engage in supervision mandate. Georgia prescription laws and regulation demands are applicable in my training in the sense that we, the nurse, will are required to prescribe both legend drug and Schedules II-V controlled drugs only after certification.

APRNs in Georgia can adhere to licensure laws and regulations by visiting the Georgia Composite Medical Board website after being authorized to complete licensure requirements. Besides, after graduating from a nursing education program, a nurse should look for licensure by endorsement as a registered nurse (Peterson et al., 2015).  A nurse should apply to evaluation. The Georgia Board of Nursing is responsible for evaluating applications for nurse licenses. In regards to prescription laws and regulations, Peterson et al., (2015) assert that APRNs can adhere to this regulation by ensuring that Schedule III and IV controlled substances cannot be filled or refilled more than five times or more than six months after the date the prescription was issued, whichever occurs first. Besides, a nurse should ensure that Schedule II prescriptions cannot be refilled. Under the Georgia State law, there is no expiration for a Schedule II prescription.

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. doi:10.1016/j.outlook.2017.10.002

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

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

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

LEARNING RESOURCES

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.

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

RE: Discussion – Week 5

          When reviewing regulations for the Nurse Practice Act it is the responsibility and expectation that every nurse is knowledgeable of the rules required by the BON to safely practice care. Health professions regulation seeks to safeguard the public by acting as a gatekeeper for entry into the health professions and by providing for ongoing maintenance of acceptable standards of practice for those professions (Milstead & Short, 2019 p 60). I am going to review prescription drug monitoring programs for Maryland, where I am currently practicing and South Carolina which is a compact state for Maryland. The National Council of State Boards of Nursing (NCSBN) offer a complete toolkit to help assist providers when prescribing controlled substances and what to monitor for patients who are currently enrolled in taking controlled medications.

Maryland is a full practice state for APRN’s and allows NP’s to evaluate patients; diagnosis, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications and control substances, under the exclusive licensure authority of the state board of nursing (American Association of Nurse Practitioners, n.d.) independently from another health provider. If an APRN is going to prescribe a Class II- IV controlled substance, they must first be board certified by the board of nursing and then register with the Maryland Prescription Drug Monitoring Program (MPDM) which is an on line data base that conglomerates all prescriptions a patient receives into a central location so prescribers can review previous prescriptions. This is required by the Maryland when any new controlled substance or benzodiazepine is prescribed and every 90 days thereafter (MDH, 2019). This is a highly recommended program provided by the State of Maryland free of charge to any provider who is going to prescribe any controlled prescriptions to patients.

In contrast to Maryland, South Carolina is a restricted state and requires career-long supervision, delegation, or team management by another health provider in order for the APRN to provide patient care (American Association of Nurse Practitioners, n.d.). According to South Carolina’s Nurse Practice Act, APRN’s are able to prescribe scheduled II-V controlled substances with the direct supervision or a physician. South Carolina’s Nurse Practice Act requires NP’s to fulfill several requirements to be a licensed prescriber including continuing education requirements, a practice agreement between the physician or medical staff and the nurse practitioner and must be renewed every two years concurrent with the Advanced Practice Registered Nurses license (SC Board of Nursing, 2019).

When comparing two states that are compact states they are very different in the autonomy they allow APRN’s to practice. Ultimately the states goal is to protect the public from any harm, but I found it interesting how two states that recognize each other’s licensing agreements do not allow the same level of independence in there APRNs. Milstead and Short refer licensing offering the public the greatest level of protection by restricting use of a specific title and scope of practice to professionals who meet theses rigorous criteria and hold a current valid license (2019, p 64) which is left up to the states to determine the amount of autonomy they allow their APRN’s to practice.

American Association of Nurse Practitioners. (n.d.). Practice Information by State. Practice Information by State (aanp.org)

Maryland Board of Nursing. (n.d.). Prescription Drug Monitoring Program. Home (maryland.gov)

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Leaning.

South Carolina Code of Laws Unannotated, SC. Stat.  Section 40-30-34 (2004 & rev. 2019). Code of Laws – Title 40 – Chapter 33 – Nurses (scstatehouse.gov)

RE: Discussion – Week 9

            Just as is true with policy and program making, nurses are a great resource for policy review.  One way to get involved in policy review is to become part of a team or group within your organization whose purpose is to review policies and programs that are in place.  Often these groups are composed of the same individuals that are involved in policy making; this can be both positive and negative.  The positive aspect comes from the individuals being able to see and interpret the results of their implemented policies.  This can be extremely rewarding when the outcomes are positive.  The negative aspect of the same people being a part of both the development and review of programs and policies is the inability to view the situation objectively.  When a great deal of time, thought, and effort is put into something, it can be difficult to accept that there are imperfections and needed changes.  Another common practice for policy review is for administrators and directors to be responsible for gathering suggestions for policy revision and to determine which suggestions have merit.  In this case it is important for nurses who notice a policy or procedure falls short of the standards of patient care make those shortcomings known to the people responsible for policy review.  It is not enough to simply state there is a problem; one must also make suggestions for how to fix the problem.  The “gap between research and practice is the result of several interacting factors, including limited time and resources of practitioners, insufficient training, lack of feedback and incentives for use of evidence-based practices, and inadequate infrastructure and systems organization to support translation.” (Glascow et al., 2003).  This article also tells us that the demands on staff’s time is a huge contributing factor to lack of involvement in measurement of effectiveness of implemented policy (2003).  It would be beneficial to include a designated amount of time during the regular shift to review what staff is experiencing with the current policies and collect suggestions for improvement.

