Discussion: Professional Nursing and State-Level Regulations

Professional Nursing and State-Level Regulations
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Professional Nursing and State-Level Regulations
Introduction
A licensed nursing practitioner in Alaska has full prescriptive authority. A licensed nursing practitioner in Indiana requires a collaborative practice agreement with a supervising medical professional to prescribe some levels of medication. In Colorado, a nurse receives full prescriptive authority after completing 1000 hours under provisional prescriptive authority. Accruing the 1000 hours is done under the supervision of a physician or a mentoring NP. In California, a nursing practitioner requires a physician or surgeon’s supervision to prescribe medication or medical devices. These instances highlight the regulations the Board of Nursing in different states impose on nurses.
While nursing education programs are standardized in the country, different states have imposed regulations on how those nurses can practice. The reasons for the different regulations are pertinent to the state. CITATION AAN20 \l 1033 (AANP, 2020) broadly defines three practice authority statuses nationwide: full practice, reduced practice, and restricted practice. Full practice states allow all NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, initiate and manage treatments, including prescribing medication CITATION AAN20 \l 1033 (AANP, 2020). States imposing reduced practice on NPs require them to engage in at least one element of NP practice. The state law requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care or limits the setting or scope of one or more elements of NP practice CITATION AAN20 \l 1033 (AANP, 2020). For the states that have imposed restricted practice, licensure law restricts a nurse practitioner’s ability to engage in at least one element of NP practice. State requires supervision, delegation, or team-management by an outside health discipline in order for the NP to provide patient care CITATION AAN20 \l 1033 (AANP, 2020).
State Practice Environment
Source: CITATION AAN20 \l 1033 (AANP, 2020)
How key regulations may impact nursing practice
CITATION Nef18 \l 1033 (Neff, et al., 2018)noted that people living in states with independent NP regulations had a <30 minutes’ drive to their primary healthcare practice. Additionally, in states with restrictive NP practice, NPs are geographically collocated with supervising MDs CITATION Nef18 \l 1033 (Neff, et al., 2018). These two observations highlight the extent to which regulations impact nursing practice. With more independent NPs, patients have to travel less to access healthcare. With more restrictive environments, NPs are collocated with supervising MDs and hence not only do the regulations increase the distance traveled by patients to access healthcare but also indirectly limit the access to quality healthcare to those who lack access to primary healthcare providers. Therefore, r...