30 Jun Professional Nursing and State-Level Regulations The nurse practitioners role in healthcare is crucial in todays healthcare system. The first nurse practitioner role bega

PEER 1

Christina Bradford 

Discussion: Professional Nursing and State-Level Regulations

The nurse practitioner's role in healthcare is crucial in today's healthcare system. The first nurse practitioner role began in the 1960s when a shortage of primary care physicians was predicted in rural areas. This goal was to increase access to primary care in this area, where physicians were less likely to practice (Milstead & Short, 2017, p. 62). Health care in the United States is necessary; allowing advanced practice registered nurses to have full practice authority (FPA) produces many benefits. "Allowing APRNs to have FPA can improve health equity while providing care that costs patients, health care systems, and payers less money" (Bosse et al., 2017). Each state has set forth its scope of practice, so many advanced practice registered nurses are not allowed to practice to their full extent.

I reside in Georgia and plan to work in the emergency department as a nurse practitioner upon graduation. Georgia is a restricted practice state regulated by the GA Board of Nursing and the Medical Board, meaning that I would be required to practice under the nursing protocols of the supervising physician. Georgia licensure requires a graduate degree and national certification upon graduation. Nurse Practitioners in Georgia are allowed to write prescriptions for drugs that fall under the schedule III-V categories. Working in the emergency department this can cause a strain on the physicians as they would have to agree to prescribe more potent narcotics such as Norco and Percocet for traumatic injuries. I often see that the nurse practitioner may treat the patient and print out any narcotic prescriptions needed, and then the supervising physician will sign the printed prescription. Since the nurse practitioner is following a nurse protocol in the emergency room, the APRN can also order tests such as CT scans or MRIs to rule out a life-threatening emergency. In Georgia, if the APRN is practicing in a physician's office, those particular scans would have to be ordered by the physician. These steps can be time-consuming for the APRN and the patient. Another example in my setting is when a patient comes in with an obvious deformity to the wrist. The NP may start the treatment for the fracture by ordering x-rays and medications for pain. Still, if the x-ray report shows that the wrist fracture is displaced, the physician would take over care of the patient to reduce the wrist under conscious sedation. In my department, there is a lot of care collaboration among the team.

Colorado is a full practice state regulated by the Colorado Board of Nursing. Being in a full practice state means that the nurse practitioner can diagnose, treat, and manage patients without the supervision of a physician, along with prescribing medications (Medsource Consultants, 2017). Being able to prescribe schedule II-V medications does not come without additional education; however, APNs must complete 1000 hours of prescribing mentorship with a physician or another APRN and register with the DEA (Medsource Consultants, 2017).

Nurse practitioners are an integral part of the healthcare workforce. With nurse practitioners' authority to practice being restricted or limited in many states, it becomes difficult to practice to full abilities and causes inefficiencies in care. Studies have also shown that relaxing scope of practice restrictions allows nurse practitioners to practice without oversight which reduces health care spending but was also done without harming patients (Smith, 2021).

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

Medsource Consultants. (2017). A state-by-state scope of practice guide for nurse practitioners. https://www.medsourceconsultants.com

Milstead, J. A., & Short, N. M. (2017). Health policy and politics (6th ed.). Jones & Bartlett Learning.

Smith, L. (2021). The effect of nurse practitioner scope of practice laws on primary care delivery. Health Economics, 31(1), 21–41. https://doi.org/10.1002/hec.4438

Peer 2