Professional Nursing and State-Level Regulations
The state and regional boards of nursing have the mission to give protection to the public through the regulation of the nursing practice. These boards do so by setting up standards for safe nursing care as well as giving licenses to people who want to practice nursing. The major mission of the state boards is to ensure that the nursing practice is safe and clinically skilled. They also target to provide a tool for evaluation of nurses by themselves to promote proficiency in the clinical sector (Mee, 2017).
There is an APRN board of nursing regulations in my state (Virginia) which show comparison with those of the neighboring state in the roles they play in their respective states. In my state, there is the Certified Nurse Practitioner which plays significant roles in being held responsible and accountable for health promotion as well as preventing diseases (Bowblis & Lucas, 2017). Another APRN is the Clinical Nurse Specialist which covers the patient, nurse, and nursing practice as well as treating diseases in the state, managing the diseases and finally preventing them.
Texas is known to have an APRN board of nursing regulations that plays the same role as that of my state, which is promoting the health of all citizens. Texas also has its Certified Nurse Practitioner which is, however, more advanced and strict (Bowblis & Lucas, 2017). When it comes to the certification of a nurse in Texas, it has to align with education. The APRN board in Texas requires a midwife to seek certification form the Midwifery Board of Certification in America. The specific exam that is used by the American Midwifery Certification Board should ensure that one qualifies to be a midwife prior to certification. This is opposed to Virginia where the state has been given the mandate to offer all practitioner exams through the Certified Nurse Practitioner, including midwifery exams (Scholes, 2018). The Clinical Nurse Specialist regulation in Texas ensures that the nurses are vetted and assessed to ensure that they are efficient in their areas of specialization. The rules in Virginia requiring specialization among the nurses are stricter than those in Texas. The government of Texas has established a shorter process of nursing specialization as compared to Virginia. One has to download the specialization forms from the official website of the Texas government (Scholes, 2018). In Virginia, a nurse willing to specialize in a given field has to undertake a training course and then attain accreditation after completion. Moreover, in Virginia, the nurses ought to attend a center of medicine to be a competent nurse but in Texas, a nurse can just attend a nursing school and get recognized as a reliable nurse. My neighboring state Alaska allows NP Full Practice Authority while my state does not.
The selected regulations can apply to APRNs who have the legal authority to practice within the full scope of their education and experience in various ways. First, they ensure that APRNs are keen while handling patients thus ought to be competent in nursing care. Secondly, they build their self-esteem and self-confidence among APRNs as they understand that they are already qualified. Third, the regulations influence the APRNs to outperform in their areas of work so as to achieve a desirable level of performance. The APRNs get accountable for their actions and decisions made while handling their patients. Besides, the regulations influence the APRNs to tirelessly enlarge their knowledge through increased experience, continuing with education as well as getting the updates on the latest guidelines in the healthcare industry (Bowblis & Lucas, 2017).
APRNs may adhere to the two regulations selected in various ways. The set regulations for nursing practice are used as a comparison tool to evaluate the care offered by nurses if the employer notices that the employer goes against the state and regional laws with regard to the healthcare industry. First, APRNs are supposed to identify areas that greatly require improvement in the clinical sector. Additionally, the regulation of nursing practice promotes trust and respect from the patients and the community at large due to the quality services offered in the healthcare sector. Finally, APRNs are supposed to be responsible for all their decisions and actions while handling patients (Mee, 2017).
You discuss that there is an APRN board of nursing regulations in your state of Virginia. You identify that Texas also has APRN board of nursing regulations with the same role as Virginia related to promoting the health of all citizens. Are there regulations that you think should be changed and if so, which regulations? With the ongoing changes taking place in health care, what strategy will be most helpful to ensure that nurses keep up-to-date with changes as reflected in renewal regulations?
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Advanced Practice Registered Nurses (APRNs) are in a unique position to assist in the Primary Care Physician (PCP) shortage the country is experiencing. According to Frasier and Melillo (2018), an APRN is capable of approximately 90% of the medical care provided by a PCP. Studies show that by 2025 there will be nearly 250,000 Nurse Practitioners providing quality care to the American population (Neff, et al., 2018). APRNs will be in a position to alleviate the strain the public feels with the physician shortage, but there are some restrictions to the APRN scope of practice.
Although APRNs are trained to provide most of the care provided by a PCP, APRNs do not necessarily have the authority to provide that care. Many state laws require that services provided by Nurse Practitioners be supervised by physicians (Frasier, Melillo, 2018). In the state of Missouri, an APRN may be delegated the authority to prescribe Schedule III, IV, and V controlled substances in collaboration with a PCP and for purposes other than sedation or anesthesia (Missouri Scope of Practice Policy, 2019). APRNs in California are allowed to prescribe Schedule II and III medications according to a protocol that is patient specific and set by a PCP (California Scope of Practice, 2019). So different states have slightly different regulations governing the prescribing of controlled substances by Nurse Practitioners.
Along with differences in prescribing authority, many states have slightly different education requirements for APRNs as well. An APRN in Missouri is required to have a degree from an accredited university concentrating on advanced practice nursing in a clinical specialty area including theory and clinical practice and a minimum of 500 hours of faculty supervised clinical experience (MO Scope, 2019). In California APRNs are required to hold an RN license, a master’s or graduate degree in nursing or a clinical field related to nursing, and completion of a board approved NP program (CA Scope, 2019). Each state has a slightly different process for preparing APRNs for practice.
Regulations for APRN practice in Missouri and California are broad in nature. According to the Texas Board of Nursing Bulletin (2018), regulations governing the practice of APRNs are written broadly in order to apply to all nurses in all settings and don’t necessarily address specific settings or issues. This is so the practice scope can be determined in a way that best meets the needs of patients in each care setting (2018). The state regulations are there to guide APRN practice and allow for individual needs or patients in a variety of health care settings.
For the purpose of this discussion, I have chosen to compare two APRN regulations specified for the state of Texas. It is important to be aware of the state regulations as the National Coalition of State Boards of Nursing notes that the ability of APRNs to practice to the full extent of their education and training is inextricably tied to the state-level scope of practice, laws and regulations (Bosse, Simmonds, et. al., 2017).
In Texas, APRNs are required to submit a request for prescriptive authority to be granted the privilege of writing prescriptions. APRNs in Texas are responsible for maintaining an active license with prescriptive authority, a valid controlled substance registration from the Department of Public Safety, a physician delegation that is registered with the Texas Medical Board and a valid Federal Drug Enforcement registration (Watson,n.d.). In comparison, Oklahoma regulations prohibit APRNs from prescribing Schedule II narcotics (FDA upscheduling of hydrocodone disadvantageous to APRNs, 2018).
Prescriptive authority is vital to APRNs as it supports full practice authority. As previously stated, an APRN would need to ensure that this designation is registered with the appropriate bodies so it is not a task that would act as a barrier to APRNs performing at full scope of their practice. In those states where APRNs have been granted this ability, fewer prescriptions for drugs commonly linked to overdose deaths has been reported (Bosse, Simmonds, et.al., 2017).
Licensure is another element of APRN regulations. In both Texas and Oklahoma, various applications must be completed to the appropriate board for review. APRNs in Texas will be allowed to receive a temporary permit that lasts for a period of six months and cannot be extended. Oklahoma has a similar regulation, but their policy / guideline does not specify for a time period for which the permit will be enforced. The requirements and criteria for licensing examine all aspects of an APRNs education, training, and national certification so it supports full practice authority for APRNs as well.
With respect to licensure, APRNs in Texas must start the renewal process a year before their licensure expires and present continuing education hours with a portion of the hours allocated to pharmacotherapeutics and their specialty.
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