Professional Nursing and State-Level Regulations

Regulations

“A regulation is defined as an act or process of control over something by rule or restriction.” (Short, 2022) As healthcare professionals, we must have regulations for patient safety and quality care. These help us continue to educate ourselves on best practices, taking an appropriate number of patients at a time, only doing tasks and skills we are trained to do, and keeping up with our license requirements. Regulation is different than legislation, however. Lawmakers form legislation and when bills come into the offices, some pass, while others die. Those that pass will turn into regulations. There are hundreds of new regulations put into the states every year, and these new regulations will be put into effect by multiple different agencies over time. It is important to keep up with your scope of practice and the ever-changing skills when you are taking care of patients.

Missouri APRN Rules

Prescription of Controlled Substances from APRN’s

To prescribe controlled substances, APRNs must adhere to certain criteria. Since I will be prescribing medications, it will be important to know what my guidelines are for prescribing pain medications for my patients. In Missouri, it is required that APRNs practice 1000 hours after graduation and prescribe medicines 300 hours before they are allowed to prescribe controlled substances. We must also complete a recent pharmacology course and have a letter with proof of hours sent to the Missouri Board of Nursing and obtain a collaborative doctor in good standing. It is also important to note that as an APRN we will not be allowed to prescribe things such as hydrocodone to sedate or use as general anesthesia. Not all prescribing APRNs will prescribe controlled substances, and that is okay. Although I don’t feel like controlled substances are the answer for every patient, I know that I might run into the idea of a patient needing them at some point, especially if I remain in the ED.

Collaboration With Providers

To prescribe any medication or perform any task within the APRN scope of practice, you must obtain a collaborating physician. To make this legal, you must have a written agreement with the provider and practice within your scope. Both the collaborating physician and the APRN must provide all details about themselves to the state including their name, address, phone number, and their place of employment. The two collaborating must practice within a 200-mile radius of one another, but this may be waived for up to 28 days if in a rural setting where other arrangements are made, such as telehealth being within the agreement. The collaborating physician must be able to provide proof of collaboration when asked by the state board and keep up-to-date records of the practicing APRN. Lastly, a collaborating physician may not go into collaborations with more than 6 full-time, practicing APRNs.

California APRN Rules

California APRNs and Controlled Substances and Collaboration

APRNs can prescribe controlled substances in the state of California under a collaborating physician. They must obtain a DEA number and register with the United States Drug Enforcement Administration. When collaborating, the APRN and the collaborator must decide which medications are okay to prescribe and which ones are not. APRNs are responsible for continuing education for the administration of controlled medications and can have their prescribing capabilities revoked if that isn’t done. They also can ask for sampled controlled medications if approved by their collaborating provider.

Comparisons and Differences

I chose California because there is a big difference between politics between here and there. I found that there are a lot of similarities between the two states, but Missouri is stricter on prescribing controlled substances. I did not see any minimum requirements for practicing as an APRN, just continuing education in California. I also noticed Missouri collaborators must be within a specific distance, whereas California doesn’t seem to have a distance criterion. I don’t think either state is right or wrong, I am just happy there is some red tape when providers are prescribing controlled substances. I like to see that in Missouri we will not be allowed to prescribe as if we were sedating. With the history of famous people overdosing on medications such as propofol or ketamine, for instance, these drugs need to be watched carefully.

Conclusion

I haven’t decided where I want to work, but what I do know is prescribing these medications can affect someone’s entire life. One careless prescription that isn’t needed can cause detrimental effects to the patient and their families. I have dreams of working with addictions, staying in the ED, working with FEMA, and on my off days, working in primary care. I could be looking at prescribing medications under a collaborating physician at any of these locations. I must keep in mind how the cause and effect of my prescribing can cause issues long-term if not carefully done.

References:

Board of Nursing. Missouri Department of Professional Registration. (2023). https://pr.mo.gov/nursing-advanced-practice-collaborative-practice.asp

Nurse practitioner expanded scope of practice in California. MIEC. (2023, February 16). https://www.miec.com/knowledge-library/nurse-practitioner-expanded-scope-of-practice-in-california/

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed., pp. 149-173). : Jones & Bartlett Learning.

335.019. Prescriptive authority, when — certificate of controlled substance prescriptive authority, issued when. (2023, August 28). Missouri Division of Professional Registration. https://revisor.mo.gov/main/OneSection.aspx?section=335.019

Comparison of Board of Nursing Regulations in Two States

An Advanced Practice Registered Nurse (APRN) is a licensed registered nurse who has received extensive training to see patients at an advanced level to diagnose, treat, and care for, similar to the role of a medical doctor or dentist. APRNs have four listed categories of fieldwork such as certified nurse midwife, clinical nurse specialist, certified registered anesthesiologist, and nurse practitioner (NP) (ANA, 2021). These degrees can be held at a master’s level or post-masters level degree. As I am in a master’s level program for nurse practitioners, I will compare the scope of practice and regulations of the state of North Carolina and the state of Nevada.

Regarding the practice of autonomy and authority, in the state of North Carolina, nurse practitioners cannot practice without a supervising physician. NC has a Restricted Practice regulatory structure. This means that a supervising physician must a licensed in the same state as the NP as well as hold a Drug Enforcement Administration (DEA) number at the same level or higher than the NP (NCBON, 2024). The supervising physician and NP will also have to have a collaborative practice agreement (CPA) that outlines the treatments and procedures that an NP may conduct, as well as the responsibility of the supervising physician in providing ongoing monitoring (NCBON, 2024). In the state of Nevada, NP can practice independently, known as Full Practice, without a supervising physician under specific prescriptive limitations (Nevada State Board of Nursing, n.d.-a). With prescribing medications, NPs in North Carolina can prescribe and refill medications but have to adhere to the controlled substance laws and rules of North Carolina, such as “Schedule II controlled substances cannot be refilled, Schedules III and IV controlled substances may be refilled up to five times in six months, and Schedule V controlled substances may be refilled as authorized by the practitioner” (NCBON, 2024). In Nevada, NPs have to apply for prescription privileges and be approved by the Board of Pharmacy prior to prescribing any medications (Nevada State Board of Nursing, n.d.-a). Additionally, a Board of Pharmacy license and a DEA certificate are required to prescribe medications such as controlled substances (Nevada State Board of Nursing, n.d.-a). If the NP plans to prescribe Schedule II controlled substances, they must have practiced in the licensed role for two years or 2,000 hours or have a collaborative physician until these metrics are met (Nevada State Board of Nursing, n.d.-a).

A Nurse Practitioner in either state can own and operate a health care clinic. Although rewarding, the APRNs in North Carolina may feel that they have less autonomy in the care practices and output than those in Nevada, being that depending on their collaborative agreement with their supervising physician, interventions may be limited. For example, if the NP needs to refill a schedule II controlled substance to a patient in the clinic and they can not reach the supervising physician at the time, this would result in care delays and possible patient dissatisfaction. Similarly, for an NP in Nevada who has not been approved for a pharmacy license, although they can practice independently until this is authorized, they cannot prescribe medications to their patients. This occurrence may also cause delays in patient care, higher healthcare costs, and possibly out-of-pocket costs, as the patient may have to pay more to see other providers in order to receive the necessary treatment.

Advanced Practice Registered Nurses in both North Carolina and Nevada may honor the regulations by simply operating within their nursing scope of practice for their state. The APRN in North Carolina must maintain adequate clinical hours for certification fulfillment. If two years or more have elapsed, a Nurse Practitioner Refresher course is required to maintain the licensure (NCBON, 2024). Upon license renewal, the APRN in Nevada is required to complete 15 hours of ongoing education that are directly linked to their specialty. This includes completing a two-hour course on suicide prevention every four years and a two-hour course on substance use and addiction every renewal cycle (Nevada State Board of Nursing, n.d.-b). Though the standards vary, each state’s regulatory system strikes a different balance between autonomy and authority, ensuring that APRNs remain current and competent.

References

Aprn-licensure-Requirements.pdf. (n.d.-a). https://nevadanursingboard.org/wp-content/uploads/2019/10/APRN-Licensure-Requirements.pdf 

APRN policy and Regulation. ANA. (2021, February 26). https://www.nursingworld.org/advanced-practice/employee-engagement-and-retention/

Aprn Renewal Faqs. (n.d.-b). https://nevadanursingboard.org/wp-content/uploads/2020/06/APRN-Renewal-FAQ.pdf

FAQ: Nurse practitioner (NP). FAQ | Nurse Practitioner (NP) | North Carolina Board of Nursing. (2024). https://www.ncbon.com/faq-nurse-practitioner-np#:~:text=The%20supervising%20physician%20must%20have,that%20he%20or%20she%20supervises.

