Discussion: Policy and State Boards of Nursing NURS 8100
Discussion: Policy and State Boards of Nursing NURS 8100
Discussion: Policy and State Boards of Nursing NURS 8100
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).
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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.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 9 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 9 Discussion
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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
Chen, A. S., & Weir, M. (2009). The long shadow of the past: Risk pooling and the
political development of health care reform in the States. Journal of Health Politics,
Policy & Law, 34(5), 679–716.
Note: You will access this article from the Walden Library databases.
The authors provide an analysis of varying state health care policies, with a basic
premise that health care risk is either “pooled”—shared, or “actuarial”—segmented by
risk level. Most states have taken a segmented approach to health care, and therefore,
have not solved health care issues such as rising costs and access to care. The authors
maintain that federal action is needed to create a uniformed approach to health care.
Junghee, L. (2009). Cultural, social, and political influences on state-level indigent
health care policy formation. Journal of Policy Practice, 8(2), 129–146.
Note: You will access this article from the Walden Library databases.
This article provides details on a 50-state study of Medicaid spending. The authors
concluded that political and economic factors can positively predict individual state
Medicaid spending, and that actual need has a negative impact on spending. In
conclusion, a uniform, federal structure may be the only method to ensure equal access
to Medicaid.
Mills, A., Engelhard, C. L., & Tereskerz, P. M. (2010). Truth and
consequences—Insurance-premium rate regulation and the ACA. New England Journal
of Medicine 363(10), 899–901.
Note: You will access this article from the Walden Library databases.
O’Connor, J. C., MacNeil, A., Chriqui, J. F., Tynan, M., Bates, H., & Eidson, S. K.
(2008). Preemption of local smoke-free air ordinances: The implications of judicial
opinions for meeting national health objectives. Journal of Law, Medicine & Ethics,
36(2), 403– 412.
Note: You will access this article from the Walden Library databases.
Sommers, B. (2010). Enrolling eligible children in Medicaid and CHIP: A research
update. Health Affairs, 29(7), 1350.
Note: You will access this article from the Walden Library databases.
The enrollment and retention of eligible children in Medicaid and Children's Health
Insurance Program (CHIP) is a health care concern. The article concludes that some
state processes have mitigated this issue but other requirements, such as providing
citizenship documentation, may have a detrimental effect. Therefore, these concerns
should be incorporated into the implementation on PPACA of 2010.
Thomas, M. B., Benbow, D. A., & Ayars, V. D. (2010). Continued competency and
board regulation: One state expands options. Journal of Continuing Education in
Nursing, 41(11), 524-528.
Note: You will access this article from the Walden Library databases.
The authors use the changes instituted by the state of Texas in regard to the licensing
of nurses to illustrate the need to adapt state licensing requirements to the changing
diversity and scopes of practice among nurses.
Watson, E., & Hillman, H. (2010). Advanced practice registered nursing: Licensure,
education, scope of practice, and liability issues. Journal of Legal Nurse Consulting,
21(3), 25–29.
Note: You will access this article from the Walden Library databases.
The expanded role of the advanced practice nurse has led to changes in licensure,
education, certification, and scope of practice definitions. The author points out that this
expanded role has led to increased liability and accountability concerns as well.
Yue, L., Harrington, C., Spector, W. D., & Mukamel, D. B. (2010). State regulatory
enforcement and nursing home termination from the Medicare and Medicaid
programs. Health Services Research, 45(6p1), 1796-1814. doi:10.1111/j.1475-
6773.2010.01164.x
Note: You will access this article from the Walden Library databases.
Those nursing homes receiving Medicare and Medicaid funding are subject to strict
quality and safety regulations. This article examines the consequences of enforcing
those federal quality standards.
Optional Resources
Wieck, K. L., Oehler, T., Green, A., & Jordan, C. (2004). Safe nurse staffing: A win-win
collaboration model for influencing health policy. Nursing Education Perspectives, 31(3),
160-166.
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.
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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