POLICY AND STATE BOARDS OF NURSING NURS 8100
POLICY AND STATE BOARDS OF NURSING NURS 8100
POLICY AND STATE BOARDS OF NURSING NURS 8100
The Board of Nursing in Miami, Florida, is a regulatory body whose functions include ensuring that nurses are fully qualified to conduct their activities within the state in various ways. The board is mandated to monitor, discipline, educate, license, and rehabilitate nurses. In Miami, nurses are mandated to ensure that they are capable of delivering quality care to all patients in various healthcare environments (Fraser & Melillo, 2018). However, failure to abide by the stated board’s standards results in forfeiting nurses’ licenses and disabling them from practicing within the state.
The Nurse Practice Act enacted by the State’s legislature provides a framework for enhancing safe and professional nursing services and offers nurses with an environment of protection to all patients. Other responsibilities of nurses in Miami under the Florida Board of Nursing include determining the health status of patients concerning risk principles and nursing leadership of patients through the performance of general duties. Based on additional laboratory outcomes of patients, physical evaluation and background, APNs should recognize and determine with the approval of the suitable physician, appropriate types of disease in the context of the specified processes (Kung, & Rudner, 2015). They should also conduct procedures frequently accepted via the established protocols to provide patients with insensitivity to pain during diagnostic, surgical, or obstetric clinical processes (Fraser & Melillo, 2018). These processes include ordering and the delivery of spinal, regional and general anesthesia; inhalation methods and agents; intravenous methods and agents; and methods of hypnosis. Also, Advanced Practice Nurses (APNs) in Miami, Florida, are authorized to sustain life functions all through the anaesthesia healthcare process and to use adequate mechanical support devices (Joel, 2017).
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Moreover, APNs should always be accountable for all patients during practice and identify the appropriate delegation of responsibilities about their obligation to render quality care to all patients (Holly, Salmond &Saimbert, 2016). APNs owe similar duties to self as to others, including the liability to enhance safety and integrity, maintain competence, and to create room for personal and professional growth and development. Advanced Practice Nurses in Miami, Florida are also required to participate in identifying, maintaining and enhancing the healthcare environments as well as conditions of recruiting conducive to the provision of appropriate and quality healthcare services about the values of the profession through collective and individual action (Fraser &Melillo, 2018). Finally, a licensed nurse is required to participate in the advancement of the nursing profession through contribution to education, practice, knowledge development, and administration. As a result, APNs should work cordially with other health specialist and the public in enhancing the national, community, and global attempts to achieve healthcare needs (Kung, & Rudner, 2015).
Although the functions of APNs in Miami, Florida are well updated, I was not aware that APNs have emerged to be a major force in evidence-based practice as a result of their increased knowledge of the relevance and immunology to emerging therapies such as utilization of published standards of care and establishment of rules and procedures common to the current world of nursing practice (Holly, Salmond & Saimbert, 2016). APNs are tasked with the role of being principal investigators in clinical trials through coordination of research efforts, conducting physical assessments as well as ensuring patients adhere to the set health protocols. Additionally, I realized that APNs are patient’s advocates as they are involved in negotiations on behalf of patients with insurance agencies, employers as well as other external agencies (Joel, 2017). As a result, APNs provide patients with situational and emotional support as advocates for nursing and other medical staff. Finally, in Miami, Florida, APNs are mandated to prescribe medications and are also tasked with the role of assessing, diagnosing, evaluating and following-up patients. Therefore, APNs are required to demonstrate a high level of understanding of multiple sclerosis, its course, management, disease treatment and modification as well as conducting diagnostic tests.
References
Fraser, M. A., & Melillo, C. (2018).Expanding the Scope of Practice of APRNs: A Systematic Review of the Cost Analyses Used. Nursing Economics, 36(1), 23-29.
Holly, C., Salmond, S., & Saimbert, M. (Eds.).(2016). Comprehensive Systematic Review for Advanced Practice Nursing.Springer Publishing Company.
Joel, L. A. (2017). Advanced Practice Nursing: Essentials for Role Development.FA Davis.
Kung, Y. M., & Rudner Lugo, N. (2015). Political Advocacy and Practice Barriers: A survey of Florida APRNs. Journal of the American Association of Nurse Practitioners, 27(3), 145-151.
