Comparing APRN Board of Nursing Regulations
Scope of Practice
Every nursing regulatory body has specific instructions as to the scope of practice of the nurses based on education, experience, and the state. In Florida, APRNs normally have a supervisory agreement with a physician as they practice. They are not allowed to practice autonomously. The need for a physician to supervise has however been removed when APRNs meet certain criteria such as completing 3000 physician-supervised clinical hours in five years, and not having been in any disciplinary action in five years, among others. This shows that Florida still limits how APRNs practice and certain areas of their scope are limited to working under a physician (Brooks, 2024).
In New York, APRNs can practice to the full extent of their scope. They are only required to complete the 3600 physician-supervised hours of practice after which they are free to practice independently. New York has allowed APRNs full autonomy meaning they can be more independent and resourceful, especially in underserved  (Poghosyan, 2021).
Authority to Prescribe
In Florida, APRNs are allowed to prescribe certain medications. The authority to prescribe controlled substances is based on certain criteria. The major criteria is that the APRN must be a Master’s or Doctoral degree graduate in a specialized nursing area and trained in specialized skills. Also, for certain schedule II drugs, APRNs can only prescribe for up to 7 days unless the condition demands prolonged use. This shows that there are limits to prescribing medication in Florida, especially in controlled substances to prevent abuse and misuse (Brooks, 2024).
In New York, APRNs can prescribe all drugs including controlled substances with fewer regulations. This is because in New York APRNs must register with the New York State Prescription Monitoring Program and the Drug Enforcement Administration. This is to monitor and control the prescription of regulated drugs to prevent misuse. This autonomy allows them to fully practice total patient care without authority challenges limiting their scope (Poghosyan et al., 2021) Walden University NURS-6050 Week 5: Discussion Professional nursing and state level regulations.
Differences Between the two States
As noted above, Florida is still restricting the autonomy of APRNs while New York has honored it. Nurses in Florida must practice under physician supervision for at least five years and fulfill other criteria for autonomy, while those in New York can fully practice autonomously after fulfilling the hours requirement (Phillips, 2021). In Florida, there are strict regulations for prescribing while in New York, the regulations are quite friendly. Also, in Florida APRNs do not register with any other body to regulate prescription while in New York, they register with the DEA and prescription monitoring program for prescription registration (Phillips, 2021).
Examples
A nurse working in a rural area clinic in Florida can handle patients independently with a physician agreement and if the patient needs regulated medication, the APRN must consult with a physician for prescribing long-term use. On the other hand, a nurse working in similar conditions in New York can practice unsupervised and prescribe medication independently with regular check-ups with the prescription monitoring program for safety in controlled substances prescription.
References
Brooks, J. (2024). Advanced Practice Registered Nurse Autonomy in Florida: A Policy Analysis (Doctoral dissertation, Jacksonville University). https://search.proquest.com/openview/e4752108934cffe873c2bdfa1235072f/1?pq-origsite=gscholar&cbl=18750&diss=y
Phillips, S. J. (2021). 33rd annual APRN legislative update: unprecedented changes to APRN practice authority in unprecedented times. The Nurse Practitioner, 46(1), 27-55. https://journals.lww.com/tnpj/fulltext/2021/01000/33rd_Annual_APRN_Legislative_Update__Unprecedented.6.aspx
Poghosyan, L., Ghaffari, A., Liu, J., Jin, H., & Martsolf, G. (2021). State policy change and organizational response: Expansion of nurse practitioner scope of practice regulations in New York State. Nursing Outlook, 69(1), 74-83. https://www.sciencedirect.com/science/article/pii/S0029655420306217

My state of California (CA) is a full practice state, meaning, “nurse practitioners can perform the full scope of practice without a supervising or collaborating physician. They can diagnose a patient, order tests, prescribe medication, and operate their own independent practices” (Feeney, 2024).

This type of independence for Nurse practitioners (NPs) in California is fairly new, with Assembly Bill 890 (AB 890) only being passed last year on January 1, 2023 (Miec, 2023). So, as of last year, NPs have the option to apply to be a 104 NP, they can “work independently outside of a group setting, including owning their own practice, and practices without standardized procedures within the population focus of their National Certification” after working “in a group setting (a clinic, hospital, or medical group) with at least one physician for at least three years” (Miec, 2023).

