APRNs Restrictions in Nurse Practice Act

APRNs Restrictions in Nurse Practice Act

As healthcare reforms evolve, nurse practitioners will be tasked with improving health outcomes for various populations. According to the Institute of Medicine (IOM), nurses should be treated as advocates for people living in complex healthcare systems. According to the report, “advanced practice registered nurses (APRNs) should be able to practice to the full extent of their training and education” (IOM, 2011, S8). However, there are barriers in the healthcare practice that limit APRN practice.

The board defines the APRN scope of practice in rule 221.12. Registered nurses provide a wide range of health services that are dependent on education, advanced practice experience, and the appropriate scope of professional practice in the specific area of specialization. APRNs work in a variety of settings and provide a wide range of healthcare services to a variety of people, depending on their specialization roles. National professional specialty organizations or advanced nursing organizations explain the scope of practice in areas of specialization for practice recognized by the board (Dubree et al., 2015). The APRN performs only those functions that are within the scope of practice and comply with the Nursing Practice Act, board rules, and other Texas laws and regulations.

The scope of an APRN reflects the patients that an APRN can attend to, as well as the procedures and activities that nurses can perform. It also reflects the APRN’s ability to request reimbursement for services rendered. Defining the scope of practice includes advanced educational practice in a role and specialty area, legal handles, and a variety of statements of practice published by national professional specialty and advanced practice nursing organizations. Most professional organizations publish practice scope statements that are purposefully written broadly in order to avoid constraints on APRNs who are specializing and expanding their practice.

The American Academy of Nurse Practitioners (AANP) and the National Association of Clinical Nurse Specialists positions are two examples. State and federal laws can both limit the agreed-upon scope of practice (McMullen & Philipsen, 2013). A facility or an institution can have an impact on the scope of practice within working areas. The scope, in this case, can be narrower than the law allows but never liberal.

Before admitting a student, emerging APRN education programs must go through pre-approval and accreditation. The programs are housed in nationally accredited graduate programs, and graduates must be eligible for national certificates used for state licensure. Individuals with the necessary education must then take certification exams to determine their national competency levels in the APRN role, core, practice, and one population practice in a specific area. A national accrediting body certifies certification for regulatory purposes. Individuals are licensed to practice as independent practitioners at the APRN level (McMullen & Philipsen, 2013). Nursing organizations and special interest groups must develop role and population foci for education, licensure, and certification. The regulation mode applies to all elements of LACE because each element is critical to model implementation.

Restriction on the scope of practice for APRNs prevents them from practicing the entire scope of their education; role clarifications failed, APRN titles proliferated, different educational requirements and the range of practice conflicts and standards variability of various education programs. The removal of these restrictions would allow for the provision of high-quality healthcare to all populations.

References

Dubree, M., Jones, P., Kapu, A., & Parmley, C. L. (2015). APRN Practice: Challenges, Empowerment, and Outcomes. Nurse Leader, 13(2), 43-49. doi:10.1016/j.mnl.2015.01.007

McMullen, P. C., & Philipsen, N. (2013). The Complex Challenges Facing APRNs. The Journal for Nurse Practitioners, 9(9), A14. doi:10.1016/j.nurpra.2013.08.009

Shaw, K. (n.d.). Advanced Practice Registered Nurse (APRN) Led Unit Nursing Rounds and Bedside Nurses’ Job Satisfaction. doi:10.18130/v32r75

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

Explanation and Rubric. Must be APA formatting and quality work.

Nurse Practice Act PowerPoint Presentation Assignment and Grading Rubric

PowerPoint Format Expectations

It is important that students understand that the legal parameters of APN practice vary tremendously across the United States. Each state has its own laws regarding the scope of practice for APNs. This assignment is to compare the Nurse Practice Acts (or whatever the name of the statute that controls APN practice) −and the accompanying rules for administration for those acts in two states: the one where you live/work now and another state to be assigned by course faculty shortly after the semester has begun. You are to develop a detailed and scholarly PowerPoint presentation that adheres to APA format for any references, as well as the standard rules of spelling, grammar, punctuation, and sentence structure. Bullet point format should be used for most slides; in other words, a few slides should have full paragraphs. However, there should be enough detail in the entire presentation so that anyone reading the slides would have the answers to the questions below. However, copying lengthy sections of a statute should be avoided. Excellent summarizing and paraphrasing—rather than just copying and pasting whole sections of a statute—is actually encouraged. Side-by-side comparison of information can be effective, assuming the slide is not too “busy.”

