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CERTIFICATION AND LICENSURE PLAN
Now that you are in the final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass the national PMHNP certification exam. Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.
Although a movement called the APRN Consensus Model is attempting to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish an independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.
Another important area to consider and plan for is prescriptive authority. The appropriate board, which may be the medical board, state board of pharmacy, or nursing board, grants prescriptive authority under state law for the appropriate state licensure. The federal government grants the authority to write for a controlled substance, and the Drug Enforcement Administration (DEA) verifies this action through by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process. In this Discussion, you will locate and review the practice agreements in the state in which you plan to practice, identify potential collaboration requirements in your state, and understand the certification and licensing process that you will need to follow.
RESOURCES
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.
· American Association of Nurse Practitioners. (2020). State practice environment Links to an external site. . https://www.aanp.org/advocacy/state/state-practice-environment
· On the map on the webpage, click on your state and review. After you complete the PMHNP Program, pass the certification exam, and get a job, you will need to revisit this website to apply for the privilege to practice as an APRN with your state Board of Nursing.
· American Psychiatric Association. (2020). Telepsychiatry Links to an external site. . https://www.psychiatry.org/psychiatrists/practice/telepsychiatry
· Buppert, C. (2021). Nurse practitioner's business practice and legal guide (7th ed.). Jones & Bartlett Learning.
· Chapter 1, “What Is a Nurse Practitioner?”
· Chapter 2, “Nurse Practitioner Scope of Practice”
· Chapter 3, “State Regulation of the Nurse Practitioner Practice”
· Chapter 4, “Federal Regulation of the Nurse Practitioner Profession”
· Chapter 5, “Prescribing”
· Centers for Disease Control and Prevention. (2020). Using telehealth to expand access to essential health services during the COVID-19 pandemic Links to an external site. . https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
· Centers for Medicare & Medicaid Services. (2019). National provider identifier standard (NPI) Links to an external site. . https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand
· The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
· Drug Enforcement Administration Diversion Control Division. (2020). Registration Links to an external site. . https://www.deadiversion.usdoj.gov/drugreg/index.html
· This site contains information about applying for your DEA registration number. This number is required for writing prescriptions.
· After completing PMHNP Program and passing the PMHNP certification exam, complete the DEA application to request prescriptive privileges. Your DEA number will be renewable every five years.
· National Panel for Psychiatric Mental Health NP Competencies. (2003). Psychiatric-mental health nurse practitioner competencies Links to an external site. . National Organization of Nurse Practitioner Faculties (NONPF). https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/imported/PMHNPcomps03.pdf
· Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.) . Jones & Bartlett Learning.
· Chapter 1, “Historical Perspectives: The Art and Science of Nurse Practitionering”
· Nurse Practitioner Core Competencies
· Nurse Practitioners’ Unique Role
· Chapter 13, “Quality, Safety, and Prescriptive Authority”
· Substance Abuse and Mental Health Services Administration. (2020). Become a buprenorphine waivered practitioner Links to an external site. . https://www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/apply-for-practitioner-waiver
· This site contains information about applying for a practitioner waiver to prescribe or dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA 2000).
· After you obtain a Drug Enforcement Agency (DEA) number and completed 24-hour medication-assisted treatment (MAT) waiver training, you may apply to Substance Abuse and Mental Health Services Administration (SAMSHA) for MAT waiver to be able to prescribe Schedule III, IV, or V opioid drugs for the maintenance and detoxification treatment of opioid use disorders relapse prevention.
· Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
· Chapter 2, “The Role of the Psychiatric-Mental Health Nurse Practitioner: Regulations and Scope of Practice”
· Chapter 3, “Theoretical Foundations of Care and Nonpharmacological Therapies”
TO PREPARE:
· Review practice agreements in your state.
· Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.
· Research the following:
· How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?
· What is the application process for certification in your state?
· What is your state’s board of nursing website?
· How does your state define the scope of practice of a nurse practitioner?
· What is included in your state practice agreement?
· How do you get a DEA license?
· Does your state have a prescription monitoring program (PMP)?
· How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state? My state is North Carolina.
In North Carolina, APRN certification is done by the North Carolina Board of Nursing (NCBON) through collaboration with the North Carolina Department of Health and Human Services (NCDHHS) which provides a streamlined registration to the NC Controlled Substances Reporting System (CSRS). Licensing and certification are done by the NCBON licensing and regulatory affairs department. They check for all academic qualifications, register for an examination, and fees payment. The applicant is licensed to practice in the state after completing all the requirements and sitting and passing the examination.
What is the application process for certification in your state?
