Professional Nursing and State-Level Regulations

RE: Discussion – Week 5 -Initial Post

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An Advanced Practice Registered Nurse (APRN) board of nursing is a fundamental part of the healthcare organizations and the delivery of healthcare services. Across the 50 board of nursing, regulations and scope of nursing practice varies in each state from full independent nursing practice to reduced nursing practice or restrictive practices (AANP, n.d).

 In this discussion I will be focusing on the New York State and Virginia State Board of Nursing. In Virginia, an APRN with a current unrestricted license, may qualify for autonomous practice by completion of the equivalent of five years of full-time clinical experience as a nurse practitioner. Five years of full-time clinical experience or 1,800 hours per year for a total of 9,000 hours. Clinical experience is considered as the postgraduate delivery of health care directly to patients pursuant to a practice agreement with a patient care team physician (Department of Health Professions, n.d.)

If one is deemed to be qualified to practice autonomically, authorization to practice is then determined upon submission of a fee and an attestation acceptable to the boards. The attestation shall be signed by the nurse practitioner and the nurse practitioner’s patient care team physician stating that he/she served as a patient care team physician with the nurse (Department of Health Professions, n.d.)

In comparison, the New York State Education Law does not require a physician to supervise an NP or to co-sign any of the NP’s orders, records or charts (NYSED, n.d.).  New York Law holds NPs independently responsible for the diagnosis and treatment of their patients. An NP is not legally allowed to perform any nursing service that the NP is not personally competent to perform. However, each nurse practitioner (NP) must enter into a written collaborative agreement with a physician to practice (NYSED, n.d.). This is in accordance with written practice protocols outlining The NP’s responsibilities. In addition, a newly certified NP’s must have a written collaborative agreement and protocol with a physician to diagnose illnesses and physical conditions and perform therapeutic and corrective measures within a specialty area of practice. Also, under New York State Education Department (NYSED) Laws a physician is not required to supervise an NP’s or co-sign any of the NP’s orders, records or charts Professional Nursing and State-Level Regulations.

APRNs may adhere to the regulations stipulated by the board of nursing by only practicing within their scope of APRNs clinical and professional training and limits of the nurse practitioner’s knowledge and experience and consistent with the applicable standards of care. In addition, the APRN should Consult and collaborate with other health care providers based on the clinical conditions of the patient to whom health care is provided. Lastly, the APRN can establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers (Department of Health Professions, n.d.)

References:

American Association of Nurse Practitioners. (2018). https://www.aanp.org/advocacy/state/state-practice-environment

Department of Health Professions. (n.d.). REGULATIONS GOVERNING THE LICENSURE OF NURSE PRACTITIONERS. https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePractitioners72220.pdf

NYSED. (n.d.). NYS Nursing:Practice Information:Collaborative Practice with Physicians. Retrieved from http://www.op.nysed.gov/prof/nurse/npcollab.htm Professional Nursing and State-Level Regulations

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5 months ago

Andrea Cholagh 

RE: Discussion – Week 5 -Initial Post

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Hi Roseline, great post!

   A APRNs role varies from state to state, and it is a nurses legal and professional responsibility to understand their legal scope of practice where they practice and follow it (Milstead & Short, 2019).  According to your post, the New York State Education Law does not require a physician to supervise an NP and holds them independently responsible for the diagnosis and treatment of their patients (NYSED, n.d.). Professional Nursing and State-Level Regulations I live in Ontario; Canada and our regulatory body called the College of Nurses of Ontario (CNO) states the same regulations and scope of practice of an NP (CNO, n.d.).  I found it interesting that the Virginia State Board of Nursing requires clinical hours before opening their independent practice (Department of Health Professions, n.d.).  I don’t disagree with these requirements, I do think that with more experience, you gain more knowledge and competence for autonomy.  How do you feel about mandatory clinical hours before being granted full autonomy of practice as an APRN?

References

College of Nurses of Ontario (CNO). (2021). Nurse Practitioner. Practice Standard. https://www.cno.org/globalassets/docs/prac/41038_strdrnec.pdf

Department of Health Professions. (n.d.). Regulations governing the licensure of nurse practitioners.https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePractitioners72220.pdf

Milstead, J.A., & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed., pp. 54). Burlington, MA: Jones & Bartlett Learning.