The State Statutes mandate the State boards of nursing to ensure continued safe and competent practice, which results in the regulatory agencies facing many challenges, due to the diversity issues that characterize the nursing practice (Thomas et al., 2010). One of the most recent regulations promulgated through the Texas State Boarding of nursing was, permitting advanced practice registered nurses (APRNs) to complete the medical certification for an adult or fetal death certificate, in accordance with Chapter 193 of the Texas Health and Safety Code (THSC), which was signed into law on June 15, 2021(Stevens & Landes, 2021). The APRNS full practice authority has not been fully embraced in Texas, which results in twenty percent of Texans, lacking access to a primary care provider, with the state being listed as 49th in the country, on access to and affordability of health care (Zhang & Wu, 2021). Recently Rep Stephanie Klick introduced the latest bill HB 2029 which removes antiquated laws, to allow APRNs full practice authority, and hopefully, Texas could soon join the full practice states (Stevens & Landes, 2021).
In my organization, the state regulations are fully supported through the provision of quality care, which is mandated by the federal, state-level regulations, and must be accredited by the Joint Commission to receive Medicare payments and the accreditation requirements. The organizations must also implement and comply with the Centers for Medicare & Medicaid Services (CMS) regulations, to promote care consistency (Hughes& Smith, 2014).
Different states differ in their scope of practice regulations, and currently, there are twenty-three states, which have granted APRNs full practice authority and can perform, the same tasks as physicians. The other states have either limitations or ultimate denial, like my home state Texas, which continues with the imposed restrictions of a physician’s supervision or collaboration. (Altman et al., 2016). This variation of the scope of practice across states has a significant impact on patient care delivery because the APRNs are subjected to different scope-of-practice (SOP) restrictions, based on the state in which they work which dictates the extent to which they can practice or prescribe They cannot, therefore, provide the same consistent level of care or independent chronic disease management, independent of a supervisory contract with a physician collaborator, the degree of physician supervision also affects the practice opportunities, and the payer policies for NPs scope of practice regulations, hinder access to primary care treatment, which results in the continued suffering of the vulnerable populations and the minorities (Hain & Fleck, 2014).
References
Altman, S. H., Butler, A. S., & Shern, L, (2016). Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington (DC): National Academies Press (US); 22. 2, Removing Barriers to Practice and Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK350160/
Buck J. (2011). Policy and the Re-Formation of Hospice: Lessons from the Past for the Future of Palliative Care. Journal of hospice and palliative nursing: JHPN: the official journal of the Hospice and Palliative Nurses Association, 13(6),
Hain, D., Fleck, L. (2014). Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript
Hughes, M. T. & Smith, T. J. (2014). The Growth of Palliative Care in the United States
Annual Review of Public Health Vol. 35:459-475 (Volume publication date March 2014)https://doi.org/10.1146/annurev-publhealth-032013-182406
Stevens, J. D., & Landes, S. D. (2021). Assessing state-level variation in signature authority and cause of death accuracy, 2005-2017. Preventive medicine reports, 21, 101309. https://doi.org/10.1016/j.pmedr.2020.101309
Thomas, M. B., Benbow, D.A., & Ayars, V. D. (2010). Continued competency and board regulation: one state expands options. J Contin Educ Nurs.11):524-8. doi: 10.3928/00220124-20100701-04. Epub 2010 Jul 8. PMID: 20672758.
Zhang, J., & Wu, X. (2021). Predict Health Care Accessibility for Texas Medicaid Gap. Healthcare (Basel, Switzerland), 9(9), 1214. https://doi.org/10.3390/h
Within the far-reaching and multi-layered realm of policy and reform, government at the state level plays an essential role. Consider the federally enacted PPACA’s individual mandate which sought to increase the number of consumers who receive insurance coverage and, therefore, greater access to care. In a system that is already stretched beyond capacity and confronting a nursing shortage, how can the health care system meet this increased demand? Since state boards of nursing determine scope of practice, it is important to stay up to date and current with the policies and regulations that are created by the state board of nursing.
To prepare:
Review the Thomas, Benbow, and Ayars article and the Watson and Hillman article focusing on how states regulate advanced nursing practice and how legislative changes are impacting scope of practice.
Visit your state board of nursing website and/or contact the board to determine how the state board controls advanced practice through regulations.
Determine if your state board has created any new policies or regulations that address changes to scope of practice in response to legislative changes.
By Day 3
Post a cohesive response that addresses the following:
What are the most recent regulations promulgated through your state board of nursing for advanced practice?
How are the state regulations supported within your place of employment?
How do the states differ in terms of scope of practice? What impact does this have on professional nurses across the United States?
Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues selecting someone from a different state and comparing your state’s scope of practice with your colleague’s. Share any insights and implications for practice.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
Week 9 Discussion: Policy and State Boards of Nursing
The Illinois state board of nursing has made several amendments to advanced nursing practice regulations. The board created a pathway for APRNs working in hospitals, hospital-affiliated settings, and ambulatory surgery centers to offer most advanced practice nursing care with no career-long collaborative agreement (Illinois General Assembly, n.d.). A written collaborative agreement is needed for all APRNs engaged in clinical practice, except those privileged to practice in a hospital, hospital affiliate, or ambulatory surgical treatment center. However, if an APRN engages in clinical practice outside of a hospital, hospital affiliate, or ambulatory surgical treatment center must have a written collaborative agreement (Illinois General Assembly, n.d.). Besides, APRNs must have an ongoing relationship with a physician to prescribe benzodiazepines and some other scheduled agents.
The state regulations are supported in my current place of employment since the organization’s leadership allows APRNs to practice within their full scope of education without a collaborative agreement with a physician. APRNs in our organization are authorized to: conduct patient assessment; diagnose; order, perform, and interpret diagnostic tests; order treatments; provide palliative and end-of-life care; provide advanced counseling, patient education, and patient advocacy.
The scope of APRN practice differs across various states in the US. Various states grant APRNs Full practice authority, while others have Reduced and Restricted practice. States with Full practice allow APRNs to practice within their full scope of education (Peterson, 2018). APRNs with Reduced practice are required to have a collaborative agreement with a physician to engage in the elements of APRN practice. Besides, states with restricted practice need supervision and delegation to practice. The APRN scope of practice disparity negatively affects APRN professional practice since APRNs in some states are not allowed to practice as their counterparts in other states. Patients in states with Full practice have more access to healthcare since APRNs act as primary care providers (Ortiz et al., 2018).
References
Illinois General Assembly. (n.d.). Nurse Practice Act. https://ilga.gov/legislation/ilcs/ilcs4
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of Nurse Practitioner Practice Regulations on Rural Population Health Outcomes. Healthcare (Basel, Switzerland), 6(2), 65. https://doi.org/10.3390/healthcare6020065
Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.
For many years, as advanced as the State of Massachusetts was on many fronts, the profession of nursing was not one of them. Up until January 6, 2021, ARNP’s we had be given temporary (full) practice authority due to the Covid Pandemic. When signed in January 2021, we were the last New England State to give ARNP’s full practice authority, and the 23rd State to pass this regulation across the United States (Health Leaders, 2021).
The Health System I work for is woefully behind adjusting policies and procedures to reflect this new amendment to ARNP’s practice authority within the state. We have a significant need for primary care providers within the Commonwealth and with this change, ARNP’s can practice independently and as primary care providers with their own panel of patients (AANP, 2021, Mass.gov, 2021). Up until a few months ago, I had to have the physician I work with listed as my supervising provider. Other policies came to question as they were completely unnecessary. According to the medical groups administrative leadership, primary care panels by APRN’s is in the works, but likely won’t occur system wide for 18-24 months (Personal Communication, April 24, 2022).
There is significant variability across the United States regarding practice Authority. According to AANP (2021), 29* states (*including Guam, Northern Marina Islands and Washington, DC) have full practice authority, 16* states (*including American Samoa, Puerto Rico and US Virgin Islands) have reduced practice authority and 11 have restricted practice authority (Nurse Journal, 2022. Full practice authority is defined as an NP practicing to the full scope of licensure without a supervising physician. Reduced practice authority means NP’s can perform parts of their scope independently and parts with supervision. Rarely does this include diagnostic testing and diagnosis and treatment but more often medication oversight. Restricted practice authority states require NP’s to work solely under the supervision of a physician (AANP, 2021, Nurse Journal, 2022).
Professional nurses, regardless of area of practice, have demonstrated competencies to be able to practice in a full scope capacity without supervision. By minimizing scope across the United States, we are ultimately denying access to healthcare by a qualified provider (AANP, 2021). Most advanced practice nurses, especially if they have Doctorate level education, have more years of school and clinical than that of their physician colleagues (Nurse Journal, 2022). Lack of recognition and utilization of our extensive capabilities, may undermine the professions’ ability for growth and respect.
Julie
References
American Academy of Nurse Practitioners (AANP). (2021). Information and resources for Massachusetts NPs. https://www.aanp.org/advocacy/massachusetts
Health Leaders (2021). Massachusetts is the 23rd state to allow NPs to practice independently. https://www.healthleadersmedia.com/nursing/nurse-practitioners-massachusetts-granted-full-practice-authority
Mass.gov. (2022). 244 CMR 4.00: Advanced practice registered nursing. https://www.mass.gov/doc/244-cmr-4-advanced-practice-registered-nursing/download
Nurse Journal. (2022). Nurse practitioner practice authority: A state-by-state guide. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/
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