Sample Answer for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility Included After Question
NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility
NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility
Discussion
Purpose
The purpose of this assignment is to identify the scope of practice in one’s state, including level of independence of practice, prescribing authority, any limitations of practice, process for obtaining licensure in your state, certification, and education requirements for licensure. Next, students will discuss how the level of independence of practice in their state, i.e., reduced, restricted or full practice, affects patients’ access to care in their local community.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
- Understand NP practice as defined by law (CO2)
- Determine legislation as defined by legislation, statutes and regulations (CO2)
- Identify barriers to ensuring patient’s rights (CO3)
Due Date: Wednesday by 11:59 pm MST of Week 6
Initial responses to the discussion topic must be posted by Wednesday 11:59 pm MT. Two additional posts to peers and/or faculty are due by Sunday at 11:59 pm MT. Students are expected to submit assignments by the time they are due.
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A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday of week 6, regardless of the number of days late. NOTHING will be accepted after 11:59 pm MT on Sunday (i.e. student will receive an automatic 0).
Total Points Possible: 100
A Sample Answer For the Assignment: NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility
Title: NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility
Preparing the Discussion
- Discuss your state NP community in terms of scope of practice. Include your state’s scope of practice for NPs, including:
- Level of independence of practice **In California, NPs are required to practice under Standardized Procedure Guidelines. If CA is your intended practice state, please provide details on how Standardized Procedures Guidelines are developed in California and an example of a California SPG.
- Prescribing authority
- Any limitations of practice
- Process for obtaining licensure in your state
- Certification and education requirements for licensure.
- If you live in a restricted or reduced practice state, how has patient care been impacted in your local community by these barriers? For instance, is the ED used for primary care? Are the EDs overcrowded with long wait times? Are there urgent care clinics readily available? Is there adequate access to primary care? If you live in a full practice, how has an independent practice of the APN resulted in improved patient access to healthcare?
- How does access to NPs impact any healthcare disparities?
- A scholarly resource must be used for EACH discussion question each week.
| Category | Points | % | Description |
| DISCUSSION CONTENT | |||
| Scope of practice and NP requirements | 30 | 30% | Provides relevant evidence of scholarly inquiry of their state’s NP scope of practice. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion. |
| Practice barriers and access to healthcare | 30 | 30% | Provides relevant evidence of scholarly inquiry of whether their state is a reduced, restricted or full practice state and the impact on the local community with respect to healthcare access. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion. |
| Healthcare disparities | 15 | 15% | Provides relevant evidence of scholarly inquiry of how access to NPs impacts healthcare disparities. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion. |
| 75 | 75% | Total CONTENT Points= 75 pts | |
| DISCUSSION FORMAT | |||
| Interactive Dialogue | 20 | 20% | 4 Required Elements:
|
| Grammar, Syntax, Spelling, & Punctuation | 5 | 5% | Grammar, syntax, spelling, and punctuation are accurate. |
| 25 | 25% | Total FORMAT Points = 25 pts | |
| 100 | 100% | DISCUSSION TOTAL= 100 pts |
In the state of New Jersey Nurse practitioners practice with reduced authority. You have the ability to work independently in treating patients but require a physician in order to prescribe medications through a collaborative agreement. In NJ a supervising physician is necessary in order for the NP to prescribe medications. By law the NP can assess, diagnose, order testing like labs or other diagnostics, provide end of life care, sign POLST forms, and pronounce death (New Jersey Division of Consumer Affairs, 2015).
According to Cadmus et.al. (2021) there is a serious issue with access to primary care in 13 of 21 counties in NJ and barriers to NP practice contributes to the issue. In 2010 the Patient Protection and Affordable Care act assisted 20 million people to get access to health insurance. This increased the demand for provider access as new conditions were diagnosed and much of the population now required maintenance care of chronic illnesses. For the state of NJ the existing barriers only limit NPs from practicing within the full extent of their license (Cadmus et. al., 2021). Collaboration agreements in NJ limit NP ability to practice through requirement for a physician to supervise the NP’s prescriptive authority, without actually requiring involvement of the physician in the patient’s care or a sign off.
This can impose financial burdens on the APN when contracts are broken (Cadmus et. al., 2021). Full practice authority would increase provider accessibility and reduce financial burdens on NPs. According to Cadmus et. al. (2021) it is projected through the U.S. Census Bureau from 2013 to 2025 there will be a 14.1% shortage of primary care physicians in the state of NJ. With full practice authority, NPs can open their own practices, offering more accessibility to patients and reducing the impact on emergency departments from patients seeking primary care. In New Jersey we have a few urgent care centers but with full authority access, more practices can be opened.
Prescriptive Authority
Under the supervision of a physician, they can prescribe medications (New Jersey Division of Consumer Affairs, 2015). For the prescription of dangerous controlled medications, the APN is required by law to register to apply with the Drug Enforcement Agency (DEA) and controlled and dangerous substance (CDS) to gain permission through licensure. Once the license number is obtained, the APN will apply for a DEA number. All APNs can prescribe level 2 to 5 controlled substance medications following a 6 hours course completion and application to the federal DEA. Prescription blanks with prescriber name, address, and information printed on specialized paper is required by NJ law to prevent changes to the 5 prescription once printed (New Jersey Division of Consumer affairs, 2015). In order to maintain your prescriptive authority in the state of NJ you must have a written collaborative agreement with a physician which is to be reviewed and signed each year. APNs need to keep their licensure up to date (ANA, 2023)
Educational Requirements-
It is required that a nurse practitioner graduate from an MSN program with clinical rotations. The program included a 45 hour pharmacology course that is approved by the NJ board of nursing equaling to a 3 credit graduate course that is accredited by a national accredited agency. NPs need to obtain 30 CEUs related to their choice of advanced practice scope, pharmakinetic, pharmadynamic principles of clinical application, and use of pharmacological agents in prevention of illness. The CEUs are required within 5 years of the application for prescriptive authority (New Jersey Division of Consumer Affairs, 2015).