                                                                         Week 5 Discussion Post

APRNs in Florida

In Florida, Advanced Practice Registered Nurses (APRNs) must hold a valid RN license, complete a graduate-level advanced nursing program, and obtain national certification in their specialized area. They have prescriptive authority with limitations and must practice in collaboration with a supervising physician or through a collaborative practice agreement. These regulations ensure safe and competent patient care. The Florida State/Regional Boards of Nursing play a crucial role in overseeing and regulating APRN practice to protect the public. Their mission involves managing resources such as staffing, funding, and educational materials to ensure high-quality care. Continuous evaluation of regulatory practices, assessing their impact, and making necessary adjustments are part of this mission. APRNs in Florida can prescribe controlled substances under specific conditions by entering a protocol with a supervising physician. (Florida Board of Nursing, 2022). The requirements and limitations for prescribing controlled substances are outlined in Florida statutes and regulations, and adherence to these regulations is crucial for compliance in the state of Florida, Advanced Practice Registered Nurses (APRNs) must adhere to specific regulations when prescribing controlled substances under the supervision of a Medical Doctor (MD). The Florida Board of Nursing provides detailed guidelines that outline the procedures and requirements for APRNs working under the supervision of a physician. It is essential for APRNs to closely collaborate with their supervising physicians to ensure strict compliance with all state regulations. This collaborative arrangement must be clearly documented in writing to formalize the working relationship. According to Florida regulations, a physician may supervise nurse practitioners at a maximum of four offices in addition to their primary practice location. (Florida Board of Nursing, 2022). While the supervising physician’s physical presence is not mandatory, they must be readily available by phone for consultation and guidance. It’s important to note that Florida is one of only two states that does not permit nurse practitioners to independently prescribe controlled substances, even with physician supervision. To prevent potential circumvention of this restriction, Florida legislators have enacted additional laws that prohibit nurse practitioners from using pre-signed prescription forms or a physician’s DEA number on a prescription. Florida Board of Nursing. (2024, September 23). Moreover, nurse practitioners in Florida are authorized to sign handicap parking permits but are not allowed to sign death certificates. In comparison to other states, Florida’s nurse practitioner scope of practice is notably stricter, reflecting the state’s commitment to maintaining stringent regulations in the healthcare field.

APRNs In New York

In the state of New York, Advanced Practice Registered Nurses (APRNs) are required to follow specific guidelines and have a written practice agreement with a collaborating physician until they have gained 3,600 hours of experience. Once they have reached this level of experience, APRNs are responsible for diagnosing and treating their patients without direct supervision from a physician. They also have the authority to issue non-patient-specific orders for actions such as administering immunizations, providing emergency anaphylaxis treatment, and conducting lab tests. The proposed Nurse Practitioner Modernization Act, which aims to allow NPs with more than 3,600 hours of experience to practice independently of physicians, is a significant development in the regulatory landscape of New York. This legislation also aims to empower experienced NPs to oversee and supervise less experienced NPs, thereby enhancing the role and autonomy of nurse practitioners within the healthcare system. According to New York State Education Law §6902, a nurse practitioner (NP) diagnoses illnesses and physical conditions and performs therapeutic and corrective measures within the specialty area of practice in which the NP is certified. New York certifies NPs to practice in various specialty areas. NPs who are required to have a written collaborative practice agreement must enter into such an agreement with a physician qualified to practice in the NP’s specialty area of practice. The written collaborative practice agreements include provisions addressing patient referral and consultation, coverage for emergency absences of either the NP or the collaborating physician, resolution of disagreements between the NP and the collaborating physician regarding diagnosis and treatment, peer review by the collaborating physician of patient records, identification of written practice protocols, and additional provisions as agreed to by the NP and the collaborating physician. A copy of the collaborative practice agreement must be kept at the NP’s practice setting(s) and made available for inspection by the New York State Education Department.  A sample practice agreement can be found at www.op.nysed.gov/prof/nurse/np-sample-collaborative-agreement.pdf.

Conclusion

The scope of practice for an Advanced Practice Registered Nurse (APRN) includes diagnosing and treating illnesses, prescribing medication, and providing primary and specialty care to patients. APRNs may also conduct physical exams, interpret diagnostic tests, and provide patient education and counseling. The scope of practice for APRNs may vary by state and is often regulated by state boards of nursing. In Florida, advanced registered nurse practitioners (ARNPs) are limited in prescribing controlled substances under a physician. However, they have a broader scope of practice, allowing them more autonomy and the authority to practice independently. In contrast, New York has more restrictions for ARNPs, requiring collaborative practice agreements with physicians.

References

Florida Board of Nursing (2022). Advanced practice registered nurse (APRN) protocols. Florida Department of Health. https://floridasnursing.gov/forms/aprn-protocol-sample.pdfLinks to an external site.

Florida Board of Nursing. (2024, September 23). REGULATION OF PROFESSIONS AND OCCUPATIONS-NURSING. The 2024 Florida Statutes. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499%2F0464%2FSections%2F0464.012.htmlLinks to an external site.

https://www.op.nysed.gov/professions/nurse-practitioners/professional-practice/practice-requirements

https://www.nysna.org/new-nurse-practitioner-modernization-act-informationupdates

https://www.op.nysed.gov/sites/op/files/prof/nurse/np-sample-collaborative-agreement.pdf

Scopes of Practice Georgia v. Michigan

It is imperative to know how scopes of practice vary from state to state. This applies to physicians, registered nurses, advanced practice registered nurses, APRNs (Kandrack et al., 2019). The United States and US territories have specific regulations that their boards of nursing enforce and stand by to guarantee that the licensure obtained is governed by a set of regulations with the goal of standardized education, which promotes safe and competent care (Hudspeth & Klein, 2019). I received my nursing licensure in Georgia, one of 41 states and two US territories allowing the use of a compact license. Compact licensure grants me the privilege to practice in other states where my license was not obtained as a registered nurse. This is also the case for APRNs. While this is a privilege, it comes with a significant responsibility to uphold each regulation from each state (Hudspeth & Klein, 2019). Georgia and Michigan are two states I would like to compare regarding APRN regulations.

Regulation comparison Georgia v. Michigan

Understanding the regional differences in regulations between Georgia and Michigan is crucial for APRNs, as these differences directly impact patient care. Both states are considered restricted practice states, meaning physicians must oversee patients’ care when APRNs provide healthcare. Georgia is in the southeast region, and Michigan is in the upper Midwest region (Georgia Board of Nursing, n.d.; Michigan Board of Nursing, n.d.). The prevalence of certain illnesses varies by region, with obesity and diabetes being statistically higher in the Southeast and various types of cancers being more prevalent in the Midwest. These regional differences influence the regulations passed to care for the patients within each region. Both states have regulations that specify what specialties are classified as APRNs under their specific boards. Michigan classifies nurse midwives, nurse anesthetists, and nurse practitioners as APRNs under section 333.17210, while Georgia, under regulation rule 410-11-.01, considers certified midwives, nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and clinical nurse specialists in psychiatric and mental health as APRNs (Georgia Board of Nursing, n.d.; Michigan Board of Nursing, n.d.). Each subsection of the regulations breaks down the scope of each specialty and the requirements that must be met to comply with their respective state boards. This is crucial because specializing in psychiatric and mental health in Michigan would not be classified as an APRN specialty, which could impact access to care with limited APRNs (Van Wicklin, 2021).

Another regulation to note is the prescribing ability of APRNs and how they vary in each state. Michigan and Georgia both allow APRNs to prescribe medications, but Georgia APRNs’ prescribing capabilities are more limited. For example, refills are only for 12 months, with exceptions including contraceptives, hormonal replacement therapy, and prenatal vitamins, which are limited to 24 months (Georgia Board of Nursing, n.d.). Abortion, which is legal in Michigan, has stringent parameters in Georgia that prohibit APRNs from prescribing medications and medical devices that could result in an abortion pharmacologically (Georgia Board of Nursing, n.d). These two regulations demonstrate how state regulations vary based on patient care needs and regional direction of what physicians will allow under their supervision. As I previously mentioned, some specialties recognized in Georgia would not be recognized in Michigan. This could impact the ability of nurses with a psychiatry and mental health specialty to move to Michigan if they desire to continue to practice as APRNs. They would potentially have to acquire another specialty or not practice as an APRN. On the contrary, a nurse from Michigan with an advanced degree in psychiatry and mental health would be recognized in Georgia (Michigan Board of Nursing, n.d). Additionally, correctly prescribing medications under each state’s scope and regulation is crucial because they vary in-state, potentially resulting in restriction, suspension, or revocation of licensure (Cimiotti et al., 2019).

Regulation Adherence

As APRNs, we are responsible for ensuring that we practice within our scope, especially in a state part of compact licensure (Van Wicklin, 2021). This includes knowing the states we reside in and any states we may travel to practice in. Being informed about what we can and cannot do will ensure that regulations per each state’s board of nursing are adhered to (Cimiotti et al., 2019). For the abovementioned regulations, APRNs must ensure their specialty is recognized and be aware of their prescribing capabilities. However, it does not stop there. Being informed about healthcare policies, such as the stance on abortion or healthcare reform, is equally important. It is not just about knowing the rules; it is about understanding the context in which we practice and being proactive in adhering to the regulations (Hudspeth & Klein, 2019).

Conclusion

Regulations govern how healthcare professionals practice to ensure that care is safe and adheres to state laws. Accountability and integrity are mandatory qualities in healthcare that APRNs must possess. (Kandrack et al., 2019). The resources are at our fingertips, and we must review them and remain updated on any changes that may occur within our current and potential states.

