Professional Nursing Practice: A 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)

In order to apply for prescriptive authority in Indiana you must submit proof of and unencumbered registered nurse (RN) license, the nursing program will then submit an official transcript to the Indiana State Board of Nursing showing successful completion of the graduate program. The college that the graduate program is completed needs to be accredited by the Commission on Recognition of Postsecondary Accreditation. It is also required to submit proof of successful completion of graduate level pharmacology course consisting of at least two semester hours, and written practice collaborative agreement (Indiana Professional Licensing Agency, n.d.). If you received a bachelor 's degree rather than a graduate degree, you must submit proof of current national certification (Indiana Professional Licensing Agency, n.d.). APNs with

In 2008, the coalition of members from the Alliance for Advanced Practice Credentialing and the National Council of State Boards of Nursing (NCSBN) created the Consensus Model for Advanced Practicing Registered Nurses (APRN’s). This model creates a framework for APRN’s in licensing, accreditation, certification, and education in the United States (Alleman & Houle, 2013). The establishment of this Consensus Model has developed a bases for the ARNP’s comprehensive knowledge base, ability for clinical reasoning, cultural, and ethical competencies, establishing a model of practice for ARNPs in which to follow. These concepts will be further discussed in this paper.

According to the Pearson Report, there is a total of 147,295 Nurse Practitioners throughout the United States (Pearson, 2009). However, for NPs in some states the battle continues over some forms of prescriptive authority or physician involvement in NP prescribing, such as the state of Pennsylvania. State regulatory approaches to NP prescribing range from no authorization for prescribing (in Georgia, 2006 legislation passed which recognized NPs as prescribers, but the rules have not been approved at the time of this writing) to unencumbered prescriptive authority (Arizona, DC, Montana, Oregon, Washington, and Wyoming) (Lugo, O’Grady, Hodnicki & Hanson, 2007).

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.

Hello, I am Angeline S. Bernard, licensed practical nurse, with Aetna’s utilization management department for long-term care. I am a 20 year veteran in the health care industry, primarily in the field of nursing, interested in pursuing a management role. With 15 years spent in the acute hospital environment, as a nurse, I have also practiced in other settings. School nursing, occupational nursing, quality management, and utilization management, are all additional areas of practice.

However, these roles require licensure through the Maryland Board of Nursing and graduate or post-graduate degrees accepted from a Board approved educational program. Maryland also requires the APRN to obtain national certification from an accredited and board approved credentialing body. The Nurse Practitioner role does include limited prescriptive authority. The regulations guiding the practice of all nursing in Maryland, the Nurse Practice Act, are separated into at least two separate regulatory documents: Maryland Code, Health Occupations, Title 8 Nurses; and The Code of Maryland Regulations, Title 10, Subtitle 27. The separation of the statutes and regulations is a cause for confusion as the language and definitions in these documents differ (NCSBN,

Legislation in our state makes it very difficult for Nurse Practitioners to practice fully. Although the need for NP’s are at an all-time high, especially in Family Practice setting. APN must get a license to practice and have to submit to the board, a written application on forms furnished to the applicant. The original application shall contain the applicant's statements showing the applicant's education and other such pertinent information as the board may require. The applicant shall at least have completed their high school course of study, or the equivalent as determined by the state board of education, and have successfully completed the basic professional curriculum in an accredited or approved school of nursing and earned a professional nursing degree or diploma.

With increasing number of Physicians choosing not to go into primary care and increasing number of baby boomers crossing 65 years by the 2030, there is a very high demand for APRNs to fill up those gaps. The consensus model, which was first initiated in 2004, has been revised many times and finalized in 2008. It helps to regulate APRNs with licensure, accreditation, certification and education (Stanley, 2012).

These elements serve as proof of acquiring and completing required formal education, skill and experience from a graduate program formal educational agencies to practice. The state of recognizes the four APRNs specialty namely CRNA, CNM, CNS and CNP. As a practicing nurse in Texas, I found out Texas’ implementation status of the consensus model is between 50-71% striving towards uniformity. According to the updated version of the consensus model, practice in Texas is a collaborative standardized care. This new model will have a positive effect on practice parameters and safety to patients in that, it will let to APRNs influx into the state which will directly ameliorate APRN to patient ratio, availability, accessibility, cost and quality of care due to competition. There is a nationwide demand for health care professionals meanwhile existing ones face restriction in their practice. The long impending nursing shortage, one of the many health professional shortages begun a movement to utilize all health care providers to the full extent of their education and training (National Association of Clinical Nurse Specialist's Statement on the APRN Consensus Model Implementation,

It is very important for the NP to understand their scope of practice and the rules they must follow to legally furnish drugs and devices in California. Different states also have different rules for furnishing drugs and devices, a function of primary care that an NP needs to perform to be successful in the patient aspect of their work. NPs in California need to address not only the Board of Registered Nursing’s (BRN) requirements, in addition to the Drug Enforcement Agency’s (DEA) requirements for writing prescriptions. Over time new rules and regulations are being presented for legislative action, so it is important to stay up to date with information that may affect the NP profession.

However variations occurs in states regulations with regards to prescriptive authority in terms of procedures and requirements that must be met by the APRN, relationship with a physician if any to prescribe, and the scope of the APRN prescriptive authority to prescribe controlled drug (Joel, 2013, p.125).

This legislation was introduced in hopes of reconsidering the law by allowing independent practice of the advanced practice registered nurse (APRN) in the state of Pennsylvania. Pennsylvania law currently states that an APRN must work under the direct supervision of a physician (Fairman, Rowe, Hassmiller, & Shalala,

At this point in time there is no standard model for the regulation of Nurse Practitioner (NP) practice throughout the country. Currently, each state determines the scope of practice, roles, and basic educational requirements for NPs (Zaccagnini & White, 2017). In addition to general confusion on the part of medical professionals and patients, this results in issues accessing health care for patients as well as limiting the mobility of NPs to move throughout the country and continue to practice. Important terms to consider when discussing the regulation of advanced nursing practice are licensure, accreditation, certification. These terms are occasionally used interchangeably, leading to further confusion.

Advanced practice nurses (APRNs) are increasingly playing a crucial role in the healthcare delivery system as they positively impact the accessibility of primary and specialty care in both rural and urban Minnesota. Fortunately for advanced practice nurses, Minnesota continues to answer the call of the Institute of Medicine (IOM) for states’ adaptation of laws and policies that would promote advanced practice nurse practicing at their fullest degree of their education and training ( IOM, 2010). The scope of practice for APRNs in Minnesota and its governance will be discussed in this paper