First

Comparison of Virginia, Maryland and District of Columbia APRN Regulations

     The region of Virginia in which I live is locally known as “the DMV” (the abbreviation for District/Maryland/Virginia). It is common for many practitioners to live in one jurisdiction and practice in another. For this reason, I chose to compare the three jurisdictions.

     According to the American Association of Nurse Practitioners, an APRN’s practice is restricted in Virginia. However, in the District and Maryland, APRNs may practice to their full scope of education and experience. Two differences I noted were in regulating agencies and in prescriptive authority. In Virginia, APRNs are regulated jointly by the Board of Nursing and the Board of Medicine. In contrast, in the District and Maryland, the respective Boards of Nursing are the only regulatory agencies.

     Regarding prescriptive authority, in Virginia, in order for a nurse practitioner (other than a nurse anesthetist or midwife) to have autonomy in practice, one must have practiced in a restricted capacity for at least five years (9000 hours). Also, nurse practitioners may only prescribe Schedule II – V medications in partnership with a physician. In the District, APRNs have full prescriptive authority (DC Health), and in Maryland, full prescriptive authority includes prescribing medical marijuana (Maryland Board of Nursing).

     Loversidge (2019), in addressing the regulation of Advanced Practice Registered Nurses (APRNs), proffered that it “has been inconsistent because…states [have] the right to establish laws governing professions and occupations” (p. 65). As a note of interest regarding practicing

RNs, the District does not participate in the Nursing Licensure Compact either, and an RN that wants to practice in DC must obtain a separate DC-specific license. In a region as geographically close as the DMV, especially during health-related crises, collaboration among the three regions Boards of Nursing could allow for scope expansion of a Virginia-licensed APRN. In the meantime, it is essential for APRNs crossing borders into other jurisdictions to familiarize themselves with the regulations of each in order to adhere to both prescriptive authority and other regulations.

References

American Association of Nurse Practitioners. Retrieved September 28, 2020, from https://www.aanp.org/advocacy/state/state-practice-environment

DC Health, Nursing Regulations, Nurse Practitioners. Retrieved September 28, 2020, from

https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Chapter%2059%20Nurse-Practitioners.pdf

Loversidge, J.M. (2019). Government response: regulation. In J. A.Milstead, & N. M. Short (Eds.), Health policy and politics: A nurse’s guide (6th ed., pp 57-86). Burlington, MA: Jones & Bartlett Learning

Maryland Board of Nursing Scope and Standards of Practice. Retrieved September 28, 2020, from http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.03.htm

Virginia Department of Health Professions Board of Nursing. Retrieved September 28, 2020, from https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePractitioners.pdf

Second 

 APRN Board of Nursing Regulations in Texas and Florida.

Most states in the U.S of America have similar and different regulations to govern APRN in their practice acts because of the complexity of the health care system. According to Milstead & Short (2019), “Regulation means to control over something by rule or restriction, and health professions regulation is needed as a mechanism to protect the interest of the public safety (p. 60). Each states Board of Nursing in the U.S put in place regulations to protect the public of interest because of the potential risk for harm so that APRN can be held accountable and responsible of any rules that are outline in the practice acts. In Texas, to renew APRN license, applicant must completed an APRN educational program, attest to having a minimum of 400 hours of current practice within the preceding biennium, and attest to being in compliance of continuing competency and APRN with prescriptive authority (Office of the Secretary of States, n.d). In Texas, APRN with full valid prescription authorization number can obtain authority to order or prescribe control substance in Schedule II, III through V. Prescription for controlled substance in Scheduled III through V including refill of the prescription shall not exceed 90 days’ supply, beyond the initial 90 days the refill prescription cannot be authorized, and prescription of the controlled substance in Schedule III through V for child less than two years of age can not be authorize prior to consultation with delegating physician and notation of consultation in the patient’s chart (Office of the Secretary of States, n.d). This regulation enables the APRN to follow the guidelines when prescribing certain categories of control substance.

In Florida, to renew APRN license, the applicant must prescribe up to 30 hours of continuing education biennially as a condition for renewal of a license or certificate, must complete at least 3 hours of continuing education on the safe and effective prescription of controlled substances, and complete a 2-hour continuing education course on human trafficking. In Florida, APRN has been granted legal authority to prescribed drugs listed as controlled substance subject to approval by their supervising Practioner, will need mid-level Practioner DEA registration, APRN cannot prescribe more than 7-day supply of Schedule II control substance except the APRN is a psychiatric nurse who only can prescribe 7-day supply of Schedule II controlled substance that is mental health drugs, and ARNPs who are not psychiatric nurses cannot prescribe psychiatric mental health controlled substances for children younger than 18 years of age (Akerman LLP – Health Law Rx, 2016).