References

Cimiotti, J. P., Li, Y., Sloane, D. M., Barnes, H., Brom, H. M., & Aiken, L. H. (2019). Regulation of the nurse practitioner workforce: Implications for care across settings. Journal of Nursing Regulation, 10(2), 31–37. https://doi.org/10.1016/s2155-8256(19)30113-9

Department 410. rules of Georgia Board of Nursing. GA R&R – GAC – Department 410. RULES OF GEORGIA BOARD OF NURSING. (n.d.). https://rules.sos.ga.gov/GAC/410

Hudspeth, R. S., & Klein, T. A. (2019). Understanding nurse practitioner scope of Practice: Regulatory, practice, and employment perspectives now and for the future. Journal of the American Association of Nurse Practitioners, 31(8), 468–473. https://doi.org/10.1097/jxx.0000000000000268

Kandrack, R., Barnes, H., & Martsolf, G. R. (2019). Nurse practitioner scope of practice regulations and nurse practitioner supply. Medical Care Research and Review, 78(3), 208–217. https://doi.org/10.1177/1077558719888424

Michigan legislature. MCL – 368-1978-15-172 – Michigan Legislature. (n.d.). https://www.legislature.mi.gov/Laws/MCL?objectName=MCL-368-1978-15-172

Van Wicklin, S. A. (2021). Determining scope of practice. Plastic Surgical Nursing, 41(1), 40–42. https://doi.org/10.1097/psn.0000000000000354

Comparison of Board of Nursing Regulations in Two States

In comparing regulations for Advanced Practice Registered Nurses (APRNs) in Florida and Washington, key differences are seen with scope of practice and prescriptive authority (Washington State Department of Health, n.d.; Online Sunshine, n.d.). Scope of practice involves an APRN’s ability to assess, diagnose, and treat patients, while prescriptive authority pertains to prescribing medications, including controlled substances (Moeller, 2023). Though related, these activities are often regulated separately in each state’s nurse practice act or administrative code (Moeller, 2023).

Washington is a full practice authority state, allowing APRNs to assess, diagnose, treat, and prescribe medications, including Schedule II controlled substances like opioids, independently upon licensure (Washington State Department of Health, n.d.; Smith, 2024). This autonomy is granted immediately, with no additional processes or restrictions for prescribing medications, allowing APRNs to fully utilize their education and training from the start (Washington State Department of Health, n.d.).

In contrast, Florida requires APRNs to gain autonomous practice status before they can assess, diagnose, and treat independently. This process involves completing 3,000 clinical hours under physician collaboration over a 5-year period and applying to the Florida Board of Nursing for autonomous practice after paying fees (Online Sunshine, n.d.; Florida Board of Nursing, n.d.). Even after gaining autonomy, Florida APRNs face restrictions on prescribing Schedule II substances, including a 7-day limit on opioid prescriptions, except in specific situations such as treating psychiatric patients or working in hospitals or hospice care, for the duration of their practice (FANA, n.d.; Online Sunshine, n.d.).

For example, a newly licensed APRN in Washington could independently manage a patient’s chronic pain by prescribing opioids like oxycodone (Washington State Department of Health, n.d.). Additionally, the same APRN could assess and diagnose a patient with diabetes, develop a treatment plan, and manage their care without needing physician oversight from the start of their career (Smith, 2024). However, a Florida APRN, even with autonomous status, must adhere to more frequent prescription renewal requirements for Schedule II substances (FANA, n.d.). Similarly, a Florida APRN without autonomous status must work under a physician’s supervision to assess and diagnose a patient with a chronic illness like hypertension, limiting their ability to practice independently until meeting specific requirements (Online Sunshine, n.d.).

References

FANA. (n.d.). Florida HB 423- ARNP/PA controlled substance prescribing. Florida Association of Nurse Anesthesiology. Retrieved September 25, 2024, from https://www.fana.org/florida-hb-423-arnppa-controlled-substance-prescribing

Florida Board of Nursing. (n.d.). Autonomous Advanced Practice Registered Nurse. Retrieved September 25, 2024, from https://floridasnursing.gov/licensing/autonomous-advanced-practice-registered-nurse/

Moeller, M. (2023, September 21). When can an NP have an independent practice? AmSpa. Retrieved September 25, 2024, from https://americanmedspa.org/blog/when-can-an-np-have-an-independent-practice

Online Sunshine. (n.d.). The 2024 Florida statutes. Retrieved September 25, 2024, from http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/Sections/0464.012.html

Smith, K. (2024, April 30). A state-by-state breakdown of nurse practitioner practice authority laws. The Intake. Retrieved September 25, 2024, from https://www.tebra.com/theintake/checklists-and-guides/legal-and-compliance/nurse-practitioner-laws-by-state#h-washington

Washington State Department of Health. (n.d.). Who can prescribe and administer prescriptions in Washington state. Retrieved September 25, 2024, from https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/pharmacy-commission/who-can-prescribe-and-administer-prescriptions-washington-state

BreAnn Norris

Main Discussion Post

NURS 6050C

Georgia VS Colorado Board of Nursing APRN Regulations 

            According to the Georgia Board of Nursing rules and regulations, advanced practice registered nurses (APRN) must work under an overseeing physician by utilizing a nurse protocol agreement (Rules and Regulations of the State of Georgia, 2024). In addition to having to work under a physician, APRN’s in Georgia also cannot prescribe schedule one or two medications (Rules and Regulations of the State of Georgia, 2024). Schedule one substances are not currently utilized medically and are highly addictive (United States Drug Enforcement Agency, n.d.). Schedule two drugs are also highly addictive; examples include narcotics and stimulants (United States Drug Enforcement Agency, n.d.).

Upon performing research on this topic, I realized that Colorado allows APRNs to practice more independently than Georgia does. APRNs in the state of Colorado can practice independently (not under an overseeing physician); however, they must meet certain qualifications (Department of Regulatory Agencies, 2021). APRN’s scope of practice in Colorado must be in their specialty they received their education in (Department of Regulatory Agencies, 2021). Upon inspection of the rules and regulations regarding Colorado, APRNs are allowed to have full prescribing authority to include controlled substances. However, they must meet certain requirements such as a preceptorship/mentorship program with a licensed physician for a specific amount of time, specific certifications, and education regarding controlled substance prescribing (Code of Colorado Regulations, 2010). 

How Regulations Apply to Full Scope Education/Experience

            The rules and regulations chosen, as listed above, are regarding scope of practice and prescriptive authority in Georgia and Colorado. The research for this discussion post has taught me that each state is different regarding rules and regulations for APRNs. I currently reside in Georgia and didn’t realize how restrictive these rules and regulations are. Education regarding advanced practice registered nursing is directed at teaching the knowledge for the entire scope of practice no matter the state of practice. Therefore, the regulations of Georgia are restrictive compared to the full scope education of an APRN because they must practice under an overseeing physician and are unable to prescribe controlled medications. However, the regulations of Colorado are less restrictive allowing the APRN to practice independently to include prescribing controlled medications, aligning with the full scope education.

How APRNs Adhere to Regulations

            APRNs whom practice in the state of Georgia adhere to these regulations by practicing under/directly working with a physician. They also do not prescribe schedule one or two medications and refer them to a physician should they need a controlled substance prescription. Colorado APRNs adheres to these regulations by obtaining the specific training required to be able to prescribe controlled substances. Colorado APRNs also adheres to the state rules and regulations by knowing their limitations and refer patients to physicians when necessary (Department of Regulatory Agencies, 2021).

References

Code of Colorado Regulations (2010). Rule 950 – the physician’s role in prescriptive authority for advanced practice nurses. https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=3791

Department of Regulatory Agencies (2021). Nursing rules and regulations. https://www.google.com/url?sa=j&url=https%3A%2F%2Fwww.sos.state.co.us%2FCCR%2FUpload%2FNoticeOfRulemaking%2FProposedRuleAttach2022-00802.doc&uct=1709164525&usg=Ba1KTDZagSLHtSopcpbyTplNuZk.&opi=89978449&ved=2ahUKEwi07ri5vt-IAxUHbTABHf6rCc0QwtwHKAB6BAgBEAE

GA. Comp. R. & Regs. R. 410-11-.14 (2024). https://rules.sos.ga.gov/GAC/410-11-.14

U.S. Drug Enforcement Administration (n.d.). Drug scheduling. https://www.dea.gov/drug-information/drug-scheduling#:~:text=Schedule%20I%20drugs%2C%20substances%2C%20or,)%2C%20methaqualone%2C%20and%20peyote.

Main Discussion Post

Each Nursing Regulatory Body (NRB) develops the scope and standards of practice for their jurisdiction; also developing requirements for licensure, reasons for and process of disciplinary actions, and requirements for content and frequency of continuing education (Short, 2022). Along with boards of nursing and other nursing regulatory bodies (NRB), state and federal laws and regulations aim to ensure the delivery of safe and effective quality care (Short, 2022). I will be comparing state APRN practice environments for Florida, my home, and Massachusetts, where I lived and worked for ten years.

