Discussion

peerpost.docx

Erin Jena J

Main Discussion Post

An APRNs scope of practice varies from state to state. There are three different levels of practice, full practice authority, restricted practice authority and reduced practice authority. Full practice authority allows the APRN to practice without the physician supervision, restricted practice authority requires that a physician direct the care they provide, and reduced practice authority states that APRNs have limitations on what they can practice (Jividen, 2023). Each state under the U.S Constitution can decide what regulations APRNs have to abide by in order to practice. The ultimate goal is to protect the people and the federal government allows the states to determine how to regulate healthcare with that in mind (Milstead & Short, 2019).

Board of Nursing Regulations in South Carolina:

Practice Authority: In my state of South Carolina APRNs have restricted practice authority. They are not allowed to practice medicine without being under the direct supervision of a physician. A physician must be reachable by any means electronically and be in close proximity of the practice.

Prescriptive Authority: APRNs in SC have the authority to write for Schedule 11 controlled substances. In 2018, prescriptive authority advanced to include Schedule 11 narcotic and non- narcotic medications. There are also limitations to these medications, Schedule 11 non narcotics can only be prescribed up to thirty days, and narcotics only five days. This does not allow the APRN to grant a refill on this medication before those days are up unless it is written and signed by an overseeing physician (Wildeman, 2020). APRNs must complete a total of 45 CEU’s and an additional 15 hours focusing on controlled substances.

Board of Nursing Regulations in Hawaii:

Practice Authority: Hawaii allows for full practice authority for APRNs. Meaning that they can practice as a primary care provider without being supervised by a physician or collaborating care with a team.

Prescriptive Authority: Hawaii allows for APRNS to prescribe Schedule 11-V controlled substances without a physician supervising. The Hawaii Board of Nursing controls the authority to prescribe these medications. They are allowed to prescribe medication, equipment or any medical needs the patient may have. Hawaiian APRNs are also able to recommend schedule 1 narcotics including medical marijuana (MedSource Consultants, 2018).

How do these two states differ with regulations? Where SC has a restricted practice authority, Hawaii has full practice authority. This is a significant difference in how they can impact the healthcare they give. SC requires a physician to oversee and agree with prescriptions that are schedule 11 narcotics whereas in Hawaii, the APRN can prescribe them independently.

How would these regulations apply to APRNs who have full authority? It is important to remember laws and regulations for each state that an APRN practices in. If for example, an NP were to move from state to state, regardless if it is a neighboring state, one has to adhere to their policies. Where they may have full authority in Hawaii, moving to South Carolina they would have to abide by a restricted practice authority. The changes in the healthcare they could and could not provide can change dramatically throughout each state. Multiple boards and organizations are working on making every state a full practice authority as more providers are needed. Some states loosened the rules during the Covid 19 pandemic so that more people could get healthcare, but have since gone back to their previous state regulations. One example is a nurse from South Carolina could move to Hawaii and be able to open their own clinic without a supervising physician. Another example is if the nurse were to move to a restricted authority state the nurse would have to follow protocol for that state by completing the CEUs and education required before they can prescribe certain medications.

References

A State-by-State Scope of Practice Guide for Nurse Practitioners. (2018). MedSource Consultants . https://medsourceconsultants.com/wp-content/uploads/2018/09/state-by-state-nurse-practitioner-REV-2018-003.pdf

Jividen, S. (2023, August 4). Full practice authority for nurse practitioners by state. Nurse.org. https//nurse.org/education/np-full-practice-authority

Milstead, J.A., & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones and Bartlett Learning.

Wildeman, M. (2020, September 14). SC nurses given broader prescribing power, greater authority to practice. The Post and Courier. https://www.postandcourier.com/features/sc-nurses-given-broader-prescribing-power/

