Discussion: Policy and State Boards of Nursing

A Sample Answer For the Assignment: Discussion: Policy and State Boards of Nursing

The Illinois state board of nursing has made several amendments to advanced nursing practice regulations. The board created a pathway for APRNs working in hospitals, hospital-affiliated settings, and ambulatory surgery centers to offer most advanced practice nursing care with no career-long collaborative agreement (Illinois General Assembly, n.d.). A written collaborative agreement is needed for all APRNs engaged in clinical practice, except those privileged to practice in a hospital, hospital affiliate, or ambulatory surgical treatment center. However, if an APRN engages in clinical practice outside of a hospital, hospital affiliate, or ambulatory surgical treatment center must have a written collaborative agreement (Illinois General Assembly, n.d.). Besides, APRNs must have an ongoing relationship with a physician to prescribe benzodiazepines and some other scheduled agents.

The state regulations are supported in my current place of employment since the organization’s leadership allows APRNs to practice within their full scope of education without a collaborative agreement with a physician. APRNs in our organization are authorized to: conduct patient assessment; diagnose; order, perform, and interpret diagnostic tests; order treatments; provide palliative and end-of-life care; provide advanced counseling, patient education, and patient advocacy.

The scope of APRN practice differs across various states in the US. Various states grant APRNs Full practice authority, while others have Reduced and Restricted practice. States with Full practice allow APRNs to practice within their full scope of education (Peterson, 2018). APRNs with Reduced practice are required to have a collaborative agreement with a physician to engage in the elements of APRN practice. Besides, states with restricted practice need supervision and delegation to practice. The APRN scope of practice disparity negatively affects APRN professional practice since APRNs in some states are not allowed to practice as their counterparts in other states. Patients in states with Full practice have more access to healthcare since APRNs act as primary care providers (Ortiz et al., 2018).

References

Illinois General Assembly. (n.d.). Nurse Practice Act. https://ilga.gov/legislation/ilcs/ilcs4

Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of Nurse Practitioner Practice Regulations on Rural Population Health Outcomes. Healthcare (Basel, Switzerland), 6(2), 65. https://doi.org/10.3390/healthcare6020065

Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

For many years, as advanced as the State of Massachusetts was on many fronts, the profession of nursing was not one of them.  Up until January 6, 2021, ARNP’s we had be given temporary (full) practice authority due to the Covid Pandemic.  When signed in January 2021, we were the last New England State to give ARNP’s full practice authority, and the 23^rd State to pass this regulation across the United States (Health Leaders, 2021). 

The Health System I work for is woefully behind adjusting policies and procedures to reflect this new amendment to ARNP’s practice authority within the state.  We have a significant need for primary care providers within the Commonwealth and with this change, ARNP’s can practice independently and as primary care providers with their own panel of patients (AANP, 2021, Mass.gov, 2021). 

Up until a few months ago, I had to have the physician I work with listed as my supervising provider. Other policies came to question as they were completely unnecessary.  According to the medical groups administrative leadership, primary care panels by APRN’s is in the works, but likely won’t occur system wide for 18-24 months (Personal Communication, April 24, 2022).

There is significant variability across the United States regarding practice Authority.  According to AANP (2021), 29* states (*including Guam, Northern Marina Islands and Washington, DC) have full practice authority, 16* states (*including American Samoa, Puerto Rico and US Virgin Islands) have reduced practice authority and 11 have restricted practice authority (Nurse Journal, 2022.  Full practice authority is defined as an NP practicing to the full scope of licensure without a supervising physician. 

Reduced practice authority means NP’s can perform parts of their scope independently and parts with supervision.  Rarely does this include diagnostic testing and diagnosis and treatment but more often medication oversight.  Restricted practice authority states require NP’s to work solely under the supervision of a physician (AANP, 2021, Nurse Journal, 2022). 

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS Discussion: Policy and State Boards of Nursing:

Professional nurses, regardless of area of practice, have demonstrated competencies to be able to practice in a full scope capacity without supervision.  By minimizing scope across the United States, we are ultimately denying access to healthcare by a qualified provider (AANP, 2021).  Most advanced practice nurses, especially if they have Doctorate level education, have more years of school and clinical than that of their physician colleagues (Nurse Journal, 2022).  Lack of recognition and utilization of our extensive capabilities, may undermine the professions’ ability for growth and respect.

References

American Academy of Nurse Practitioners (AANP).  (2021). Information and resources for Massachusetts NPs.  https://www.aanp.org/advocacy/massachusetts

Health Leaders (2021).  Massachusetts is the 23rd state to allow NPs to practice independently.   https://www.healthleadersmedia.com/nursing/nurse-practitioners-massachusetts-granted-full-practice-authority

Mass.gov. (2022).  244 CMR 4.00: Advanced practice registered nursing. https://www.mass.gov/doc/244-cmr-4-advanced-practice-registered-nursing/download

Nurse Journal.  (2022).  Nurse practitioner practice authority: A state-by-state guide.   https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/

The State Statutes mandate the State boards of nursing to ensure continued safe and competent practice, which results in the regulatory agencies facing many challenges, due to the diversity issues that characterize the nursing practice (Thomas et al., 2010).  One of the most recent regulations promulgated through the Texas State Boarding of nursing was, permitting advanced practice registered nurses (APRNs) to complete the medical certification for an adult or fetal death certificate, in accordance with Chapter 193 of the Texas Health and Safety Code (THSC), which was signed into law on June 15, 2021(Stevens & Landes, 2021).