However, in a state like South Carolina (SC), for nurse practitioners, it is considered a restricted practice state, in this type of state, “nurse practitioners must work under the supervision of a physician for all of their scope of practice. While they may have extensive autonomy in some nurse practitioner functions, they are not acting as independent practitioners” (Feeney, 2024). This means at this time, NPs in the state of SC are unable to open their practice compared to ones in CA.

In a state like CA many NPs I know are opening their own Med spas, in SC a NP can also do this but would need a medical doctor to oversee the practice. What NPs can still do in both these states is prescribe medications. In CA, “a registered nurse may dispense drugs or devices upon

an order by a licensed physician and surgeon if the nurse is functioning within a licensed clinic” (State of California Director of consumer affairs, 2013). As well in SC, “administration of medications means the acts of preparing and giving drugs in accordance with the orders of a licensed, authorized nurse practitioner” (South Carolina code of laws unannotated, 2006).

References

Feeney, A. (2024, May 23). Nurse practitioner practice authority: A state-by-state guide. NurseJournal.org. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/

Nurse practitioner expanded scope of practice in California. MIEC. (2023, February 16). https://www.miec.com/knowledge-library/nurse-practitioner-expanded-scope-of-practice-in-california/

Nurse practitioners: Laws & regulations. State of California Director of Consumer Affairs. (2013, November 11). https://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf

South Carolina Code of Laws Unannotated. Code of laws – title 40 – chapter 33 – nurses. (2006, September 30). https://www.scstatehouse.gov/code/t40c033.php

Application to Advanced Practice Registered Nurses 

Advanced Practice Registered Nurses (APRNs) are subject to varying regulations across states, particularly concerning their scope of practice, prescriptive authority, and collaboration requirements. A comparison between two APRN boards of nursing regulations in California and Texas provides a fundamental point of analysis. The first regulation is on collaborative practice where NPs in California, are required to collaborate with a supervising physician. As part of this partnership, written protocols and standardized processes outlining the NP’s practice area, including their prescription authority, are collaboratively developed. Collaboration with a licensed physician is also a requirement in the state of Texas. APRNs must establish and maintain a formal agreement to practice and prescribe medications.

Another significant APRN Board of Nursing regulation involves prescriptive authority. In California, unlike in most other states across the country, NPS have the prerogative of writing prescriptions and this is inclusive of the Controlled Substances, as soon as they meet the conditions laid down under the collaborative agreement. On the other hand, in Texas, where the NPs have gotten Full Practice status, they still need a supervisory agreement for prescribing controlled substances. This is a significant difference because it might limit the patient’s access to the drugs as he or she may not be able to consult the physician in charge every time he or she needs a drug. Walden University NURS-6050 Week 5: Discussion Professional nursing and state level regulations This is especially so in the rural areas where the R.Ph. might be the only professional health facility available. For example, if a patient in Texas is required to have immediate access to pain management that involves a prescription of substances controlled under VITA, the NP may be confined to physician supervision. Nevertheless, the article by Bosse et al. (2017), “Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care,” strongly supports the case for full practice authority (FPA) for APRNs.

In essence, APRNs need to have a collaborative partnership with a physician in order to work effectively. For the APRNS privileged to practice within the statutes of their education and experience, this regulation is both a strength and a weakness. Although the collaborative model provides APRNs with a support structure where they may turn to physicians for advice, this structure poses challenges to autonomous practice. This is because it may also delay care if an NP needs immediate prescribing authority to address a patient’s urgent needs, potentially impacting the overall quality of care. Prescriptive authority remains one of the APRN practice essentials that define the scope of their practice in terms of effective care delivery. Whereas, California’s independence framework for NP practice allows NPs to have more authority, limitations inherent in the Texas model hinder practice as it may lead to delayed treatments. “Allowing NPs full autonomy to practice may be a relatively simple policy mechanism for states to improve access to primary care” (Neff et al., 2018).

APRNs in California or Texas might focus on improving their practical knowledge of the emerging trends in new treatment and continuing their education requirements. “In the fast-moving world of health care, it is vital that nurses are able to practice to the full extent of their education and abilities, in order to deliver the most efficient, quality care to patients” (American Nurses Association, n.d.)  By realizing these regulations, APRNs are well equipped to maneuver within their practice environments while observing the legalities in providing some of the best quality patient care.