Brittney

Advanced Practice Registered Nurse Regulations in Pennsylvania vs. Tennessee

Nursing regulatory bodies were established to protect the public’s wellbeing by ensuring safe nursing practice (National Council of State Boards of Nursing, n.d.). This group outlines standards and issues nursing licensure. Nursing has a scope of practice that contains regulations the practitioner is to follow. These regulations may differ in each state. In Pennsylvania, advanced practice registered nurses (APRN) are recognized as primary care providers (Pennsylvania Coalition of Nurse Practitioners (PCNP), n.d.). This means they can care for patients in settings such as a family practice, pediatric officer, clinic, or outpatient settings. For example, an APRN can care for a child at a pediatric outpatient office or a woman at a women’s health center. APRN in Tennessee are also recognized as primary care providers (National Conference of State Legislatures (NCSL), n.d.). These providers can operate in a general medicine office or in a mental health clinic. In Pennsylvania, APRN are able to prescribe medication with an outlined written collaboration agreement from a physician if the medication is relevant to the provider’s specialty. They are able to prescribe Schedule II-V controlled substances (PCNP, n.d.). This gives a nurse practitioner freedom to treat patients using pharmaceutics if deemed necessary. If a patient visits the APRN in an outpatient setting following a hospital stay involving an injury, the APRN can prescribe oxycodone, a Schedule II controlled substance, to alleviate increased pain. In contrast, APRN in Tennessee are able to prescribe medication following a written protocol from a physician but need to consult the provider before prescribing Schedule II-V controlled substances (NCSL, n.d.). This can hinder the care a nurse practitioner is providing because the physician is not always readily available when they may be caring for a patient. If an APRN is caring for a patient that has taken analgesics in the past and needs a specific one for short-term pain control, this might impede the treatment. A patient may require Tramadol, which is a Schedule IV controlled substance, but the APRN in Tennessee cannot prescribe that without deliberating with the physician. Pennsylvania Orders for Life-Sustaining Treatment (POLST) or Physician Order for Scope of Treatment (POST) is a process that aids in ensuring patients receive the medical treatment they desire and avoiding that which they do not want, when they are incredibly ill or frail (POLST, n.d). A form is signed that will be with the patient in all healthcare settings to guarantee a patient’s wishes are follow in emergency situations. In Pennsylvania, an APRN can legally sign a POLST/POST form (PCNP, n.d.). If a patient is visiting a family practice for an annual check-up appointment, the APRN can review information then sign a POLST/POST form if a patient would like to decline life-sustaining treatment in emergent situations. In Tennessee, the APRN is unable to sign a POLST/POST form unless they are recognized by the Tennessee Board of Nursing as able to provide POST treatment (NCSL, n.d.). There are certifications in Tennessee an advance practitioner must obtain before being qualified to provide life-sustaining treatment. This can delay a patient’s wishes being respected if a physician is not available to sign the form and the APRN is not qualified.

References

National Council of State Boards of Nursing (NCSBN)Links to an external site. . (n.d.). Retrieved September 24, 2023 from https://www.ncsbn.org/nursing-regulation/about-nursing-regulatory-bodies.pageLinks to an external site.

National Conference of State Legislatures (NCSL). (n.d.) Scope of Practice Policy. Retrieved on 2023, September 24 from https://scopeofpracticepolicy.org/states/tn/Links to an external site.

Pennsylvania Coalition of Nurse Practitioners (PCNP). (n.d.). Scope of Practice. Retrieved on 2023, September 24 from https://www.pacnp.org/page/ScopeofPracticeLinks to an external site.

Pennsylvania Order for Life-Sustaining Treatment (POLST). (n.d.) POLST. Retrieved on 2023, September 24 from https://www.papolst.org/#:~:text=POLST%20is%20a%20process%20that,are%20seriously%20ill%20or%20frailLinks to an external site. .

PROFESSIONALNURSINGANDSTATE.docx

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.

WEEKLY RESOURCES

To Prepare:

· Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.

· Consider how key regulations may impact nursing practice.

· Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.

BY DAY 3 OF WEEK 5

Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

BY DAY 6 OF WEEK 5

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.

· Required readings

· Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.

· I live in California please write about California

· Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.

· Chapter 4, “Government Response: Regulation” (pp. 57–84)

· American Nurses Association. (n.d.). ANA enterprise Links to an external site. . Retrieved September 20, 2018, from http://www.nursingworld.org

· Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary careLinks to an external site. . Nursing Outlook, 65(6), 761–765.

· Halm, M. A. (2018). Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing Download Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing. Worldviews on Evidence-Based Nursing, 15(4), 272–280. doi:10.1111/wvn.12291

· National Council of State Boards of Nursing (NCSBN)Links to an external site. . (n.d.). Retrieved September 20, 2018, from https://www.ncsbn.org/index.htm

· Neff, D. F., Yoon, S. H., Steiner, R. L., Bumbach, M. D., Everhart, D., & Harman J. S. (2018). The impact of nurse practitioner regulations on population access to careLinks to an external site. . Nursing Outlook, 66(4), 379–385.

