Professional Nursing and State-Level Regulations

Initial Post 

The two states I’m comparing APRNs are Texas and California. Texas is where I currently reside and California would be my dream state to live in. The comparison will give me insight into the differences within the state’s scope of practice. California isn’t a compact state but one can apply for endorsement. Texas is one of the compact states for all nurses and APRNs. The two states I’m comparing APRNs are Texas and California. Texas is where I currently reside and California would be my dream state to live in. The comparison will give me insight into the differences within the state’s scope of practice. California isn’t a compact state but one can apply for endorsement. Texas is one of the compact states for all nurses and APRNs.

The scope of practice for APRNs varies widely from one jurisdiction to the next. Some regions and states have stricter regulations than others. For instance, some states and regions need APRNs to have a specific amount of clinical experience before they may be licensed. For instance in California to be a PMHNP, they require a master’s degree along with 2 years of clinical experience (which includes 1 year of supervisory experience) after you obtained your master’s degree. In Texas, that law isn’t required.

There are certain regulations for every state. In California, APRNs are not allowed to work independently. Broadly speaking, NPs are trained to assess, diagnose, order, and interpret medical tests, prescribe medications, and collaborate in the care of patients (Levine, 2019). . The scope of practice for a nurse practitioner varies from state to state, and sometimes even from hospital to hospital. In California, NPs practice in collaboration with a licensed physician (Levine, 2019). In Texas, Nurse Practitioners can exercise the full scope of their training and work autonomously. That means you can own and operate a nurse practitioner private practice without physician oversight (TWU, 2020).

In California, BPC 2836.1 was amended changing furnishing to mean “order” for a controlled substance and can be considered the same as an “order” initiated by the physician. This law requires the NP who has a furnishing number to obtain a DEA number to “order” controlled substances, Schedule II, III, IV, V (DCA, n.d.) The mission of the Texas Board of Nursing (BON) is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the State of Texas is competent to practice safely (TBON, n.d.). Acting in accordance with the highest standards of ethics, accountability, efficiency, effectiveness, and openness, the Texas Board of Nursing approaches its mission with a deep sense of purpose and responsibility and affirms that the regulation of nursing is a public and private trust (TBON, n.d.).

References

GENERAL INFORMATION: NURSE PRACTITIONER PRACTICE. (n.d.). https://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf. Retrieved December 28, 2022, from https://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdfLinks to an external site.

How to Start a Nurse Practitioner Private Practice | Texas Woman’s University Online. (2020, October 26). https://onlinenursing.twu.edu/blog/how-start-nurse-practitioner-private-practiceLinks to an external site.

Mission and Values. (n.d.). Texas Board of Nursing. Retrieved December 28, 2022, from https://www.bon.texas.gov/about_mission_and_values.asp.htmlLinks to an external site.

What Does a Nurse Practitioner Do? (n.d.). Cedars-Sinai. https://www.cedars-sinai.org/blog/nurse-practitioners.html

The nursing profession is controlled by rules and regulations that vary by state and laws that govern them. Most of their rules are related to public safety and licensing. “Health professions regulation is needed as a mechanism to protect the interests of public safety” (Milstead &Short, 2019).  They specify certification criteria as well as the scope of practice in the state. Knowledge of the individual State’s Nurse Practice Act (NPA) is essential to practicing within the expected guidelines by law and ensures the safety of patients. The NPA is set in place by States to detail requirements for nursing education, licensure, and scope of practice (Haddad & Huynh, 2022)

Comparison of Nursing Regulations

I am a registered nurse in Texas; therefore, I will compare the Texas board of nursing regulations to that of the Arizona board of nursing regulations. Texas has a “reduced practice” policy; this means Texas Nurse Practitioners cannot perform the full scope of practice without a supervising or collaborating physician (Clarke, 2022).  According to the Texas Board of Nursing (2022), “Protocols or other written authorization should be jointly developed by the advanced practice nurse and the appropriate physician(s)” (p.169). The prescriptive authority in Texas requires “an agreement entered into by a physician and an advanced practice registered nurse (APRN) or physician assistance (PA) through which the physician delegates to the APRN or PA the act of prescribing or ordering a drug or device” (Texas Board of Nursing, n.d.). In contrast, APRNs in Arizona have full independent practice authority and do not require a physician’s supervision or collaboration. They can practice unsupervised within the area of their certification only. They can prescribe and dispense drugs and devices within the nurse practitioner’s population focus. They may also prescribe scheduled II-V controlled substances (NCSL, n.d.)

Full Practice Authority

According to Bosse et al. (2017), the benefits of having APRNs with full practice authority (FPA) include cost-efficient care, reduced number of prescriptions, decreased emergency room visits, and improved collaboration between clinicians. Hence, in the states where FPA is not in place, there is no opportunity for improvement in the overall healthcare system. For example, if Texas nurse practitioners were granted FPA, they could take care of patients independently and prescribe medications. With this, more patients can receive care, and the cost of healthcare will be reduced for the patient and the healthcare organization. As for APRNs, it is critical to pay close attention to the scope of practice for the state where you work.

                                                             References

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 care. Nursing Outlook, 65(6), 761–765. https://doi.org/10.1016/j.outlook.2017.10.002Links to an external site.

Huynh, A. P., & Haddad, L. M. (2022). Nursing Practice Act. StatPearls. Retrieved December 27, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK559012/#article-26029.s1Links to an external site.

Milstead, J. A., & Short, N. M. (2021). Government Response: Regulation. (pg. 57–84) Health Policy and Politics: A Nurse’s Guide 6th Edition (6th ed.). Jones & Bartlett Learning.

NCSL. (n.d.). Scope of practice policy state overview: Arizona. Retrieved December 27, 2022, from https://scopeofpracticepolicy.org/states/az/Links to an external site.

Nurse Journal. (2022). Nurse practitioner practice authority: A state-by-state guide. Retrieved December 26,, 2022, from https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/Links to an external site.

Texas Board of Nursing. (n. d.). Texas administrative code: chapter 222 advanced practice registered nurse with prescriptive authority. Retrieved December 25, 2022, from https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=11&ch=222&rl=5Links to an external site.