References

American Nurses Association. (n.d.). ANA enterpriseLinks to an external site.Links 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.. Nursing Outlook, 65(6), 761–765.

Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., 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.

      Advanced practiced registered nurse(APRN), or NP, means a Registered nurse who has completed an advanced formal graduate education program at the master’s level or Doctoral level acceptable to the board and who demonstrates advanced knowledge and skill in the assessment and management of physical and psychosocial health, illness status persons, families, and group. (Ohio Board of Nursing). Because the United States does not have a National APRN licensing board, states have different methods for evaluating credentials and qualifications.

Differences between Ohio APRN and South Carolina APRN

In terms of certification, Ohio APRNs must complete an application, pay fees, pass a criminal background check, and complete a master’s or Doctoral program in a nursing specialty, while in South Carolina, APRNs must have a doctorate, post-nursing master’s certificate or master’s degree in advanced Education in a specific area.

In Ohio, APRNs must enter into collaborative agreements with physicians and other healthcare professionals for the duration of their careers. While in South Carolina, the APRN must practice in collaboration with the physician.
For example, in the State of South Carolina, APRNs can only practice independently with direct collaboration with a physician(South Carolina Board of Nursing). However, in Ohio, APRNs can practice independently once a collaborative agreement is signed with a physician for the period of his or her career. (Ohio Board of Nursing).

Reference:

National Council of State Boards of Nursing (NCSBN)Links to an external site.Links to an external site.. (n.d.). Retrieved September 20, 2018, from https://www.ncsbn.org/index.htm

APRN scope of practice. Ohio Board of nursing. (n.d.).

APRN scope of practice. South Carolina board of nursing. (n.d.).

Initial post

Comparing the APRN nursing regulation between the states of Texas, California, and Oregon

Firstly, looking at the scope of practice between the three states:

According to the American Association of Nurse Practitioners, Texas is a “restricted practice state.” In Texas, APRNs have a supervisory or collaborative agreement with physicians to be able to provide diagnosing activities for patients, prescribe medicines, and monitor treatments (A State-by-State Breakdown of Nurse Practitioner Practice Authority Laws, n.d.). These supervisory arrangements usually need to be in writing, detailing the physician’s role as supervisor, with a notation of the frequency in which the physician will review the charts. This type of arrangement limits APRN autonomy because physicians are required to be involved in most aspects of patient care. This can make practicing difficult, especially in rural or underserved areas with a doctor shortage. California has a mixed model; it gradually moves toward full practice authority over time. Currently, some settings require NPs to have standardized protocol agreements for some aspects of their practice. NPs can apply to work without physician supervision if they have completed 4,600 hours or three years of full-time clinical work. Still, the facility must have a doctor on site (A State-by-State Breakdown of Nurse Practitioner Practice Authority Laws, n.d.). After three additional years, they can apply for full practice authority.

There is also a written code of conduct or guidelines for APRNs in their line of duty. APRNs in California may diagnose and treat patients. Still, they cannot practice independently due to these collaborative agreements that restrict their clinical decision-making and prescription powers in the first couple of years after graduation. This, therefore, renders it impossible for APRNs to utilize their full scope, especially in clinical decision-making independent of direct physician supervision. Oregon, in contrast, is a full-practice state (ORS 678.375, Nurse Practitioners, n.d.). APRNs can evaluate patients, determine diagnoses, interpret diagnostic tests, and develop treatment plans, including ordering medications, independently of physician oversight. APRNs are educated and competent to provide this level of care; therefore, they may practice independently and provide complete care. Full practice authority in Oregon allows APRNs to utilize their complete skill and knowledge, adding accessibility and quality to healthcare, particularly in rural and impoverished communities.

The second comparison will be based on prescriptive authority.

