NURS Week 5 Discussion

Professional Nursing and State-Level Regulations NRSE 6050

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.

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.

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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.

By Day 3 of Week 5

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. Professional Nursing and State-Level Regulations NRSE 6050

READINGS

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)

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.

https://class.waldenu.edu/bbcswebdav/institution/USW1/202050_27/MS_NURS/NURS_6050/artifacts/USW1_NURS_6050_Halm_2018.pdf

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.

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Professional Nursing and State-Level Regulations NRSE 6050 SAMPLE

Different states tend to have unique regulations for the Advance Practice Registered Nurse but all aims at securing the interest of the public health safety by regulating the activities of the health care professionals (Milstead, 2019). The board of nursing of a state acts on the power derived from the Nurse Practice Act passage that allows them to set and regulate standard for safe nursing practice within its jurisdiction for nurses that have the qualification and for advanced practice including licensure requirements and license renewal as well as any necessary disciplinary actions (Milstead, 2019).

Comparing the State of Georgia, my home state APRN board of nursing regulation to that of the State of Nebraska; the first thing I noticed is that Georgia state regulatory body is the board of nursing while that of Nebraska is the Department of Health and Human Services. The credentialing criteria are similar, but there are some differences in the scope of practice. Georgia state practice regulation has a restrictive tendency; the practice authority allows limited actions for APRN practice requiring supervision by health care provider throughout the APRN’s practice or team management before an APRN such as an NP can provide care to patients (American Association of Nurse Practitioners (AANP), 2018). In the state of Georgia, the practice authority requires a written protocol between the NP and the overseeing physician which specifies medical acts delegated by the physician and demands an instant session with the physician (Scope of Practice Policy, 2019). No wonder at my practice setting an NP is not allowed to initiate care nor partake in a patient discharge process.

On the other hand, Nebraska state and licensure law permit all NPs to exercise autonomy in practice such that they can assess patients, diagnose, order diagnostic tests, initiate and manage treatments, prescribe all medications including control substances without a provider’s supervision after fulfilling the criteria for doing so (Nebraska legislature, n.d). Allowing APRNs to have full practice access will enable an increase in experience and expand the talents inherent in the nurse practitioners and encourage significant innovations in the nursing profession; also motivates other NPs to spring up in filling the gap created by the shortage of providers in America.

In Georgia, an NP can only prescribe a schedule III to V control substance if operating under the prescriptive authority of a supervising physician by submitting a written protocol to the supervising physician and permission is granted (American Medical Association (AMA), 2017). While in Nebraska, an NP may prescribe both legend drug and Schedules II-V controlled substances after the NP has put in first 2000 hours of practice under the supervision of a physician as well as completing 30 hours of education in pharmacotherapeutics and the board does not track the number of the NPs with DEA numbers (AMA, 2017). Both states require that providers should register in the prescription drug monitoring program (PDMP) for Benzodiazepines and opiates but the difference is that APRN in Georgia is practicing under the prescriptive authority of a physician and are not able to delegate access to PDMP unless a nurse who has prescriptive authority (Georgia Department of Public Health, 2018). While in Nebraska, APRN has prescriptive authority; thus, can delegate access to PDMP (Borcher, 2016).

It would be to the perfect interest of patients and the society as a whole for all the APRN in America to have equal full legal authority in all the states as in Nebraska to enable them to practice within the full scope of the education and experience they have earned through rigorous academic and clinical training. According to Doyle et al., (2017), NPs have all it takes to practice to the full scope of education gained; this prompted the IOM to call on states with unjustifiably restrictive regulations on the NPs like Georgia state to amend the law that will authorize NPs to practice to the full scope of their ability across the countries. Also as mentioned earlier, allowing NPs to have full practice authority that would enable them to practice and prescribe independently would assist in addressing the workforce shortage allowing underserved areas to have access to health care as well as all Americans in general (Doyle et al., 2017)

References

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

American Medical Association. (2017). Retrieved from https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-prescriptive-authority.pdf

Borcher, K. C., & Houseman, R. (2016). Nebraska and Prescription Drug Monitoring Program. Retrieved from http://www.nebraskahospitals.org/file_download/inline/c0cd1c7d-0de6-477d-b92c-0cee2f87f23d

Doyle, J. M., Zangaro, G. A., Howie, B. A., & Bigley, M. B. (2017). Retrospective Evaluation of the Advanced Nursing Education Expansion Program. The Journal for Nurse Practitioners, 13 (97), 488-495 DOI:10.1016/j.nurpra.2017.04.019

Georgia Department of Public Health. (2018). Retrieved from https://dph.georgia.gov/pdmp