Texas Board of Nursing. (2022). Texas Board of Nursing: Rules and regulations relating to nurse education, licensure and practice. Retrieved December26, 2022, from  https://www.bon.texas.gov/pdfs/law_rules_pdfs/rules_regulations_pdfs/October%202022%20Rules%20and%2200Regulations.pdfLinks to an external site.

Nurs 6050N State Comparison  Discussion Post 1

As someone who has worked in Michigan her whole life and has never contemplated working out of state, I looked to Ohio to compare to my home state of Michigan, which is within an hour’s commute. Keep in mind I have worked with Ohio nurses in Michigan for nearly 20 years.

Ohio currently recognizes the national mandate by the president to acknowledge nurses from outside of the state that want to practice in Ohio during the pandemic under a White House Briefing released in February 2022. Also, per the Nurse License Compact (NLC), Nurses from Ohio can practice in another one of 39  NLC states without applying for a license. Michigan nurses do not have this same luxury.

Also, Michigan is a restricted practice state along with a minority of other states across the US; legislation is currently in Michigan’s state legislature to bring Michigan up to speed to a full practice authority state. This current weakened scope of NP practice contradicts the suggested goals of the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) (IOM & RWJF, 2010) assessment report,  stating the future of nursing was to enhance health care in the United States by optimally utilizing the nursing workforce(Yoon et al., 2018).

References

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 care. Nursing Outlook, 65(6), 761–765. Retrieved December 26, 2022, from https://doi.org/10.1016/j.outlook.2017.10.002

House, W., & . (2022, February 18). Notice on the continuation of the national emergency concerning the coronavirus disease 2019 (covid-19) pandemic. The White House. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/02/18/notice-on-the-continuation-of-the-national-emergency-concerning-the-coronavirus-disease-2019-covid-19-pandemic-2/

Nurse licensure compact (nlc). (n.d.). NCSBN. Retrieved December 27, 2022, from https://www.ncsbn.org/compacts/nurse-licensure-compact.page

Neff, D. F.,Yoon, S.H., Steiner, R. L.,,  Bumbach, M. D. , & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379-385.

The key distinction between Texas and Louisiana is that Texas does not need APRNs to have a collaborative agreement with a physician. This means that whereas APRNs in Texas are permitted to practice without a formal, written agreement with a physician, they are not permitted to do so in Louisiana. APRNs must possess a license in order to work in both states. APRNs need to have finished an accredited APRN program and passed a national certification exam in order to obtain a license. Both states permit APRNs to prescribe drugs as part of their scope of practice. APRNs are only permitted to prescribe Schedule II–V controlled medications in Louisiana, but, if they have successfully registered as a controlled substance prescriber with the state’s board of pharmacy.

In Texas, APRNs are permitted to prescribe any controlled substance on Schedules II through V. In order to practice, APRNs must keep their RN licenses up to date in both states. APRNs in Louisiana must also keep their APRN licenses up to date. APRNs must complete continuing education requirements in both states in order to renew their licenses. Every two years, APRNs in Louisiana are required to complete at least 15 contact hours of continuing education. Every two years, APRNs in Texas are required to complete at least 20 contact hours of continuing education. Both states’ APRNs are obligated to follow the rules established by the state in which they are licensed to practice.

This means that in order to prescribe restricted medications in Louisiana, APRNs must have a collaboration agreement with a doctor and be registered with the Louisiana Board of Pharmacy. Although a collaborative agreement is not required in Texas for APRNs to prescribe restricted medications, they must still be registered with the Texas Board of Pharmacy.

Both states demand that APRNs keep their RN licenses up to date and complete continuing education requirements in order to renew their credentials. Each state has its own criteria for continuing education, though. Every two years, APRNs in Louisiana are required to complete at least 15 contact hours of continuing education, while APRNs in Texas are required to complete at least 20 contact hours.

References

https://www.bon.texas.gov/pdfs/aprn_position_statement.pdfLinks to an external site.

https://www.lsbn.state.la.us/docs/default-source/publications/aprn-practice-guidelines.pdf?sfvrsn=2

https://www.aacnnursing.org/News-Information/Fact-Sheets/Scope-of-Practice-forLinks to an external site. Nurses

https://www.ncsbn.org/Aprn_Consensus_Model.pdf

Regulations (rules) enable reasonable implementation of the law (Milstead & Short, 2019). Note the terms regulation and rule are also used interchangeably (Milstead & Short, 2019). Whereas law is written in broad language, regulations are detailed and specify how the law will be put into practice (Milstead & Short, 2019). APRN practice is typically defined by the Nurse Practice Act and governed by the Board of Nursing, but other laws and regulations may impact practice, and other boards may play a role (American Nurses Association, n.d.).

Arkansas is a reduced practice state which means nurse practitioners can perform some of their scope of practice without physician supervision (NurseJournal, 2022). These restrictions typically involve operating their own practices or prescribing certain types of medications (NurseJournal, 2022). They rarely involve the nurse practitioner’s ability to order tests or diagnose conditions (NurseJournal, 2022). For example, a nurse practitioner might need to be part of a practice that is supervised by a physician, rather than running their own practice, but within that practice, can operate with relative autonomy (NurseJournal, 2022).

South Dakota is a full practice authority state (NurseJournal, 2022). Nurse practitoners can perform the full scope of practice without a supervising or collaborating physician (NurseJournal, 2022). They can diagnose a patient, order tests, prescribe medication, and operate on their own independent practices (NurseJournal, 2022). Nurse practitioner independent practice states may require a certain level of experience working under a physician’s supervision or require additional training before allowing full practice authority (NurseJournal, 2022). Because these requirements are not permanent, these states are still considered full practice authority states (NurseJournal, 2022). If a nurse practitioner practiced under a physician in Arkansas for the required amount of time and then moved to South Dakota, they could open their own practice.

References

American Medical Association. (2021). State law chart: nurse practitioner practice authority. American Medical Association. https://www.ama-assn.org/system/files/2020-02/ama-chart-np-practice-authority.pdf

American Nurses Association. (n.d.). State law and regulation. https://www.nursingworld.org/practice-policy/state-law-and-regulation/Links to an external site.

