Nurse practitioners in reduced practice states can perform some of their duties without the supervision of a physician.
I need a positive feed back for the following discussion ( 2 in total ) with two references
Discussion 1
Laws and regulations are different from state to state. According to Milstead & Short (2019) Laws and regulations are enacted at the state level to help protect the public from harm. Nurse practitioner practice authority varies from state to state. The scope of practice is divided into three categories of practice authority: Full, reduced, and restricted (NurseJournal Staff, 2022).
In states where nurse practitioners have full practice authority, they can perform the full scope of practice without the supervision or collaboration of a physician. They can diagnose patients, order tests, prescribe medication, and run their own businesses. Before granting full practice authority to a nurse practitioner, some states may require a certain level of experience working under the supervision of a physician or additional training (NurseJournal Staff, 2022).
Nurse practitioners in reduced practice states can perform some of their duties without the supervision of a physician. These restrictions usually involve running their own practices or prescribing specific medications. They rarely require the nurse practitioner’s ability to order tests or diagnose conditions. A nurse practitioner, for example, may need to be part of a practice supervised by a physician rather than running their own practice but can operate with relative autonomy within that practice (NurseJournal Staff, 2022).
Nurse practitioners in restricted practice states must work under the supervision of a physician for the entirety of their scope of practice. While they may have significant autonomy in some nurse practitioner functions, they are not independent practitioners (NurseJournal Staff, 2022).
I live in North Carolina, but I lived most of my life in Florida. Consequently, I will focus on these two states.
In North Carolina, physician supervision is required for nurse practitioners. A collaborative practice agreement is required between the NP and the supervising physician. The agreement must establish minimum standards of consultation and must be reviewed yearly. Nurse practitioners are recognized in North Carolina as primary care providers (NCSL Scope of Practice Policy, 2022). As of 2022, The joint committee is hearing from experts as they consider passing the SAVE Act, which was first introduced in 2021 to expand full practice authority for primary care NPs in North Carolina (Duke University School of Nursing, 2022).
The bill granting Florida Nurse Practitioners full practice authority was finally passed. Beginning in July 2020, advanced NPs with at least 3,000 hours of experience under physician supervision can independently operate primary care practices in Florida without the supervision of a doctor. To qualify, they must also complete graduate-level coursework in differential diagnosis and pharmacology (Thomas, 2020). In Florida, Nurse practitioners may practice autonomously in primary care settings, including family medicine, general pediatrics, and general internal medicine. In Florida, NPs are also recognized in state policy as primary care providers (NCSL Scope of Practice Policy, 2022).
Another regulation that comes along with practice authority is prescriptive authority. Nurse practitioners in Florida can prescribe any drug and Schedules II-V controlled substances if the NP is practicing autonomously. In North Carolina, NPs need to be supervised by a physician (NCSL Scope of Practice Policy, 2022). I find it shocking that one state will grant a nurse practitioner complete control and another will not.
My opinion is that I feel that nurse practitioners should be working to their full extent nationwide. Nurse practitioners should be able to practice at the highest level of their competencies, education, and licensing. We have 30 years of evidence from 24 states that indicate that granting full practice authority to NPs is beneficial (Duke University, 2022). Granting full practice authority would expand health care to underserved populations. (Duke University, 2022). The first states to give full NP practice authority did so in 1994, nearly three decades ago, and full NP practice authority has never been repealed (Duke University, 2022). It simply does not make sense, in my opinion, for a knowledgeable advanced practice nurse to be restricted in one state but not another. More research must be done to prove that granting full practice authority to NPs benefits the population, and nurses must continue advocating for change.
DISCUSSION 2
Where I reside, the Nurse Practitioner role is regulated by the North Carolina Board of Nursing and the North Carolina Medical Board. They help develop the rules that establish the scope of practice for NPs in NC. The NP must have a supervising physician when practicing and that physician must provide them with a written agreement. The agreement is instructions about indications and contraindications for prescribing drugs along with a policy requiring the physician to review drugs prescribed by the NP. There are some restrictions like the NP must consult with the supervising physician before prescribing a targeted controlled substance under specific criteria. The criteria include if the patient is being treated at a facility that primarily focuses on pain management by prescribing narcotics and the controlled substance will be prescribed for a period of more than 30 days. Continuous consultation with the physician once every 90 days is required to ensure its appropriateness if the patient is continued on the controlled substance (North Carolina General Assembly, 2022). Orders written by an NP which can include medications, lab tests, and treatments are to be carried out by an RN or LPN just as if it was written by an MD.
On the other hand, a CRNA in NC is only regulated by the North Carolina Board of Nursing. The method of authorization for a CRNA is through recognition while an NP must have registration and approval to practice. Both APRNs must have graduate education completed and national certification. While physician supervision is required for an NP, it is not for a CRNA. The NP must have a written collaborative practice agreement with a physician and also have meetings with the supervising physician once a month for the first 6 months. Afterward, it is every 6 months (NCBON, 2022). The CRNA just has to be in collaboration with a physician, podiatrist, or another healthcare provider. The CRNA also doesn’t have prescriptive authority and durable medical equipment. In Connecticut per the Department of Public Health, an APRN that has had their license for at least 3 years and has practiced in collaboration with a physician for at least 3 years can then decide to practice alone or in continued collaboration with a physician (Connecticut State Department of Public Health, n.d.). The number of hours worked in 3 years must also be at least 2,000 to transition to full practice authority. The documentation must be submitted to the Department of Public Health if then the NP is looking to practice independently. But just like in NC for prescriptive authority the physician must address levels two and three of controlled substances in writing.
APRNs that have full practice authority reap several benefits for patients and the interdisciplinary healthcare team. This includes fewer ER visits, lower hospital admission rates, expanded health care usage in underserved communities, and cheaper care in comparison to physicians (Bosse et al., 2017). No matter how many years of experience you may have as an APRN, you must refer to your state board of nursing to learn about licensure requirements and your scope of practice which can differ from state to state. APRNs in NC must adhere to the regulations I mentioned first by completing a master’s degree or higher in the specialty area from an accredited NP program. They must also have a current unencumbered nursing license. Then the individual must obtain certification from one of their local credentialing bodies which will involve passing a test. Similarly in Connecticut, the individual must have a current nursing license and have completed a master’s program from a nationally accredited organization. This allows them to sit to take the certification test. They must have 30 hours of education in a pharmacology course for advanced nursing practice though.
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