· Peterson, C., Adams, S. A., & DeMuro, P. R. (2015). mHealth: Don’t forget all the stakeholders in the business caseLinks to an external site. . Medicine 2.0, 4(2), e4.

peerpost.docx

Erin Jena J

Main Discussion Post

An APRNs scope of practice varies from state to state. There are three different levels of practice, full practice authority, restricted practice authority and reduced practice authority. Full practice authority allows the APRN to practice without the physician supervision, restricted practice authority requires that a physician direct the care they provide, and reduced practice authority states that APRNs have limitations on what they can practice (Jividen, 2023). Each state under the U.S Constitution can decide what regulations APRNs have to abide by in order to practice. The ultimate goal is to protect the people and the federal government allows the states to determine how to regulate healthcare with that in mind (Milstead & Short, 2019).

Board of Nursing Regulations in South Carolina:

Practice Authority: In my state of South Carolina APRNs have restricted practice authority. They are not allowed to practice medicine without being under the direct supervision of a physician. A physician must be reachable by any means electronically and be in close proximity of the practice.

Prescriptive Authority: APRNs in SC have the authority to write for Schedule 11 controlled substances. In 2018, prescriptive authority advanced to include Schedule 11 narcotic and non- narcotic medications. There are also limitations to these medications, Schedule 11 non narcotics can only be prescribed up to thirty days, and narcotics only five days. This does not allow the APRN to grant a refill on this medication before those days are up unless it is written and signed by an overseeing physician (Wildeman, 2020). APRNs must complete a total of 45 CEU’s and an additional 15 hours focusing on controlled substances.

Board of Nursing Regulations in Hawaii:

Practice Authority: Hawaii allows for full practice authority for APRNs. Meaning that they can practice as a primary care provider without being supervised by a physician or collaborating care with a team.

Prescriptive Authority: Hawaii allows for APRNS to prescribe Schedule 11-V controlled substances without a physician supervising. The Hawaii Board of Nursing controls the authority to prescribe these medications. They are allowed to prescribe medication, equipment or any medical needs the patient may have. Hawaiian APRNs are also able to recommend schedule 1 narcotics including medical marijuana (MedSource Consultants, 2018).

How do these two states differ with regulations? Where SC has a restricted practice authority, Hawaii has full practice authority. This is a significant difference in how they can impact the healthcare they give. SC requires a physician to oversee and agree with prescriptions that are schedule 11 narcotics whereas in Hawaii, the APRN can prescribe them independently.

How would these regulations apply to APRNs who have full authority? It is important to remember laws and regulations for each state that an APRN practices in. If for example, an NP were to move from state to state, regardless if it is a neighboring state, one has to adhere to their policies. Where they may have full authority in Hawaii, moving to South Carolina they would have to abide by a restricted practice authority. The changes in the healthcare they could and could not provide can change dramatically throughout each state. Multiple boards and organizations are working on making every state a full practice authority as more providers are needed. Some states loosened the rules during the Covid 19 pandemic so that more people could get healthcare, but have since gone back to their previous state regulations. One example is a nurse from South Carolina could move to Hawaii and be able to open their own clinic without a supervising physician. Another example is if the nurse were to move to a restricted authority state the nurse would have to follow protocol for that state by completing the CEUs and education required before they can prescribe certain medications.

References

A State-by-State Scope of Practice Guide for Nurse Practitioners. (2018). MedSource Consultants . https://medsourceconsultants.com/wp-content/uploads/2018/09/state-by-state-nurse-practitioner-REV-2018-003.pdf

Jividen, S. (2023, August 4). Full practice authority for nurse practitioners by state. Nurse.org. https//nurse.org/education/np-full-practice-authority

Milstead, J.A., & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones and Bartlett Learning.