Background Information about State Regulations

Please note that you must actually read the practice acts and the accompanying rules of the states assigned. But the good news is that the language about APN practice is usually located in a single, identifiable section of each act; therefore, you may focus on only the part of the acts specific to advanced practice nurses. I have noted elsewhere that you should not rely on the summaries done by Carolyn Buppert in our textbook simply because, in any given year, a state may change its act. The Nurse Practitioner Journal article, 28th annual legislative update:  Advancements continue for APRN practice can be helpful, although again any statute might have been revised since that article was published. The article can be found on the course home page under articles, videos, and PowerPoints for weekly assignments.

Finally, there is yet another resource for this assignment, which is provided by Barton Associates, which is a locum tenens staffing company. This site was discovered by one of our students who took NURS 610 previously. Below is the link for a very interesting color-coded diagram indicating the various elements of practice acts for all of the states and Washington, D.C. This may not be up to date.

http://www.bartonassociates.com/nurse-practitioners/nurse-practitioner-scope-of-practice-laws/

While the references are instructive in terms of the frameworks of nurse practice acts in different states, you still must still read the actual statutes and rules of both states.

The accompanying rules for administration are often contained in an entirely different document from the practice act itself. What is the difference between statutes and rules? The statute is the law passed by each state’s legislature; it is usually more general in its verbiage and is comparable to a policy. Rules, on the other hand, are written by government employees in the state agency/regulatory body and are much more specific like procedures.

Locating the practice acts for each state can be tricky: Some states have an actual governmental agency called the Board of Nursing; however, in other states, the “Board of Nursing” is simply an advisory committee comprised of volunteer members–which is true in Illinois. Illinois, like a few other states, has a “mega-agency” that regulates professionals in a whole host of professions. Illinois’ regulatory agency has the title of the Illinois Department of Financial and Professional Regulation (IDFPR) and oversees not just health professionals but wrestlers, hairdressers, real estate agents, bankers, and the list goes on and on. Then there are some states that regulate nurses through their state departments of health. However, there are two resources listed on your syllabus that should be helpful:

National Council of State Boards of Nursing: https://www.ncsbn.org/index.htm

State Nurses Associations: http://www.theagapecenter.com/Organizations/State-Nursing.htm

Once again, do not rely on Buppert for information about these state agencies, since the information about Illinois and many other states are not correct. The Advanced Practice Nursing Board in Illinois merged with the “regular” Board of Nursing (that oversees the practices of registered nurses and licensed practical nurses) in 2007 and, as I noted above, is only a voluntary board that advises the staff of IDFPR. The final authority for the practice of any professional licensed by IDFPR is the Secretary of the Department.

Formatting Statutes and Regulations

Do not be overly anxious regarding citations and references for the Nurse Practice Act PowerPoint presentation. Even the APA manual admits that its source for proper citation and reference format is based on another source; namely, the “Bluebook.” Nurse practice acts are statutes and their format is discussed on p. 220-221 in the APA manual. On the top of page 221 in the APA manual, a format for a reference is provided; however, that format may not be very helpful for the particular practice acts that you are comparing. Remember that the real purpose of citations and references is to help the reader find original sources if desired. For example, the full legal “name” of the Illinois Nurse Practice Act is this: 225 Illinois Compiled Statutes 65/60-1 — 65/75-20 (FYI: You MAY abbreviate Illinois Compiled Statutes as ILCS).

While the information focuses on how the Illinois Nurse Practice Act works, I hope the gist of this makes sense for all states, even though other states may have a somewhat different way of “naming” their acts. In Illinois, the majority of information about advanced practice nursing can be found under Article 65, within which there are several sections like this:

65/65-5: Qualifications for APN licensure. The first “65” refers to the “name” of the act, and it just so happens that the APN section is also Article 65. The “5” after the dash refers to a particular section within Article 65.

The next section of Article 65 is:

65/65-10: APN license pending status. And this section is followed by:

65/65-15: Expiration of APN license renewal. ….etc.

This is how you should begin this assignment. Early in your PowerPoint presentation, I would like you to indicate the “names” of the two acts that you are comparing, as I did with the Illinois Nurse Practice Act above (ILCS Compiled Statutes 65/60-1 — 65/75-20)…or how the acts you are comparing are legally “named.” Once you provide the legal names of both practice acts in your presentation, you do not have to refer to that name anywhere else in the presentation (not even at the end). However, I would like to see citations on the slides as you address the various elements of the grading rubric.

