Nurse Practitioners: A Case Study

The Arizona Campaign for Action Coalition is formed of a comprehensive team of health care professionals and diverse Arizona stakeholders. Arizona has chosen multiple areas to focus on for implementation however this paper will discuss two. The first initiative for discussion will be that of the removal of the scope-of-practice barriers that face advance practice nurses in Arizona. The report states that Arizona has one of the most liberal practice scopes in The United States however nurse practitioners often have difficulty with receiving credentialing by the Arizona version of Medicaid known as AHCCCS (Randolph, Hrabe,

First, the state licensure regulates NP practice and it has been a big issue since NPs are not able to practice to the fullest extent despite of their education and training. NPs practice is regulated by state licensure and only about one-third of the nation has adopted full practice authority licensure and practice laws for NPs (Hain & Fleck, 2014). The American Association of Nurse Practitioners (AANP) reports that, under a full practice authority model, NPs are still required to meet

been restricted on what they can and can’t do including signing certain documents and orders they can prescribe. With the Affordable Care Act the demand for primary care providers is growing (Gadbois, Miller, Tyler, & Intrator, 2015). This means that the need for APRNs is rising and the need change is approaching. In the primary care setting, there is a variety of medical staff working including medical assistance, LPNs, and RNs. This can become more for the APRN when delegating medication administration. When the APRN cannot delegate medication administration the quality of patient care is sacrificed and is not productive in providing care to the patients.

The APRN Consensus Model was released in July of 2008 to define advanced practice registered nurse, identify the titles to be used by APRNs, and define specialty area of practice. The Consensus Model also describes population foci, suggests a process for recognition of new APRN roles, and recommends requirements for implementation (American Nurses Association [ANA], 2010). The APRN regulatory model helps uniform scope of practice of APRN across the United States, which benefit individual APRN, enhance patient outcomes, and improve the quality of care. Consensus Model consists of Licensure, Accreditation, Certification, and Education. The Education criteria in LACE Consensus Model relate to all APRN programs regardless of master’s or doctoral

This paper explores the practice of the APRNs autonomy in the state of Georgia and compares it with other states. Also to advocate for policy recommendations of the APRNs scope of practice that are needed to improve the healthcare in the state of Georgia. APRNs are registered nurses that provide continuous care and treatment in many different areas, such as pediatrics, primary care, acute care, maternity, mental health and chronic disease management. APRNs also have advanced education, training, and national certification in specific areas of practice. Even with the changing and expanding of healthcare, APRNs continue to face challenges in practicing to the full extent of

This paper explores the perception of clinical practitioners to the change in policy related to the advanced practice registered nurse (APRN) full practice authority. The author conducts a one-on-one, open-ended interview of 5 nurse practitioners and 5 physicians licensed to practice in Maryland on their perceptions of the recent passage of the Advanced Practice Registered Nurse Full Practice Authority. A literature review was conducted in a policy report by the professional nursing organization, and discussion within the peer-reviewed article supported an overview, regulatory differences among 50 states, including the District of Columbia. Their policy implication for enhancing APRNs role nationally. The author discusses a critical component

State law is made up of two different forms: statues and regulations (Buppert, 2015). Under the established rules and regulations, an ARNP can: (a) monitor and alter drug therapies; (b) initiate therapies for certain diagnosis’; (c) perform additional functions as may be determined by rule; (d) and order diagnostic tests and appropriate therapies (The Florida Legislature, 2016). A practitioner licensed under chapters 458, 459 or 466, must maintain supervision for directing certain course and medical treatment (The Florida Legislature, 2016). Within the context of advanced nursing practice and the Florida Statues chapter 464.003(2), an ARNP may diagnosis, treat, alter medication regimes, diagnose, prescribe and operate, which are approved by a joint committee composed of three members appointed by the Board of Nursing, three members appointed by the Board of Medicine and the State Surgeon General or his/her designee (The Florida Legislature, 2016). On the other hand, the federal government regulates nurse practitioner practice through statutes passed by Congress and regulations (Buppert, 2015). According to Buppert (2015), federal law can override state law, and when federal and state law conflict with one another, federal law usually triumphs. Due to these state and federal statutes and regulations, this can impose a huge threat and impact to NP practice since the BON and the Nurse Practice Act usually help