Wildeman, M. (2020, September 14). SC nurses given broader prescribing power, greater authority to practice. The Post and Courier. https://www.postandcourier.com/features/sc-nurses-given-broader-prescribing-power/

Brittney

Advanced Practice Registered Nurse Regulations in Pennsylvania vs. Tennessee

Nursing regulatory bodies were established to protect the public’s wellbeing by ensuring safe nursing practice (National Council of State Boards of Nursing, n.d.). This group outlines standards and issues nursing licensure. Nursing has a scope of practice that contains regulations the practitioner is to follow. These regulations may differ in each state. In Pennsylvania, advanced practice registered nurses (APRN) are recognized as primary care providers (Pennsylvania Coalition of Nurse Practitioners (PCNP), n.d.). This means they can care for patients in settings such as a family practice, pediatric officer, clinic, or outpatient settings. For example, an APRN can care for a child at a pediatric outpatient office or a woman at a women’s health center. APRN in Tennessee are also recognized as primary care providers (National Conference of State Legislatures (NCSL), n.d.). These providers can operate in a general medicine office or in a mental health clinic. In Pennsylvania, APRN are able to prescribe medication with an outlined written collaboration agreement from a physician if the medication is relevant to the provider’s specialty. They are able to prescribe Schedule II-V controlled substances (PCNP, n.d.). This gives a nurse practitioner freedom to treat patients using pharmaceutics if deemed necessary. If a patient visits the APRN in an outpatient setting following a hospital stay involving an injury, the APRN can prescribe oxycodone, a Schedule II controlled substance, to alleviate increased pain. In contrast, APRN in Tennessee are able to prescribe medication following a written protocol from a physician but need to consult the provider before prescribing Schedule II-V controlled substances (NCSL, n.d.). This can hinder the care a nurse practitioner is providing because the physician is not always readily available when they may be caring for a patient. If an APRN is caring for a patient that has taken analgesics in the past and needs a specific one for short-term pain control, this might impede the treatment. A patient may require Tramadol, which is a Schedule IV controlled substance, but the APRN in Tennessee cannot prescribe that without deliberating with the physician. Pennsylvania Orders for Life-Sustaining Treatment (POLST) or Physician Order for Scope of Treatment (POST) is a process that aids in ensuring patients receive the medical treatment they desire and avoiding that which they do not want, when they are incredibly ill or frail (POLST, n.d). A form is signed that will be with the patient in all healthcare settings to guarantee a patient’s wishes are follow in emergency situations. In Pennsylvania, an APRN can legally sign a POLST/POST form (PCNP, n.d.). If a patient is visiting a family practice for an annual check-up appointment, the APRN can review information then sign a POLST/POST form if a patient would like to decline life-sustaining treatment in emergent situations. In Tennessee, the APRN is unable to sign a POLST/POST form unless they are recognized by the Tennessee Board of Nursing as able to provide POST treatment (NCSL, n.d.). There are certifications in Tennessee an advance practitioner must obtain before being qualified to provide life-sustaining treatment. This can delay a patient’s wishes being respected if a physician is not available to sign the form and the APRN is not qualified.

References

National Council of State Boards of Nursing (NCSBN)Links to an external site. . (n.d.). Retrieved September 24, 2023 from https://www.ncsbn.org/nursing-regulation/about-nursing-regulatory-bodies.pageLinks to an external site.

National Conference of State Legislatures (NCSL). (n.d.) Scope of Practice Policy. Retrieved on 2023, September 24 from https://scopeofpracticepolicy.org/states/tn/Links to an external site.

Pennsylvania Coalition of Nurse Practitioners (PCNP). (n.d.). Scope of Practice. Retrieved on 2023, September 24 from https://www.pacnp.org/page/ScopeofPracticeLinks to an external site.

Pennsylvania Order for Life-Sustaining Treatment (POLST). (n.d.) POLST. Retrieved on 2023, September 24 from https://www.papolst.org/#:~:text=POLST%20is%20a%20process%20that,are%20seriously%20ill%20or%20frailLinks to an external site. .

PROFESSIONALNURSINGANDSTATE.docx

PROFESSIONAL NURSING AND STATE-LEVEL REGULATIONS

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.

WEEKLY RESOURCES

To Prepare:

· Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.

· Consider how key regulations may impact nursing practice.

· Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.

BY DAY 3 OF WEEK 5

Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

BY DAY 6 OF WEEK 5

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.

· Required readings

· Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.

· I live in California please write about California

· Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.

· Chapter 4, “Government Response: Regulation” (pp. 57–84)

· American Nurses Association. (n.d.). ANA enterprise Links to an external site. . Retrieved September 20, 2018, from http://www.nursingworld.org

· Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary careLinks to an external site. . Nursing Outlook, 65(6), 761–765.

