Peer Response – Scope of Practice for Nurse Practitioners (NPs) in Georgia

Peer Response – Scope of Practice for Nurse Practitioners (NPs) in Georgia

Responding to Natalie

Hello,

Great work with your post. It provides a comprehensive overview of the scope of practice for nurse practitioners (NPs) in Georgia, highlighting the significant limitations imposed by the state’s restrictive policies. The discussion also effectively captures the challenges NPs face, particularly in terms of their limited prescribing authority and the mandatory supervision by physicians.

To add on, practice restrictions lead to constraints in the reception of primary health care, especially in rural settings. Inevitably, the dearth of NP autonomy is correlated with escalating ED attendance, which is particularly inconvenient. Research has highlighted the increase in the usage of services that accompany the generalization of the job description of NPs, which, in turn, results in enhanced patient outcomes because of enhanced timely and cost-efficient services. For instance, DePriest et al. (2020) note that independent practice authority for NPs leads to reduced ED encounters due to non-emergencies, which corresponds to overcrowded EDs in Georgia.

However, while there is no doubt that the restrictions in Georgia are present, it is also necessary to look at the position of those who support the continuation of physician involvement. Advocates state that such supervision helps to provide a better level of care and prevent certain risks arising from the independent practice of NPs (Kleinpell et al., 2023). This viewpoint was considered contentious; nevertheless, it is within the discourse on the optimal levels of NP autonomy and patient protection.

Moving to the future possibilities, there is a chance of advocacy and policy shift. With the continuing changes in healthcare, the calls for reform regarding the NP scope of practice may be further modified and adapted in order to address the needs of all individuals, especially in areas where they are most needed. There are reasons, based on the findings elaborated in this paper, to argue in favor of altering the practice of NPs’ work. Besides, Chiu et al. (2021) note that full practice authority has been found to help close gaps in access to healthcare, decrease spending on healthcare, and so on.

References

Chiu, P., Cummings, G. G., Thorne, S., & Makaroff, K. S. (2021). Policy advocacy and nursing organizations: A scoping review. Policy, Politics, & Nursing Practice, 22(4), 276–296. https://doi.org/10.1177/15271544211050611

DePriest, K., D’Aoust, R., Samuel, L., Commodore-Mensah, Y., Hanson, G., & Slade, E. P. (2020). Nurse practitioners’ workforce outcomes under the implementation of full practice authority. Nursing Outlook, 68(4), 459–467. https://doi.org/10.1016/j.outlook.2020.05.008

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to APRN practice: Policy and regulatory implications during COVID-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9

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Respond to Natalie

Discuss your state NP community in terms of scope of practice. Include your state’s scope of practice for NPs, including:

Level of independence of practice- In Georgia NPs are required to practice under the Nurse Practice Act (NPA). The law is passed by legislation, and it outlines how the NP is allowed to practice under defined regulations. The NPA created the Board of Nursing (BON) that is responsible for the loss anger process and enforcing the regulations. Georgia is a restricted practice state. This type of restriction has been debated since 1965, stating that it decreases access to care. (Patel et al., 2019).

Scope of Practice for Nurse Practitioners (NPs) in Georgia

Prescribing authority- NPs are currently prohibited from prescribing schedule II drugs in Georgia. Georgia is the most restrictive state of all. Legislator and the Governors office fight against the scope of practice rather than working to improve patient access to care. (Bachtel et al., 2020).

Any limitations of practice- Georgia is a restricted practice state. The law requires supervision by physician career long. NPs are not allowed to prescribe schedule II drugs, provide proof of disabilities to allow for handicap parking, to sign POLST or DNR forms, or sign death certificates. This policy inhibits the ability to deliver services that they are trained to do. (Patel et al., 2019).

Process for obtaining licensure in your state- Nurse practitioners apply for a license with the Georgia Board of Nursing (BON). The BON will authorize initial license and renewal, they monitor the nurse’s work performance within their scope of practice and discipline if the any laws are violated. (Kaplan, 2020). The process for obtaining licensure in Ga is to graduate with your degree and obtain national certification related to the specific track of training. After this you file an application and submit fees and all required documentation to the Georgia Board of Nursing located on the Ga Secretary of State website. Applications are processed and applicants are notified in approximately 20 days. (Georgia Secretary of State, 2024).

Certification and education requirements for licensure. In Georgia we must keep our national certification active. We must renew the license every two years and complete thirty hours of continued education courses. Then we submit the renewal application, complete an attestation form and submit the renewal fees. (Georgia Secretary of State, 2024). These requirements ensure the APN continues to have the expert knowledge, competencies and the ability to make appropriate decision making. (Lopes-Júnior, 2021).

If you live in a restricted practice state, how has patient care been impacted in your local community by these barriers? According to Mark and Patel (2019), restricted states have barriers for primary care providers and if policies are removed it would allow patients easier access to care.

For instance, is the ED used for primary care? The Emergency Departments (ED) in Georgia are being used for primary care purposes. John Hopkins research shows 58% of ED visits were primary care sensitive meaning they could have been avoided. Increasing access to additional providers would allow for more timely appointments, providing for pt needs and decreasing costly unnecessary hospital visits. (Hobson et al., 2022).