Another way for nurses to be involved in policy review is on a wider scale and is something that has been discussed since beginning a career as a professional nurse.  That is to become a member of a professional nursing organization (PNO).  These professional nursing organizations typically have members that are lobbyist who are experienced at presenting the issues to their state representatives or even to capitol hill when issues rise to a national level.  “Professional nursing organizations (PNOs) play a critical role in maximizing the influence of our nursing profession on health systems and policy, through support of patient safety, the socioeconomic welfare of nurses, and professional practice.” (Crumley, 2020).  This concept has been presented repeatedly.  While people join professional nursing organizations for a variety of reasons, the fact that joining is invaluable is indisputable.  The challenges for being involved in policy review are like the challenges for being involved in policy making.  “Most nurses say they just want to get on with their job, and not worry about the macro‐level concerns of policy and politics.” (Salvage & White, 2019).  Good nurses spend every minute of a shift providing patient care, education, reviewing charts, catching mistakes, and being advocates for their patients.  By the end of the day, there is often little time or energy left to discuss and review policy.  When an individual is involved in a PNO, they feel more empowered to offer suggestions for improvement and are not required to do so after or during an already busy shift.

Communicating the existence of the opportunity for policy review can be done by encouraging peers at work to verbalize their grievances to the individuals responsible for changing the policy.  It would even be beneficial for a nurse and her peers to write out what they feel is not working and a few strategies they believe would work better.  An APRN such as an educator has a unique opportunity to advocate for the prospects for policy review by expressing the importance of and outlining the steps that can be taken to improve existing policies.  An educator may even be able to point out flaws of policies within an organization where there are participating in clinicals and make it an assignment to review the policy.  This can make the student passionate about being involved and set the groundwork for being involved in policy.

References:

Crumley, Carolyn. (2020). The Benefits of Active Engagement in Nursing Professional Organizations: A View From Here. Journal of Wound, Ostomy & Continence Nursing, 47, 547. https://doi.org/10.1097/WON.0000000000000700

Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93(8), 1261–1267.

Salvage, J., & White, J. (2019). Nursing leadership and health policy: everybody’s business. https://doi.org/10.1111/inr.12523

RE: Discussion – Week 5

Each state has the constitutional right to govern the responsibilities and norms of Advanced Practice Registered Nurses (APRNs) (Milstead
& Short, 2019). As a result practitioners’ scopes of practice may differ from state to state. Each state has a Board of Nursing (BON) that is responsible for enforcing the Nurse Practice Act and regulating the standard of nursing practice (NPA). The National Council of State Boards of Nursing (NCSBN) works with the state’s BON to ensure that the NPA is followed in each state. I’ll be comparing Virginia and Washington, my home state. The scope of practice differs slightly between the two states. Virginia is one of the states where APRNs have limited practice rights, but APRNs in Washington have full practice rights. In order to practice in their job, APRNs in Virginia must be supervised and managed by a physician, but those in Washington have complete autonomy over their patients’ care. Under the exclusive licensure power of the state board of nursing, they can “diagnose, order, and interpret diagnostic tests; and initiate and manage treatments, including prescription drugs and controlled substances” (AANP.org. 2018). In Washington, the professional has total independence over their FPA although they “shall get instruction, supervision, and interview as vital some time recently actualizing modern or new methods or practices” (wa.gov, 2019).

In Virginia, APRN’s have controls on the controlled substances they can prescribe. They have the specialist to endorse Plan II through Plan VI drugs, but must still sign a composed or electronic understanding their prescriptive practices and which controlled substances they can and cannot endorse (laws.lis.virginia.gov, 2019). In Washington, once endorsed by the Nursing Commission, an APRN is able to prescribe schedule V drugs of the Uniform Controlled Substances Act, as well as Plans II through IV drugs. In regards to instructional hours, APRNs in Virginia must total 8 hours of pharmacology training and 2 must be related to endorsing controlled substances, and Washington APRNs must total 15 hours of pharmacology for each permit recharging period. There are a few benefits in states where APRNs have Full Prescriptive Authority (FPA), counting less crisis room visits for non emergent healthcare, less hospitalizations, lower costs for preventative care than doctors, and medicine of less drugs related to overdose deaths (Bosse, et al., 2017). Without independence to practice inside their scope of their instruction and training, many APRNs are hindered from working in certain states, so eventually, numerous helpless patients are at a standstill when attempting to access primary wellbeing healthcare because it is anticipated that be a deficiency of essential care suppliers within the Joined together States (Neff, et al., 2018).

It would be best o to permit all APRN’s to work inside their full scope of practice. The medical profession need reliable essential healthcare service especially since there are APRN’s able to supply essential care where they live. Patients cannot see a doctor, and eventually, decide not to look for preventative care driving from place to place. Whereas it would benefit the patients if they allow APRN’s to operate as primary caregivers, this is often not the case in all states. APRN’s will have to follow their individual state’s particular controls; it is important that a professional remain up to date with the NPA overseeing their state’s policy to guarantee they are practicing inside the scope of practice.

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