Nurse State Licensure Case Study

Credentialing from advanced practice registered nurses (APRNs) perspective is defined as “furnishing the documentation necessary to be authorized by a regulatory body or institution to engage in certain activities and use a certain title” (Hanson, 2014). Credentialing is also define from a local institutional process that consider specific documentations for APRN before they assume the practice role as APRN within their facility. In health care system, credentialing ensures individuals meet required standards of practice and is prepared to perform those duties implied by the credentials. National certification and education are considered as part of credentialing for APRN to acquire basic level of competence to practice. (Hanson, 2014)

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

In recent years, APRNs have been very vocal through many nursing coalitions and associations. The voices of all ARNPs seeking full practice authority has been heard with the proposed bills. The Florida Panhandle Nurse Practitioner Coalition (FRNPC), has given information to all ARNPs to keep ahead in legislative issues. A white paper published by the American College of Physicians have been shared to all Floridian ARNPs through the

According to reports found on the web page MEDPAGETODAY (2014) there has been an increase in the independent practice for advanced practice registered nurses (APRN). The article quotes data from the American Association of Nurse Practitioners (AANP) which reports 17 states and the District of Columbia allowing “full practice” with this meaning the APRN evaluates, diagnoses, orders testing, prescribes medication and initiates and manages treatments. 21 states require “collaborative agreement” with a physician and 12 requiring supervision of a physician. Collaborative agreement scope of practice varies by state and institution of employment.

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

Within the DEA is a registration system in place that authorizes medical professionals, such as APRN’s to apply for authority, and if approved, will receive the jurisdiction to prescribe controlled substances as outlines by his or her board of nursing regulations (United States Department of Justice, 2014). As mentioned above, the practitioner applies for a DEA registration number through the administration agency; once approved, the provider will be assigned a DEA number by the U.S. Drug Enforcement Administration allowing them to prescribe controlled substances while in his or her practice.

The South Carolina State Board of Nursing is responsible for licensure of APRNs (American Association of Nurse Practitioners, 2014). South Carolina (SC) is a restricted practice state, requiring Nurse Practitioners (NP) to be 1) supervised by, 2) perform delegated tasks from or 3) work as part of a team managed by, a medical doctor or dentist (American Association of Nurse Practitioners, 2014). To obtain an APRN license in SC requires a RN license, in good standing, a graduate degree and certification from an approved national credentialing source (American Association of Nurse Practitioners, 2014).

Texas has a rapidly growing population with complex healthcare needs, but has limited resources in terms of healthcare provider workforce. There is an expanding need for healthcare in Texas even without taking federal reform into account. Currently, more than forty percent of states have adopted full practice authority licensure and practice laws for Advanced Practice Registered Nurses (APRN). Texas is not one of them. Currently, APRN’s are regulated by both the Texas Board of Nursing and the Texas Medical Board. Passage of Senate Bill 681 would grant full practice authority to APRN’s, and therefore be regulated exclusively by the state nursing board.

In Georgia, Nurse Practitioners practice is regulated by the nursing board and is restricted. NPs are not allowed the same autonomy as other states and their capability to practice independently is not supported. According to American Associate of Nurse Practitioners (2017), restricted practice is when state practice and licensure law install limitations on the NP’s ability to practice to the full extent of their training and education. Today Georgia’s NPs are required to work collaboratively with a physician which restricts their ability. I believe that NPs are educated and competent to deliver quality care without physician oversight. Removing practice barriers can promote optimal role fulfillment and assessment for the NP providing

I believe the Future of Nursing report can impact the APRN role in many different ways. One major way I feel the report can directly impact the APRN role is the recommendation to remove the scope-of-practice barriers. The recommendation includes, "States with unduly restrictive regulations should be urged to amend them to allow advanced practice registered nurses to provide care to patients in all circumstances in which they are qualified to do so"(Institute of Medicine, 2010, p. S-9). I currently reside in Missouri and I intend to continue practicing in Missouri even after I become an APRN. Unfortunately, Missouri is one of the most restricted states in regards to the scope of practice for APRNs. According to the Kaiser Family Foundation

In practice, there is ground to make in terms of independent practice, equity in reimbursement rates, and ability to broaden the scope of practice of APRNs in order to better serve the healthcare needs of patients, their families, and our communities. As each state updates their Nurse Practice Acts (NPA), APNs will be able to deliver safe, quality, and affordable patient care in accordance with their education and training. I will continue to develop competencies in these areas as move through the program and start my practicum rotations.

Educational requirements for the APRN-NP remain the same throughout the US in that all NPs must be master’s degree prepared. The National Organization of Nurse Practitioner Faculties (NONPF) has set forth core NP competencies in which all NP program curriculums are based upon. This ensures that the NP is trained to serve as a provider, direct caregiver, client advocate, teacher, consultant, researcher, and educator. (Faculties,

This includes advanced practice RN’s. Many states do not allow advanced practice RNs to practice to the extent of their abilities. Restrictive scope of practice regulations, physician opposition, a fragmented healthcare system, and outdated insurance policies are all obstacles this country must overcome in order for APRNs to practice to the extent of their abilities. The committee recognizes the importance of APRNs to provide the majority of primary care in the US. Increasing the number of providers would make primary care more accessible to the population. If the recommendations of the IOM are followed, nurses could be responsible for the majority of primary care for patients.

Nursing is a field where there are high levels of autonomy due to the nature of the job. However, this autonomy also increases the risk of harm to the general public if practiced by an unqualified nurse. In order to minimize that harm, it is important for nurses to undergo licensure and certification. Licensure is the legal authority granted by the state to practice within the scope of nursing whereas certifications are issued by non-governmental organizations which acknowledge that a nurse is qualified and competent in a specific field.

In respond to the letter from the Ohio Board of Nursing received on 9/26/2016 requesting for documentation for nursing employment in the state of Ohio prior to nursing license application, I am pleased to inform you that, I have never worked as a nurse in the state of Ohio prior to applying for my nursing license with the state of Ohio or currently. If I marked yes on my licensure application, I apologize as this may have been done in error and not deliberately.