PEERS RESPONSE

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.

 

 

TIFF

Advanced practice registered nurses are nurses that have at least obtained their Masters degree or further. These nurses have obtained additional education and training to be able to assess and treat patients, order diagnostics, as well as prescribe medications (NCSBN, 2023). State regulations for APRN’s vary by state. It is important for a nurse to understand the regulations of the state they are in. I have chosen to compare Arizona and California.

In Arizona, an APRN may practice independently. APRN’s in this state have the autonomy to practice in a primary care setting or urgent care without needing an MD/DO to oversee them (AMA, 2017a). These nurses are able to perform assessments, diagnoses, order diagnostic testing, prescribe medications, and implement care (AZBN, 2020). In addition, they are also able to order schedule II-V medications (AMA, 2017b). To be able to do so, it is required that they complete an additional 45 hours in pharmacology training and the number of nurses seeking applications for these medications is regulated and tracked (AMA, 2017b).

In California, an APRN may still complete an assessment, but must then collaborate with a physician, therefore limiting their autonomy (AMA, 2017a). They are able to order medical devices, change an already set forth plan for home health, and certify a disability, again after collaboration with an MD/DO (AMA, 2017a). When prescribing medications, an APRN in California must complete 6 months of supervision, pharmacology education, as well as education relating to schedule II medications (AMA, 2017b). Only a certain number of applications will be approved and continuing education is required to be able to prescribe schedule II medications (AMA, 2017b).

Understanding that the scope of practice and continuing education may change by state is important for a nurse to recognize. The American Nurses Association helps to outline some basics of the scope of nursing, however each state has their own regulatory guidelines for practice (ANA, 2018). It is a nurses job to verify that we are practicing within our scope in the region in which we intend to practice.

 

 

 

 

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.

EDWARD

Advanced Practice Registered Nurses (APRNs) play a crucial role in healthcare by filling the needs of providers in rural communities or patient-saturated communities. When comparing my home state of Texas to our neighboring state of Oklahoma, some significant differences for APRNs were noticed.

In Texas, APRNs currently have a reduced practice environment, which requires them to have a collaborative agreement with a supervising physician to practice (Texas Board of Nursing [BON], 2023). This agreement lays out the specific practice details, including prescriptive authority and the scope of services the APRN may provide. It aims to ensure a high standard of care and enhance patient safety, but it may limit the APRN’s full practice capability (BON, 2023).

In Oklahoma, however, APRNs have a full practice environment (Oklahoma Board of Nursing [OBN], 2023). They can practice to the full extent of their education and training without a mandated collaborative agreement with a physician. This autonomy empowers APRNs to manage patient care independently, including the ability to diagnose, treat, and prescribe medication (OBN, 2023).

In March 2023, at the 88^th regular legislative session, the Texas Nurse Practitioner organization introduced State Bill 1700 for retiring delegation requirements to expand access for patients. If passed, this would allow APRNs to practice to the full extent of their scope and training and would remove delegation agreements with physicians. APRNs would be placed under the regulatory authority of the BON (88th Regular Legislative Session, n.d.).

The regulation differences between neighboring states can sometimes vary greatly. These differences can impact the practice authority and the degree of collaboration required with physicians. For APRNs traveling or working in multiple states, understanding and adhering to these regulations to ensure legal and efficient practice is a must.