California, Arizona Virginia APRN board of nursing state licensure comparison

There are four distinct Advanced Practice Registered Nurse (APRN) roles: nurse practitioner (NP), certified nurse midwife (CNM), clinical nurse specialist (CNS), and certified nurse anesthetist (CRNA). Each type of APRN plays a unique and vital role in healthcare, with specialized training and expertise that enhances patient care across various settings (Bosse, J. et al. (2017). APRNs are often primary care providers and are at the forefront of providing preventive care services to the public. They treat and diagnose illnesses, advise the public on health issues, manage chronic disease, and engage in continuous education to remain ahead or other developments in the field according to nursingoutlook.org. (n.d.).  

This discussion topic is between California and Arizona NPs scope of practice. According to California Association for Nurse Practitioners, nurse practitioner in California is an advanced practice registered nurse who has completed graduate level education like master’s or a doctoral degree. To get a license to practice in California, NPs must complete an accredited NP program and be certified by the Board of Registered Nursing (BRN). NPs specialized in many areas including Family/individual across lifespan; Adult-gerontology, primary care, or acute care; Neonatal; Pediatrics, primary care, or acute care; Women’s health/gender related; and Psychiatric-Mental Health across the lifespan as per California Board of Nursing, (n.d.). 

In California, NPs categories are under Restricted Practice Authority State. In restricted practice states, nurse practitioners must work under the supervision of a physician for all their scope of practice, nursejournal.org. (n.d.). While they may have extensive autonomy in some nurse practitioner functions, they are not acting as independent practitioners, nursejournal.org, (n.d.). However, in California, restrictions may loosen as the NP gains experience, nursejournal.org. (n.d.).  

In September 2020, as presented in California Board of Nursing, Governor Gavin Newsom signed Assembly Bill (AB) 890 (Wood, Chapter 265, statutes 2020) into law which created two new categories of Nurse Practitioners (NP) that can function within a defined scope of practice without standardized procedures. These new categories of NPs are 103NP and 104NP. 103 NP works under the provisions outlined in Business and Profession code 2837.103, California Board of Nursing, (n.d.). This NP works in a group setting with at least one physician and surgeon within the population focus of their national certification. 104 NP works under the provisions outlined in Business and Profession code section 2837.104, California Board of Nursing, (n.d.). This NP may work independently within the population focus of their national certification. The law was in effect last January 2023 and according to the Board of California Nursing, 103NP application is now live in BreEZe.  

The law requires a licensee to first work as a 103NP in good standing for at least 3 years prior to becoming a 104NP. The Board is only able to certify 103NPs currently and will not be able to certify 104NPs until 2026. According to rn.ca.gov., (n.d.), progress to 103NP or 104NP is not required; it is just an option. The traditional role of the NP in California remains. NPs can continue to work under physician supervision with standardized procedures in their existing settings, California Board of Nursing, (n.d.). 

An example scenario where California NP must have a collaborative agreement or standardize procedure that defines their scope of practice, including which conditions or treatments require physician input: A patient presents with feeling of dizziness, irregular heartbeat, and sudden shortness of breath, with history of Congestive Heart Failure. The NP evaluates the patient and suspects a possible pulmonary embolism. According to the collaborative agreement, the NP consults with the physician for further assessment and for hospital admission to acute care. This practice ensures comprehensive care and safety of the patient.  

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On the other hand, Arizona Registered Nurse Practitioners (RNPs) have Full Practice Authority. According to nursejournal.org. (n.d.), in full practice states, nurse practitioners can perform the full scope of practice without supervising or collaborating with physicians. They can diagnose a patient, order tests, prescribe medication, and operate their own independent practices, azbn.gov. (n.d.). As per azbn.gov. (n.d.), RNPs means registered nurse who is certified by the board, completed nurse practitioner education program approved or recognized by the board, has an expanded scope of practice within a specialized area of education the RNP has prepared for.  

In addition, the Nurse Practice Act defines the scope of practice that an RNPs shall refer a patient to a physician or another health care provider if the referral will protect the health and welfare of the patient and consult with a physician and other health care providers if a situation or condition occurs in a patient that is beyond the RNPs knowledge and experience.  

An example scenario of an RNP in Arizona: A 66-year-old male arrives in the clinic for a routine checkup. He has a history of hypertension and type 2 diabetes with uncontrolled A1C, he complains of always feeling tired and he gained weight. The RNP did a thorough assessment, vital signs, checking laboratory results and talking to him about his lifestyle. The RNP adjusted the patient’s meds and upon talking to him patient expressed feeling low and depressed, the RNP did a referral to a mental health counselor. During this visit, the RNP took time in discussing his findings with the patient and how to manage his condition at home. A follow up visit has been scheduled. Based on this scenario, the RNP took an integrated approach in taking care of the patient. This shows the Arizona RNP can manage independently chronic stable conditions in their state of practice. 

According to Capitol beat blog of American Nurses Association, the ANA supported by a growing body of evidence of the safe and cost-effective provision of care by APRNS, that there is a NATIONAL CALL to remove all barriers to Full Practice Authority from organizations such as the Institute of Medicine (IOM), the Federal Trade Commission (FTC), the National Governors Association (NGA), the Bipartisan Policy Center, and the Veterans Health Administration (VHA), among others.  