· Halm, M. A. (2018). Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing Download Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing. Worldviews on Evidence-Based Nursing, 15(4), 272–280. doi:10.1111/wvn.12291

· National Council of State Boards of Nursing (NCSBN)Links to an external site. . (n.d.). Retrieved September 20, 2018, from https://www.ncsbn.org/index.htm

· Neff, D. F., Yoon, S. H., Steiner, R. L., Bumbach, M. D., Everhart, D., & Harman J. S. (2018). The impact of nurse practitioner regulations on population access to careLinks to an external site. . Nursing Outlook, 66(4), 379–385.

· Peterson, C., Adams, S. A., & DeMuro, P. R. (2015). mHealth: Don’t forget all the stakeholders in the business caseLinks to an external site. . Medicine 2.0, 4(2), e4.

peerpost.docx

Erin Jena J

Main Discussion Post

An APRNs scope of practice varies from state to state. There are three different levels of practice, full practice authority, restricted practice authority and reduced practice authority. Full practice authority allows the APRN to practice without the physician supervision, restricted practice authority requires that a physician direct the care they provide, and reduced practice authority states that APRNs have limitations on what they can practice (Jividen, 2023). Each state under the U.S Constitution can decide what regulations APRNs have to abide by in order to practice. The ultimate goal is to protect the people and the federal government allows the states to determine how to regulate healthcare with that in mind (Milstead & Short, 2019).

Board of Nursing Regulations in South Carolina:

Practice Authority: In my state of South Carolina APRNs have restricted practice authority. They are not allowed to practice medicine without being under the direct supervision of a physician. A physician must be reachable by any means electronically and be in close proximity of the practice.

Prescriptive Authority: APRNs in SC have the authority to write for Schedule 11 controlled substances. In 2018, prescriptive authority advanced to include Schedule 11 narcotic and non- narcotic medications. There are also limitations to these medications, Schedule 11 non narcotics can only be prescribed up to thirty days, and narcotics only five days. This does not allow the APRN to grant a refill on this medication before those days are up unless it is written and signed by an overseeing physician (Wildeman, 2020). APRNs must complete a total of 45 CEU’s and an additional 15 hours focusing on controlled substances.

Board of Nursing Regulations in Hawaii:

Practice Authority: Hawaii allows for full practice authority for APRNs. Meaning that they can practice as a primary care provider without being supervised by a physician or collaborating care with a team.

Prescriptive Authority: Hawaii allows for APRNS to prescribe Schedule 11-V controlled substances without a physician supervising. The Hawaii Board of Nursing controls the authority to prescribe these medications. They are allowed to prescribe medication, equipment or any medical needs the patient may have. Hawaiian APRNs are also able to recommend schedule 1 narcotics including medical marijuana (MedSource Consultants, 2018).

How do these two states differ with regulations? Where SC has a restricted practice authority, Hawaii has full practice authority. This is a significant difference in how they can impact the healthcare they give. SC requires a physician to oversee and agree with prescriptions that are schedule 11 narcotics whereas in Hawaii, the APRN can prescribe them independently.

How would these regulations apply to APRNs who have full authority? It is important to remember laws and regulations for each state that an APRN practices in. If for example, an NP were to move from state to state, regardless if it is a neighboring state, one has to adhere to their policies. Where they may have full authority in Hawaii, moving to South Carolina they would have to abide by a restricted practice authority. The changes in the healthcare they could and could not provide can change dramatically throughout each state. Multiple boards and organizations are working on making every state a full practice authority as more providers are needed. Some states loosened the rules during the Covid 19 pandemic so that more people could get healthcare, but have since gone back to their previous state regulations. One example is a nurse from South Carolina could move to Hawaii and be able to open their own clinic without a supervising physician. Another example is if the nurse were to move to a restricted authority state the nurse would have to follow protocol for that state by completing the CEUs and education required before they can prescribe certain medications.

References

A State-by-State Scope of Practice Guide for Nurse Practitioners. (2018). MedSource Consultants . https://medsourceconsultants.com/wp-content/uploads/2018/09/state-by-state-nurse-practitioner-REV-2018-003.pdf

Jividen, S. (2023, August 4). Full practice authority for nurse practitioners by state. Nurse.org. https//nurse.org/education/np-full-practice-authority

Milstead, J.A., & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones and Bartlett Learning.