Regulations for Advance Practice Registered Nurse (APRNs): Legal Authority to      Practice

American Health care delivery system is face with so many complex issues which requires adequate access to health care for positive health outcome. There is a barrier to health delivery because of shortage of health care providers in the U.S and these are affecting millions of Americans to seek health care at their convenient time. Every year, foreign immigrants, people living in rural areas, lower-middle class citizen find it difficult to access health care due to race, color, ethnicity, nationality, sexual orientation or socioeconomic status. Granting APRN full legal authority to practice without limitation can help resolve the issue of the barriers facing health care delivery system in the U.S. Some states allow APRNs to practice independent without physician supervision to lessen the high demands of their health care delivery system while other states are still deliberately on the issue. In 2017, 15 states report that NPs are regulated solely by a BON and have independent scope of practice and prescriptive authority without physician supervision, delegation, consultation, or collaboration… (Milstead & Short, 2019 p.63). If an APRN with full legal right to practice moved to another states with limitation, the APRN must abide to the regulations of the new states when it comes to renewal of license and prescription of some categories of control substance. For example, Texas regulation requires APRN to obtain authority to prescribe control substance in Schedule II, III through V, the APRN with legal right to practice independently must abide to the rules of Texas with no exception to the law because the APRN is within the jurisdiction of the new states.

                                                References

Akerman LLP – Health Law Rx. (2016). Deciphering Florida’s New Laws on ARNP and PA Controlled Substance Prescribing. Retrieve from: https://www.jdsupra.com/legalnews/deciphering-florida-s-new-laws-on-arnp-25553.

Milstead, J & Short, N. (2019). Health Policy and Politics: A Nurse’s Guide. Government Response: Regulation. p. 60, 63, 6th edition. Burlington. MA. Jones & Bartlett Learning.

Office of Secretary of States. (n.d). Texas Administrative Code. Retrieve from: https://texreg.sos.state.tx.us/public/readta1c$ext.ViewTAC?tac_view=3&ti=22&pt=11

 PLEASE FOLLOW THE INSTRUCTIONS BELOW

5 REFERENCES

ZERO PLAGIARISM

Is there a difference between “common practice” and “best practice”?

When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.

Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.

Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.

To Prepare:

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course. 
• Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
• Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
• Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: Identifying Research Methodologies

After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

• The full citation of each peer-reviewed article in APA format.
• A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
• A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
• A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
• A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selec

Discussion: Importance of Strategic Planning Framework

Module 1 discusses the importance of model or framework as it relates to strategic planning. As we progress, you will see that there are many theories that may be used to address health concerns and each has its benefits and limitations. Respond to the following questions:

1. Discuss the importance of framework in relation to strategic planning.
2. How do you decide which theories/frameworks to use when developing a program?
3. What things can go wrong when a framework is not applied?

Begin reviewing and replying to peer postings/responses early in the week to enhance peer discussion. See the rubric for participation points. Participate in the discussion by asking a question, providing a statement of clarification, providing viewpoints with a rationale, challenging aspects of the discussion, or indicating relationships between two or more lines of reasoning in the discussion. Always use constructive language, even in criticism, to work toward the goal of positive progress.

Peer 1

Topic 1:  Causes of Death

The CDC’s website makes data available for different causes of death, and some studies break it down by ethnicities.   According to to data from the National Vital Statistics System, in 1999 there was a gap in life expectancy between white and black ethnicities, with white people living an average of 5.9 years longer than their African-american counterparts (cdc.gov, 2020).  

It appears that the last time data was published for this statistic was in 2013, and at tht time, the gap had decreased to 3.6 years between the two groups.  

            The decrease is attributed to a decrease in death rates in the black population from “heart disease, cancer and HIV disease (cdc.gov, 2020).”  This tells me that there is hope, but still a lot of work needs to be done.  Putting this in years, the average white person can expect to live 79.1 years, and the average black person may expect to live 75.5 years (cdc.gov, 2020).  Those years in the gap are probably important to most actual people.  Many of the issues explored by the Healthy People 2030 Project regarding Social Determinants of Health have some influence on life expectancy.  For example, for my aggregate in this class project, 2/3 are African American. (I am referring to the 3 people we may use to gather data.)  Proportionately, I have not done a database search by ethnicity on the free clinic’s patients, because the software is cheap and does not allow this, but I suspect that one ethnicity is represented more than another, based on the day to day patient loads I’ve seen.  