NYSED. (n.d.). Nys nursing: Practice information: Collaborative practice with physicians. http://www.op.nysed.gov/prof/nurse/npcollab.htm

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5 months ago

Faith Momodu 

RE: Discussion – Week 5-Response 2

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Hello Roseline,

“Depending on legal and practicing rights, APNs may practice independently or collaboratively with physician” ((Soh et al., 2021, p. 542) Learning about the scope of practice for New York and Virginia was helpful with your post. I like that Virginia gives a path to working autonomously after five years. An NP can work under a physician to learn as much as they can before branching out on their own. I think this gives them and the patients confidence in their care. “Advanced clinical practice is delivered by experienced, registered health and care practitioners. It is a level of practice characterized by a high degree of autonomy and complex decision making” (Wood, 2021, p.282)

Soh, B. F., Ang, W. H., De Roza, J. G., Quek, I. P., Lim, P. S., & Lau, Y. (2021). They are partners in care: A qualitative exploration of physicians’ perceptions of primary care advanced practice nurses. Journal of Nursing Scholarship, 53(5), 542–551. https://doi.org/10.1111/jnu.12665

Wood, C. (n.d.). Leadership and management for nurses working at an … Retrieved October 2, 2021, from https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2021.30.5.282.

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5 months ago

Ahou Karelle Koffi 

RE: Discussion – Week 5 -Initial Post

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Professional Nursing and State-Level Regulations Hi Roseline, I agree with you that every state and its board of nursing vary in the scope of practices from other boards. Every state is fully independent when it comes to nursing practices. For instance, in Virginia State, an APRN with unrestricted license is very different from New York. They can qualify for autonomous practices through undergoing years of clinical experience (Department of Health Professions, n.d.). I also agree with you that if anyone feels to have qualified for the practice, they are required to submit acceptable attestation and specific fees to the board. I like how you have elaborated on the specifications for the attestations that must be signed by the nurse practitioner and the patient’s care team. Concerning the New York board, I agree with you that, unlike the Virginia state, New York laws are very different in that no physician is required to supervise any nurse practitioner. The board indeed acknowledges nurse practitioners as independent and responsible for the diagnosis and treatment of patients (NYSED, n.d.). In both states, nurses’ boards must adhere to the regulations laid down by their respective boards. I would like to add that all nurse practitioners are expected to stick within their practicing scope as required to provide standard and quality care.

References

Department of Health Professions. (n.d.). REGULATIONS GOVERNING THE LICENSURE           OF NURSE PRACTITIONERS.                   https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePractitioners72220.p     df

NYSED. (n.d.). NYS Nursing: Practice Information: Collaborative Practice with Physicians.                  Retrieved from http://www.op.nysed.gov/prof/nurse/npcollab.htm

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5 months ago

Scott Lamprecht 

RE: Discussion – Week 5 -Initial Post

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It would be great to have a Standard Scope but the AMA is very powerful and its all about the money and authority.

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5 months ago

Betsy Koplin 

RE: Discussion – Week 5

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The two state nursing boards I researched is Maine and New Hampshire. I currently live in Maine but work in New Hampshire (NH). I still hold a NH nursing license because I lived in NH up until a year ago. I am in the process of switching it over to Maine. It is important that I understand nursing regulations and scope for both state licenses because I could end up working in either Maine or New Hampshire once I obtain my nurse practitioner license. The idea behind licensing and regulations is based on two different variables: the first is the potential of the professional to conduct harm if safe standards are not met, and the second is the degree of autonomy and accountability for the individual’s decision making (Milstead & Short, 2019). Professional Nursing and State-Level Regulations Understanding this helps when researching licensing requirements and regulatory agencies.

A regulation in Maine that does not exist in New Hampshire is the requirement of an Advanced Practice Registered Nurse (APRN) to practice for the first 24 months under the supervision of a licensed physician. The APRN is required to apply to the Board of Nursing to register this supervisory relationship (NCSBN, n.d.). In New Hampshire, APRN’s are free to practice independently, free of any supervision. This is an important difference that tends to vary state to state, so an APRN must be mindful of this and adhere to these guidelines to have a license in good standing. Having this knowledge and finding an organization that is willing to provide a supervising physician is the best way to ensure this is followed.

Another difference between Maine and New Hampshire is the continuing education requirements. In New Hampshire, it is required 30 hours of continuing education every 2 years, 20 of those hours must be dedicated to the specific specialty the license is held, and 5 hours must be related to pharmacology. In Maine, 50 hours is required every 2 years and only 3 hours must be dedicated to prescribing opioids (American Nurses Association, n.d.). This is critical in keeping a good standing license. Having memberships to different official nursing organizations can help with networking and finding the right continuing education courses for the specialty needed.

References:

American Nurses Association. (n.d.) ANA enterprise. Retrieved September 29, 2021, from www.nursing world.org.

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

National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved September 29, 2021, from https://www.maine.gov/boardofnursing/laws-rules/index.html.

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5 months ago

Cyrin Natividad 

RE: Discussion – Week 5

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Hi Betsy, 

Your post is very interesting! I did my research and found out that the state of New Hampshire provides that nurse practitioners can assess, diagnose, prescribe, select, administer, and provide therapeutic measures and treatment protocols independently. In addition, After graduating from an NP program, nurse practitioners can apply for a temporary license to practice in New Hampshire before taking the national certification exam (Thrive AP, 2014). Although nurse practitioners are not physicians by definition, they undergo rigorous training and credentialing while focusing on whole-person health (NP School, 2021). It’s fascinating that in New Hampshire, NPs can work independently, just like physicians.  