The Florida Board of Nursing’s Mission states, in part, that their goal is to ensure “competence in providing health care services for the people of Florida” (Florida BON, 2024). Feeney identifies Florida as a full practice environment which allows practitioners autonomy (2024). Bosse et al. indicates that communities with full practice environments experience increased availability of safe and effective quality healthcare for vulnerable populations (2017). Chapter 464 of the Florida Legislature provides that an APRN can practice autonomously and prescribe medications including controlled substances with certain criteria that includes education, area of practice, training, and an established formulary (2024). The formulary is developed by the BON appointed committee and establishes controlled medications that cannot be prescribed by an APRN, controlled medications that can be prescribed, and medications that can be prescribed if certain criteria are met (The Florida Legislature, 2024).

The Mission of the Massachusetts Board of Registration in Nursing (BORN) in part states it “protects the health, safety, and welfare of the citizens of the Commonwealth through the fair and consistent application of the statutes and regulations that govern nursing practice and nursing education” (2024). The American Association of Nurse Practitioners (AANP) identifies Massachusetts as a full practice state which means that as a licensed APRN by the Massachusetts Board of Registration in Nursing (BORN) they can “evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing mediations and controlled substances” (2023). After completing two years of supervised prescribing, an APRN licensed by the BORN can apply to the US Drug Enforcement Administration for independent controlled substance registration allowing them to prescribe controlled substances along with other medications previously permitted (Massachusetts BORN, 2021).

The AANP (2023) and Feeney (2004) identify three State Practice Environments. The first is a Full Practice Environment which is discussed above with Florida and Massachusetts. The second practice environment identified is Restricted Practice Environment which requires that the APRN must establish and maintain a predetermined agreement with a physician for the length of their career, limiting their ability for complete practice autonomy (AANP, 2023 & Feeney, 2024). The third practice environment identified by AANP is Reduced Practice Environment which limits an APRN from practicing with full autonomy and requires supervision in some areas of practice while other areas permit full autonomy (AANP, 2023 & Feeney, 2024).

Bosse et al. (2017) reports the benefits of full practice environments of decreased emergency room visits, decreased healthcare costs, decreased prescribing of controlled substances, and increased care coordination. The National Council of State Boards of Nursing (NCSBN) supports the transition across all states from restricted practice to full practice environments to increase access to healthcare and improve the quality of healthcare provided (NCSBN, 2024).

References

American Association of Nurse Practitioners (AANP) (2023, October). State practice environment. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., and Poghosyan, L. (2017). Position statement: Full practice authority for advanced practiced registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761-765. Retrieved from https://www.nursingoutlook.org/article/S0029-6554(17)30558-4/fulltext

Feeney, A. (2024, May 23). Nurse practitioner practice authority: A State-by-state guide. Retrieved from https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/

Florida Board of Nursing. (2024, June 20). Florida Nursing Quarterly. Florida Board of Nursing ” Florida Nursing Quarterly – Vol. 10 Issue 2 – Licensing, Renewals & Information. Retrieved from https://floridasnursing.gov/florida-nursing-quarterly-vol-10-issue-2/

The Florida Legislature. (2024). Online Sunshine. The 2024 Florida Statutes. Retrieved from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/Sections/0464.012.html

Massachusetts Board of Registration in Nursing (BORN). (2021, September 3). Advanced practice registered nursing. 244 CMR 4.00 – Advanced practice registered nursing. Retrieved from https://www.mass.gov/regulations/244-CMR-400-advanced-practice-registered-nursing

Massachusetts Board of Registration in Nursing (BORN). (2024). Board of Registration in Nursing. Retrieved from https://www.mass.gov/orgs/board-of-registration-in-nursing

National Council of State Boards of Nursing. (2024). Policy. NCSBN. Retrieved from https://www.ncsbn.org/policy.page

Short, N. M. (2022). Milstead’s Health policy and politics: A Nurse’s guide (7^th ed). Jones & Bartlett Learning.

Week 5: Discussion

Vladimir Berrios- Student ID A01238310

MSN-PMHNP, Walden University

NURS-6050C-40: Policy & Advocacy for Pop Hlth-Fall 2024

Dr. Crystal Dodson

As a future Psychiatric-Mental Health Nurse Practitioner (PMHNP) who hopes to practice in Florida, it is crucial to understand the differences in APRN regulations in states like Florida and California in order to help navigate my professional practice. These regulations directly impact my ability to provide care, more specifically regarding prescriptive authority, which is a huge part of my practice, and is a necessity when collaborating with physicians. While both Florida and California are moving toward increased autonomy for APRNs, there remain significant differences that impact day-to day practice, especially for PMHNPs managing complex psychiatric medications and patient care independently.

In both Florida and California, the regulations governing APRNs are different when it comes to the scope of practice and independence. In the state of Florida, the state now allows independent practice for APRNs (Florida Board of Nursing, 2024), by having Full Practice Authority it means that they have the ability to practice without the supervision of a physician if certain criteria are met (Florida Board of Nursing, 2024):

• 3,000 hours of clinical experience under physician supervision within the last five years.
• Hold a national certification in their respective APRN role
• File an application with the Florida Board of Nursing to practice independently.

However, one key area is prescriptive authority as there certain restrictions still apply in the state of Florida for controlled substances, as APRNs although able to prescribe, must do so under a supervising physician.

In the state of California, APRNs also have a prescriptive authority, but they require a transitional period in which they work under standardized procedures developed in collaboration with a supervising physician before they gain full autonomy (CA Nurse practitioners: Laws & regulations 2013).

Another Key area when it comes to regulations governing APRNs is collaborative agreements. The state of Florida mandates that APRNs work under a supervisory protocol  with a physician. This agreement must outline the responsibilities and specific practices of the PRN and physician. Although recent changes have granted greater autonomy, APRNs are still required to maintain this collaborative partnership (Florida Board of Nursing, 2022). California also requires APRNs to have a collaborative agreement with a physician for their scope of practice. However, the state is slowly moving toward more independence. The passage of AB 890 in 2020 allows for independent practive after certain requirements are met, including three years of practice under phuscian supervision and completing additional education (California Legislature, 2020).

In conclusion, the regulatory frameworks in Florida and California significantly shape the practice of a Psychiatric-Mental Health Nurse Practitioner (PMHNP). In Florida, the need for a collaborative agreement with a physician directly impacts how a PMHNP operates, especially regarding treatment planning and prescribing medications, including controlled substances. In contrast, California’s AB 890 provides a path to independent practice after fulfilling certain requirements, granting more autonomy to PMHNPs in decision-making and patient care.

For example, a Florida PMHNP prescribing psychiatric medications for patients with anxiety and depression must adhere to a supervisory protocol with a physician, ensuring all treatment plans are aligned with the agreement. This collaborative practice may involve periodic reviews of treatment efficacy and medication adjustments under the physician’s oversight. Conversely, a PMHNP in California could eventually practice independently, creating and adjusting treatment plans without direct supervision after meeting the state’s requirements for autonomous practice.

These regulations require PMHNPs to remain vigilant about the legal scope of their practice, ensuring patient care is compliant with state law.

References

American Nurses Association. (n.d.). ANA enterpriseLinks 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.

Florida Board of Nursing. (2024, September 23). REGULATION OF PROFESSIONS AND OCCUPATIONS-NURSING. The 2024 Florida Statutes. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499%2F0464%2FSections%2F0464.012.html

Florida Board of Nursing (2024). Florida Board of Nursing ” HB 607 Passes Legislature – Impact to RNs, CNAs, and APRNs – Licensing, Renewals & Information. (n.d.). https://floridasnursing.gov/hb-607-passes-legislature/#:~:text=Eligibility%20for%20registration%20as%20an%20autonomous%20APRN%20includes,years.%20These%20hours%20may%20include%20clinical%20instructional%20hours.

Florida Board of Nursing (2022). Advanced practice registered nurse (APRN) protocols. Florida Department of Health. https://floridasnursing.gov/forms/aprn-protocol-sample.pdf

CA Board of Registered Nursing. (2021). Nurse practitioner practice requirements. California Department of Consumer Affairs. https://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf

CA Board of Registered Nursing. (2024, n.d.). General information: Nurse practitioner practice. California Board of Registered Nursing. https://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf

CA Nurse practitioners: Laws & regulations. CA Board of Registered Nursing. . (2024, n.d.). https://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf

California Legislature. (2020). Assembly Bill No. 890, Chapter 265. California Legislative Information. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB890

Registered nurse’s follow their state regulations that are based on The Board of Nursing (BON). The Board of Nursing regulates specific rules and regulations that guide practices of all registered nurses of every state in the United States (Boehning & Haddad, 2023). Within the Board of Nursing, the National Council of State Boards of Nursing (NCSBN) work side by side with each state’s board of nursing to ensure safety and practice efficiently for their patients (Boehning & Haddad, 2023).

I currently work in North Carolina under the North Carolina Board of Nursing (NCBON) and where I would work as a Nurse Practitioner.  The NCBON regulates all rules and regulations for any nurse practicing and holding a license within the state. Nurse practitioners or Advanced practice registered nurses (APRN’s) are monitored by the NCBON as well as the North Carolina Medical Board (NCMB) (North Carolina Board of Nursing, n.d.). Education wise, APRN’s must obtain a Masters degree in Nursing as well as a certification by a nursing credentialing body (North Carolina Board of Nursing, n.d.).