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

NurseJournal Staff. (2022, November 29). Nurse practitioner practice authority: a state-by-state guide. NurseJournal. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/#definitionLinks to an external site.

APRN Board Nursing Regulations

The APRN is an organization that is part of the legislation helping make policies to help keep the public safe. Six representatives help lead the organizations, and members, including the NCSBN, have made a toolkit to support the legislators and regulatory bodies in making changes to the healthcare professionals within the scope of practice. Certain states go by state-specific resources to determine the scope of practice. The states are Ohio, Oregon, New York, and Louisiana. (APRN State Law and Regulation, n.d.).

The Ohio APRN regulations are Drug Enforcement Administration (DEA). Certain drugs are under section 4723.42, which certifies that nurse practitioners can administer certain medications. Certified nurse practitioners are allowed to prescribe scheduled II controlled substances under specific guidelines.  The guidelines state that the physician initially prescribes the substance when the patient has terminal conditions. There are several other guidelines that the certified nurse practitioner has to follow before administering a schedule II substance. The nurse practitioner can prescribe controlled substances under the direction of the physician of the practice or facility.  (Section 4723.481 | Authority of A.P.R.N. Designated as a Clinical Nurse Specialist, Certified Nurse-Midwife, or Certified Nurse Practitioner to Prescribe Drugs and Therapeutic Devices., 2021). Another regulation that Ohio APRN has to follow is to maintain Standard Care Arrangement by collaborating with specialists such as podiatrists or physicians.  Commonly prescribed medications from certified nurse practitioners are ant-asthmatics, antibiotics, anti-hypertensives, diabetic agents, and cholesterol medication. (The Authority to Prescribe Medications and Therapeutic Devices, n.d.). The Standard Care Arrangement is to help make a guide for evaluating and planning patient healthcare.

The Standard Care Arrangement is developed by the general physician, podiatrist, CNP, CNM, and CNS. This regulation must be renewed every two years, and the employer must keep a copy of the SCA in case the board wants to see it. (What Is a Standard Care Arrangement, n.d.).

I work in a long-term care facility that also has a skilled unit. The skilled unit is where patients come to get rehab after they have had a knee replacement, hip replacement, open heart surgery, wound care, strokes, etc. The nurse practitioner works under a medical director who is the primary physician. The nurse practitioner addresses the needs and treats the patient, ensuring their pain is controlled. If the nurse practitioner does not treat the patient’s pain properly, then the patient will not be able to do their therapy and get better and go home. The nurse practitioner needs to be able to work under the primary care physician to prescribe the proper medications. Nurse practitioners need to go by specific guidelines to make sure the patients are getting excellent care for better outcomes and return home safely. The Standard Care Act helps nurse practitioners with guidelines on how to treat the patients they see. Each patient is different, so they need to know what direction to go to ensure they receive the proper care.

Different states have different guidelines for APRN regulations. For example, Federal Controlled Substance and State define North Carolina guidelines when prescribing controlled substances. The nurse practitioner must have a DEA number entered when prescribing the controlled substances. The nurse practitioner must follow a primary or backup supervising physician when prescribing the controlled substances. When the nurse practitioner orders the controlled substances, the patient’s name and the nurse practitioner’s name and telephone number have to be on the prescription. (Prescribing Authority, 2021).

For instance, NC and Ohio have similar and different controlled substance prescription regulations. Both states have their nurse practitioners working under primary care physicians when prescribed controlled substances. There are differences in that North Carolina’s regulations when prescribing controlled substances are stricter. The nurse practitioner in North Carolina goes by Federal and state guidelines. The NP has to make sure their name, patient’s name, and telephone number are where the NP can be reached by staff and primary physician. The NP must also give their DEA number each time they order a controlled substance. Ohio NP was not as strict on ensuring their DEA number was given each time a controlled substance was prescribed.

Nurse practitioners must be able to prescribe controlled substances, even if under a primary physician. There are more NP available to assess patients. Physicians rely on and trust their NP to help treat their patients. NP should be able to prescribe controlled substances on a limited basis.

References

APRN state law and regulation. (n.d.). ANA America nurses association. Retrieved December 27, 2022, from https://www.nursingworld.org/practice-policy/advocacy/state/aprn-state-law-and-regulation/Links to an external site.

Prescribing authority. (2021, August 1). 21 NCAC 36.0809. Retrieved December 27, 2022, from http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0809.htmlLinks to an external site.

Section 4723.481 | authority of A.P.R.N. designated as a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner to prescribe drugs and therapeutic devices. (2021, July 30). Ohio Laws & administrative rules. Retrieved December 27, 2022, from https://codes.ohio.gov/ohio-revised-code/section-4723.481Links to an external site.

The authority to prescribe medications and therapeutic devices. (n.d.). Ohio ARRNs providing quality, affordable healthcare in a variety of settings.. Retrieved December 28, 2022, from http://www.ohioaprn.com/prescriptive-authority.html#:~:text=Learn%20more%20about%20the%20rules%20governing%20APRN%20prescribers,substances%29%20continuing%20education%20on%20a%20regular%20basis%20%28bi-annually%29Links to an external site.

What is a standard care arrangement. (n.d.). Ohio APRNs providing quality, affordable healthcare in a variety of settings. Retrieved December 28, 2022, from http://www.ohioaprn.com/sca—standard-care-arrangement.htmlLinks to an external site.

Main Post:

Professional Nursing and State-Level Regulations

There are more than 50 state board nursing bodies in the country. The Board of Nursing ensures that its nurses have regulation that guides their practice in the State. For instance, in Minnesota, nurse practitioners are allowed to practice independently. The State joined eleven states in January 2015, allowing Nurse Practitioners to prescribe or practice independently (Graziano et al., 2017). The move has contributed to having a state with highly improved healthcare services. For example, the NPs have contributed to improving access to mental health services, helping Minnesota to counteract the ever-increasing primary care gap.

