Respond?to?two?of your colleagues on??in one or more of the ways listed below. Share an insight from having viewed your colleagues’ posts. Suggest additional actions or perspectives.

Peer 1

Erika Cepero

Week 1: Discussion Post

Erika Cepero

Walden University

NRNP 6675F: PMHNP Across the Lifespan II

Dr. Ishkova

March 27, 2024

Week 1: Discussion Post

Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.

In Florida, advanced practice registered nurses can become autonomous by registering as such, otherwise, they must work under a physician. To become an autonomous advanced practice registered nurse in Florida, one needs to have an active nurse practitioner license. Within the last 5 years the NP must have documented 3000 hours working with a licensed physician.  They must also have three semester hours in diagnosing and three semester hours in pharm at the graduate level.  They must also have no disciplinary action on file in that states (Florida Board of Nursing, n.d.).

How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?

To achieve APRN certification you need to take an exam by an accredited specialty certification board specifically the ANCC.

To obtain licensure as an Advanced Practice Registered Nurse, you must apply to the Florida Board of Nursing. To obtain licensure, you need to be an RN in the US, have a master’s degree or post-master certification, NP certification, insurance for malpractice, $110 application fee, and electronic fingerprinting.  Board applications can be filled out and filed online at https://mqa-vo.doh.state.fl.us/datamart/voservicesportal (Florida Board of Nursing, n.d.).

What is the application process for certification in your state?

To sit for the certification exam, you need to be an RN, have obtained a master's, post-graduate certificate, or DNP in psychiatric-mental health nurse practitioner (PMHNP).  The program must have a minimum of 500 practicum hours as well as graduate-level NP Core courses.  You must also have received education on health promotion, diagnosis, treatment, including prescription of medications and nonpharmacologic treatment. Training in psychotherapy is required as well.  The credential remains valid for a period of 5 years (American Nurses Credentialing Center, 2024).

What is your state’s Board of Nursing website?

The State of Florida Board of Nursing has a website that can be accessed at  https://floridasnursing.govLinks to an external site. .

How does your state define the scope of practice of a nurse practitioner?

In Florida, NPs work under a physician according to a set protocol, unless authorized for autonomous practice. The advanced registered nurse practitioner has the authority to prescribe, dispense, administer, and order drugs, including restricted substances with a DEA license. The healthcare provider can start treatments for specific problems, request diagnostic tests, prescribe physical and occupational therapy, handle simple acute illnesses, and care for patients with stable chronic diseases. They can identify behavioral issues, provide diagnoses, and suggest treatment options. Psychiatric mental health nurse practitioners (PMHNP) can prescribe psychotropic restricted medications under a set protocol with a supervising psychiatrist (The Florida Legislature, 2023). 

What is included in your state practice agreement?

NPs in Florida must practice under a physician with a set protocol, unless they have been granted permission for autonomous practice. When practicing under supervision, the nurse practitioner must have a collaboration agreement with a physician outlining certain protocols for the nurse practitioner to adhere to. This protocol outlines the responsibilities for the nurse practitioner under the supervision of the collaborating physician. Nurse practice legislation ensure that nurses meet the essential qualifications for practice and may do so safely (The Florida Legislature, 2023).

How do you get a DEA license?

To acquire a DEA license, you have to apply for registration number through the DEA Form 224 online at: http://www.deadiversion.usdoj.gov/index.html. An application fee of $888 is required for a 3-year term. Individuals employed by federal, state, or local government institutions, or public universities are eligible for an application cost waiver. You must also confirm that you have completed 8 hours of training in controlled substances (U.S. Department of Justice, n.d.)

Does your state have a prescription monitoring program (PMP)?

Florida has PMP named E-Force.  The program aims to promote safe prescribing of controlled substances and decrease misuse of drug and abuse, and diversion. You can register an account on the website https://florida.pmpaware.net (Florida Department of Health, 2024).