Each state has different nursing rules and regulations for practicing APRN’s. There are 3 different types of practicing authority; Full, Reduced and Restricted (Feeney, 2024). North Carolina is listed as a restricted practicing authority. Being under a restricted practicing authority means that practicing as a Nurse Practitioner in North Carolina requires you to work under a licensed physician or medical doctor, meaning you are not able to work independently (Feeney, 2024). APRN”s are still able to assess, diagnose, treat, and prescribe medications to patients (North Carolina Board of Nursing, n.d.).

When talking about a different state and their rules and regulations, such as Wyoming, they are considered a full practicing authority. Being a full practicing state, this means that a Nurse Practitioner who practices in Wyoming can practice independently within any setting and NOT require a licensed physician to supervise them (Wyoming State Board of Nursing, n.d.).

When comparing and contrasting a practicing Nurse Practitioner in North Carolina and Wyoming, to maintain your practicing license in North Carolina you must complete 50 continuing education hours with 20 of those being approved by the ANCC (North Carolina Board of Nursing, n.d.). Wyoming is different from North Carolina. To maintain their licensure, nurse practitioners in Wyoming must submit their RN license and verification of the original state of licensure as well as documentation of a certification (Wyoming State Board of Nursing, n.d.).

Practicing as an APRN in any state, you must follow each rule and regulation. Staying up to date with what is required is very important to legally practice safe and efficient care for your patients.

References:

Boehning, A. P., & Haddad, L. M. (2023, July 17). Nursing practice act. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK559012/

Feeney, A. (2024, May 23). Nurse practitioner practice authority: A state-by-state guide. NurseJournal.org. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/

North Carolina Board of Nursing. (n.d.). Nurse practitioner. Nurse Practitioner | North Carolina Board of Nursing. https://www.ncbon.com/nurse-practitioner

Wyoming State Board of Nursing. (n.d.). Practice. WSBN. https://wsbn.wyo.gov/practice

In comparing Advanced Practice Registered Nurse regulations in Florida and California, two key areas of distinction are prescriptive authority and collaborative agreements. In the state of Florida APRN’s have restricted prescriptive authority. APRN’s in Florida are allowed to prescribe controlled substances, but there are limitations. They must complete additional coursework on controlled substances and be supervised or have a collaborative agreement with a physician to prescribe scheduled class two substances. For example, the APRN can only prescribe a schedule two medication for up to seven days without a physician’s oversight. On the contrast in California APRN’s operate with independent prescriptive authority under certain conditions. As of 2023, California enacted full practice authority to APRN’s under assembly Bill 890, allowing APRN’s to prescribe medications, including controlled substances, without physician supervision after completing a three-year transition to practice. However, APRN’s in California must meet education certification and clinical training requirements before prescribing independently.

Florida requires APRN’s to enter into a collaborative agreement with a supervising physician to practice fully, especially when it comes to prescribing. This means that APRN’s are not able to practice independently without a formal agreement outlining the scope of their collaboration with a physician. This arrangement restricts full scope practice since the APRN’s ability to treat patients or prescribe medications is tied to the presence and availability of a collaborating physician. As of recent legislative changes, APRN’s in California no longer require a collaborative agreement with a physician after they fulfill their transition to practice period. They are allowed to practice independently, meaning they can assess, diagnose, and treat patients without physician oversight. This significantly expands the ability of APRN’s to practice to the full scope of their training and education.

These differences in regulations have profound implications for APRN’s in both states who wish to practice to the full extent of their education and training. In Florida APRN’s are limited by the requirement of a collaborative agreement with a physician, especially for prescribing medications. This creates dependency that can limit access to care in areas where physicians are scarce or unavailable. For example, an APRN in a rural area may be unable to open an independent clinic or serve patients fully without securing a collaborative agreement with a local physician, which may not always be feasible. In California APRN’s are able to practice autonomously after completing their transition period, which empowers them to work in underserved areas without the need for physician collaboration. For example, an APRN in California could open an independent clinic in a rural community, providing full-spectrum primary care, prescribing medications, and managing patient health without requiring physician oversight. This independence allows for greater access to care for all communities.

Both Florida and California would adhere to these regulations very differently. In Florida the APRN would adhere to the regulations by securing a formal agreement with a physician. For instance, if an APRN specializing in family medicine wants to prescribe controlled substances, they would need a physician to sign off on the agreement, detailing the types of medications they can prescribe and the physician’s oversight responsibilities. In California the APRN would adhere to the state requirements by completing the necessary transition to practice under physician supervision for the first three years of their career. Afterward, the APRN could practice independently, managing patient care, including prescribing controlled substances, in compliance with California’s full-practice regulations.

In summary, while California grants APRN’s a more autonomous role, Florida’s regulations impose more oversight through collaborative agreements and limited prescriptive authority. These differences impact how APRN’s can deliver care, especially in those underserved communities. This draws attention to the need and the importance towards independent APRN practice, so that more people can get the care they need and deserve.

References

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 care. Nursing Outlook, 65(6), 761–765. https://doi.org/10.1016/j.outlook.2017.10.002

Florida Board of Nursing   » Advanced Practice Registered Nurse (APRN) – Licensing, Renewals & Information. (n.d.). https://floridasnursing.gov/nursing-faqs/advanced-practice-registered-nurse-aprn/

Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., Bumbach, M. D., Everhart, D., & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379–385. https://doi.org/10.1016/j.outlook.2018.03.001

Nurse Practitioner Expanded Scope of Practice in California – MIEC. (2023, February 16). MIEC. https://www.miec.com/knowledge-library/nurse-practitioner-expanded-scope-of-practice-in-california/

Introduction

            Advanced practice registered nurses are an integral piece of the United States healthcare system and bring a holistic, patient and family-centered approach to health and behavioral issues in a myriad of settings across one’s lifespan. Advanced Practice Registered Nurses (APRN) work collaboratively with other healthcare providers to optimize patient care and health (Bosse et al., 2017). There are three categories of nurse practitioner regulations, based upon practice laws and regulations specific to each stated and derived from the American Academy of Nurse Practitioners: independent practice, minimum restrictive practice, and most restrictive practice; with the minimum restrictive and most restrictive requiring physician supervision (Neff et al., 2018). APRNs have the education, knowledge, experience, and skillsets needed to provide comprehensive and basic healthcare services, improve access to care, and contribute to reducing healthcare disparities while lowering the cost of such needed care (Bosse et al., 2017). However, due to the state’s varying scope of practice and regulations, APRNs are not utilized to the full extent of their comprehensive abilities.

APRN Regulations and Scope of Practice in Different States

            In the state of Florida, which is considered a restrictive state, APRNs or Certified Nurse Practitioners (CPN) may perform a multitude of functions within the framework of an established protocol under a supervising physician. Within this established protocol, an APRN can initiate, monitor, and alter therapies for certain uncomplicated acute illnesses, manage selected medical problems and order physical and/or occupational therapy, monitor and manage patients with stable chronic diseases, establish behavioral problems and diagnosis, and make treatment recommendations. Once an APRN has completed at least 3,000 clinical practice hours under the supervising physician within 5 years and has not been subject to disciplinary action, the APRN can request to become autonomous. Becoming autonomous would allow the APRN to practice in primary care settings, including family medicine, general pediatrics, and general internal medicine, without the constraints of having a supervising physician (Florida Board of Nursing, 2024).

In the state of Arizona, which is considered a full-practice state, Advanced Practice Registered Nurses (APRN) or Registered Nurse Practitioners (RPR) are able to practice independently within their scope of practice without the need for an established protocol under a supervising physician. APRNs in Arizona have the freedom to examine a patient and establish a medical diagnosis through patient history, physical and other criteria, order and interpret labs, radiographic/diagnostic tests, and other tests as determined by the nurse practitioner within the scope of practice. They can also prescribe, order, administer, and dispense therapeutic measures, including pharmacological interventions, physical and occupational therapy, and hospice, as well as identify, implement, develop, and evaluate a patient plan of care (Arizona Board of Nursing, 2020)

As I am studying to be a Family Nurse Practitioner (FNP), each specialty also has a specific scope of practice with the Arizona Board of Nursing. In Arizona, FNPs are educationally prepared to care for individuals and families across their lifespan. The role of FNP in Arizona includes preventative healthcare, including assessment, diagnosis, and treatment of acute/chronic illness and preventative healthcare, as well as common acute/chronic physical and mental illnesses. FNPs can also screen for psychiatric illnesses and treat common psychiatric conditions such as anxiety and depression (Arizona Board of Nursing, 2020)

In Arizona, an APRN can open and run their own independent practice within their scope of practice without needing an established protocol with a supervising physician. In contrast, an APRN working in primary care in Florida would need an established protocol under a physician’s supervision to ensure that their scope of practice aligns with what the physician agrees to supervise.