Before practice, the Minnesota Board of Nursing mandates that individuals meet all educational and certification requirements. The State has made numerous adjustments to its policies to ensure that only qualified individuals can handle patients’ issues. For instance, in 2014, the State stipulated that advanced practice nurses must have separate APRN licensing in addition to the Registered Nurse license. All the process and requirement allows the healthcare providers to meet the educational requirement for rendering them competent in rendering effective healthcare services in the State.

Each State may have its regulations and programs on how they want healthcare services to be rendered in their State. It is crucial to compare the Minnesota APRN regulations to those in California. The Nursing Practice Act (NPA) is the organization of the body for California mandating the Board on setting the scope of practice, duties, and responsibilities of Registered nurses (Lin et al., 2018). The State requires all individuals who may want to obtain certification for practicing as nurse practitioners to ensure they have an active license as a registered nurse for California. An additional requirement is that the nurse must also have a master’s degree in nursing or any clinical field that can be equated to nursing. The healthcare provider needs to complete a nurse practitioner education program.

The State requires nurse practitioners to practice within the scope of practice described in the Nursing Practice Act of California. The roles of nurse practitioners, as stipulated by the Nurse Practice Act, are not limited to assessment, ordering, requesting, and interpreting diagnostic tests, diagnosing, treating, and prescribing medications (Smith, 2022). Nurse practitioners have the relevant skills for managing, counseling, and educating patients and their families on their health conditions.

Nurse practitioners working in the State have the mandate of adhering to the provided policies and regulations and ensuring that they render the healthcare services highlighted in the scope of practice. It is relevant to ensure that all the education and certification requirements are met. Nurse practitioners are vital for healthcare providers as they deliver services that primary care physicians could only render. The regulations and accreditations process may be different for the two states described in this document. Still, they all aim to ensure that the public receives competent and safe services.

The Board of Nursing for states ensures the protection and regulation of nurses and nursing practice. It ensures improvement, which contributes to having healthcare facilities that are competent in solving and meeting the patients’ healthcare needs. At times healthcare providers wanting to practice in other states may need to follow the provided requirements in the State before being accredited to practice.

References

Smith L. B. (2022). The effect of nurse practitioner scope of practice laws on primary care delivery. Health Economics, 31(1), 21–41. https://doi.org/10.1002/hec.4438Links to an external site.

Graziano, J. A., Uppman, F., Anderson, K., Johnson, L., Frosch-Erickson, S., Hill, D., Eccles, J., Beasley, L., & Kohler, S. (2017). Minnesota Alliance for Nursing Education (MANE): A Unique Multi-institutional Approach to Preparing Nurses for the Future. Nursing Education Perspectives, 38(5), E2–E7. https://doi.org/10.1097/01.NEP.0000000000000198Links to an external site.

Lin, V. W., Juraschek, S. P., Xu, L., Jones, D., & Turek, J. (2018). California regional registered nurse workforce forecast. Nursing Economic$, 26(2), 85–121. https://pubmed.ncbi.nlm.nih.gov/18524374/

For this discussion post, I am comparing the APRN scope of practice regulations between New Hampshire, where I currently live, and Texas, where my extended family lives. New Hampshire is a full independent practice state, meaning that a fully licensed nurse practitioner in the state does not need to practice under the supervision of a physician. As a fully independent practitioner, a nurse practitioner within New Hampshire has full prescriptive ability, can sign POLST forms, and can work as a primary care provider within the state.  In comparison, nurse practitioners within Texas must have a written scope of practice agreement with a physician (that is renewed annually) that dictates what their scope of practice will be, and what medications and medical devices they can prescribe. Nurse practitioners in Texas may work as primary care providers, but they must practice within the scope of the practice agreement between themselves and a physician, and they cannot sign POLST forms.

These scope of practice regulations affect nurse practitioners who have legal authority to practice within their full scope of practice of their education and experience in that Nurse practitioners in Texas, although they may have the knowledge and experience to practice independently, cannot practice as a provider without the supervision of a delegating physician, who is ultimately responsible for all the care that the nurse practitioner provides to patients. Furthermore, a nurse practitioner in Texas, would not be legally able to practice independently, and could not sign any POLST forms for their patients. The same nurse fully licensed practitioner working in New Hampshire, however, would be able to independently see their patients (without a delegating or supervising physician), and would be able to sign the POLST form without having to go to a physician for a signature.

Bin Abdul Baten, R., & Wehby, G. L. (2022). Effects of the aca medicaid expansions on access and health by nurse practitioner scope of practice laws. Nursing Outlook, 70(2), 228–237. https://doi.org/10.1016/j.outlook.2021.12.011

NCSLSOP. (2022). Nurse practitioners: scope of practice policy. Retrieved December 28. 2022, from https://scopeofpracticepolicy.org/practitioners/nurse-practitioners/?

Discussion 5:

Regarding licensure authority for an APRN, each state has its own set of regulations (American Association of Nurse Practitioners, 2022). Two differences between New Mexico and Florida are the ability to practice independently without restrictions or oversight and work in different specialty areas. In all 50 states, APRNs fall into one of three different levels of practice. According to the American Association of Nurse Practitioners, the three different levels are as follows:

Full Practice
State practice and licensure laws permit all NPs to evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing.

Reduced Practice
State practice and licensure laws reduce the ability of NPS to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider for the NP to provide patient care, or it limits the set of one or more elements of NP practice.

Restricted Practice
State practice and licensure laws restrict the ability of NPS to engage in at least one element of NP practice. State law requires career-long supervision, delegation, or team management by another health provider for the NP to provide patient care (American Association of Nurse Practitioners, 2022).

New Mexico falls under the full practice, while Florida is restricted practice. The New Mexico board of nursing states that an APRN can “practice independently and make decisions regarding healthcare needs of the individual, family or community and carry out all health regimens, including the prescription and distribution of dangerous drugs and controlled substances” (New Mexico Board of Nursing, 2022b). Florida is a restricted practice state where the APRN can only work under an approved protocol or a Physician.