How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

Advanced registered nurse practitioners (APRNs) in Florida are allowed to prescribe meds which are controlled if they hold a master's or doctorate in a clinical nursing specialty area and have received training in prescribing controlled substances (3 hrs). Nurse practitioners cannot provide psychiatric controlled substances to children under 18 years old unless they are advanced practice registered nurses specializing in psychiatry. Nurse practitioners are authorized to prescribe schedule II, III, or IV  drugs (Florida Board of Nursing, n.d.).

Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.

In Florida, nurse practitioners must have certification and licensing to practice. Various restrictions are in place to ensure that nurse practitioners are proficient in delivering care to patients. Nurse practitioners must be certified by a professional nursing association before obtaining a license in the State of Florida according to existing regulations. Regulations must be followed to obtain a license in Florida. To become licensed you need apply to the Florida Board of Nursing and pay a $110 application fee. To obtain licensure, you need to be an RN in the US.  You also need a master’s degree or post-master degree certification, certification from nursing specialty board, proof of malpractice insurance, and electronic fingerprinting by an FDLE-approved Livescan service provider. Nurse practitioners must meet these regulations and criteria to guarantee they have completed the necessary educational requirements for safe practice. In Florida, a nurse practitioner can seek autonomous nursing practice by meeting specific requirements, including holding an active Florida APRN license, completing 3000 supervised clinical hours with a licensed physician in the last 5 years, graduate-level coursework in diagnosing and pharmacology, and maintaining a clean disciplinary record in any state for the past 5 years. In addition, nurse practitioners in Florida can establish their own practice to provide primary care services if they are autonomous.

            The greatest obstacle to establishing an independent primary care clinic and practicing autonomously is the challenge of building confidence and confidence comes with experience.  Being knowledgeable about certification, licensure, autonomous practice, and controlled substance prescribing requirements has helped me to realize the steps I will need to take when I graduate and transition into the psychiatric mental health nurse practitioner role.

I am surprised by the various applications required after graduating to work as a psych NP, as well as the anticipated fees associated with these applications, including the fee for obtaining the DEA license, which I do not currently have.

References

American Nurses Credentialing Center. (2024).  Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC). Retrieved February 27, 2024, from https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/ 

Florida Board of Nursing. (n.d.).  Advanced Practice Registered Nurse. Retrieved February 27, 2024, from  https://floridasnursing.gov/licensing/advanced-practice-registered-nurse/Links to an external site.

Florida Board of Nursing. (n.d.).  Autonomous advanced practice registered nurse. Retrieved February 27, 2024, from  https://floridasnursing.gov/licensing/autonomous-advanced-practice-registered-nurseLinks to an external site.

Florida Board of Nursing. (n.d.)  Important Legislative Update Regarding HB 423. Retrieved February 27, 2024, from https://floridasnursing.gov/new-legislation-impacting-your-profession/ 

Florida Department of Health. (2024, January 5).  E-FORCSE. E-FORCSE Home page. Retrieved February 27, 2024, from  https://www.floridahealth.gov/statistics-and-data/e-forcse/Links to an external site.  

The Florida Legislature. (2023).  Nurse Practice Act: Autonomous Practice by an Advanced Practice Registered Nurse. Online Sunshine. Retrieved February 27, 2024, from  http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/Sections/0464.0123.htmlLinks to an external site.

The Florida Legislature. (2023).  Nurse Practice Act: Licensure of Advanced Practice Registered Nurses, Fees, Controlled Substance Prescribing. Online Sunshine. Retrieved February 27, 2024, from  http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/Sections/0464.012.htmlLinks to an external site.