Wishing you luck Betsy!  

References: 

Nurse Practitioner Schools, 2021. Nurse Practitioner vs Doctor (Physician).https://www.nursepractitionerschools.com/resources/np-vs-doctor/ 

Thrive AP, 2014.  Nurse Practitioner Scope of Practice: New Hampshire.https://thriveap.com/blog/nurse-practitioner-scope-practice-new-hampshire#:~:text=Nurse%20practitioners%20in%20New%20Hampshire,measures%20and%20treatment%20regimens%20independently 

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5 months ago

Scott Lamprecht 

RE: Discussion – Week 5

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Maine sure is a lot more stringent. Why do you think that is?

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5 months ago

Betsy Koplin 

RE: Discussion – Week 5

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Hi Cyrin,

Thank you for the reply! I found it interesting the autonomy that nurse practitioners have in New Hampshire too. I will likely end up working in New Hampshire, rather than Maine, even though I live in Maine. I am right over the boarder and have been at this hospital for the last 8 years so I hope to continue with the organization! Thanks again!

Betsy

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5 months ago

Sophie Enjema Ndumbe 

RE: Discussion – Week 5

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Hello Besty,

 Great post, it is good for us to know the nursing regulations in each state so that when we plan on moving to another state, things will not be difficult for us. Some states do not allow Advanced practice registered nurses to practice independently. I like the nursing regulation in Maine which allows the APRN to practice under the supervision of a physician for 24 months before becoming independent. This is good because the APRN will learn more form the physician, will gain more skills, knowledge, become more confident working with patients. Poghosyan et al. (2020) States “more than 90% of NPs and physicians reported that NPs and physicians practice as a team” (p.1024). The nurse’s practitioner must always practice within their scope of practice, they need to follow the rules and regulations for each state before practicing Professional Nursing and State-Level Regulations.

In North Dakota The APRN has full practice authority they can practice independently, they do assessment, treatment, diagnose, interpret labs, and prescribe medications to patient (American Association of Nurse Practitioners, 2021). This is a good experience  for many new nurse practitioners, even though the beginning is always tough, it gets much better.

References

American Association of nurse Practitioners (2021) state practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

Poghosyan, L., Ghaffari, A., Liu, J., & Friedberg, M. W. (2020). Physician-Nurse Practitioner Teamwork in Primary Care Practices in New York: A Cross-Sectional Survey. JGIM: Journal of General Internal Medicine, 35(4), 1021–1028. https://doi-org /10.1007/s11606-019-05509-2

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5 months ago

Betsy Koplin 

RE: Discussion – Week 5

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Hi Sophie,

Thank you for the reply. I too don’t mind the regulation in Maine that requires 24 months of physician supervision. I like that once that time is up you are able to practice independently. It is reassuring to know that as a new nurse practitioner, a physician is available as a mentor if needed and it gives time to ensure you are comfortable with the scope of practice, prescribing procedures, etc.

-Betsy

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5 months ago

Sophie Enjema Ndumbe 

RE: Discussion – Week 5

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Arizona APRN Board Regulation

In Arizona Advanced practice registered nurses  does not have to work under the supervision of a physician, they work independently and are responsible for all their actions. However, they must practice within their standards and scope of practice. According to the American Association of Nurse Practitioners (2021) States which have full authority to practice, Nurse practitioners diagnose medical conditions, manage illness, evaluate patient’s conditions, prescribed medications and interpret labs.  Arizona is one of the states where Advanced practice registered nurses have full practice authority and are independent.  The APRN has the right to prescribe pharmacological and non-pharmacological therapies for patients when needed (National council for state board of Nursing, 2021). In Arizona Nurse practitioners have prescriptive authority since they work independently. They are allowed to prescribe medications to patients without having any issues or limitations.

Texas APRN Board Regulation

In Texas Advance Practice registered nurses have a restricted practice, they are supposed to be supervised by a physician before they can provide care to a patient.  All Nurse practitioners in Texas according to their state board of nursing and regulations must be under the supervision of a  physician (American Association of Nurse practitioners, 2021). The APRN in Texas are allowed to prescribe medications only under the supervision and authority of their supervisor who must be a physician (Texas Board of Nursing, 2021).