To comply with this regulation, the APRN must enter a supervisory protocol with at least one physician within the physician group practice. In Florida, an APRN can apply to become an “Autonomous Advanced Nurse Practitioner,” where they can practice independently but can only engage in autonomous practice in primary care practices, including family medicine, general pediatrics, and general internal medicine, as defined by board rule. They also must have completed a minimum of 3,000 hours in the specialty they are approved to work in before they can be licensed as autonomous and have to apply to the state of Florida for approval and compliance (Statutes & constitution: view statutes: Online sunshine, 2022). New Mexico APRNs can work independently as soon as they are licensed and can work in all specialties. Since we are a rural state with limited access to care and specialists, our state would suffer if we had restrictions in a place like Florida. APRNs are vital to our healthcare system in New Mexico; we have a limited number of physicians and need our APRNs’ support to continue caring for our patients.

References

American Association of Nurse Practitioners. (2022). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environmentLinks to an external site.

New Mexico Board of Nursing. (n.d.). Retrieved December 28, 2022, from https://nmbon.sks.com/nurse-practice-actLinks to an external site.

NursingLicensure.org (2022a). Advanced Practice Nurse Requirements in New Mexico. https://www.nursinglicensure.org/np-state/NewLinks to an external site. Mexico-nurse-practitioner/

Statutes & Constitution: view statutes: Online Sunshine. (2022, December 28). Retrieved December 28, 2022, from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499%2F0464%2F0464.htmlLinks to an external site.

The Board of Nursing varies between each state on how they regulate the APRNs(American Association of Nurse Practitioners, 2022). The New Jersey Board of Nursing was established in 1912 to protect the health, safety and welfare of New Jersey’s residents by ensuring that those who practice nursing are qualified and competent to do so. This board licenses registered nurses and practical nurses, and regulates the nursing profession in New Jersey. The board certifies advanced practice nurses, sexual assault forensic nurses, and certified homemaker-home health aides. The board accredits nursing schools and approves clinical affiliates. (American Association of Nurse Practitioners, 2022). The state of New Jersey has certain regulations that only pertain to the state of New Jersey. I also hold my NLC. An NLC is a nursing compact license that RN can apply for if they live in a compact state. The Nurse Licensure Compact (NLC) allows a nurse to have one multistate license with the ability to practice in the home state and other compact states. (NCBSN, 2022). This allows for nurses who are doing travel nursing to not have to apply for each state separately.

APRNs in most states are able to independently treat and diagno patients. For example, in the state where I live and will obtain my license, APRNs still have to practice under the delegation of a physician. On the contrary in the State of Oregon, they have allowed for nurses to have full practice authority. This means that the APRNs in Oregon can diagnose and treat patients independently. (AANP 2022). I understand that each state follows different regulations, but sometimes it makes no sense considering we all take similar NCLEX in the beginning. There should be a standardized practice from state to state for APRNs. I understand Oregon may have more vast rural areas than New Jersey and that is why they may give APRNs more freedom with providing care. New Jersey is a metropolitan area with access to arguably some of the best healthcare in the country, which may be why they have more restrictions on APRNs they do not see the full value they bring to the healthcare system. However, if we all receive the same schooling and take very similar boards, why not just standardize the scope of practice for all APRNs. This would most likely lead to a better continuity of care from state to state. APRNs are a vital and very important part of the healthcare system and letting them work to the full extent of their scope of practice is important.

Furthermore, regulations of the different states in the United States work differently between state to state. Some licenses limit nurses in some states, where as other states nurses are able to practice freely.

References: 

American Association of Nurse Practitioners. (2022). New Jersey: Information and Resources for New Jersey NPs. https://www.aanp.org/advocacy/new-jersey

Nurse Licensure Compact (NLC). NCSBN. (n.d.). Retrieved December 28, 2022, from https://www.ncsbn.org/compacts/nurse-licensure-compact.page

American Association of Nurse Practitioners. (2022). Alaska: Information and Resources for Oregon NPs. Retrieved December 28, 2022, from https://www.aanp.org/advocacy/Oregon

In Texas, Nurse practitioners are not allowed to sign death certificates or handicap parking permits.  They are able to sign worker’s compensation claims and be named primary care providers. (Nurse Practitioner Scope of Practice: Texas | ThriveAP, n.d.) Texas Nurse Practitioners have a limited scope of practice. Nurse practitioners practicing in Texas have laws requiring physician supervision in prescribing and practice. In Texas, the nurse practitioner must practice within 75 miles of the supervising physician. Physicians cannot supervise greater than four nurse practitioners at one time.  The supervising physician must also review at least 10 percent of the nurse practitioner’s charts each month. In Texas Nurse Practitioners are allowed to prescribe under physician supervision. They can only prescribe a 30 day supply of medications and cannot o prescribe schedule 2 drugs.

In Arkansas unlike Texas Nurse practitioners allow full practice rights. Nurse Practitioners, like in Texas can evaluate and examine patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.

The issue with restricting Nurse Practitioner’s right to practice fully is it reduces the amount of providers, especially in rural areas. All states with reduced rights for Nurse Practitioner practice are trying to move towards full authority, but it is a long and tedious process that requires much work.

Arkansas. (n.d.). American Association of Nurse Practitioners. Retrieved December 28, 2022, from https://www.aanp.org/advocacy/arkansas

‌

Important Scope of Practice Information – Texas Nurse Practitioners. (n.d.). Www.texasnp.org. https://www.texasnp.org/page/34Links to an external site.

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

American Nurses Association. (n.d.). ANA enterprise Links to an external site.Links to an external site.. Retrieved September 20, 2018, from http://www.nursingworld.orgLinks 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 care Links to an external site.Links to an external site.. Nursing Outlook, 65(6), 761–765.

Halm, M. A. (2018). Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing Download Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing. Worldviews on Evidence-Based Nursing, 15(4), 272–280. doi:10.1111/wvn.12291

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.htmLinks to an external site.

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 Links to an external site.Links to an external site.. Nursing Outlook, 66(4), 379–385.

Peterson, C., Adams, S. A., & DeMuro, P. R. (2015). mHealth: Don’t forget all the stakeholders in the business case Links to an external site.Links to an external site.. Medicine 2.0, 4(2), e4.

