Respond to at least two of your colleagues* on two different days and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples.

1 Response for each discussion. Discussion 1 and 2

Discussion 1

APRN Board of Nursing Regulations in Kansas and Missouri

MAIN QUESTION POST- Throughout history, defining APRNs scope of practice has been an ongoing issue in different states. According to Loversidge (2019), “the actual practice acts are inevitably a product of individual states’ political forces, so titles, definitions, criteria for entrance into practice, scopes of practice, reimbursement policies, and models of regulation are state-specific” (p.63). APRN regulations are state-specific and can differ in multiple ways. In Kansas, it is important to know the license renewal regulations. When renewing your license in Kansas, you must complete 30 hours of continuing nursing education about the advanced practice registered nurses role (“Kansas Administrative Regulations,” n.d.). Also, you can’t roll-over continuing nursing educations hours from different years. If the Kansas Board of Nursing asks for proof of the education you completed, you must provide it. As an APRN in Kansas, when prescribing controlled substances, you must put the D.E.A. registration number issued to the advanced practice registered nurse (“Kansas Administrative Regulations,” n.d.). When prescribing medications, it is crucial to know the rules behind what an APRN can and cannot prescribe and the correct way to fill out prescriptions.

In Missouri, as an APRN, you do not have to do continuing nursing education hours to renew your license. Also, in Missouri, APRNs do not have the authority to prescribe schedule II controlled substances. Only being one state apart shows that each state defines its regulations for APRNs. In Missouri, when renewing your license, you need to know your “RN license expires every odd-numbered year on April 30th and you must keep your RN license current to maintain your APRN recognition (“State of Missouri Advanced Practice Registered Nurse Document of Recognition Renewal Instructions,” n.d.). In Kansas, when renewing your license, you need to know “advanced practice registered nurse licenses shall be renewed on the same biennial cycle as the cycle for the registered professional nurse licensure renewal” (“Kansas Administrative Regulations,” n.d.). As you can see, each state has specific regulations on when to renew your license, which shows the importance of researching your state board of nursing regulations.

Regulations for Advanced Practice Registered Nurses (APRNs): Legal Authority to Practice

When it comes to allowing full practice authority for APRNs it differs from state to state.  Not all states allow full practice authority as an APRN and this causes a barrier to the accessibility and affordability to health services for low income citizens (Bosse et al., 2017).With the shortage of primary care doctors, the states that do not allow full practice authority limit healthcare access to their vulnerable populations (Bosse et al., 2017).  The regulations of license renewal requirements and the ability to prescribe controlled substances apply to all APRNs, depending on their educations and state laws. Even though they differ by state, APRNs need to abide by the rules for renewing and keeping their current licenses, such as through education hours and meeting renewal deadlines. When prescribing controlled medications following the rules for what to write, such as DEA numbers or the physician they are working under, is essential for APRNs. Researching and understanding your state board of nursing APRN regulations is crucial for your success in your career as an APRN.

Discussion 2

Comparison between South Carolina and North Carolina Nursing Regulations

South Carolina, my home state, is a part of AANP Region 4, which includes KY, NC, SC and TN.

Nurse Practitioner in South Carolina

Practice Authority

Written protocol with a physician is required. The protocol must outline information for delegated medical acts and a description of how consultation with the physician is provided. The protocol must be reviewed annually. 

Prescriptive Authority

Drugs and devices prescribed must be within the NP’s specialty and listed in the written protocol developed by the NP and the supervising physician. An NP may also prescribe Schedules II-V controlled substances. 

Nurse Practitioner as a Primary Care Provider

NPs are recognized in state policy as primary care providers. The South Carolina Medicaid Provider Manual lists the provider types that may enroll as a primary care provider.

(Scope of Practice Policy.2020)

Nurse Practitioner in North Carolina

Practice Authority

Collaborative practice agreement required between the NP and the supervising physician. The agreement must establish minimum standards of consultation and must be reviewed yearly.

Prescriptive Authority

The drugs and devices an NP may prescribe must be outlined in the collaborative practice agreement. Schedules II-V controlled substances may be prescribed if outlined in the agreement. 

Nurse Practitioner as a Primary Care Provider

NPs are recognized in state policy as primary care providers. Primary care means preventive, diagnostic, treatment, consultant, referral and other services rendered by physicians, physician assistants and nurse practitioners.

(Scope of Practice Policy.2020)

            In the states of South Carolina and North Carolina nurse practitioners are not allowed to practice to their full scope of practice without the oversight of a Medical doctor. As far as I can tell through some research is that only 14 states allow for nurse practitioners to practice without physician oversight. These states include Alaska, Arizona, Hawaii, Idaho, Iowa, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Utah, Washington, Wyoming. (Beckers, 2019). While I feel that having no limits on my education and training in the practice setting, I think that have a physician to collaborate with will help me with the anxiety of being an autonomous provider. I might can see where this may get redundant when becoming a more experienced family nurse practitioner. In both SC and NC, the NP can prescribe Schedules II-V controlled substances within the scope of the agreement guidelines with overseeing physicians. Both states only allow for no more than a 30-day supply of these medications. It is the position of AANP that NP prescriptive authority be solely regulated by state boards of nursing and in accordance with the NP role, education and certification. (AAPN.2020). Both states recognize nurse practitioners as a primary care provider. Therefore, allowing reimbursement from Medicaid and Medicare and private insurance companies. For nurse practitioners wanting to open their own practice in the states of NC and SC would have to live with in 45 miles of the overseeing physician. If this were one’s goal to own their own practice it would probably be a lot less headache to do so in one of the states that allow full scope of practice with out an agreement with a physician.