“FULL PRACTICE AUTHORITY” is defined as an APRNs ability to utilize knowledge, skills, and judgment to practice to the full extent of their education and training, nursingworld.org, (n.d.). Since the requirements such as mandated collaborative practice agreements (CPAs) and physician-supervised transition-to-practice periods still exist, APRNs cannot fully fill the gaps in the needs of our healthcare system and deter them to work in their full capacity, nursingoutlook.org. (n.d.). As APRNs continue to show their competence and compassion to our community, slowly we earn the trust and confidence of the patients we see, and it can transcend to our decision makers that approve the laws and regulations of Advanced Practice Registered Nurse. We are getting there but we must act now by showing them our comprehensive and holistic approach in treating patients in whatever specialty we choose. 

References 

AZBN. (2020). Arizona Board of Nursing Scope of Practice APRN Questions & Answers SCOPE OF PRACTICE Nurse Practitioners. https://www.azbn.gov/sites/default/files/2020-11/FAQs%20Final%20Questions-%20NP%207.24.20%20%281%29.pdfLinks to an external site.  

Bosse, 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 careLinks to an external site.Links to an external site.. Nursing Outlook, 65(6), 761–765.  

California Association for Nurse Practitioners. (n.d.). What is an NP? Canpweb.org. https://canpweb.org/About/What-is-an-NPLinks to an external site. 

California Board of Registered Nursing. (2022). Assembly Bill 890. California Board of Registered Nursing. https://www.rn.ca.gov/practice/ab890.shtmlLinks to an external site.  

Capitol Beat – From the American Nurses Association. (n.d.). https://anacapitolbeat.org/Links to an external site. 

Feeney, A. (n.d.). Nurse practitioner practice authority: A State-by-state guide. Nurse Journal. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/Links to an external site.  

Nursingworld.org. (2017). Advanced Practice Registered Nurses (APRN). American Nurses Association. https://www.nursingworld.org/practice-policy/workforce/what-isnursing/aprn/#:~:text=Advanced%20Practice%20Registered%20Nurse%20(APRN)Links to an external site.   

Professional Nursing and State-Level Regulations

Advanced practice registered nurses (APRNs) include the broader categories of clinical nurse specialists, certified nurse midwives, and nurse anesthetists. Each state has a board of nursing regulations that define nursing practitioners’ roles. The regulations also define the scope of practice and professional activities that each nurse offers based state’s board of nursing regulations. This discussion gives a detailed analysis of the APRN regulations in Virginia and California.

Virginia regulations

Licensing and education: The Virginia Board of Nursing allows the licensing of nurse practitioners with five years of experience (VBON, n.d). They should have completed a bachelor of nursing degree, hold an active registered nurse license and pass the national certification exam.

Practice authority: In Virginia, nurse practitioners have restricted practice authority, meaning they are supervised of physicians in all areas of practice (Clarke, 2023). They have some autonomy as nurse practitioner after five years of experience but APRNs cannot be allowed to act independently.

California regulations

Licensing and education: The California Board of Nursing requires APRNs to have satisfactorily completed a bachelor’s degree in nursing in specific roles, such as midwives or nurse practitioners, and should have passed the National certification exam.

Practice authority: In California, nurses have full practice authority, thus they can perform their scope of practice as nurse practitioners with zero supervision or collaboration with physicians (Clarke, 2023). Nurse practitioners can independently diagnose patients, prescribe medication and order tests.

Differences

Collaboration aspects:

In Virginia, APRNs must practice under the supervision of a physician, but after five years of experience, they become flexible and can work independently. However, in California, the standardized procedure for ARPNs is to collaborate with other healthcare professionals throughout their careers, even after extensive experience California, Arizona Virginia APRN board of nursing state licensure comparison.

Independence 

In Virginia, APRNs only become independent to make their own decisions and carry out full-time clinical practice after five years of experience, but California nurse practitioners get additional training to carry out clinical practice independently without a time limit.

Application

The difference in regulations between the two States shows that nurses will carry out their clinical roles differently. In Virginia, APRNs have restricted practice authority; hence, there must be a close working relationship with doctors, as they are required to approve any decisions nurses make (Smith, 2024). The nurses do not have the autonomy to make their own decisions. For example, when treating patients with asthmatic conditions, they must consult with a pulmonologist on the best treatment to use. In California, the ARPNs have full practice authority and hence work independently, depending on their experience and training. When treating patients with asthmatic conditions, they can administer the nebulizer treatment process to patients without consultation with physicians (Clarke, 2023). They have the autonomy to carry out patient examinations, conduct diagnoses, and make drug prescriptions. The nurses can manage all patients’ health challenges without consulting the physician for assistance. Thus, the two states depict how boards of nursing regulations can affect the clinical practice of APRNs.

Conclusion

The board of nursing issue regulations on how APRNs works and their practice in clinical activities. Each state has different regulations on how they use their knowledge and experience and how they collaborate with other healthcare professionals. In Virginia, APRNs have restricted practice, meaning they must collaborate with physicians until they become flexible after five years of practice. In California, APRNs have full practice authority, meaning they can perform nurse practitioner roles in full scope without supervision or collaboration with physicians. The difference shows the impacts of each state’s board of nursing regulations on clinical practice California, Arizona Virginia APRN board of nursing state licensure comparison.

 References

Clarke, E. (2023, November 10). Nurse practitioner practice authority: A State-by-state guide. NurseJournal. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/

Smith, K. (2024). A state-by-state breakdown of nurse practitioner practice authority laws. Www.tebra.com. https://www.tebra.com/theintake/checklists-and-guides/legal-and-compliance/nurse-practitioner-laws-by-stateLinks to an external site.