Posted: January 22nd, 2023
NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations
Each state has different regulations, titles, scopes of practice, and regulatory standards (Milstead & Short, 2019, pp. 65) yet they have similar standards for education requirements. As a registered nurse and future advanced practicing registered nurse (APRN) in the state of Michigan, Nurse Practitioners are not recognized as a primary care provider as an individual (NCSLSOP, n.d.). This means as an APRN I would require a Physician to overlook or delegate ‘tasks’ to maintain care for patients in the state of Michigan. That being stated, Michigan APRNs may prescribe nonscheduled drugs without a delegated physician (NCSLSOP, n.d.), but can prescribe schedules II-V controlled substances if a physician where to delegate the task to an APRN (NCSLSOP, n.d.). Schedules II-V controlled substances would include but not limited to Dilaudid, Methadone, Ketamine, Xanax, Ativan, Phenergan with Codeine, and more (Diversion Control Division, 2021) NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.
Comparing Michigan, a single licensure state, to a state included in the Nurse Licensure Compact (NCL) is slightly different for APRNS. Arizona for an example allows APRNs to practice independently without the licensure of a physician compared to Michigan and they are recognized as primary care providers (NCSLSOP, n.d.). That being said, APRNs must work within the guideline and regulations of the state board of nursing, BON, (Milstead & Short, 2019) and they must practice within their scope as well as population focus (NCSLSOP, n.d.). As an RN we are licensed and regulated by our BON and must continuously monitor for changes to verify that we are adhering our care within our scope of practice, especially if one is a travel nurse or if you have recently moved to a different state since state specific practices can vary (Milstead & Short, 2019). To adhere to the regulations as an APRN one should research the states BON for their regulations as well as monitoring the jobs you apply for as an APRN. Some states, such as Arizona, allows APRNs to work without a delegating physician as I stated earlier, but that APRN has to apply for positions within their population focus, such as a Psychiatric mental health NP should not apply for a Pediatric primary care position in Arizona. Although, Arizona allows APRNs to work within their full scope of their education and experience, does not mean every state allows that and research should be done to validate proper and safe care is provided for communities. With the proper education and training, APRNs should be able to work within their scope and practice, as long as the care they are providing are within the guidelines of their BON or delegated from their overseeing Physician NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.
Diversion Control Division. (2021, March). Scheduling actions controlled substances regulated chemicals. U.S. Department of Justice. https://www.deadiversion.usdoj.gov/schedules/orangebook/orangebook.pdf
Milstead, J. A., & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones Bartlett Learning.
Milstead, J. A., & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed., pp 57-84). Burlington, MA: Jones Bartlett Learning.
NCSLSOP. (n.d.). Nurse Practitioners. Scope of practice policy. Retrieved March 30, 2021, from https://scopeofpracticepolicy.org/practitioners/nurse-practitioners/?fbclid=IwAR0xWHuSPdq8iCfp0dAnEfL-tXd6M0vdq6MY9_Aunw54FsUC5fcXW_a1g3A NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations
I was surprised to learn from your post that Michigan remains a single licensure state, so I looked around and found on the Michigan Health and Hospital Association (2020) that the Michigan House Bill 4042 passed both chambers but was vetoed by the governor December 30th. Representative Mary Whiteford did reintroduce the legislation as HB 4046 for the 2021-2022 legislative session and hopefully it will pass and continue all the way through.
It is important to note that the Enhanced Nursing Licensure Compact (eNLC) was implemented in 2018 to include new standards like state and federal fingerprint based criminal background checks that the original Nursing Licensure Compact (NLC) did not have (Gaines, 2021). The eNLC will allow practitioners who travel to practice in multiple states without delay, and this is especially important when examining the current pandemic and the increased importance of advanced practice registered nurses. There are continued concerns that do need to be addressed in the eNLC as it moves forward like how to properly discipline, loss of state revenue, and how to work with the increase need for telehealth NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.
Gaines, K. (2021, March 7). Compact nursing states list 2021. Nurse. Retrieved from https://nurse.org/articles/enhanced-compact-multi-state-license-eNLC/
Michigan Health and Hospital Association. (2020). Nurse Licensure Compact passes the house. Retrieved from https://mha.org/Newsroom/ID/2351/Nurse-Licensure-Compact-Passes-the-House
Discussion: Professional Nursing and State-Level Regulations
Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.
It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.
Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.
Respond to at least two of your colleagues* on two different days and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.
Professional Nursing and State-Level Regulations
Throughout the years, the evolution of Advanced Practice Registered Nurses (APRN) has been inconsistent due to the U.S. Constitution giving states the right to establish laws governing professions and occupations. Thus, each state has unique titles, scopes of practice, and regulatory standards (Milstead & Short, 2019). According to the American Nurses Association (ANA) (n.d.), “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”. APRNs who have legal authority to practice within the full scope of their education and experience, the state permits those NPs to evaluate patients; initiate and manage treatments; diagnose, order, and interpret diagnostic tests; and prescribe medications and controlled substances (State Practice Environment, 2021).
Currently in my state of practice, Virginia, a Nurse Practitioner (NP) with a current license may qualify for autonomous practice after the completion of having five years of full-time clinical experience, a total of 9,000 hours, under a patient care team physician. An NP that has been authorized to practice autonomously can only practice within the scope of the NP’s clinical and professional training and limits of the NP’s knowledge and experience, consult and collaborate with other health care providers based on a patient’s clinical condition, and establish a plan for referral of complex medical cases and emergencies to other health care providers. Another regulation that Virginia has is that unless an NP has been authorized for autonomous practice, the NP may only prescribe Schedule II-VI drugs after meeting certain criteria, having authorization from the Boards of Nursing and Medicine, and obtaining registration from the U.S. Drug Enforcement Administration (DEA). An example of one of these criteria includes having authorization to prescribe medications through a practice agreement with a collaborating physician (Laws and Regulations, 2018).
In the state of North Carolina, NPs are not allowed to practice autonomously at any given time and must have a collaborative practice agreement with a primary supervising physician. For an NP to prescribe medications in North Carolina, the NP has to have authorization by the physician approved by the boards as the NP’s supervisor and the supervising physician has stated the drugs that the NP may prescribe in the collaborative practice agreement. In order to prescribe controlled substances, the NP must have an assigned DEA number that is entered on each prescription. This is similar to the regulation stated by Virginia; however, in North Carolina, NPs can prescribe Schedule II-IV drugs with the additional ability to prescribe Schedule V drugs. (Nurse Practitioner Laws & Rules: North Carolina Board of Nursing, 2021) NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.
APRN state law and regulation. American Nurses Association. (n.d.).
Laws and regulations. Virginia Board of Nursing. (2018, July 6).
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).
Burlington, MA: Jones & Bartlett Learning.
Nurse practitioner laws & rules: North carolina board of nursing. North Carolina Board of
State practice environment. American Association of Nurse Practitioners. (2021, January 1).
https://www.aanp.org/advocacy/state/state-practice-environment NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations
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