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

Nebraska legislature (n.d). Retrieved from https://nebraskalegislature.gov/laws/statutes.php?statute=38-2315

Scope of practice policy. (2019). Georgia Scope of Practice Policy: State Profile. Retrieved from http://scopeofpracticepolicy.org/states/ga/#practitioner-nurse-practitioners

RE: Discussion – Week 5 Collapse

         The National Council of State Boards of Nursing (NCSBN) is a non-profit organization that works with different nursing regulatory bodies and allows them to come together to discuss and work on multiple interests and concerns. Currently, they are the world leader in nursing regulatory knowledge (National Council of State Boards of Nursing, 2020). There are 59 nursing regulatory bodies in the U.S and they all are members of the NCSBN. They outline the safety standards for nursing care and issuing licenses to practice (National Council of State Boards of Nursing, 2020). The two APRN regulation boards I chose for this purpose of this discussion board are my home state North Carolina and Texas.

The first aspect of North Carolina nursing regulation I looked into was education and certification requirements. According to 21 NCAC 3.0805, nurse practitioners must provide certification evidence from a national credentialing body (NC Board of Nursing, 2020a). A nurse practitioner education program needs to be successfully completed, with 400 didactic and preceptorship hours. Courses of health assessment and diagnosis, pharmacology, pathophysiology, various disease management, prevention services, client education, and role development are required (NC Board of Nursing, 2020a, para. #1).

Next, I looked into continuing education requirements for APRNs in North Carolina. To maintain practice approval 50 hours of continuing education are due each year, as stated in 21 NCAC 36.0807. 20 of the hours must be obtained by the ANCC or ACCME, other credentialing bodies, or practice relevant courses (NC Board of Nursing, 2020b, para. #1.).  If the APRN is prescribing controlled substances, one hour of continuing education mut be dedicated to substance practice acts.

In comparison, Texas APRN educational requirements are approved by the State of Texas accrediting board. According to Rule §219.1 program must be at a Master’s level of nursing education, and the director and faculty all must comply with the Nurse Practice Act and Board of Nursing regulations (Texas Board of Nursing, 2018). The education program should have uniform standards and the program must promote safe and effective advanced practice nursing, seen as a developmental guide, and provide criteria to evaluate new APRNs (Texas Board of Nursing, 2018).

Texas APRNs are required to complete 20 hours that correlate to their profession, or they have the option of obtaining, maintaining, or renewing national nursing certification approved by the Texas Board of Nursing (Texas Board of Nursing, 2019). 5 additional contact hours must be dedicated to pharmacotherapeutics. Competencies must be earned with a two-year period preceding license renewal (Texas Board of Nursing, 2019).

Licensure requirements and continuing education requirements apply to APRNs because they must show and maintain educational competence. Both states have misconduct regulations and not adhering to competent care can lead to unsafe practice, patient harm, and being seen in front of the nursing board with potentials of a license being revoked. Autonomy comes with the advance practice licensure, which leads to an expectation and responsibility of professionals to stay current and competent when practicing at all times.

APRNs can adhere to these regulations by staying up to date on current education and practices that correlate to the care they provide. They can also join professional organizations that can be used to access journals and continuing education opportunities. The American Association of Nurse Practitioners (AANP) is a great example of a professional organization that provide advocacy to APRNs, CE hours, journal subscriptions, and more (American Association of Nurse Practitioners, n.d.). Along with this, APRNs can be become certified and gain expertise in their professional area.

References

American Association of Nurse Practitioners. (n.d.). Membership. https://www.aanp.org/membership

National Council of State Boards of Nursing. (2020). About U.S. nursing regulatory bodies. https://www.ncsbn.org/about-nursing-regulatory-bodies.htm

NC Board of Nursing. (2020a). Education and certification requirements for registration as a nurse practitioner. http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0805.html

NC Board of Nursing. (2020b). Continuing education (CE). http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0807.html

Texas Board of Nursing. (2018). Advanced practice registered nurse education. https://www.bon.texas.gov/rr_current/219-1.asp

Texas Board of Nursing. (2019). Requirements for APRNs. https://www.bon.texas.gov/education_continuing_education.asp#E

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

  • Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
  • Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
  • One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
  • I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

  • Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
  • In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
  • Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
  • Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

  • Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
  • Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
  • I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

  • I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
  • As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
  • It is best to paraphrase content and cite your source.

LopesWrite Policy

  • For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
  • Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
  • Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
  • Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

  • The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
  • Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
  • If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
  • I do not accept assignments that are two or more weeks late unless we have worked out an extension.
  • As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

  • Communication is so very important. There are multiple ways to communicate with me: 
    • Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
    • Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.
Content
Name: NURS_6050_Module03_Week05_Discussion_Rubric

Grid View
List View

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