In Texas, APRNs can only prescribe under the delegating authority of a physician. APRNs may prescribe drugs, including Schedule III-V controlled substances, but not Schedule II drugs unless they are in a hospital or hospice setting (NursingLicensure.org, 2021). Because of this provision, APRNs have no choice but to rely on physicians if they are to enjoy full prescribing privileges. This may delay patient care and reduce efficiency, especially in busy areas such as emergency rooms or rural clinics where doctors may be unavailable. In California, Advanced Practice Registered Nurses (APRNs) can prescribe medications if they adhere to the agreed-upon standards and procedures with a supervising physician (A State-by-state Breakdown of Nurse Practitioner Practice Authority Laws, n.d.). However, like Texas, California restricts the prescribing of controlled substances, particularly Schedule II drugs, unless under specific rules or direct physician authorization. For instance, an APRN can prescribe medicines for chronic conditions. However, they must adhere to strict protocols and frequently undergo periodic evaluations by a physician. This prevents the APRN from autonomously adjusting patient care according to their evolving needs. In Oregon, however, APRNs have full prescribing practice authority. They can prescribe any medication at any time for patients, including controlled substances. Having no restrictions on their scope of practice puts APRNs in a position to use all their education and training to provide timely and effective care without physician intervention. Full prescribing authority is beneficial in primary care, where APRNs can monitor patient responses and alter treatment plans independently of physicians while managing complex medication regimens Walden University NURS-6050 Week 5: Discussion Professional nursing and state level regulations.

Comparing the three states and their regulations, Texas and California restrict the autonomy of APRNs by requiring them to collaborate with physicians or follow standardized procedures. This regulatory framework often creates barriers to achieving important goals, such as coordinating care across multiple providers, managing supervisory constraints, and processing additional paperwork. These criteria pose significant challenges to implementing APRN-led care models in healthcare facilities, even when their services are required to substitute unavailable doctors, particularly in rural areas. However, in Oregon, APRNs can practice independently in the whole practice model, making major clinical decisions without physician oversight (ORS 678.375, Nurse Practitioners, n.d.). This autonomy complements the APRN’s role as a primary care provider and provides latitude in taking responsibility for patient care, reducing healthcare expenditure, and improving accessibility to services when needed.

Regarding healthcare access, Texas and California, for example, have strict rules that make getting care challenging, particularly in underserved areas of the states. The limited scope of practice in these states, which often burdens APRNs, impacts the entire healthcare service. This can be a disadvantage; for example, in remote regions where the need for doctors to cooperate may delay care, particularly in situations where APRNs must communicate with doctors who are not present or accessible. Oregon’s plan addresses doctor shortages by allowing APRNs to practice independently. It also facilitates the establishment of APRN-led clinics and provides direct care to patients without awaiting physicians’ consent. The plan enables access to health care, thus improving health outcomes in urban and rural areas.

In the cases of states where APRN practice is restricted, like Texas and California, APRNs may still find ways around the rules and perform at their best. For instance, in a rural health clinic in Texas, an APRN can independently treat chronic conditions like diabetes or hypertension by conducting assessments, prescribing medications with approval, and providing patient education. The APRN adheres to the regulatory requirements through a collaborative agreement with a physician who reviews the charts monthly. As limited as this arrangement may be, it still gives the APRN tremendous authority to change the level of care provided for patients and fill substantial gaps within the local healthcare personnel.

When applying APRN rules to work in California, An APRN practicing in California can, with the help of a supervising physician, establish a standardized procedure when working in primary care. The APRN can independently perform regular examinations, provide follow-up care for chronic conditions, and order prescription medications for noncontrolled substances under these circumstances. For instance, an APRN may have a protocol that enables them to provide asthma management for pediatric patients by adjusting inhaler prescriptions per the established guidelines without direct and immediate consultation with a physician, provided the physician periodically reviews the treatment plan. These examples show how APRNs can work around strict rules to provide excellent care within the law in their states. They also show the importance of thoughtful, collaborative agreements and standard processes.

In conclusion, the biggest problem is considerable discrepancies in the rules, making it challenging for APRNs to practice independently and utilize their entire education and training. States such as Texas and California have rigid regulations that pose a severe barrier to allowing APRNs to practice as they wish, which may reduce access to care, particularly in underserved areas. On the other hand, states like Oregon grant full practice authority to APRNs, providing examples of how giving such professionals discretion in handling all concerns pertinent to patient care can be effective. Thus, less restrictive models would make the professional role of APRNs more substantial by improving the quality of healthcare and catering to the needs of more people.