Wildeman, M. (2020, September 14). SC nurses given broader prescribing power, greater authority to practice. The Post and Courier. https://www.postandcourier.com/features/sc-nurses-given-broader-prescribing-power/

Brittney

Advanced Practice Registered Nurse Regulations in Pennsylvania vs. Tennessee

Nursing regulatory bodies were established to protect the public’s wellbeing by ensuring safe nursing practice (National Council of State Boards of Nursing, n.d.). This group outlines standards and issues nursing licensure. Nursing has a scope of practice that contains regulations the practitioner is to follow. These regulations may differ in each state. In Pennsylvania, advanced practice registered nurses (APRN) are recognized as primary care providers (Pennsylvania Coalition of Nurse Practitioners (PCNP), n.d.). This means they can care for patients in settings such as a family practice, pediatric officer, clinic, or outpatient settings. For example, an APRN can care for a child at a pediatric outpatient office or a woman at a women’s health center. APRN in Tennessee are also recognized as primary care providers (National Conference of State Legislatures (NCSL), n.d.). These providers can operate in a general medicine office or in a mental health clinic. In Pennsylvania, APRN are able to prescribe medication with an outlined written collaboration agreement from a physician if the medication is relevant to the provider’s specialty. They are able to prescribe Schedule II-V controlled substances (PCNP, n.d.). This gives a nurse practitioner freedom to treat patients using pharmaceutics if deemed necessary. If a patient visits the APRN in an outpatient setting following a hospital stay involving an injury, the APRN can prescribe oxycodone, a Schedule II controlled substance, to alleviate increased pain. In contrast, APRN in Tennessee are able to prescribe medication following a written protocol from a physician but need to consult the provider before prescribing Schedule II-V controlled substances (NCSL, n.d.). This can hinder the care a nurse practitioner is providing because the physician is not always readily available when they may be caring for a patient. If an APRN is caring for a patient that has taken analgesics in the past and needs a specific one for short-term pain control, this might impede the treatment. A patient may require Tramadol, which is a Schedule IV controlled substance, but the APRN in Tennessee cannot prescribe that without deliberating with the physician. Pennsylvania Orders for Life-Sustaining Treatment (POLST) or Physician Order for Scope of Treatment (POST) is a process that aids in ensuring patients receive the medical treatment they desire and avoiding that which they do not want, when they are incredibly ill or frail (POLST, n.d). A form is signed that will be with the patient in all healthcare settings to guarantee a patient’s wishes are follow in emergency situations. In Pennsylvania, an APRN can legally sign a POLST/POST form (PCNP, n.d.). If a patient is visiting a family practice for an annual check-up appointment, the APRN can review information then sign a POLST/POST form if a patient would like to decline life-sustaining treatment in emergent situations. In Tennessee, the APRN is unable to sign a POLST/POST form unless they are recognized by the Tennessee Board of Nursing as able to provide POST treatment (NCSL, n.d.). There are certifications in Tennessee an advance practitioner must obtain before being qualified to provide life-sustaining treatment. This can delay a patient’s wishes being respected if a physician is not available to sign the form and the APRN is not qualified.

References

National Council of State Boards of Nursing (NCSBN)Links to an external site. . (n.d.). Retrieved September 24, 2023 from https://www.ncsbn.org/nursing-regulation/about-nursing-regulatory-bodies.pageLinks to an external site.

National Conference of State Legislatures (NCSL). (n.d.) Scope of Practice Policy. Retrieved on 2023, September 24 from https://scopeofpracticepolicy.org/states/tn/Links to an external site.

Pennsylvania Coalition of Nurse Practitioners (PCNP). (n.d.). Scope of Practice. Retrieved on 2023, September 24 from https://www.pacnp.org/page/ScopeofPracticeLinks to an external site.

Pennsylvania Order for Life-Sustaining Treatment (POLST). (n.d.) POLST. Retrieved on 2023, September 24 from https://www.papolst.org/#:~:text=POLST%20is%20a%20process%20that,are%20seriously%20ill%20or%20frailLinks to an external site. .

PROFESSIONALNURSINGANDSTATE.docx

peerpost.docx

PROFESSIONALNURSINGANDSTATE.docx

peerpost.docx

PROFESSIONALNURSINGANDSTATE.docx