Licensure requirements-
NJ licensure is determined through state recognition requirements. This includes having a current RN license without restrictions, nationally recognized certification, and proof of graduation from an advanced MSN or DNP nursing program. The cost of licensure is $100 non-refundable fee with a certification fee of $80/160 depending on the expiration of the RN license. RN licensure must be in good standing, with a passed criminal background check, uploaded, current fingerprints done electronically in order to complete application (New Jersey Division of Consumer Affairs, 2015).
The nursing board requires official transcripts to be submitted in order to process applications in a timely fashion. A requirement to keep the NP licensure is active certification. Proof of CEUs and practice house are needed to certify (New Jersey Division of Consumer Affairs, 2015). ach certification exam is given according to chosen specialty and the NJ board requires the highest level examination be taken. 17 certification agencies are recognized by the board of nursing and accredited. The cost of certification is $365 for non-member and $290 for members of the American Nurses Association (ANA, 2022).
How does access to NPs impact any healthcare disparities?
According to Nikpour et. al. (2022) adult patients enrolled in Medicare and Medicaid have higher rates of diseases like coronary artery disease and diabetes resulting in twice as many hospitalizations. Nikpour et. al. (2022) conducted a Nurse practitioner primary care organizational climate questionnaire with 189, 420 patients with Coronary artery disease or diabetes enrolled in Medicare and Medicaid. 470 practices in PA, NJ, CA, and FL were involved in the study.
Results reflected higher odds of hospitalization for patients living in poor environments who were dually eligible for Medicare and Medicaid (Nikpour et.al., 2022). With increasing patient conditions that require ambulatory care, primary care, and hospitalization, there will be a demand for providers. Nurse practitioners have the training and ability to fill a void for provider care and help to address health conditions worsened by disparities. States that reduce the NPs ability to practice at full authority have higher incidences of health care disparities (Nikpour et. al., 2022).
References:
American Nurses Association (2022). Advanced Practice. https://www.nursingworld.org/advancedpractice.
American Medical Association. (2021). State Law Chart: Nurse Practitioner Prescriptive Authority.
https://www.ama-assn.org/system/files/2020-02/ama-chart-np-practice-authority.pdf
Cadmus, de Cordova, P. B., Weaver, S., & Ravichandran, A. (2020). Access to Care in New Jersey: Making the Case for Modernizing Legislation. Journal of Nursing Regulation, 11(1), 36–41. https://doi.org/10.1016/S2155-8256(20)30059-4
New Jersey Division of Consumer Affairs (2015). Advanced Practice Nurse Certification.
https://www.njconsumeraffairs.gov/nur/Pages/APN-Certification.aspx. Assessed 06/8/2023
Nikpour, Brom, H., Mason, A., Chittams, J., Poghosyan, L., & Carthon, M. B. (2022). BETTER NP PRACTICE ENVIRONMENTS REDUCE HOSPITALIZATION DISPARITIES AMONG DUALLY ENROLLED PATIENTS. Innovation in Aging, 6(Supplement_1), 64–65. https://doi.org/10.1093/geroni/igac059.257
Excellent work and thank you for sharing more about your state laws surrounding NP’s practice. Please take a look at this clip and share your thoughts, why is it that so many states require physician oversight? Great work.
I found the video clip helpful in presenting the point of view of some nurse practitioners, especially regarding team care. I do feel that physicians already have an egotistical viewpoint of education in comparison with nurses or nurse practitioners. Many physicians still view nurses as below them to the point they may not value the opinion of the nurse regarding patient care.
I feel that physicians are our biggest resistance when it comes to passing any bills related to full authority. If you look at the article from the AMA (2020) you will notice numerous reasons for why a nurse practitioner should not be able to practice with full authority. The American Medical Association is indeed an association of physicians who produced the article “3 Big Reasons Why Letting NPs Practice Independently is a Bad Idea.” According to AMA (2020) the AMA is strongly urging California governor Gavin Newsom to veto the A.B.890 bill to allow NPs to practice independent of supervision. Biggest Resistance! The AMA feels that patients with chronic conditions require a physician to lead the primary health care team to benefit. Although they do feel that NPs are an important part of the healthcare team, it is unsafe for an NP to be the leader of the team, mainly because they do not undergo the 10,000 to 16,000 hours of medical training received by physicians (AMA, 2020).
According to AMA (2020) health care costs will be increased due to NPs prescribing more opioids and diagnostic tests, with Medicare claims from 2003 to 2015 showing x-ray ordering increased to over 400% among non-physicians. Just to be clear I do not agree with their claims or reasoning but wanted to show that this is the resistance we face in the remainder of states trying to gain independence from supervision of physicians. I think the main issue physicians feel threatened by is the fear that patients will seek out NP providers in place of physicians, therefore, potentially decreasing the number of patients they have access to. Although this is a possibility, it is not a reality and patients could benefit from both providers depending on the nature of their condition.
Reference:
American Medical Association (AMA). (2020). 3 Big Reasons Why Letting NPs Practice Independently is a Bad Idea. [Internet] Retrieved from hhtps://www.ama-assn.org