            The nursing workforce may have some impact on these trends in many ways.  Political activism and providing volunteer services to the community within one’s scope of practice are two ways, off the top of my head, that we may help to change this discrepancy.

References

Centers for Disease Control and Prevention, (2020).  Leading Causes of Death Contributing to Decrease in Life Expectancy Gap Between Black and White Populations: United States, 1999-2013.  Retrieved from https://www.cdc.gov/nchs/products/databriefs/db218.htm

U. S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, (2020).  Healthy People 2030:  Social Determinants of Health.  Retrieved from https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Peer 2

Topic 2: Responsibilities of a Nurse

Bachelor prepared nurses are important to the delivery of care and the coordination of care. They possess a broad knowledge base for healthcare delivery. In contrast, the Master of Science in Nursing (MSN) degree prepares at the specialty level. The MSN prepared nurse has education in a specialty field. A Nurse Practitioner (NP) is prepared at this level. The advanced practice nurse or NP is a licensed professional that is prepared at the master’s or doctorial level for advanced nursing practice and leadership roles in a community (Stanhope & Lancaster, 2020). These nurses use their critical thinking skills along with the nursing process to achieved specific health outcomes. They are autonomous and frequently work independently in clinics. There are many NPs in my community. They work in primary care clinics with patients of all ages. They are utilized as physician extenders at the local community hospital. Along with the strategic location of community health care clinics in my community, the NPs provide increased access to healthcare. In the state of Georgia, an NP can work independently, diagnose and write prescriptions. They can also order labs and diagnostic studies. To becomes an NP in the state of Georgia, one must hold an unrestricted Registered Nurse license, be a graduate of an accredited MSN program, and pass the National NP Certification exam (American Association of Nurse Practitioners [AANP], 2020). NPs are valuable to healthcare delivery because they treat the sick and they work to promote wellness. In my experience, nurses are prepared to be excellent educators. When I have had to visit an NP, I generally receive very in-depth teaching unlike when I see a physician.  

References: 

American Association of Nurse Practitioners. (2020). The path to becoming a Nurse Practitioner (NP). Retrieved November 16, 2020, from https://www.aanp.org/news-feed/explore-the-variety-of-career-paths-for-nurse-practitioners 

Stanhope, M., & Lancaster, J. (2020). Public health nursing: Population-centered health care in the community (10 th ed.). Elsevier. https://doi.org/https://digitalbookshelf.southuniversity.edu/#/books/9

Write a full 1-2 page paper with references…

What is the number 1 illegal drug?

What groups use it the most?

What are the harmful effects?

What are the potential benefits? Who do they benefit?

Should it be legalized? If so, in what capacity?

Look up the new Florida laws-what are they?

 Re: Topic 3 DQ 1

Great post Alyssa. Advance directives are established to guide decision-making in times when patients are unable to make rational, effective, and abiding decisions for their healthcare (Tjia et al., 2018). Thus, it is essential for nurses to inform critical care patients on the need for advance directives to help in decision making in their future. In the absence of advance directives, the ethics committee becomes necessary in making important decisions for the patient. The engagement of the committee is important in ensuring that patients’ rights are respected in the provision of care and that their healthcare needs are addressed adequately and effectively.

References

Tjia, J., Dharmawardene, M., & Givens, J. L. (2018). Advance directives among nursing home residents with mild, moderate, and advanced dementia. Journal of Palliative Medicine, 21(1), 16-21. https://doi.org/10.1089/jpm.2016.0473

Hi I need to reply to this post, can you help me with it?

Compilation

Summarize, in 3-4 pages, this assignment that provides information from Weeks 1 to 4.

In addition to the work you completed in the last four weeks, your assignment should also:

• Include an introduction and a conclusion.
• Describe the role of nursing informatics.
• Explain how nursing informatics or technology in health care will help or hinder your leadership.
• Support your responses with examples.

On a separate references page, cite all sources using APA 7 format. 

•Please note that the title and reference pages should not be included in the total page count of your paper.

Submission Details

Name your document SU_NSG4029_W5_Project_LastName_FirstInitial.doc.

Advocating for the Nursing Role in Program Design and Implementation

In a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions:

• Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
• Who is your target population?
• What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
• What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
• What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
• Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

How has nursing evolved since you graduated from your original nursing program? Is nursing today what you expected when you enter nursing education?

I don’t have a research question yet. Someone help!