APRN Prescriptive Authority in Different States

In Florida, APRNs have limited prescriptive authority. APRNs may prescribe medications, including Schedule II through V controlled substances with restrictions. For example, prescribing Schedule II controlled substances such as opioids is limited to a 7-day supply except in instances of chronic pain management or palliative care (Florida Board of Nursing, 2024).

In Arizona, APRNs have full prescriptive authority, including the ability to prescribe Schedule II controlled substances. APRNs can independently prescribe and dispense medications, including controlled substances, without limitations on the number of days or a supervising physician (Arizona Board of Nursing, 2020).

As an example, an APRN in Arizona, treating a patient with severe pain from an acute injury, would be able to prescribe a longer supply of oxycodone if needed, based upon their clinical judgment. While comparatively, an APRN in Florida, treating a patient with a similar acute injury, would only be able to prescribe a 7-day maximum supply.

Conclusion

Allowing NPs to practice to the full extent of their knowledge, competencies, skills, and to have full practice authority has the potential to improve health equity, access to healthcare, and high-quality patient care that not only costs patients less but also healthcare systems and payers (Bosse et al., 2017).

References

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 care

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 care

Florida Board of Nursing (2024). Section 464.012: certification of advanced registered nurse practitioners; fees. Retrieved September 21, 2024, from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/Sections/0464.012.html

Florida Board of Nursing (2024). Section 464.0123: autonomous practice by an advanced practice registered nurse. Retrieved September 21, 2024, from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/Sections/0464.0123.html

Arizona Board of Nursing (2020). Arizona board of nursing scope of practice APRN questions & answers scope of practice. Retrieved September 21, 2024, from https://www.azbn.gov/sites/default/files/2020-11/FAQs%20Final%20Questions-%20NP%207.24.20%20%281%29.pdf

Main Discussion- Week 5

Comparison of Board of Nursing Regulations: Florida and California

The Florida and California Boards of Nursing have distinct regulatory frameworks that reflect differences in licensure processes and continuing education requirements, especially for Advanced Practice Registered Nurses (APRNs). In Florida, the Board of Nursing is part of the Nurse Licensure Compact (NLC), which allows nurses with a multi-state license to practice in other compact states without obtaining additional licenses. This flexibility is especially beneficial for nurses who frequently move or work in telehealth. Florida requires 24 hours of continuing education (CE) for license renewal every two years, with specific courses in areas like medical error prevention, laws and rules, and human trafficking (National Council of State Boards of Nursing [NCSBN], n.d.; Short, 2022). Additional requirements, such as domestic violence training every third renewal cycle, reflect Florida’s focus on maintaining up-to-date practice standards and patient safety.

In contrast, California is not part of the NLC, requiring nurses to obtain separate licensure to practice in the state. California mandates 30 hours of CE every two years, but without the specific subject area requirements that Florida imposes. California also places stricter regulations on APRNs, requiring advanced education in pharmacology and more comprehensive supervision in certain practice settings. APRNs must meet higher educational and practice standards to ensure public safety (Neff et al., 2018; NCSBN, n.d.). California further emphasizes the importance of nursing programs that meet stringent standards to safeguard clinical practice and public health (Bosse et al., 2017). These differences demonstrate the varying approaches each state takes to balancing regulatory flexibility and educational rigor, with Florida focusing on providing multi-state licensure options and specific CE requirements, while California imposes stricter educational and licensure standards.

For APRNs, these licensure and CE requirements reflect each state’s broader stance on full-practice authority. In Florida, APRNs can practice within the full scope of their education and experience, but their licensure requirements remain somewhat restrictive. Florida grants limited full-practice authority, meaning APRNs must still maintain supervisory or collaborative agreements with physicians to prescribe medications and manage patients independently (Short, 2022). These APRNs are subject to the same CE requirements as registered nurses but with additional pharmacology training for those with prescriptive authority (NCSBN, n.d.).

In contrast, California has begun moving toward full-practice authority for APRNs, though the process is still evolving. Historically, APRNs in California were required to have physician supervision for prescribing and treating patients (Bosse et al., 2017). Recent legislative changes, like AB-890, are paving the way for more independent APRN practice. However, California APRNs must complete additional education in areas like pharmacology and clinical practice, and they must adhere to more rigorous CE requirements than their counterparts in Florida (Neff et al., 2018). APRNs in California must complete 30 hours of CE for license renewal every two years, with additional requirements often applying to those in specialized roles.

To comply with these regulations, a family practice APRN in Florida who wishes to prescribe medications must maintain a collaborative agreement with a supervising physician and complete 24 hours of CE, including a 3-hour course on the safe prescribing of controlled substances, as well as training on medical errors and human trafficking prevention (Short, 2022). This ensures their continuing education aligns with Florida’s legal mandates for licensure renewal and prescriptive authority. Conversely, an APRN in California working in a similar role may need to complete 30 hours of CE every two years, but without mandatory courses in specific areas unless they are required by their specialization. APRNs with full-practice authority under AB-890 would likely need to focus their CE on pharmacology updates relevant to their practice, ensuring they meet California’s advanced clinical education requirements while maintaining both licensure and independent prescriptive rights.

Overall, Florida’s regulation of APRNs emphasizes collaboration with physicians, while California is gradually shifting toward granting more autonomy to APRNs. Both states aim to prioritize public safety but differ in the level of autonomy and education required for APRNs based on their education and scope of practice.

References

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full-practice authority for registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761-765. https://doi.org/10.1016/j.outlook.2017.08.006

National Council of State Boards of Nursing (NCSBN). (n.d.). Nurse licensure compact. Retrieved from https://www.ncsbn.org/nlc.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 care. Nursing Outlook, 66(4), 379–385. https://doi.org/10.1016/j.outlook.2018.03.001

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

Professional Nursing and State Level Regulations

The functions of state and regional boards of nursing ensure the vital protection of nursing practice in the interest of public health and safety. The main objective of the nursing regulations is to ensure that nurses exhibit both competence and ethics, and also deliver safe, high-quality care to patients. Different regulatory measures are applied that involve educational specifications, define certification requirements, and set out the duties and freedoms of nurses at various levels where the rules established by regulatory boards have the power to enormously change nursing practice (Neff et al., 2018). For an example, ongoing education requirements assure nurses are updated with the changes in medical understanding and best practices. In addition, the regulation that oversees advanced practice roles, especially the role for nurse practitioners, has the ability to deeply influence the ease with which patients get care, which is particularly crucial in areas with insufficient services.

In defining regulations for advanced practice registered nurses (APRNs), the Colorado Board of Nursing and Ohio Board of Nursing apply differing guidelines covering central elements relating to their scope of practice and the authority to write prescriptions for drugs. For example, an APRN regulation in Colorado is focused on prescriptive authority. In Colorado, APRNs who have received necessary education and certification may prescribe with full authority, including managed substances, unaccompanied by physician collaboration or supervision (Colorado CCR Document List, 2024). Colorado APRNs are permitted to practice to the limits defined by their education and training under the regulation. However, the rules of Ohio stipulate that APRNs must develop a set care agreement with a collaborating physician to be able to prescribe medications (Ohio Laws & Rules, 2024). The variation in prescriptive authorization affects APRN practice and patient access to healthcare. In Colorado, the strategy may enhance the utilization of advanced practice registered nurses (APRNs) as essential caregivers in underserved areas, but in Ohio, a more rigorous approach may restrain the maximum capability of APRNs.

Also, APRN regulation in Colorado relates to scope of practice. Colorado gives full practice authority to APRNs who can practice independently, prescribe and offer diagnosis, order and even explain the results of a diagnostic test among other functions (Colorado CCR Document List, 2024). The prescription permits APRNs to practice autonomously and manage the main prerequisite or important care critical for the population, without referring to the physicians. In Ohio, APRNs have a fairly free practice scope but the regulation still demands that they establish formal collaborations with physicians, which often may restrict APRNs in the extent to which they can perform some of the functions of a physical, independently.

References

Ohio Laws & Rules. (2024). Ohio.gov. https://nursing.ohio.gov/compliance-and-regulation/laws-and-rules/laws-and-rules

‌Colorado CCR Document List. (2024). State.co.us. https://www.sos.state.co.us/CCR/DisplayRule.do?action=ruleinfo&ruleId=2251&deptID=18&agencyID=78&deptName=Department%20of%20Regulatory%20Agencies&agencyName=Division%20of%20Professions%20and%20Occupatio

‌Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., Bumbach, M. D., Everhart, D., & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379–385. https://doi.org/10.1016/j.outlook.2018.03.001

Comparison of APRN Board of Nursing Regulations: North Carolina vs. Florida

Scope of Practice

One significant area of difference between the APRN regulations in North Carolina (NC) and Florida pertains to their scope of practice. In North Carolina, the regulations allow APRNs to practice independently depending on their experience and certification levels. According to the National Council of State Boards of Nursing, NC permits Nurse Practitioners (NPs) to engage in a broader range of activities without a physician’s direct supervision after obtaining necessary experience and additional certification (National Council of State Boards of Nursing, n.d.). This can include diagnosing and treating patients, ordering and interpreting diagnostic tests, and initiating treatment plans.

