Assignment

Respond to at least  two of your colleagues on  2 different days in one or more of the ways listed below.

· Share an insight from having viewed your colleagues’ posts.

· Suggest additional actions or perspectives.

· Share insights after comparing state processes, roles, and limitations.

· Suggest a way to advocate for the profession.

· Share resources with those who are in your state.

Please respond to 1#

I feel very fortunate that I work in a state that allows Nurse Practitioners to work in full practice independently. This means that as a nurse practitioner in the state of Maryland, I will be allowed to order tests, evaluate patients, diagnose, and prescribe medications for them.

Upon graduation, I will have to have a copy of my official transcript sent to the Maryland Board of Nursing directly to get authorization to test. This authorization to test will allow me the opportunity to sign up for my test to become an Advanced Practice Registered Nurse within the state of Maryland. Growing demand for nurse practitioners and full practice authority allows patients greater access to their healthcare needs (Moore et al., 2020). While full practice authority will enable providers to meet their patient's needs, it's also important that the quality of care being provided is the highest level of standards. This authority should also coincide with great responsibility and should not be taken lightly.

· From graduation, several steps are needed to happen to get certified and licensed within the state of Maryland. The first step usually involves the ANCC. The purpose of the ANCC is to provide a certification exam to prove one's competency to become a psychiatric mental health nurse practitioner. An official transcript must be sent to them directly during the first step when this happens, you will get authorization to test and can go to the facility for testing.

· Once you have completed the ANCC certification, you can apply for your NPI number. The NPI number stands for national provider identifier. After completing this step, you can convert your Merlin board of nursing RN license from RN to NP. This process usually costs $50 and requires you to provide an updated picture of your driver's license end voter registration card to be submitted to the Maryland board of nursing.

· Most facilities within the state of Maryland require you to register for the CRISP system, a centralized database for medical records within the state of Maryland, including prescription drug records. This is usually completed as the 4th step after you have converted your license from an RN to NP. The next step in Maryland usually involves applying for your controlled dangerous substance or CDs. It is tricky in Maryland as the CDS also requests your DEA license number, but you will not have that until you complete your CDS registration. Once this is completed, you can finalize your payment of $731 to request your DEA license. This step should be completed last as they will take your money, and if you have not completed the first steps, they will decline your application and make you pay the money again after you've completed all the necessary documentation.

· I live in Maryland, and the Maryland board of nursing website is https://mbon.maryland.gov. Within Maryland, nurse practitioners have the full practice authority appointed to them by the Maryland board of nursing. Maryland stipulates that you have to have either a doctor or a mental health nurse practitioner as a mentor to acquire a license. This person should be available for any questions you may have when starting your practice. In Maryland, you are not required to work directly under a physician to practice.

· Maryland does have a prescription monitoring program. This program is in place to help securely track and monitor the uses of controlled substances and how they are dispensed to patients within Maryland. This system also correlates with CRISP, which allows providers to see what other medications have been prescribed to their patients. Within Maryland, nurse practitioners can prescribe schedule 2 and three through 5 prescriptions. Nurse practitioners are also allowed to prescribe Buprenorphine, but this medication requires an additional 16-hour course before prescriptive rights are granted, and it has been found that this has significantly reduced the abuse of this medication being prescribed by nurse practitioners (Klein et al., 2022).

· There is a big shortage for providers within the United States. It was estimated that from 2010 through 2017 that the number of nurse practitioners in the United States more than doubled to help meet the needs of our community (Auerbach et al., 2020). As nurse practitioners, we must understand our roles and responsibilities within the healthcare system. One scope of practice can be significantly different from state to state. We must know the limitations of these practices to ensure that we are providing the best possible care to our patients while protecting ourselves. I highly suggest that if anyone is to move or relocate, they check with their state's board of nursing to evaluate the level of practice they are allowed to participate in.

· References

· Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2020). Implications of the rapid growth of the nurse practitioner workforce in the us. Health Affairs, 39(2), 273–279.  https://doi.org/10.1377/hlthaff.2019.00686 Links to an external site.

· Klein, T. A., Hartung, D., & Markwardt, S. (2022). The impact of cara mandates on nurse practitioner controlled substance prescribing in oregon: A cohort study. Substance Abuse Treatment, Prevention, and Policy, 17(1).  https://doi.org/10.1186/s13011-022-00431-z Links to an external site.