Are the EDs overcrowded with long wait times? ED overcrowding in Georgia is a significant problem. The local ED’s often must divert patients to other facilities due to no bed availability. The overcrowding concerns impact patient’s safety and quality of care. Patients with critical needs must wait while someone with non-critical concerns could have been seen at a primary care visit or an urgent care but did not get appropriate treatment due to unavailability of providers. According to Savioli et al (2022), using microlevel strategies of increasing health care resources would improve ED overcrowding and reduce mortality risks.

Are there urgent care clinics readily available? There are urgent care clinics readily available in Georgia. However, I’ve seen that many of them are overcrowded with long wait times, and they are only open for a short time in the evening. The urgent cares are facing these barriers due to limited access to the primary care provider. (Allen et al., 2021).

Is there adequate access to primary care- Georgia is a state that is labeled as having higher risk levels due to inadequate access to primary care. It is shown that the rural areas have higher risk of inadequate access to primary care partially due to state specific influence with the nurse practitioners’ scope of practice limitations. (Streeter et al., 2020).

How does access to NPs impact any healthcare disparities? In 2020, 149 of 159 counties had a primary care shortage. There is an economic impact due to lack of self-employment. If this barrier was not present, more NP could open practices and be more readily available to patient needs. Medicaid patients suffer due to over half the physicians do not accept Medicaid patients. Medicare patients are also suffering even though the aging population is so prevalent. (Timmons & Denson, 2022). To stop the negative impacts of disparity we must provide heath equality. This will happen when all patients have sufficient access to all the resources they need. I believe that if the authority to practice were improved for NP, there would be professionals to improve health care outcomes and reduce the disparities. (Peterson et al., 2020).

References

Allen, L., Cummings, J. R., & Hockenberry, J. M. (2021). The impact of urgent care centers on nonemergent emergency department visits. Health Services Research, 56(4), 721–730. https://doi.org/10.1111/1475-6773.13631Links to an external site.

Bachtel, M. K., Hayes, R., & Nelson, M. A. (2020). The push to modernize nursing regulations during the pandemic. Nursing Outlook, 68(5), 545–547. https://doi.org/10.1016/j.outlook.2020.05.006Links to an external site.

Georgia Secretary of State. (2024). How to Guide: APRN / NP https://sos.ga.gov/how-to-guide/how-guide-aprn-npLinks to an external site.

Georgia Secretary of State. (2024, July 23). Chapter 410-11 regulation of advanced practice registered nurses. GA Rules & Regulations. https://rules.sos.ga.gov/gac/410-11Links to an external site.

Hobson, J., Ombres, R., Clark, J., Panjwani, S., Visser, C., Zeman, S., Lovell, J., Lobick, D., & Majewski, P. (2022). Improving care coordination and reducing ED utilization through patient navigation. The American Journal of Managed Care, 28(5), 201–206. https://doi.org/10.37765/ajmc.2022.89140Links to an external site.

Kaplan, L. (2020). NP licensure and the discipline process. The Nurse Practitioner, 45(3), 14–15. https://doi.org/10.1097/01.npr.0000653976.42290.01Links to an external site.

Lopes-Júnior, L. C. (2021). Advanced practice nursing and the expansion of the role of nurses in primary health care in the Americas. SAGE Open Nursing, 7, 237796082110194. https://doi.org/10.1177/23779608211019491Links to an external site.

Mark, B. A., & Patel, E. (2019). Nurse practitioner scope of practice: What do we know and where do we go? Western Journal of Nursing Research, 41(4), 483–487. https://doi.org/10.1177/0193945918820338Links to an external site.

Patel, E. Y., Petermann, V., & Mark, B. A. (2019). Does state-level nurse practitioner scope-of-practice policy affect access to care? Western Journal of Nursing Research, 41(4), 488–518. https://doi.org/10.1177/0193945918795168Links to an external site.

Peterson, A., Charles, V., Yeung, D., & Coyle, K. (2020). The health equity framework: A science- and justice-based model for public health researchers and practitioners. Health Promotion Practice, 22(6), 741–746. https://doi.org/10.1177/1524839920950730Links to an external site.

Savioli, G., Ceresa, I. F., Gri, N., Bavestrello Piccini, G., Longhitano, Y., Zanza, C., Piccioni, A., Esposito, C., Ricevuti, G., & Bressan, M. A. (2022). Emergency department overcrowding: understanding the factors to find corresponding solutions. Journal of Personalized Medicine, 12(2), 279. https://doi.org/10.3390/jpm12020279Links to an external site.

Streeter, R. A., Snyder, J. E., Kepley, H., Stahl, A. L., Li, T., & Washko, M. M. (2020). The geographic alignment of primary care health professional shortage areas with markers for social determinants of health. PLOS ONE, 15(4). https://doi.org/10.1371/journal.pone.0231443Links to an external site.

Timmons, E., & Denson, C. (2022, December 13). Addressing Georgia’s healthcare disparities: The benefits of full practice authority for nurse practitioners and physician assistants. Georgia Public Policy Foundation. https://www.georgiapolicy.org/publications/addressing-georgias-healthcare-disparities-the-benefits-of-full-practice-authority-for-nurse-practitioners-and-physician-assistants/Links to an external site.