Conversely, in Florida, APRNs are generally more restricted and must practice under protocols that outline the supervisory relationship with a physician. The Florida Board of Nursing specifies that while APRNs can perform many of the same functions as their counterparts in NC, they must do so under the supervision or in collaboration with a licensed physician (Florida Board of Nursing, n.d.). This restricts their ability to practice independently, affecting their role in direct patient care.

Prescriptive Authority

Another critical difference lies in prescriptive authority. In North Carolina, APRNs have the authority to prescribe drugs, including controlled substances, following state and federal guidelines. This is facilitated by the regulatory environment that supports full practice authority, allowing APRNs to utilize their training fully in pharmacological management of patient care (North Carolina Board of Nursing, n.d.).

In contrast, Florida has historically limited the prescriptive authority of APRNs, particularly regarding controlled substances. Recent changes have begun to allow more autonomy, but APRNs in Florida still face more significant restrictions compared to North Carolina. They must adhere to specific protocols and often require a supervising physician to approve prescriptions for controlled substances (Florida Board of Nursing, n.d.).

Application to APRNs Practicing Within Full Scope

For APRNs in North Carolina, the ability to practice within the full scope of their education and experience means they can autonomously diagnose and manage patient care, which enhances accessibility to healthcare services, especially in underserved areas. An example of adhering to these regulations would be an NP in a rural clinic in North Carolina who independently evaluates a patient, orders appropriate lab tests, diagnoses the condition, and prescribes medication, all within the legal framework established by the NCBON.

Conclusion

The comparison of APRN regulations between North Carolina and Florida highlights significant differences in scope of practice and prescriptive authority, reflecting broader trends in how states are addressing healthcare access and the utilization of APRN capabilities. As states continue to evolve their nursing regulations, the impact on healthcare delivery and the nursing profession will likely be substantial, promoting greater autonomy and possibly leading to changes in states with more restrictive practices like Florida.

References

Florida Board of Nursing. (n.d.). Florida Board of Nursing – Licensing, Renewals & Information.  https://floridasnursing.gov/ 

National Council of State Boards of Nursing (n.d.). North Carolina. https://www.ncsbn.org/bon-member-details/NorthCarolina 

North Carolina Board of Nursing (NCBON). (n.d.). Registered Nurse/Licensed Practical Nurse. https://www.ncbon.com/ 

APRN Regulations Comparison: Tennessee vs Texas

Health professions regulation exists to safeguard the public by gatekeeping entry into the health professions and providing for ongoing maintenance of acceptable standards of practice for those professions (Short, 2022). APRN practice is typically defined by the Nurse Practice Act and governed by the Board of Nursing (BON), but other laws and regulations may impact practice, and other boards may play a role (ANA, n. d.). In comparing the Advanced Practice Registered Nurse (APRN) board of nursing regulations between Tennessee and Texas, there are several key differences, particularly in terms of practice authority and prescriptive authority. Below is a detailed comparison of the regulations in these two states.

Licensure Requirements

Per the Rules of the Tennessee BON, APRNs in Tennessee must hold a current RN license and have completed a graduate-level APRN program. They must also pass a national certification exam in their specialty area. Similar to Tennessee, APRNs in Texas must hold a current RN license and have completed a graduate-level APRN program. They must also pass a national certification exam in their specialty area. These requirements are listed by the Texas BON.

Scope of Practice

Scope of practice is a legal term used by states to define what activities an individual professional can undertake (Kleinpell et al, 2012). Tennessee is a reduced practice state, meaning APRNs have reduced ability to engage in at least one element of APRN practice. They require a collaborative agreement with a physician to prescribe medications and certain treatments. APRNs can diagnose, treat, and manage patient care independently but need a collaborative agreement for prescriptive authority. Texas is also a restricted practice state, meaning APRNs have limited ability to engage in at least one element of APRN practice. They require physician supervision or delegation to provide patient care. APRNs must have a supervisory or collaborative agreement with a physician to practice.

Prescriptive Authority

In Tennessee APRNs must have a written collaborative agreement with a physician to prescribe medications, including controlled substances. The agreement must outline the scope of prescriptive authority and be reviewed and updated regularly. APRNs in Texas must have a written prescriptive authority agreement (PAA) with a physician to prescribe medications, including controlled substances. The PAA must specify the types of drugs that can be prescribed and the extent of the APRN’s prescriptive authority.

Application to APRNs with Full Scope of Practice

For APRNs who have the legal authority to practice within the full scope of their education and experience, these regulations can impact their practice in several ways. Collaborative Agreements: In both Tennessee and Texas, APRNs must enter into collaborative or supervisory agreements with physicians to have prescriptive authority. This can limit their autonomy and may require regular reviews and updates to these agreements. Prescriptive Authority: The need for a collaborative agreement to prescribe medications can affect the efficiency and timeliness of patient care, as APRNs must coordinate with physicians for approval.

Example of Adherence to Regulations

An APRN in Tennessee working in a rural clinic may diagnose and treat patients independently but must have a collaborative agreement with a physician to prescribe medications. This agreement is reviewed quarterly to ensure compliance with state regulations. An APRN in Texas working in an urban hospital may manage patient care and perform procedures within their specialty. However, they must have a prescriptive authority agreement with a supervising physician to prescribe medications. This agreement is reviewed annually and specifies the types of medications the APRN can prescribe.

Conclusion

In summary, while both Tennessee and Texas require APRNs to have collaborative or supervisory agreements with physicians for prescriptive authority, the specifics of these agreements and the extent of the APRNs’ autonomy can vary. APRNs in both states must navigate these regulations to practice within the full scope of their education and experience. These regulations ensure that APRNs provide safe and effective care while maintaining a level of oversight by physicians. Because these regulations may prevent APRNs from practicing to the full extent of their training, they may have an impact on access to care, particularly in underserved areas. APRN autonomy may grow as a result of efforts to change these rules, which could enhance patient outcomes and healthcare delivery. Providing clarification of the NP scope of practice, especially as it pertains to NPs working in acute care settings, remains needed to support practice based on educational preparation, licensure, certification, and focus of practice (Kleinpell et al., 2012).

References:

American Nurses Association. (n.d.). ANA enterprise. Retrieved September 20, 2018, from http://www.nursingworld.org

Kleinpell, R. M., Hudspeth, R., Scordo, K. A., & Magdic, K. (2012). Defining NP scope of practice and associated regulations: focus on acute care. Journal of the American Academy of Nurse Practitioners, 24(1), 11–18. https://doi.org/10.1111/j.1745-7599.2011.00683.x

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

Rules of the Tennessee Board of Nursing.  (2019). Advance Practice Nurses and Certificates of Fitness to Prescribe. Chapter 1000-04.

https://publications.tnsosfiles.com/rules/1000/1000-04.20190812.pdf

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning. Chapter 7, “Government Response: Regulation” (pp. 147–173)

Texas Board of Nursing (2024) Rules and Regulations Relating to Nurse Education, Licensure and Practice. https:// texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=2&ti=22

Week 5 Discussion Post:

This week, we are comparing two regulations from different APRN regulatory bodies. I chose to compare my home state of Missouri to its neighbor, Kansas. The most notable variance in the regulation of APRNs in these states relates to the scope of practice allowed. Missouri regulates the APRNs within the state to what the American Association of Nurse Practitioners refers to as a restricted scope of practice (State Practice Environment, n.d.). This refers to the amount of freedom given to nurse practitioners regarding the level of independence granted within their practice. With Missouri having a restricted scope of practice, state nurse practitioners must operate under a doctor in order to perform patient care (Missouri Scope of Practice Policy – State Profile, n.d.), which contrasts with the neighboring state of Kansas, allows qualifying APRNs to operate independently within their full scope of practice (Kansas Secretary of State – KAR Regulations, n.d.).

For example, an APRN in Missouri has to operate under the strict supervision of a collaborating physician. With this level of collaboration, the APRN would be able to operate independently or see patients to provide care. In the state of Kansas, APRNs are able to operate independently so long as they remain within their full scope of practice. This means that an APRN in Kansas would be unencumbered by state-level restrictions and could be free to practice without the additional regulatory barrier to care.

When we compare these two regulations to the scope of practice of nurse practitioners, we must consider the potential benefits of both outcomes. In states with a restricted scope of practice standards, like Missouri, we see that these healthcare providers are limited below their full scope of practice. This also presents an additional barrier for patients to get access to healthcare providers and the services they need. However, the analysis of outcomes between these different regulatory stances supports the abolition of the scope of practice restrictions in favor of improved patient outcomes (Kleinpell et al., 2023).

References:

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9

Kansas Secretary of State – KAR Regulations. (n.d.). https://sos.ks.gov/publications/pubs_kar_Regs.aspx?KAR=60-11-101&Srch=Y

Missouri Scope of Practice Policy – State Profile. (n.d.). Scope of Practice Policy. https://scopeofpracticepolicy.org/states/mo/

State practice environment. (n.d.). American Association of Nurse Practitioners. https://www.aanp.org/advocacy/state/state-practice-environment#:~:text=Restricted%20Practice,-State%20practice%20and&text=State%20law%20requires%20career%2Dlong,NP%20to%20provide%20patient%20care.

