You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your responses must be substant

Discussion 1 George

Introduction

Nursing practice requires specialized knowledge and skills attained through education and training in accredited institutions. The boards of nursing in each state have their requirements for certification and scope of practice. This essay discusses the scope of practice in the state of California and compares it with that of Florida.

Scope of Practice for The Advanced Practice Nurse (APN) in The State of California

The scope of practice for the advanced practice nurse in California is among the strictest laws in the United States. According to Montague (2020), the regulations require nurse practitioners (NPs) to have a written agreement with the supervising physician and make treatment decisions collaboratively with the physician. Notably, one of the Board of Registered Nursing (BRN) requirements is that NPs should practice under a physician’s oversight and comply with the standardized procedures established via teamwork with various healthcare disciplines such as administrators, surgeons, physicians, and nurse practitioners.

The standardized procedures provide NPs with the ability to do tasks that would otherwise fall under the practice of medicine. Additionally, NPs require accreditation from the BRN for prescribing or ordering medications or devices used in the standardized procedures in California (Montague, 2020). Generally, these supervisory agreements render physicians legally responsible for NP’s practice, and they determine the suitable level of supervision.

The state recently introduced some law changes under AB 890, effective from January 2023, which permits independent NPs’ practice after a transitional supervision period (Montague, 2020). Two categories of NPs created by this law function independently. However, if an NP does not want independent practice or does not meet the qualifications under this law for the two categories, they continue to practice their current agreements. The two categories are under sections 2837.103 and 2837.104 with special schooling, preparation, accreditation, governing requirements (Montague, 2020). This law expands the scope of practice of NPs such that they can practice independently without standardized procedures in any setting. The law allows them to open their own practice.

Comparison to Florida state practice laws for APNs

California compares to Florida in terms of supervision laws in that both states require physicians to supervise NPs. In Florida, a physician supervises NPs in at least four settings, excluding their primary practice setting (Toney-Butler & Martin, 2018). The physician does not have to physically avail themselves at the health setting for consultation but must be available via phone. Additionally, the state requires that patients receive notifications about the availability of physicians at a clinic. The stricter rule applies to speciality clinics where physicians can only oversee nurse practitioners in one health setting in addition to their primary practice settings, and they have to be at most 75 miles apart (Toney-Butler & Martin, 2018).

Also, both states require the nurse to meet certain competency standards to become fully certified to perform tasks within their scope of practice as per the state. Bushy (2019) establishes that registered nurses must demonstrate high competence and accountability in all aspects of practice, including suitable recognition, referrals, consultations, and appropriate interventions when complications arise.

In contrast with California, Florida NP prescribing laws do not allow them to prescribe controlled drugs despite a physician’s supervision. To prevent some practices from circumventing this law, the state created laws that bar NPs from using pre-signed physicians’ prescription forms and their DEA numbers on prescriptions (Toney-Butler & Martin, 2018).

References

Bushy, A. (2019). Laws and Rules Governing Nursing Practice in Florida. Retrieved from https://www.nursece.com/courses/129-laws-and-rules-governing-nursing-practice-in-florida

Montague A. (2020). Expanding scope of practice for nurse practitioners in California: AB 890 compromises to permit independent practice. California legislative beat. Retrieved from https://sourceonhealthcare.org/expanding-scope-of-practice-for-nurse-practitioners-in-california-ab-890-compromises-to-permit-independent-practice/

Discussion 2 Mentor

Scope of Nursing Practice in Texas 

            Scope of nursing practices are the activities performed by nurses in the healthcare setting when delivering patient care. Professional nursing is applying a certain level of skills, judgment and the appropriate performance based on the understanding and the use of the principles of social, physical, and biological science acquired by a nurse after completing a nursing course (Grimes et al., 2018). The legal scope of practice for professional registered nurses in Texas is defined by Nursing Practice Act (NPA) (Grimes et al., 2018). Experienced nurses in Texas have the duty of observing, assessing, evaluating, rehabilitating, caring for, and educating ill patients and those experiencing changes in their normal health processes (Grimes et al., 2018). Nurses are also responsible for upholding health living in the hospital and the prevention of diseases.

            In addition, nurses administer medicines to the patient according to the physician's prescription. They oversee and educate other nurses; they are also responsible for administering and evaluating nursing practices, policies, and procedures (Grimes et al., 2018). It is the responsibility of practice nurses in Texas to receive, sign, and distribute samples of prescription drugs to patients (Grimes et al., 2018). Therefore, the responsibility of the registered nurse in Texas is to provide safe nursing care to patients.

Scope of Practice in Florida

            In Florida, nurses are responsible for providing specialized and advanced nursing practice. Through professional nursing practice, nurses perform advanced-level nursing acts recommended by the board (Unruh et al., 2018). Nurses might perform certain actions such as medical and nursing diagnosis, nursing treatment, and prescription following an established protocol. Florida has legislation enabling nurses to practice independently in delivering primary care practices (Unruh et al., 2018). The same is applicable in Texas for ARPNs to treat and diagnose illnesses and offer advice to patients concerning their health, control chronic conditions, and engage in continuous education to remain ahead of other developments in the field.

            The scope of nursing practice in the two states is also similar in that they license nurses to operate in the healthcare sector. In Texas, the enhanced nurse licensure compact (eNLC) model allows nurses to physically, electronically, and telephonically practice in the home state and other eNLC states (Unruh et al., 2018). Nurses in Florida are also given licenses to offer patients healthcare services (Unruh et al., 2018). Therefore, the two states are licensure compact states because their nursing licensure compact is a multi-state agreement that enables nurses to practice in different states without applying for a new license.

            Nursing license requirements in Florida differ from those in Texas. For instance, there are various options for primary licensure, which vary according to the professional designation of an individual (Unruh et al., 2018). Florida's board of nursing handles the initial licensure and renewals for all classes for nursing staff. Even though there are some variations, in all cases, applicants ought to graduate from an accredited institution, complete fingerprinting for a criminal background check, pass a specific examination and pay for the examination and licensing fees (Unruh et al., 2018). On the other hand, Texas issues licenses to graduates of approved nursing education programs seeking licensure by exam.

References

Grimes, D. E., Thomas, E. J., Padhye, N. S., Ottosen, M. J., & Grimes, R. M. (2018). Do state restrictions on advanced practice registered nurses impact patient outcomes for hypertension and diabetes control?. The Journal for Nurse Practitioners, 14(8), 620-625. https://doi.org/10.1016/j.nurpra.2018.06.005

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