· Moore, C., Kabbe, A., Gibson, T. S., & Letvak, S. (2020). The pursuit of nurse practitioner practice legislation: A case study. Policy, Politics, & Nursing Practice, 21(4), 222–232.  https://doi.org/10.1177/1527154420957259 L

Please respond to #2

Certification and Licensure Plan

The state of Michigan does require physician collaboration and supervision for NPs. This collaboration includes that all covered medical services that are billed to the Michigan Department of Community Health by the nurse practitioner will be made with the physician. The guidelines include: Agreement is documented in writing and available upon request by the state of Michigan agents and also includes descriptions of the services to be provided. The collaborative practice agreement is developed and approved by both the physician and the NP. Formal and systematic meetings will occur between both parties. There is documented evidence of consultation if needed between the NP and the physician. Finally, there is recognition of limits of clinical and statutory authority and accountability in relation to the established goals and needs of all beneficiaries (MICNP, 2022).

To get certified and licensed as an APRN in the state of Michigan, the graduate nurse must go through LARA, otherwise known as the Michigan Department of Licensing and Regulatory Affairs (State of Michigan, 2022). Eligibility for an NP specialty requires a current Michigan RN license, a national certification by an approved certifying organization, and the nurse specialty certification can be submitted online at  https://aca3.accela.com/MILARA/ Links to an external site. .

The application process is rather simple and can be done online at  https://www.michigan.gov/lara/bureau-list/bpl/miplus Links to an external site. . Paper applications are not accepted in the state of Michigan.

The board of nursing website for Michigan is  https://www.michigan.gov/lara/bureau-list/bpl/health/hp-lic-health-prof/nursing Links to an external site. .

The APRN’s scope of practice in Michigan is defined by their specialty training and includes comprehensive exams and assessments, promotion and maintenance of health, prevention of illness and injury, management of healthcare, health counseling and guidance, admission of clients to different healthcare facilities (hospitals, LTCs, etc.), healthcare referrals, diagnosis of health and illness status, application of EBP and research, prescription and/or administration of medications, therapeutic devices and measures, ordering and interpreting labs and diagnostic tests, and client advocacy (MICNP, 2022).

The state practice agreement for Michigan includes all of the scope of practice abilities as well as the duties that go beyond that scope in which supervision and/or collaboration is conducted with a physician (MICNP, 2022).

To obtain a DEA license in Michigan, one must first obtain a license number and then complete the application required. The State of Michigan LARA website has this information as well as what is needed including a license fee that runs concurrently with one’s professional license. There is also a 1-day training that must take place in order to obtain a DEA license. There are also good moral character questions that are asked which shows that the NP has the ability and are likely to serve the public in a fair, open, and honest manner (2022).

Michigan does have a PMP known as MAPS and it is used to track substances, schedules 2-5 drugs. This helps providers ensure that they are not overprescribing and also prevents drug abuse and diversion at all levels (LARA, 2022).

APRNs can prescribe controlled substances 2-5, but only under the authority of a physician. Both the APRN and the physician’s DEA registration numbers need to be used, recorded or otherwise indicated in connection with the prescription (MICNP, 2022).

The biggest barrier that I observed from this research is the prescriptive authority of controlled substances and the requirement that a physician must basically “sign-off” on this. This limits the ability for an APRN to use full autonomy. This is something that I was aware of in my state, as I had already started looking into this when I started this program. I know that there are states that do not require this, and hopefully states with this limited ability (such as Michigan) will adjust these guidelines to open up a broader prescriptive authority to APRNs. There was not much that surprised me during my research. I did find it interesting that the DEA licensing requires just a one time, 1-day training. With the guidelines and rules surrounding controlled substance prescribing, one would think that this may be more intensive or have to be done more than just once.

References

Mi automated prescription system (MAPS). SOM - State of Michigan. (2022). Retrieved from  https://www.michigan.gov/lara/bureau-list/bpl/health/maps#:~:text=Welcome%20to%20MAPS%2C%20Michigan's%20prescription,%2C%20pharmacy%2C%20and%20patient%20levels Links to an external site. .

Nursing. SOM - State of Michigan. (2022). Retrieved from  https://www.michigan.gov/lara/bureau-list/bpl/health/hp-lic-health-prof/nursing Links to an external site.   

Resources - Michigan Council of Nurse Practitioners. Michigan Council of Nurse Practitioners. (2022). Retrieved from  https://micnp.org/page/resources Links to an external site.