Initial Post:

Collaborative Agreements

In North Carolina, APRNs are required to have a supervisory or collaborative agreement with a physician to practice (North Carolina Board of Nursing, 2023). This means that APRNs must work under the oversight of a licensed physician and cannot practice independently. The regulations stipulate the need for these agreements to outline the shared responsibilities of patient care, medication management, and referral processes (North Carolina Board of Nursing, 2023).

Conversely, Texas has a more flexible approach to APRN practice, particularly since the passage of House Bill 435 in 2021 (Texas Board of Nursing, 2023). While APRNs still require a supervisory or collaborative agreement, they can opt for “autonomous practice” after completing a certain number of hours in clinical practice (Texas Board of Nursing, 2023). This allows them to operate without a formal agreement in some circumstances, promoting greater independence.

Discussion Board Week 5: APRN BON Regulations

            Each state sets requirements for all Advanced Practice Registered Nurses (APRN).  These are set by Nursing Regulatory Bodies (NRB) such as a state Board of Nursing (BON).  It is the BON’s responsibility to govern the requirements and ensure that APRNs are following them accordingly.  The Practice Act defines this oversight as “APRN standards and requirements for practice and prescribing, disciplinary procedures, and standards of continuing education or competence.” (Short, 2019).  APRNs play a pivotal role in the healthcare system of America.  APRNs are nurses with master’s or post-master’s degrees specializing in a specific role within a patient population.  “APRNs bring holistic as well as patient-centered and family-centered approaches to the prevention and management of complex health and behavioral issues addressed in various care settings across the life span.” (Bosse et.al., 2017).  As we compare continuing education and prescribing authority between my home state of North Carolina and the state just north, Virginia, you will notice several similarities but also many differences.

Continuing Education

            In North Carolina, 21 NCAC 36. 0807 states that an APRN (or NP) should have 50 continuing education credit hours every two years.  Also, 20 of these hours should be related to your national certification and have approval from a national crediting body or the Accreditation Council on Continuing Education (ACCME). (2021).  There is also a clause stating that if an APRN prescribes controlled drugs, one hour of continuing education each year should be based on the following: Controlled substance prescription practice, prescribing for chronic pain management, recognizing substance abuse and misuse, or non-opioid treatment options as an alternative to opioids. (2021).  The APRN must also keep records of all continuing education for five years so that it is available for audit if needed.  Virginia slightly differs in some areas but is similar in others.  In Virginia law 18VAC90-30-105, APRNs must hold a specialty certification like North Carolina and be approved by ACCME.  They are required to complete 10 hours less of continuing education than North Carolina at 40 hours every two years.  They must hold on to their continuing education records for four years rather than five in Virginia. 

Prescribing Authority

            Another regulation is prescribing authority.  In North Carolina, APRNs can prescribe controlled drugs if all the requirements are met as outlined in 21 NCAC 36. 0809.  An APRN must be assigned a DEA number, all refills must align with controlled substance laws and regulations, and the supervising physician must write an equal amount or more controlled substance prescriptions than the APRN. (n.d.).  There are also stipulations around prescribing outside of a practice agreement and that any controlled prescription should be noted in the patient’s chart.  There is a format to prescriptions that must be followed and APRNs cannot prescribe to family members or love interests.  According to Virginia law 18VAC 90-40-40, the APRN must apply to prescribe controlled substances after meeting all the requirements which include professional certification and licensure and completion of a graduate-level course in Pharmacology or Pharmacotherapeutics within five years of the application.   They also must practice as an APRN for at least 1000 hours and have 15 continuing credit hours related to their area of practice for each of the two years immediately following submission of the application or submit 30 continuing education credit hours of education in Pharmacotherapeutics. (n.d.).  You also must develop a practice agreement with your overseeing physician like in North Carolina.

Adhering to Regulations

            In the states I chose, it would be difficult to practice within one’s full scope of education and experience.  There are so many stipulations in place by these state’s NRBs.  If you can continue to keep up with the amount of continuing education and the breakdown of different types of continuing education that you need such as controlled substance education, there should be no issue with regulations.  Also, if you treat your job professionally and do not prescribe outside of your scope or to family members, you should be able to adhere to your prescribing authority.

Resources

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 care. Nursing Outlook, 65(6), 761–765. https://doi.org/10.1016/j.outlook.2017.10.002

Continued competency – advanced practice registered nurse – new. Virginia Board of Nursing. (2018, July 6). https://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/ContinuedCompetency/AdvancedPracticeRegisteredNurse/#:~:text=Complete%20at%20least%2040%20hours%20of%20continuing%20education,a%20Category%20I%20Continuing%20Medical%20Education%20%28CME%29%20course.

Nurse practitioner. Nurse Practitioner | North Carolina Board of Nursing. (n.d.). https://www.ncbon.com/nurse-practitioner

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide. Jones & Bartlett Learning.

Title 18. professional and occupational licensing. 18VAC90-40-30. Authority to prescribe, general. (n.d.). https://law.lis.virginia.gov/admincode/title18/agency90/chapter40/section30/

Main discussion-Week 5

How Maryland Compares with Georgia APRN Board of Nursing Regulations

The State licenses nurse practitioners as it does every other type of licensed nurse. Remember that the states determine how you get licensed by each state board of nursing. These requirements consist of graduation from a certified program, passing the certification examination, and re-licensuring every two years through continuing education. (Feeny, 2024).

The Maryland APRN Board of Nursing regulations relative to practice and prescriptive authority are different from those of the Georgia APRN Board of Nursing.

APRNs in Maryland enjoy full practice authority.

A significant aspect of their professional autonomy. For example, in Maryland, an APRN may practice without physician supervision. The NP must have a mentorship with a physician or an entire practice authority non-physician who has at least three years of clinical practice experience and has signed an agreement to be available for advice, consultation, or collaboration on selected issues during the 18 months following receipt of the application by the Board of certification as an NP is required to provide services in thStateate. (Phillips, S. J. 2024).

Example: An APRN can be credentialed as a PCP, but they are only qualified to evaluate/ manage the patient for one acute problem and order labs, radiographs, and prescription drugs if there is well-documented proof that the person performing it has education, training, and competency in performing each correct BH procedure.

APRN’s in Maryland also has full prescriptive authority

For instance, in Maryland, a license from the Medical Board of Maryland licenses APRNs to be able to assess and treat patients by prescribing schedule II-V drugs, including Hydrocodone, Tylenol with codeine, Xanax, and analgesics without requiring supervision or authorization from a physician. (ama-assn. org)

APRNs in Georgia operate under restrictive practice authority, which significantly limits their professional autonomy.

Georgia, in contrast, imposes more stringent regulations. Georgia’s practice and licensure law significantly restricts patient access to NP care, necessitating protocol agreements with a supervising physician and additional supervision requirements. This highlights the importance of being cautious and aware of the legal boundaries when practicing in Georgia.

APRNs are NOT A PCP. They cannot adequately evaluate and treat a patient for an acute complaint; at the same time, they can only order radiographs if a situation is life-threatening and labs or medication prescriptions require the approval of the supervising physician. The specific conditions under which a radiographic image test may be ordered and also, as specified by the law of statute, authorizing continued prescribing under an NP or CNM protocol concerning how well-refined prescription drug order may be executed by the NP and approved by the delegating physician. Reid Ponte, P. (2022)

APRN’s in Georgia has restrictive prescriptive authority

In Georgia, where I live, APRNs are limited in the number of refills that can be ordered for a prescribed medication. NPs can prescribe up to schedule III-V drugs (like Tylenol with codeine, Xanax, and analgesics)—this requires physician authorization. Schedule II drugs, such as Hydrocodone, can not be prescribed by an APRN (Smith, 2024).

An APRN’s practice and prescriptive authority may comply with the regulations that may guide the legally practiced laws for thStateate. For example, if you practice in Georgia and know that you are not permitted to prescribe a schedule II drug such as Hydrocodone while practicing in person there, do not violate the law of Georgia (where your patient is located) by issuing a prescription for the same just because you have been used to prescribing Schedule II drugs in person when practicing in Maryland. Violating a state law and practicing out of your Scope of practice in another state will result in you facing penalties that can lead to having your license suspended or revoked.

References

Phillips, S. J. (2024). 36th Annual APRN Legislative Update: Improving practice scope and authority, statute at a time. Nurse Practitioner, 49(1), 21-46–46. https://doi.org/10.1097/01.NPR.0000997664.36722.49

Become advocates for full practice authority in Georgia. (2022). Nurse Practitioner, 47(1), 11. https://doi.org/10.1097/01.NPR.0000812808.84684.b8

Reid Ponte, P. (2022). Full Practice Authority for APRNs to Meet the Needs of Underserved Communities: An Interview With Monica O’Reilly-Jacob. Journal of Nursing Administration, 52(9), 445-446–446. https://doi.org/10.1097/NNA.0000000000001179

Phillips, S. J. (2021). 33rdAnnual APRN Legislative Update: Unprecedented changes to APRN practice authority in unprecedented times. Nurse Practitioner, 46(1), 27-55–55. https://doi.org/10.1097/01.NPR.0000724504.39836.69