So, in Illinois, for example, when you describe the scope of practice of an APN, you would note somewhere on the slide that you obtained that information from § 65-30 (§ is the symbol for the section). And you should make that citation in a much smaller (but readable) font than the rest of the text on the slide. By the way, the easiest way to get that section symbol into your presentation is probably to go into Microsoft Word, find the “insert” tab in the top toolbar, and find the “symbol” icon (in my version of Word, it is the last option on the right), and find the symbol, which seems to be in the category of “Basic Latin,” and just copy and paste that symbol into a slide. Once you do that, you should be able to just copy and paste that symbol from one slide to another.  Due to space constraints, some liberties must be taken with APA format, but you do owe the reader enough information so that he or she can find the source of the information for each slide if desired.

Grading Rubric (NOTE: Issues should be addressed in the sequence as listed below.)

The presentation must compare and contrast how each state addresses the following issues:

1. What is the exact title that is used to identify advanced practice nurses as a whole? Which specialties of APNs that we have discussed in this course are included in whatever APN title(s) each state uses? Are these titles “protected”? If not all specialties are specifically noted in the Nurse Practice Act (NPA), in what other statutes are these other specialties licensed, and which state agency regulates their practice? (5 points)

2. How is licensure addressed; that is, must APNs have separate RN and APN licenses? (5 points)

3. What are the requirements for education and certification of each type of APN? (10 points)

4. Compare and contrast how APN oversight is addressed in each state: Is there physician oversight? If so, is it: Supervision (written or unwritten agreements) or collaboration (written or unwritten agreements)? Or is there independent/autonomous authority?  If independent authority, are there specific requirements before an APN is eligible for this autonomy? Are there other limitations to this autonomy (e.g., must submit a formulary of medications that the APN will prescribe, etc.)?  (15 points)

5. What body is responsible for controlling APN practice? Board of Nursing (or its equivalent)? Board of Medicine? Both the Board of Nursing and Board of Medicine? Some other entity (e.g., Department of Health)?   Is there APN representation on the Board of Nursing (or its equivalent), and if so, how many APNs are required?  (10 points)

6. What is allowed or not allowed in terms of prescriptive authority, and how does it relate to the issue of supervision or collaboration described above? Is the dispensing of sample medications specifically mentioned one way or the other? What are the regulations about controlled substances (e.g., must APNs obtain a controlled substance license from their state prior to applying for a DEA number)?  What are the other requirements regarding prescriptive authority? (15 points)

7. How does each statute address the components of the APRN Consensus Model for Advanced Practice Registered Nurses (a.k.a., LACE)? NOTE: It is unlikely that any practice act will specifically mention the terms APRN Consensus Model or LACE. Your task is to interpret and convey if there are any requirements in either act that seem to correspond to any of the components of LACE (albeit in other words).  (10 points)

8. Do the practice acts specifically address APNs having hospital admitting and/or discharging privileges or otherwise mention some other type of hospital clinical privileges? If so, describe the details of those privileges. (Note: APNs simply being able to perform admission history and physicals are NOT the same as having admission privileges.) If privileges are not addressed in the statutes or rules, review the TNPJ article for this information.  (10 points)

9. Do the practice acts address reimbursement for APN services?  If not noted in the practice acts themselves, what does the TNPJ article have to say about this topic? Also, what other elements of the scope of practice are noted either in the practice acts or the diagram on the Barton Associates website?  (10 points)

10. Overall appearance of PowerPoint slides: Appropriate graphics are encouraged (but, please, no graphics of women wearing nurses’ caps!). There should be some color to the slides.  Points will be deducted if the following are not present: (a) Slides should include appropriate citations that correspond to the reference list at the end of the presentation, and (b) proper spelling, grammar, punctuation, and sentence structure. Again, much of the content should be formatted in bullet points, and legal language should be carefully paraphrased. It is acceptable (indeed, desirable) for citations to be in a much smaller font compared to the rest of the words on a slide. (10 points)

This assignment is worth 100 points. A follow-up to this assignment is that each student will critique one other student’s presentation both for the quality (aesthetics, clarity) of the presentation, as well as the accuracy of its content. That assignment will be worth 50 points.

*****COMPARISON OF ARIZONA AND NEW MEXICO REQUIRED *****