Reference

A state-by-state breakdown of nurse practitioner practice authority laws. (n.d.). The Intake. https://www.tebra.com/theintake/checklists-and-guides/legal-and-compliance/nurse-practitioner-laws-by-stateLinks to an external site.

NursingLicensure.org. (2021, September 21). APRN license requirements in Texas | How to become a nurse practitioner in TX—NursingLicensure.org. NursingLicensure.org: A More Efficient Way to Find Nursing License Requirements in Your State. https://www.nursinglicensure.org/np-state/texas-nurse-practitioner/Links to an external site.

ORS 678.375: Nurse practitioners. (n.d.). Retrieved on September 22, 2024, from https://oregon.public.law/statutes/ors_678.375

Comparing APRN Regulations in State Boards of Nursing

Nursing practice in different states is guided by policies, standards, and regulations that allow professionals to deliver various services to meet the needs and preferences of patients and populations. In the state of California, the Board of Registered Nursing (BRN) defines the specific regulations and standards by which Advanced Nurse Practitioners (APRNs) must maintain the targeted levels of healthcare services that meet the needs and preferences of patients (California Board of Registered Nursing, 2024). These standards require that an individual seeking licensure to practice as an APRN must have a minimum of a master’s degree and a national certification in the specialty of interest. The Board of Nursing in Texas requires additional requirements, such as prescriptive authority, that include supervisory requirements in the form of collaborative agreements with a physician. The distinction outlines the level of practice, particularly the autonomy and independence of advanced nurse practitioners in prescribing medications to patients.

In California, APRNs can prescribe treatments independently after obtaining a Nurse Practitioner Furnishing Number, which the provider attains upon meeting the full educational and certification requirements. On the other hand, Texas nurse practitioners must have a formal agreement with the supervising physician as a collaborative agreement (Texas Board of Nursing, 2021). These agreements may limit the nurse practitioners’ ability to respond quickly to the patient’s needs. These issues contribute to barriers that can delay the nurse practitioner’s ability to offer timely interventions or respond to emergencies Walden University NURS-6050 Week 5: Discussion Professional nursing and state level regulations.

Concerning the scope of practice, the nurse practitioners in California have a full practice model, allowing them to evaluate patient needs, diagnose conditions, order and interpret diagnostic tests, and initiate treatments independently. On the other hand, nurse practitioners in Texas have a restricted practice that requires them to work under the full supervision of a qualified physician (California Board of Registered Nursing, 2024). The practice status in Texas implies that nurse practitioners have limited practice, which does not allow them to practice to the fullest of their training and education. Nurse practitioners have to collaborate with the supervising physician and have limited independence in ordering and interpreting tests initiating treatments, as well as diagnosing various conditions that impact public health. In this case, although the nurse practitioner may have the necessary skills and abilities for managing patient needs, the limited practice authority by the state board requires them to collaborate with other professionals, impacting their professional autonomy.

The state board practice authorities significantly impact the level of practice and population health outcomes. For instance, in California, where nurse practitioners have full practice, they can independently assess patient needs, order and interpret tests, and develop treatment plans to manage underlying patient needs. The practice authority contributes to the expansive access to healthcare resources among vulnerable populations (McGilton et al., 2023). On the other hand, in Texas, where the state board has limitations, access to primary care services may be limited, resulting in growing health disparities. The collaborative agreements may complicate the decision-making processes, limiting the nurse practitioner’s ability to respond effectively to patient needs (Short, 2022). The process can limit the effectiveness of patient needs, compromise responsiveness to patient needs, and result in high dissatisfaction levels among patients and populations.

Adhering to the state board regulations requires the nurse practitioner to maintain key strategies and mechanisms that attain the desired safety and ethical code of practice and promote professional growth and ability to serve diverse populations (Short, 2022). Nurse practitioners in both state boards must maintain continuing education and adhere to the certification requirements. These strategies are necessary to promote adherence to the recommended standards and maintain the guidelines outlined by the collaborative agreements.

References

California Board of Registered Nursing. (2024). Advanced Practice and Certification. Www.rn.ca.gov. https://www.rn.ca.gov/applicants/ad-pract.shtmlLinks to an external site.