For my discussion, I have chosen to look at the Mississippi Board of Nursing (MSBON) and Tennessee Board of Nursing (TNBON) regulations and requirements for the Advance Practice Registered Nurse (APRN). Both states are Nurse Licensure Compact (NLC). I live in Mississippi (MS) and am licensed through the MSBON, but I currently work in Tennessee (TN). I have worked as a nurse in both states throughout my nursing career.

As an RN or APRN in the State of MS, you must be fingerprinted along with a background check. This background check and fingerprinting must be redone every two years if you change to another employee. In Tennessee, no fingerprinting is required with one’s background check. To practice as an APRN in Mississippi, the RN must have or obtain a Mississippi BON license even though MS is an NCL state. (Mississippi Board of Nursing, n.d.). A licensed MS APRN can apply to work in TN as a practicing APRN without obtaining a TN BON license because Tennessee, as a multi-state compact license state, recognizes the MS APRN license (Tennessee Board of Nursing, n.d.).

In the state of MS, APRNs can only practice independently if they enter into a collaborative agreement with a physician that must be sent to the MSBON (Mississippi Board of Nursing, n.d.). In TN, practicing APRNs can only practice independently in their place as long as a practicing physician represents them. The physician and APRN must have a written practice protocol outlining an acceptable standard of patient care, and a copy must be present at each practice site (Tennessee Board of Nursing, n.d.).

As with all BON, the purpose of regulations is to provide safety for the public and allow nurses to work within their scope of practice to ensure public safety.

References

Mississippi Board of Nursing. (n.d.). Advance Practice Registered Nurse. Retrieved

December 27, 2023. https://www.msbn.ms.gov/Links to an external site.

Mississippi Board of Nursing. (n.d.). Advance Practice. Retrieved December 27, 2022

https://www.sos.ms.gov/ACProposed/00022833b.pdfLinks to an external site.

Tennessee Board of Nursing. (n.d.). Rules of the Tennessee Board of Nursing. Retrieved

December 27, 2022. https://publications.tnsosfiles.com/rules/1000/1000-04.20190812.pdfLinks to an external site.

I will be comparing the regulations for Advanced Practice Registered Nurses (APRNs) in the state of Pennsylvania where I reside and the state of Minnesota. For APRNs in the state of Pennsylvania, 30 hours of continuing education (CE) must be completed every two years for license renewal (Pennsylvania Department of State, n.d.). In Minnesota, CE hours are not needed to renew your APRN license and only 24 hours of CE credits are required within two years to renew your registered nurse (RN) license (Minnesota Board of Nursing, n.d.).

An APRN in Pennsylvania can prescribe and order medications by obtaining approval through collaboration with a physician within their specialty and must complete 45 hours in advanced pharmacology education (Pennsylvania Code, 2022). In comparison, APRNs in Minnesota may prescribe and administer medications independently including controlled substances, but prescribers must complete two hours of CE on best practices for opioid prescribing and alternative treatments for pain (Minnesota Board of Nursing, n.d.).

Both APRNs in Pennsylvania and Minnesota can sign death certificates as well as POLST forms (Wiesen, n.d.). In Minnesota, cause of death can be provided by an APRN; however, in Pennsylvania APRNs cannot report cause of an individual’s death but can only sign the death certificate (Minnesota Board of Nursing, 2020).

In Pennsylvania, APRNS have reduced practice which means that nurse practitioners (NPs) must have a collaborative agreement with a physician to care for patients and to carry out certain orders (American Association of Nurse Practitioners, 2022). Whereas in the state of Minnesota full practice authority (FPA) has been implemented so that Certified Nurse Practitioners (CNP) and Certified Nurse Specialists (CNS) with 2,080 practice hours after the date July 1, 2014, can manage patients independently without a collaborating physician if their previous practice hours were in a collaborative agreement (Minnesota Board of Nursing, n.d.). This significantly effects care as APRNs are trained to independently care for patients and having FPA can improve access to healthcare as well as be more cost effective for patients and hospitals (Bosse et al., 2017).

APRNs who have FPA can manage patient’s medications in their entirety without having to be under a physician contract and research has shown that with the use of APRNs prescribing under their full scope less prescriptions linked to overdose deaths have been given to patients (Bosse et al., 2017). When FPA is in effect across the board this can enable APRNs to sign, and report causes of death without hesitation and in a respectful way for patients’ families and for postmortem care to take place in a timely manner. When APRNs in Pennsylvania, adhere to the CE hours needed for renewal in the coming year they will have to make sure they have obtained 30 hours within two years. Pennsylvania APRNs will also need to have completed their 45 hours of advanced pharmacology along with a collaboration contract with a physician in their practice to prescribe medications for patients.

References

American Association of Nurse Practitioners. (2022). Retrieved on December 27, 2022, from https://www.aanp.org/advocacy/state/state-practice-environment

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 care. Nursing Outlook, 65(6), 761–765.

Minnesota Board of Nursing. (n.d.). Advanced Practice Registered Nurse (APRN) Licensed General Information. Retrieved on December 28, 2022, from https://mn.gov/boards/nursing/advanced-practice/advanced-practice-registered-nurse-(aprn)-licensure-general-information/

Minnesota Board of Nursing. (2020). APRNS and Authority to Pronounce Death and Provide Case of Death. Retrieved December 28, 2022, from https://mn.gov/boards/assets/APRNS_Auth_Pronounce_Death_12-2020_tcm21-37245.pdf

Pennsylvania Code. Title 49. Chapter 21. 49 Pa. Code § 21.283. Authority and qualifications for prescribing, dispensing and ordering drugs.

Pennsylvania Department of State. (n.d.). Retrieved on December 27, 2022, from https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Pages/Certified-Registered-Nurse-Practitioner-Licensure-Requirements-Snapshot.aspx

Wiesen, K. (n.d.). Nurse Practitioner Scope of Practice by State – 2023. Retrieved December 28, 2022, from https://www.nursingprocess.org/nurse-practitioner-scope-of-practice-by-state.html

Professional Nursing and State-Level Regulations

Nursing regulations have the fundamental purpose of ensuring that the public is provided with safe nursing care by impacting the quality of nursing education, the relevance of academic programs, and professional practice. Regulations are government oversight measures of professional nursing practice to avoid the risk of harm to the public if they receive nursing care from an incompetent or inexperienced person. Regulations present mechanisms for safeguarding the public including continuing nursing education, competency exams, and seminars to keep up with the ever-changing nursing skills.   The presence of regulations is intended to ensure that the nurses are well-trained, competent, resilient, adaptive, and responsible for population needs (DeNisco, 2021). This paper compares nursing regulations for the State of California and the State of New York.