The APRNS full practice authority has not been fully embraced in Texas, which results in twenty percent of Texans, lacking access to a primary care provider, with the state being listed as 49th in the country, on access to and affordability of health care (Zhang & Wu, 2021). Recently Rep Stephanie Klick introduced the latest bill HB 2029 which removes antiquated laws, to allow APRNs full practice authority, and hopefully, Texas could soon join the full practice states (Stevens & Landes, 2021).

In my organization, the state regulations are fully supported through the provision of quality care, which is mandated by the federal, state-level regulations, and must be accredited by the Joint Commission to receive Medicare payments and the accreditation requirements. The organizations must also implement and comply with the Centers for Medicare & Medicaid Services (CMS) regulations, to promote care consistency (Hughes& Smith, 2014).

Different states differ in their scope of practice regulations, and currently, there are twenty-three states, which have granted APRNs full practice authority and can perform, the same tasks as physicians. The other states have either limitations or ultimate denial, like my home state Texas, which continues with the imposed restrictions of a physician’s supervision or collaboration. (Altman et al., 2016).

This variation of the scope of practice across states has a significant impact on patient care delivery because the APRNs are subjected to different scope-of-practice (SOP) restrictions, based on the state in which they work which dictates the extent to which they can practice or prescribe

They cannot, therefore, provide the same consistent level of care or independent chronic disease management, independent of a supervisory contract with a physician collaborator, the degree of physician supervision also affects the practice opportunities, and the payer policies for NPs scope of practice regulations, hinder access to primary care treatment, which results in the continued suffering of the vulnerable populations and the minorities (Hain & Fleck, 2014).

References

Altman, S. H., Butler, A. S., & Shern, L, (2016). Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington (DC): National Academies Press (US); 22. 2, Removing Barriers to Practice and Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK350160/

Buck J. (2011). Policy and the Re-Formation of Hospice: Lessons from the Past for the Future of Palliative Care. Journal of hospice and palliative nursing: JHPN: the official journal of the Hospice and Palliative Nurses Association, 13(6),

Hain, D., Fleck, L. (2014). Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript

Hughes, M. T. & Smith, T. J. (2014). The Growth of Palliative Care in the United States

Annual Review of Public Health Vol. 35:459-475 (Volume publication date March 2014)
https://doi.org/10.1146/annurev-publhealth-032013-182406

Stevens, J. D., & Landes, S. D. (2021). Assessing state-level variation in signature authority and cause of death accuracy, 2005-2017. Preventive medicine reports, 21, 101309. https://doi.org/10.1016/j.pmedr.2020.101309

Thomas, M. B., Benbow, D.A., & Ayars, V. D. (2010). Continued competency and board regulation: one state expands options. J Contin Educ Nurs.11):524-8. doi: 10.3928/00220124-20100701-04. Epub 2010 Jul 8. PMID: 20672758.

Zhang, J., & Wu, X. (2021). Predict Health Care Accessibility for Texas Medicaid Gap. Healthcare (Basel, Switzerland), 9(9), 1214. https://doi.org/10.3390/h

Policy and State Boards of Nursing

Within the far-reaching and multi-layered realm of policy and reform, government at the state level plays an essential role. Consider the federally enacted PPACA’s individual mandate which sought to increase the number of consumers who receive insurance coverage and, therefore, greater access to care. In a system that is already stretched beyond capacity and confronting a nursing shortage, how can the health care system meet this increased demand? Since state boards of nursing determine scope of practice, it is important to stay up to date and current with the policies and regulations that are created by the state board of nursing.

To prepare for Policy and State Boards of Nursing:

• Review the Thomas, Benbow, and Ayars article and the Watson and Hillman article focusing on how states regulate advanced nursing practice and how legislative changes are impacting scope of practice.
• Visit your state board of nursing website and/or contact the board to determine how the state board controls advanced practice through regulations.
• Determine if your state board has created any new policies or regulations that address changes to scope of practice in response to legislative changes.

By Day 3 of Policy and State Boards of Nursing

Post a cohesive response that addresses the following:

• What are the most recent regulations promulgated through your state board of nursing for advanced practice?
• How are the state regulations supported within your place of employment?
• How do the states differ in terms of scope of practice? What impact does this have on professional nurses across the United States?

Read a selection of your colleagues’ postings.

By Day 6 of Policy and State Boards of Nursing

Respond to at least two of your colleagues selecting someone from a different state and comparing your state’s scope of practice with your colleague’s. Share any insights and implications for practice.

Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

NURS 8100 Week 9: State and Local Role in Health Care Policy

As noted previously, policy is enacted and carried out through multiple levels of government. This week, the focus turns to the role of state and local government in policy making, with particular attention to the function of state boards of nursing in the regulation of practice. In light of health care reform efforts, scope of practice issues are of central importance and this falls under the purview of state boards of nursing. How do the states differ in terms of scope of practice? What impact does this have on professional nurses across the United States?

Learning Objectives

Students will:

• Analyze the role of state boards of nursing in the regulation of nursing practice
• Assess state and local politics and issues surrounding a current health care policy

Photo Credit: [poplasen]/[iStock / Getty Images Plus]/Getty Images

---

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Chen, A. S., & Weir, M. (2009). The long shadow of the past: Risk pooling and the political development of health care reform in the States. Journal of Health Politics, Policy & Law, 34(5), 679–716.

Note: You will access this article from the Walden Library databases.

The authors provide an analysis of varying state health care policies, with a basic premise that health care risk is either “pooled”—shared, or “actuarial”—segmented by risk level. Most states have taken a segmented approach to health care, and therefore, have not solved health care issues such as rising costs and access to care. The authors maintain that federal action is needed to create a uniformed approach to health care.

Junghee, L. (2009). Cultural, social, and political influences on state-level indigent health care policy formation. Journal of Policy Practice, 8(2), 129–146.

Note: You will access this article from the Walden Library databases.

This article provides details on a 50-state study of Medicaid spending. The authors concluded that political and economic factors can positively predict individual state Medicaid spending, and that actual need has a negative impact on spending. In conclusion, a uniform, federal structure may be the only method to ensure equal access to Medicaid.

Mills, A., Engelhard, C. L., & Tereskerz, P. M. (2010). Truth and consequences—Insurance-premium rate regulation and the ACA. New England Journal of Medicine 363(10), 899–901.

Note: You will access this article from the Walden Library databases.

O’Connor, J. C., MacNeil, A., Chriqui, J. F., Tynan, M., Bates, H., & Eidson, S. K. (2008). Preemption of local smoke-free air ordinances: The implications of judicial opinions for meeting national health objectives. Journal of Law, Medicine & Ethics, 36(2), 403– 412.

Note: You will access this article from the Walden Library databases.

Sommers, B. (2010). Enrolling eligible children in Medicaid and CHIP: A research update. Health Affairs, 29(7), 1350.

Note: You will access this article from the Walden Library databases.

The enrollment and retention of eligible children in Medicaid and Children’s Health Insurance Program (CHIP) is a health care concern. The article concludes that some state processes have mitigated this issue but other requirements, such as providing citizenship documentation, may have a detrimental effect. Therefore, these concerns should be incorporated into the implementation on PPACA of 2010.

Thomas, M. B., Benbow, D. A., & Ayars, V. D. (2010). Continued competency and board regulation: One state expands options. Journal of Continuing Education in Nursing, 41(11), 524-528.

Note: You will access this article from the Walden Library databases.

The authors use the changes instituted by the state of Texas in regard to the licensing of nurses to illustrate the need to adapt state licensing requirements to the changing diversity and scopes of practice among nurses.

Watson, E., & Hillman, H. (2010). Advanced practice registered nursing: Licensure, education, scope of practice, and liability issues. Journal of Legal Nurse Consulting, 21(3), 25–29.

Note: You will access this article from the Walden Library databases.

The expanded role of the advanced practice nurse has led to changes in licensure, education, certification, and scope of practice definitions. The author points out that this expanded role has led to increased liability and accountability concerns as well.

Yue, L., Harrington, C., Spector, W. D., & Mukamel, D. B. (2010). State regulatory enforcement and nursing home termination from the Medicare and Medicaid programs. Health Services Research, 45(6p1), 1796-1814. doi:10.1111/j.1475-6773.2010.01164.x

Note: You will access this article from the Walden Library databases.

Those nursing homes receiving Medicare and Medicaid funding are subject to strict quality and safety regulations. This article examines the consequences of enforcing those federal quality standards.

Optional Resources

Wieck, K. L., Oehler, T., Green, A., & Jordan, C. (2004). Safe nurse staffing: A win-win collaboration model for influencing health policy. Nursing Education Perspectives, 31(3), 160-166.

NURS 8100 Week 1 Assignment 1: Issues in Health Care Reform (Interview)

Continue to work on this Assignment, assigned in Week 2. Your Health Care Reform interview is due by Day 7 of this week.

By Day 7

Submit this Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK9Assgn1+last name+first initial.(extension)” as the name.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Assignment 1: Issues in Health Care Reform (Interview)

Continue to work on this Assignment, assigned in Week 2. Your Health Care Reform interview is due by Day 7 of this week.

By Day 7

Submit this Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK9Assgn1+last name+first initial.(extension)” as the name.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.