U.S. Department of Justice. (n.d.).  DEA Forms and Applications. U.S. Department of Justice Drug Enforcement Administration Diversion Control Division. Retrieved February 27, 2024, from https://www.deadiversion.usdoj.gov/online_forms_apps.html 

Peer 2

David Hinkle

Hello Professor and class,

When it comes to getting certified and licensed as an advanced practice registered nurse in Florida, you will need to pass an examination or endorsement. Previously, an individual must take and pass a licensure examination, which is reserved for registered nurses who have practice nursing currently within another state or jurisdiction within the last three years without an incident of criminal activity or suspension to their current license (Nurse Practitioner License, 2022). Following obtaining the license as a registered nurse, the individual must complete higher education within one of the advanced practicing fields from an accredited institution (Nurse Practitioner License, 2022). Advanced education for nurses is liable to verification from a national certification agency.

The application process for certification in Florida must be completed online. Applicants must renew they're registered nurse license before applying for an advanced practice registered nurse license if the license expires within 120 days from the date of the applicant’s application (Nurse Practitioner License, 2022). Applicant’s official transcripts should be sent by the nursing programs to which they attended to the Florida nursing board. In addition, an appropriate agency should send a notification of national certification to the board establishing proof that the applicant is qualified for licensure (Nurse Practitioner License, 2022). The applicant must have no criminal record. In addition, must be able to verify their current nursing license and provide proof of professional male practice insurance or an exemption notice (Nurse Practitioner License, 2022).

The state of Florida has a board of nursing whose mandate includes licensing, monitoring, discipline, education, and when needed, rehabilitation 2 licenses to ensure they are competent in providing healthcare services (Florida Board of Nursing, 2023). Nurse practitioners in Florida have a full scope of practice. They practice autonomously to the full extent of their knowledge and training which includes the prescription of medication (Nurse Practitioner License, 2022). With this said, they are required a Drug Enforcement Administration license to prescribe any controlled substances (Florida Board of Nursing, 2023). Due to this requirement, nurse practitioners must apply for a DEA number. These DEA numbers will be linked to the state licenses. Therefore, they can be suspended or revoked upon disciplinary actions against a licensee (Florida Board of Nursing, 2023).

Nurse practitioners in Florida can prescribe schedule II to IV controlled substances (Kellams & Maye, 2017). The Florida board of nursing has requirements regarding nurse practitioners to complete 3 hours of continuing education on safe, effective controlled substance prescribing with each APRN license renewal (Kellams & Maye, 2017). The Florida Prescription Drug Monitoring Program, known as Electronic Florida Online Reporting of Controlled Substance Evaluation Program or (E-FORCSE), was created to ensure safe prescribing of all controlled substances to assist in decreased drug abuse in diversion within the state of Florida (Florida Department of Health, 2023). Dispensers of controlled substances must submit controlled substance dispensing information to the database (Florida Department of Health, 2023). Within this database, the requirement is to report to the PD MP every time it controlled substance in schedules II, III, IV, and V are dispensed to a patient, as soon as possible but no later than close of business the day after the prescription was dispensed (Florida Department of Health, 2023). This information within the database should be made available for consultation by the prescribers.

It was new to me, that the state of Florida was the last state to give nurse practitioners prescriptive authority for controlled substances by implementing Florida HB 423, which is also known as the Barbara Lumpkin Prescribing Act, in 2017.

References

Florida Board of Nursing. (2023). Florida Board of Nursing – Licensing, Renewals & Information.  https://floridasnursing.govLinks to an external site.

 Florida Department of Health. (2023). Prescription drug monitoring program. FL HealthSource • Health Care Resources for Consumers & Providers.  https://flhealthsource.gov/FloridaTakeControl/pdmp/Links to an external site.

 Kellams, J. R., & Maye, J. P. (2017). The last state to grant nurse practitioners DEA licensure. Journal of Addictions Nursing, 28(3), 135–142.  https://doi.org/10.1097/jan.0000000000000177Links to an external site.

 Nurse Practitioner License. (2022, October 20). Florida nurse practitioner licensure steps.  https://www.nursepractitionerlicense.com/nurse-practitioner-licensing-guides/floridanurse-practitioner-licensure-steps/Links to an external site.

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