The educational qualifications are APRNs are set by the NCBON. The national certifying agencies verify the academic papers before approving a candidate to take an exam. Before any APRN is allowed to practice in NC, they must hold a Registered Nurse (RN) license or another compact state RN. Once the candidate passes their examination, they can then apply for licensure by completing the form on the NCBON website. Once approved, the applicant will receive a confirmation letter and Identity number via the email address provided.
What is your state's board of nursing website?
The North Carolina Board of Nursing website is https://www.ncbon.com Links to an external site.
How does your state define the scope of practice of a nurse practitioner?
APRN in NC practice autonomously and in coordination with their physician supervisor and other healthcare professionals. They provide vast care of health services, including assessment, diagnosis, management of acute, chronic, and complex medical issues, health promotion, medication management, disease prevention, health education, and counseling to individuals, families, groups, and communities. They also allow participation in health care research, interdisciplinary consultants, and patient advocates. In North Carolina, APRNs are not allowed to practice independently; they must work under physician supervision as outlined in a collaborative practice agreement.
What is included in your state practice agreement?
The state of North Carolina has enacted a registration that guides the practice agreements between practicing physicians and APRNs. The agreement must include a description of the arrangement between the nurse practitioner and physician. The physician must be continuously available for consultation, collaboration, referral, and care evaluation by the nurse practitioner. The supervising provider may be at a different location from the APRN but must be available for consultation by phone or video. The supervising physician may also provide backup supervising physicians in situations they are not available. The collaborative agreement must be reviewed each year and resigned by the APRN and the supervising physician.
How do you get a DEA license?
In NC, to obtain a DEA license, all applicants must meet the state requirements and obtain an NC Controlled Substance License number. Once the NC state requirements are completed, the applicant can apply for DEA registration by filling and submitting a DEA form 224 found in the North Carolina Department of Health and Human Services (NCDHHS). Applicant must also pay a non-refundable fee of $731 which is good for three years.
Does your state have a prescription monitoring program (PMP)?
Yes, NC has a PMP, and its acronym is NC CSRS, known as North Carolina Controlled Substance Reporting System. The NCDHHS Division of Mental Health, Developmental Disabilities, and Substance Abuse Services administer it. These services provide data for prescription opioids, and other controlled medications patients have received from other clinicians to determine whether a patient is receiving opioid dosages or combinations that can put them at high risk for overdose or patients seeking medication inappropriately (Alexandridis, Dasgupta, Ringwalt, Rosamond, Chelminski, & Marshall, 2020).
How-do-you-get-certified-and-licensed-as-an-Advanced-Practice-Registered-Nursedocx/ How does your state describe a nurse practitioner's controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
APRNs in North Carolina are allowed to prescribe medications, including controlled substances II-V. They can also prescribe up to 5 refills for schedule III-controlled substances, and doses must be limited to a 30-day supply for each refill. For example, an APRN may prescribe Buprenorphine, a Schedule III drug, and refill it five times. Also, the APRN's ability to prescribe in NC must also be outlined in the collaborative practice agreement. North Carolina has a prescription drug monitoring program called the NC Controlled Substance Reporting System (CSRS). The program helps in collecting information on dispensed controlled substances (NCDHHS, n.d.). The information collected is always availed to dispensers and prescribers. The system is implemented as a clinical tool designed to improve patient care and safety. Additionally, CSRS helps to prevent prescriptions misuse and overdose (Anand et al., 2017). All prescribers and pharmacists are required to access the patient report from the system and ascertain their eligibility before prescribing a controlled substance. A patient’s prescription-fill history should be verified before a controlled substance is prescribed.
Becoming an APRN NC requires more than getting an academic qualification from a credited university. It is also very vital to get the appropriate certifications and licensures. It is also required to practice under a supervising physician and have a signed collaborative practice agreement. APRNs must also follow their scope of practice. Thus, NC remains one of those states that rank poorly compared to other states when giving NP autonomy in their approach.
References
Alexandridis, A. A., Dasgupta, N., Ringwalt, C. L., Rosamond, W. D., Chelminski, P. R., & Marshall, S. W. (2020). Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data. PLoS One, 15(1) doi:https://doi.org/10.1371/journal.pone.0227350
Anand, V., Lee, J. G. L., & Rivers-Allen, J. (2017). Utilization of drug monitoring System in north Carolina. North Carolina Medical Journal, 78(4), 280–280. https://doi.org/10.18043/ncm.78.4.280
https://www.ncbon.com Links to an external site.
NCDHHS. (n.d.). NC Controlled Substances Reporting System | NCDHHS. Www.ncdhhs.gov. https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-abuse/north-carolina-drug-control-unit/nc-controlled-substances-reporting-system
https://www.ncdhhs.gov/providers/licensure
https://www.nursingprocess.org/nurse-practitioner-scope-of-practice-by-state.html