Practice requirements

Advanced Practice Registered Nurses (APRN) practice in the states of California and New York under the regulations developed by their respective state boards of nursing. In California, APRNs are under the jurisdiction of the California Board of Nursing. To be certified as an APRN, the practitioner must be licensed as a registered nurse in the state and be educated at the graduate level in advanced specialty areas of nurse anesthetist, nurse practitioner, nurse-midwife, clinical nurse specialist, and psychiatric/mental health nurse. APRNs from out of the state must receive a state registered nurse license before being allowed to practice within the state (NursingLicensure.org, 2022a). Like California, the New York Board of Nursing certifies all APRNs seeking to practice in the state, requiring them to hold a state-specific registered nurse license and certification for the specialty after completing a program registered with the New York State Education Department or its equivalent (NursingLicensure.org, 2022b).

Although the APRN practice requirements for the states of California and New York are similar, there are significant differences in prescription authority. In the State of California, APRNs are required to complete a master’s or post-master advanced pharmacology course that meets the state board requirements after which a furnishing number is issued to allow the APRN to have the prescriptive privilege. While the course does not have to be delivered by an institution in California, a nationally accredited program must deliver it. This implies that an APRN would only be eligible for the prescriptive privilege if he/she completes an advanced pharmacology course through an approved program (NursingLicensure.org, 2022a). In contrast, an APRN can enjoy prescriptive privilege in New York State if he/she demonstrates competence in pharmacology. This involves completing a registered nursing program that has pharmacology content. Alternatively, APRNs who do not complete programs with pharmacology content can complete a stand-alone registered program presented as a three-semester course that includes pharmacology content and passes an acceptable pharmacology examination. The pharmacology coursework must follow all the criteria that the New York Board of Nursing requires.  Also, for the   APRN who completes pharmacology coursework within the state of New York, the law requires to complete a complete state-specific legal curriculum delivered by the Nurse Practitioner Association of New York State or the New York State Nurses Association (NursingLicensure.org, 2022b).

Practice Authority

APRNs in New York State have long enjoyed full practice authority. This implies that they are allowed to evaluate patients in terms of diagnosing, ordering, and interpreting diagnostic tests. In addition, APRNs are permitted to initiate and manage treatments including medication and controlled substances prescriptions as authorized by the exclusive licensure authority of the state board of nursing (American Association of Nurse Practitioners, 2022). In contrast, APRNs in California State are subjected to restricted practice authority. The state regulations restrict the ability of APRNs to engage in some elements of practices, requiring that APRNs who seek to provide patient care must be subjected to career-long team management, delegation, or supervision by another health provider (American Association of Nurse Practitioners, 2022).

Still, there have been some changes in the state regulations with the changes expected to take effect on January 1, 2023. The changes allow certified APRNs to practice independently and enjoy full practice authority within the state. Assembly Bill 890 which was signed into law in 2020 by California Governor Gavin Newsom gives certified APRNs a pathway to full-practice authority after going through three years of physician supervision. The regulation clarifies that within three years, APRNs are allowed to practice independently and can consult a physician if needed. After three years of supervised practice, APRNs can gain full practice authority without any restrictions. This regulation implies that the earliest that APRNs in California state can gain full practice authority is in 2026. This will allow APRNs to practice within the complete scope of their license without supervision including performing physical exams, prescribing medication, ordering tests, and diagnosing patients. Besides that, full practice authority would still allow APRNs to collaborate with other health providers but no longer requires other providers to sign off on assessments.  The APRNs will continue to work together with other providers for the best patient outcome.

Conclusion

One must accept that the nursing regulations are developed by state nursing boards and are intended to ensure that the nursing workforce is well-trained, competent, resilient, adaptive, and responsible for population needs. In addition, one must acknowledge that APRNs in the states of California and New York are under the authority of the state board of nursing, educated to the level of APRN, and licensed to practice as APRNs. Besides that, APRNs in California are subjected to restricted practice authority and would begin enjoying full practice authority in 2023, while APRNs in New York enjoy full practice authority.

References

American Association of Nurse Practitioners (2022). State Practice Environment. https://www.aanp.org/advocacy/state/state-practice-environmentLinks to an external site.

DeNisco, S. M. (2021). Advanced Practice Nursing: Essential Knowledge for the Profession (4^th ed.). Jones & Bartlett Learning, LLC.

Monday, R. (2022, December 7). California Expands Nurse Practitioner Practice Authority. https://nursejournal.org/articles/california-expands-nurse-practitioner-practice-authority/Links to an external site.

NursingLicensure.org (2022a). Advanced Practice Nurse Requirements in California. https://www.nursinglicensure.org/np-state/california-nurse-practitioner/Links to an external site.

NursingLicensure.org (2022b). Advanced Practice Nurse Requirements in New York. https://www.nursinglicensure.org/np-state/new-york-nurse-practitioner/Links to an external site.

During the COVID-19 pandemic in 2020, the US healthcare system faced an unprecedented challenge in providing healthcare services to its citizens. In response to the urgent need for healthcare providers, state governmental leadership focused on removing barriers for many healthcare professions including Advance Practice Registered Nurses (APRN) (Melander, S., et al 2020).

State Board of Nursing (BON) across the country answered the call during the pandemic. In California, Governor Gavin Newsom signed Assembly Bill 890, Chapter 265 of the CA statutes of 2020 about nurse practitioners (NP) scope of practice. NPs who practiced in licensed healthcare settings as defined in the statute, meet the education requirements, transition to practice experience (3 years full-time equivalent [FTE] or 4,600 hours), and certification requirements are authorized to practice independently under a newly defined scope of practice without standardized procedures and physician supervisions (California Board of Nursing).