2. Can an APRN be licensed solely within a specialty such as an ER nurse practitioner?

The Texas Nurses Association (TNA) District one meeting for the El Paso area, took place on September 20, 2016 at 1845. The President of District one, Paula Meagher was unable to attend the meeting as she was ill. She did however provide us with a list of the current Advanced Practice Registered Nurse (APRN) issues that TNA is engaged in. The issue that really caught my attention was Texas Occupations Code, section 157.011 (b-1) which deals with APRN restrictions on writing prescriptions for Schedule two controlled substances. The TNA website states:

After attending the Arizona State Board of Nursing meeting through live stream on September 18, 2015 at approximately eleven in the morning, I had the opportunity to witness how the board enforces all the rights and regulations of the Nurse Practice Act and upholds the requirements set for each standard. The board consists of the board president Randy Quinn, RN, MSN, CRNA, the boards vice president Carolyn Jo Mccormies, RN, MS, FNP-BC, Kathryn Busby, J.D., Public Member, Lori A. Gutierrez, BS,RN-C,DON-CLTC,CBN, Terri Berrigan, LPN, C-AL who is the board secretary, Patricia Johnson, LPN, M. Shawn Harrell, RN, MS, Charleen Snider, BSN,RN , Dr. Kimberly A. Post, DNP,MBA/HCM,RN,NEA-BC, and Leslie Dalton, MSN, RN. Nine out of the ten board member were in attendance and conducting rulings in this particular meetings.

Since the inception of the Nurse Practitioner (NP) role in the 1960s, NPs have thrived in the delivery of primary healthcare and nurse case management. Despite patient satisfaction with NPs ' style of care, nurses have been critical of NPs, while physicians have been threatened by NP encroachment on MD practice. Balancing assessment, diagnosis, and treatment with caring defines NPs ' success as primary care providers. Understand the role and Scope of Practice of NPs is sometimes difficult for some to understand. The purpose of this paper is to define the role and history of NP, compare and contrast licensure versus certifications, understand NP Scope Of Practice and Standards of Care, discuss how the State Practice Acts regulate FNP practice, discuss credentialing and privileging, and differentiate between legislative and regulatory processes.

Three issues or trends I see that are important with regard to credentialing are reimbursement, malpractice and education. Within each issue are opportunities for the advance practice nurse (APN) to grow in knowledge and participate in change. It is important to understand why each one effects credentialing for the APN.

The historic article by Safriet (1992) fully lists and analyzes the major challenges facing the advanced practice nurse (APN). At the time the article was written compared to now, a few aspects are changing. In areas where change has occurred, it has been an exceedingly slow process. Change for APNs is often dependent on legislation and regulatory authorities which receives half-hearted support, at best, from the medical establishment (Safriet, 1992). Since the first day nurses were given any authority to practice outside of regular practice, physicians only objected when it began to encroach upon their perceived hierarchal status or potential for compensation (Hamric, Hanson, Tracy, & O’Grady, 2014). The concern that this

In 2013, the prescriptive scope of practice was expanded for Physicians Assistants to include Schedule II drugs in limited circumstances (South Carolina Academy of Physician Assistants, 2013). These include a one time dosing in a hospital setting and renewals of medications prescribed by an MD (South Carolina Academy of Physician Assistants, 2013). Hopefully, the South Carolina Board of Nursing will, aggressively, pursue both full practice and increased prescriptive authority of Schedule II drugs, for APNPs, in the near future.

Of the many obstacles that presently affect APRN practice uniformity, the most prevalent problems are the inability to practice to the full extent of APRN education and licensure, the inability of APRNs to practice across state lines, and the inequality of the reimbursement scale for payment of services. “Such lack of uniformity has had unintended consequences, including decreased mobility for APRNs, which in turn has reduced access to health care for patients” (Chornick, 2010, p. 58). The most concerning issue is the one concerning full practice authority.