McGilton, K. S., Haslam-Larmer, L., Wills, A., Krassikova, A., Babineau, J., Robert, B., Heer, C., McAiney, C., Dobell, G., Bethell, J., Kay, K., Keatings, M., Kaasalainen, S., Feldman, S., Sidani, S., & Martin-Misener, R. (2023). Nurse practitioner/physician collaborative models of care: A scoping review protocol. BMC Geriatrics, 23(1). https://doi.org/10.1186/s12877-023-03798-1Links to an external site.

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

Texas Board of Nursing. (2021). Texas Board of Nursing – Practice – APRN Scope of Practice. Texas.gov. https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp.html#:~:text=in%20Disaster%20Areas-Links to an external site.

   When applying for an Advanced Registered Nurse Practitioner (ARNP) license in the state of Idaho the individual must have an active Registered Nurse (RN) license, have completed an accredited advanced nurse practice graduate or post-graduate program, and be nationally certified by the desired specialty (IBON, 2023). Washington state requirements are the same as the State of Idaho as they require a copy of the individual’s national certification, official transcripts from the completed ARNP program, and an active RN license.  

   The State of Idaho requires that an APRN renewal applicant undergo a peer-review process to display competency to the regulatory board (DOPL, 2023). According to the policy, an applicant must have a peer review that includes evidence of competence according to the national standards of care by either another ARNP, physician, or Physician’s Assistant. Competence can be displayed through clinical rounds, record reviews, and on-site peer collaboration (DOPL, 2023). The State of Washington does not require any peer-review process for ARNP renewal. Instead, the Washington State Board of Nursing (WABON) requires the applicant to provide an attestation that the applicant completed at least a minimum of thirty hours of continuing education per renewal period (WABON, n.d.). Both states, however, require an active license in addition to the peer-review process or continuing education. 

   The Washington State Scope of Practice states that the ARNP is able to “assume primary responsibility and accountability for the care of patients within their roles” (DOH, 2023, para. 1) Primary responsibility includes diagnostic testing, management of health conditions, education, and prevention (DOH, 2023, para. 2). According to the Idaho Board of Nursing, the ARNP’s scope of practice includes “assume primary responsibility for the care of their patients in diverse settings. This practice incorporates the use of professional judgment in the assessment and management of wellness and conditions appropriate to the advanced practice registered nurse’s role” (2023, p.3). Both regulations on the ARNP’s scope of practice state that the ARNP will take primary responsibility for care. Also, both Washington and Idaho state that the ARNP can manage an individual’s health & wellness.  Walden University NURS-6050 Week 5: Discussion Professional nursing and state level regulations

References 

ARNP License. Washington State Board of Nursing. (n.d.). https://nursing.wa.gov/licensing/apply-license/arnp-licenseLinks to an external site. 

Department of Health, WAC 246-840-300 ARNP Scope of Practice. Retrieved February 20, 2023, from https://apps.leg.wa.gov/wac/default.aspx?cite=246-840-300Links to an external site.. 

Idaho Board of Nursing. (2023, March 28). IDAPA 24 – Division of Occupational and Professional Licenses. Boise, ID. 

Renew or Reactivate a License. Washington State Board of Nursing. (n.d.-b). https://nursing.wa.gov/licensing/renew-or-reactivate-licenseLinks to an external site. 

State of Idaho Division Of Occupational and Professional Licenses. (2023, October 12). Idaho Board of Nursing ADVANCED PRACTICE REGISTERED NURSES POLICIES: Boise, ID. 