However, per the California Board of Registered Nursing, all NPs will meet these provisions outlined in AB 890 on January 1, 2023. It means, California NPs will not be able to see the changes and progress until after January 1, 2023, when NPs and Certified Nurse Midwives included, may be able to practice independently when the above requirements are met. It is funny how this law is being implemented after two years when it is needed the most.

On the other hand, Nevada adopted the Full Practice Authority (FPA) in 2013. Nevada law authorizes NPs to evaluate, diagnose, prescribe medications and provide therapeutic measures and, it saw increased access among patients to healthcare providers especially patients in rural areas (cdc.gov).

I compared Nevada to California for its proximity. While Nevada is also a member of the APRN compact (NCSBN), California is not for several reasons. Nursing interest groups and politicians shaped their argument in favor of FPA around the increasingly insured population because of the Affordable Care Act (ACA), provider shortages, and rural healthcare access (VanBeuge, S.S., & Walker, T. 2014).

NPs have gained a lot recently. Since 2011-2016, 8 states adopted Full Practice Authority (FPA), a twofold increase from the previous 10 years. Institutional challenges do exist. NPs need to educate stakeholders about the value and capacity of their services to address perceptions about parity in payments for similar services by physicians (Phillips S.J., (2021).

References:

APRN state law and regulation. ANA. (2017, October 20). Retrieved December 27, 2022, from https://www.nursingworld.org/practice-policy/advocacy/state/aprn-state-law-and-regulation/Links to an external site.

How state scope-of-practice policies impact NP care. NursingCenter. (n.d.). Retrieved December 27, 2022, from https://www.nursingcenter.com/journalarticle?Article_ID=5637152Links to an external site.

Susanne J. Phillips is the associate dean of clinical affairs and a practicing family NP at the Sue & Bill Gross School of Nursing. (n.d.). 33rd annual APRN legislative update: Unprecedented changes…: The nurse practitioner. LWW. Retrieved December 27, 2022, from https://journals.lww.com/tnpj/fulltext/2021/01000/33rd_annual_aprn_legislative_update__unprecedented.6.aspxLinks to an external site.

Melander, S., Hardin-Pierce, M., & Howard, P. B. (2020). Meeting the challenges of Expanded Practice Through Postgraduate APRN Certification. The Nurse Practitioner, 45(6), 8–10. https://doi.org/10.1097/01.npr.0000666212.83911.d3Links to an external site.

T; V. B. S. S. W. (2014, June 26). Full Practice Authority–effecting change and improving access to care: The Nevada journey. Journal of the American Association of Nurse Practitioners. Retrieved December 28, 2022, from https://pubmed.ncbi.nlm.nih.gov/24688001/Links to an external site.

APRN Board of Nursing Regulations

Each state board of nursing regulates specific exclusive licensure authority for their APRNs (American Association of Nurse Practitioners, 2022). While each state board of nursing governs the laws, the state legislature must pass the laws (West Virginia RN Board, 2022b). I have found two differences from state to state: the ability for reduced or restricted practice and the ability to prescribe schedule II narcotics (American Association of Nurse Practitioners, 2022). These differences are shown in West Virginia and Georgia regulations.

West Virginia is a state with reduced practice regulations, and Georgia has restricted practice regulations (American Association of Nurse Practitioners, 2022). Restricted practice guidelines require another health provider to deliver career-long supervision, delegation, or team management (American Association of Nurse Practitioners, 2022). Reduced practice regulations require career-long collaborative agreements with another provider, or it limits the setting of one or more components of nurse practitioner practice (American Association of Nurse Practitioners, 2022). For example, Georgia’s state board of nursing requires a written nurse protocol signed by the nurse and licensed physician. This agreement specifies the delegated medical acts by the physician to the nurse. It provides immediate consultation with that physician or a physician designated in the absence of the delegating physician (Rules and Regulations of the State of Georgia, 2022). However, West Virginia APRNs still need a career-long collaborative agreement with less supervision of periodic evaluation (West Virginia Legislature, 2022). Georgia APRNs must have more direct supervision by a physician, whereas West Virginia APRNs are allowed less physician supervision (West Virginia Legislature, 2022).

Another difference between Georgia and West Virginia APRN laws is the ability to prescribe schedule II narcotics (West Virginia RN Board, 2022a; Rules and Regulations of the State of Georgia, 2022). On May 2, 2022, West Virginia’s governor signed a bill giving APRNs under specific regulations new prescriptive authority for a 3-day supply of schedule II narcotics (West Virginia RN Board, 2022a). These medications include hydromorphone, methadone, oxycodone, fentanyl, morphine, hydrocodone, and codeine (Diversion Control Division, 2022). What stands out most to me is the ability of APRNs to prescribe methadone in an attempt to combat West Virginia’s opioid epidemic. APRNs in Georgia do not have the prescriptive authority to prescribe schedule II drugs (Rules and Regulations of the State of Georgia, 2022). In Georgia, only a physician can prescribe schedule I and II medication when deemed appropriate (Rules and Regulations of the State of Georgia, 2022). These two different laws create a difference in the care APRNs can provide in West Virginia and Georgia.

References

American Association of Nurse Practitioners. (2022). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

Diversion Control Division. (2022). Controlled substances schedules. https://www.deadiversion.usdoj.gov/schedules/

Rules and Regulations of the State of Georgia. (2022). Chapter 410-11 Regulation of advanced practice registered nurses. https://rules.sos.ga.gov/gac/410

-11

West Virginia Legislature. (2022). West Virginia code. http://www.wvlegislature.gov/WVCODE/ChapterEntire.cfm?chap=30&art=7&section=

=15B#7

West Virginia RN Board. (2022a). Board message regarding APRN prescriptive authority. https://wvrnboard.wv.gov/Pages/Board-Message-Regarding

-APRN-Prescriptive-Authority.aspx

West Virginia RN Board. (2022b). Law/scope. https://wvrnboard.wv.gov/lawandscope/pages/default.aspx#:~:text=The%20laws%20are

%20passed%20by,are%20found%20in%20Chapter%2030