When an APRN has the full authorization to practice, she /he learns, develops more skills and knowledge. The APRN uses the skills gained throughout school to work well with patients of different backgrounds. Even though they have full authority to practice they can still ask questions to physicians if they have challenges.   Summers (2010) Professional Nursing and State-Level Regulations. States “APRN professional societies have developed role-specific standards of practice and core competencies for the APRN in nursing community” (p.9). They APRN must adhere to the rules and regulation within their practice, if not, they will have issues with their license in the state where they practice. So going to a state to practice, the APRN must check the regulations of the state board of nursing before applying for a job. If you are not authorized to prescribe medications and you prescribe it then it means you are not working within the scope and standard of practice.

                                        References

American Association of nurse practitioner (2021). State practice environment https://www.aanp.org/advocacy/state/state-practice-environment

National council State Board of Nursing (2021). APRN consensus implementation status

https://www.ncsbn.org/5397.htm

Summers, L. (2010). APRN Focus. Scope of practice. American Nurse, 42(4), 9.

Texas Board of Nursing (2021). Practice -Advanced practice information

https://www.bon.texas.gov/practice_nursing_practice_aprninfo.asp

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5 months ago

Shanaa Wheeler-Yard 

RE: Discussion – Week 5

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Nurse practitioners (NP)have a major role in providing health care services in a variety of health care settings (Hain, Fleck, May 31, 2014). The scope of which nurse practitioners practice varies from state to state. As all clinicians NP’s desire to practice at full scope. It is of great importance for NP’s to understand practice policies for the state in which they practice.  Comparing Advance Practice Nurse Practitioners independent practice polices and malpractice insurance requirements by state provided insight on state practice similarities and differences. Understanding state practice polices is priority for practicing practitioners.

Malpractice insurance is required for practicing providers and practitioners. Insurance requirements vary from state to state. It is the responsibility of the practicing practitioner to be informed and compliant with their practicing states malpractice insurance requirements (Malpractice, 2007).  Practitioners may be covered under the malpractice policy of the facility which they are employed.  Comparing malpractice insurance policy requirements provided valuable insight.

PA

Practice Laws

Collaborative agreements with Physicians every two years

Malpractice Insurance

CRNP – Act 48 of 2007 requires CRNPs to maintain professional liability insurance in order maintain the CRNP designation. CNS – Act 49 of 2007 requires the CNS to maintain professional liability insurance in order to maintain the CNS designation. The laws require that CRNPs and CNSs maintain professional liability insurance coverage at a level required of nonparticipating health care providers under the MCARE Act (Act 13 of 2002), which is currently $1 million per occurrence and $3 million in annual aggregate. Some confusion has arisen as to whether this insurance must be obtained by an individual or whether CRNPs and CNSs may continue to be covered under their employer’s policy, under a group policy, or other shared risk policy. It has come to the attention of the Board that some CRNPs and CNSs have been led to believe that they must obtain individual insurance policies in their own name and that their participation in group policies will be terminated. The Board has determined that a CRNP or CNS whose employer maintains insurance coverage covering CRNPs and CNSs as employees, officers, or agents, or who are covered under or participating in group insurance programs are in compliance with Acts 48 and 49 professional liability insurance requirements and do not require individual policies or individual limits on a group policy Professional Nursing and State-Level Regulations.

TX

 Practice Laws

NP’s may practice independently however prescription must be obtained from physicians

APRN’s with prescription authority must have a physician’s agreement

Malpractice Insurance

Texas does not require providers or nurse practitioners to carry malpractice insurance however, facilities in the state of Texas have individual provider/practitioner malpractice insurance requirements.

FL

Practice Laws

 NPs require supervision of physician or surgeon.

Malpractice Insurance

NP’s must also provide proof of malpractice insurance or provide proof of exemption.

References

Hain, D., Fleck, L., (May 31, 2014) “Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign” OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 2.

Malpractice Insurance: What You Need to Know. (2007). Journal of oncology practice, 3(5), 274–277. https://doi.org/10.1200/JOP.0756501

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5 months ago

Orsela Younano 

RE: Discussion – Week 5

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Interesting post, Shanaa!  It compelled me to also take another look at the liability/malpractice laws of the two states I had chosen.  I currently reside in California; however, I also enjoy visiting Boston, MA and so I was curious about their APRN regulations.  In regards to malpractice insurance, it seems both CA and MA are very similar even though they are vastly different in terms of the practice they permit for an APRN.  Both MA and CA have a minimum required liability limit of $100,000 per occurrence and yearly aggregate of $300,000 per policy period (Nurse practitioner application information 2021).

References

DHCS. (2021). Nurse practitioner application information. Nurse Practitioner Application Information. Retrieved October 2, 2021, from https://www.dhcs.ca.gov/provgovpart/Pages/NursePractitionerApplicationInformation.aspx.

Gallagher . (2021). Massachusetts Medical Malpractice Insurance. Massachusetts Medical Malpractice Insurance | Free Quote. Retrieved October 2, 2021, from https://www.gallaghermalpractice.com/state-resources/massachusetts-medical-malpractice-insurance/.

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