I currently have two nursing licenses, one in South Carolina which is a compact state and one in Alaska which is not. I hold two licenses because I am a military spouse and had to get an Alaskan nursing license when we moved up here last year. It would be so helpful if all 50 states were compact states, especially for military spouses who are forced to move at a moment’s notice. I will become an APRN while living in the state of Alaska. So, I have chosen to compare the board of nursing regulations to Alaska compared to South Carolina. According to the NCSBN website, “More than 100 years ago, state and territorial governments established NRBs to protect the public’s health and welfare by overseeing and ensuring the safe practice of nursing. NRBs achieve this mission by outlining the standards for safe nursing care and issuing licenses to practice nursing (National Council of State Boards of Nursing, n.d.).” According to the state of Alaska board of nursing website, to practice as an APRN in Alaska you must first be licensed as an RN in Alaska. (Alaska Department of Commerce, Community, and Economic Development, n.d.) Alternatively, according to the state of South Carolina board of nursing website, any nurse from a compact state with a current RN license can be licensed in the state of South Carolina as an APRN. With that said, you must have a South Carolina APRN license to work in South Carolina. The NLC requirements that apply to RN licenses are different than an APRN.  (South Carolina Department of Labor, Licensing and Regulation, n.d.) The other difference between the two is scope of practice. Alaska allows APRNs to work a little more independently, with full prescriptive authority. Whereas South Carolina tends to have tighter guidelines and requires collaboration with a physician before prescribing medications.

References:

Alaska Department of Commerce, Community, and Economic Development. (n.d.). Advanced practice registered nurses (APRN). https://www.commerce.alaska.gov/

National Council of State Boards of Nursing. (n.d.). About nursing regulatory bodies. https://www.ncsbn.org/nursing-regulation/about-nursing-regulatory-bodies.pageLinks to an external site.

South Carolina Department of Labor, Licensing and Regulation. (n.d.). APRN update lead. https://llr.sc.gov/nurse/Online/APRNUPDATELEAD.aspxLinks to an external site.

Kentucky:

1. Before prescribing controlled substances the APRN must consult with a KY physician, report that to the KBN, and have been an APRN for 1 year. All prescribed meds must be sent to the KBN (Kentucky Boards of Nursing, n.d).
2. Meet with a physician with whom you’ve entered into a collaborative agreement quarterly to review the KASPER report or prescription drug monitoring report used in KY and this meeting must be sent to the KBN (Kentucky Board of Nursing, n.d).

Tennessee:

1. APRN’s can prescribe controlled substances once receiving a certificate of fitness by the State Board of Nursing (NCSL, n.d).
2. APRN’s do not have to have the constant presence of a physician but one must be available to them if needed. A written protocol must be jointly developed that outlines standards of care and reviewed biennially. I was unable to find if any of this information of the prescriptions of controlled substances must be reported to the Tennessee Board of Nursing (NCSL, n.d)

The difference I’m seeing between Kentucky and Tennessee is that Tennessee’s regulations on prescribing controlled substances are laxer. Kentucky Is required to meet with a physician before being able to prescribe controlled substances. The APRN then must turn this information in to the KBN. The APRN and physician must enter a “collaborative agreement” upon hiring the APRN. The physician and APRN meet quarterly to review and discuss KASPER records. This information also must be turned into the KBN (Kentucky Board of Nursing, n.d). Tennessee allows APRNs to prescribe controlled substances if they receive a certification of fitness from the Tennessee Board of Nursing. Physicians do not have to be consulted before prescribing; one must be available if needed. I did not find any information that indicated the record of controlled substances had to be turned in to their board of nursing (NCSL, n.d). One example of how APRNs must adhere to the regulations listed is ensuring that they’re meeting with a physician before prescribing controlled substances and reporting this information to the board of nursing Walden University NURS-6050 Week 5: Discussion Professional nursing and state level regulations.

APRNs who have the full legal authority to practice within the full scope of their education and experience can perform a wider range of medical services without the need for content physician supervision in most cases. I feel like this is important in rural areas where there are not a lot of physicians or APRNs. The regulations in Kentucky are stricter on prescribing controlled substances than those in Tennessee. However, I do not feel that either state’s regulations hinder the APRN from performing to their full scope of education and experience.   Following these regulations in my state ensures that your nursing license is safe and will not be revoked due to not following rules. I feel like consulting with a physician is the safest and most patient-centered approach to prescribing controlled substances.

References:

Aprn Prescriptive Authority. Kentucky Board of Nursing. (n.d.). https://kbn.ky.gov/advanced-practice-registered-nurse/Pages/aprn-prescriptive-authority.aspx

Tennessee Scope of Practice Policy – State Profile. NCSL-Scope of Practice Policy. (n.d.). https://scopeofpracticepolicy.org/states/tn/ Walden University NURS-6050 Week 5: Discussion Professional nursing and state level regulations