Respond?to two?of your colleagues and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and prov
Respond to two of your colleagues and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples.
I live in Miami Florida
Peer 1
Discussion
The regulations for Advanced Practice Registered Nurses in California and Georgia share similarities and differences. These regulations were obtained from the California Board of Registered Nursing and Rules and regulation of the state of Georgia (n.d.), respectively.
For education and experience, to adhere to this regulation, an APRN in both states must complete a graduate or postgraduate level program in their chosen nursing specialty. For instance, if a student wishes to become a Certified Registered Nurse Anesthetist in either California or Georgia, they should seek out and complete specific programs that focus on anesthesia. Striving for additional education, such as a doctoral degree in nurse anesthesia, would also help APRN exceed the minimum requirements, keeping them competitive and updated on the current methods and research in their field.
For Practice Agreement, in Georgia, an APRN must have a protocol agreement with a collaborating physician to practice and for prescriptive authority. This means that all major decisions regarding patient care and medication must go through the collaborating physician, potentially resulting in a time delay for the start of treatment. In contrast, California allows Advanced Practice Registered Nurses (APRNs) to operate independently but requires collaboration or a standardized protocol with a physician when prescribing medication. This requirement for collaboration or standardized protocols with physicians aligns with the findings of (Schorn et al., 2022), and (Germack, 2020), who highlighted that in states with reduced practice authority for APRNs, practice must occur in collaboration with or under the supervision of a physician, limiting their ability to engage fully in independent practice (Schorn et al., 2022; Germack, 2020). Additionally, Schirle and McCabe (2016) noted that there are variations in opioid and benzodiazepine prescriptions between independent and non-independent APRN prescribing states, indicating the impact of state regulations on prescribing practices (Schirle & McCabe, 2016). Furthermore, Barnes et al. (2016) categorized states based on their level of restrictiveness, with implications for healthcare delivery and access, emphasizing the influence of regulation and payment policies on APRN clinical practices, including prescribing authority (Barnes et al., 2016). The variation in practice agreements between states highlights the impact of regulatory policies on the autonomy and prescribing authority of APRNs.
The findings from various studies suggest that the variation in practice agreements between states has a significant impact on the autonomy and prescribing authority of APRNs. The requirement for collaboration or standardized protocols with physicians in California reflects the broader landscape of APRN practice across the United States, where regulatory and payment policies significantly influence their clinical practices and autonomy. It is crucial for policymakers and stakeholders to consider these implications when evaluating and shaping regulations surrounding APRN practice, with the ultimate goal of optimizing patient care and improving access to healthcare services.
References
Barnes, H., Maier, C., Sarik, D., Germack, H., Aiken, L., & McHugh, M. (2016). Effects of regulation and payment policies on nurse practitioners’ clinical practices. Medical Care Research and Review, 74(4), 431-451. https://doi.org/10.1177/1077558716649109
California Board of Registered Nursing (.gov). (2019). Nurse practitioners: Laws & regulations [PDF]. https://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf
Germack, H. D. (2020). States should remove barriers to advanced practice registered nurse prescriptive authority to increase access to treatment for opioid use disorder. Policy, Politics, & Nursing Practice, 22(2), 85–92. https://doi.org/10.1177/1527154420978720
Rules and regulations of the state of Georgia. (n.d.). Regulation of advanced practice registered nurses. https://rules.sos.ga.gov/gac/410-11
Schirle, L., & McCabe, B. E. (2016a). State variation in opioid and benzodiazepine prescriptions between independent and nonindependent advanced practice registered nurse prescribing states. Nursing Outlook, 64(1), 86–93. https://doi.org/10.1016/j.outlook.2015.10.003
Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a national survey: Ongoing barriers to aprn practice in the united states. Policy, Politics, & Nursing Practice, 23(2), 118–129. https://doi.org/10.1177/15271544221076524
Peer 2
Nursing regulatory bodies exist today to help ensure that providers stay up to date with current practice guidelines to meet standard of care, as well as to protect the public from harm as a result of unsafe or unqualified nurses (Milstead & Short, 2019). For the purposes of this assignment, we will examine the nursing board of regulation for APRN’s in Florida, as well as Massachusetts.
In Florida, in order to become an Advanced Practice Registered Nurse (APRN), one must hold an active, unencumbered RN license, and have received graduate level education (Master’s degree or higher) in nursing specialty, as well as hold certification from an approved nursing specialty board. APRN’s in Florida may practice under the terms of their scope of practice to assess, diagnose, order tests, prescribe, and manage ongoing care of patients under the supervising authority of a licensed physician. (Florida Board of Nursing, n.d.). The Florida ARNP may also prescribe medications under protocol by a physician, and may prescribe controlled substances as well. This also applies to CRNA’s as well as certified nurse midwives, that they be able to practice within their specific scope and adhere to their own specific advisory boards. Interestingly, Florida additionally has passed legislation where the APRN may elect to practice under full autonomy, and are therefore considered Autonomous Advanced Practice Registered Nurses (AAPRNS). These individuals do not need the supervision of a physician to evaluate and treat patients, and may also prescribe medications without supervision. Upon further research, these practitioners do not need a supervising physician if they choose to open their own office/ practice. These autonomous APRNs must submit a specific application to practice independently, have completed over 3000 clinical hours under the supervision of a physician, as well as have completed extensive education and further training in pharmacology, as well as medical decision making/differential diagnoses.
As far as regulatory stance for APRNs in Massachusetts, there are 5 separate regulatory bodies for each specialization of advanced nursing practice (nurse practitioners, certified nurse midwives, CRNA, psychiatric clinical nurse specialist, as well as clinical nurse specialist. With the exception of the clinical nurse specialist, an APRN is authorized to order medications, treatments, and therapeutics for their patients (Mass.gov, n.d.). APRN’s must still work under the supervisory guidance of a physician, and this also applies for prescriptive practice as well. The ARNP may be responsible for assessment, diagnosis, treatment, referrals, as well as any needed consultations. However, they must consult with the supervising physician if they were to prescribe medications. APRN’s in MA do additionally have the option to elect to practice without physician supervision, however these individuals must have 2 years of previous supervised practice, and then may elect to practice without physician guidance, prescriptive practice, and without written guidelines. APRN’s in MA must also hold post graduate level education and national certification to practice as well.
These two separate regulatory bodies do appear very similar in what the APRN may or may not do, and both states do have the option to practice with full autonomy as well, meeting their own specific criteria for doing so. In recent years, it has become more evident that APRN’s are pushing for more autonomy in their practice, and there are studies published that show how autonomy in this practice is in the best interest of the patient. According to Bosse, J. et al. (2017), lack of full practice for APRN’s is a barrier to the provision of efficient, cost effective, high quality, and comprehensive health care services for vulnerable citizens.
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.
Florida Board of Nursing, (n.d.). Advanced Practice Registered Nurse. Retrieved December 22, 2023.
https://floridasnursing.gov/nursing-faqs/advanced-practice-registered-nurse-aprn/
Mass.gov, (n.d.). Learn about Advanced Practice Registered Nurses (APRN). Retrieved December 19, 2023.
https://www.mass.gov/info-details/learn-about-advanced-practice-registered-nurses-aprn
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.
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