An Analysis of APN Practice Regulations Paper

An Analysis of APN Practice Regulations Paper

An Analysis of APN Practice Regulations Paper

Advanced practice nurses (APNs) play a vital role in the healthcare system, providing specialized care, improving patient outcomes, and filling gaps in primary care. However, the scope of practice and regulatory frameworks for APNs vary across states due to varying regulations established by state-level nursing boards (Boehning & Punsalan, 2023). The National Council of State Boards of Nursing recognizes the importance of harmonizing APN scopes of practice to enhance the mobility of APNs and address the growing demand for healthcare services by the general public. This paper aims to analyze and compare the APN practice regulations in Arizona and New Jersey, exploring the similarities and differences in their respective approaches.

Background

The regulation of advanced practice nurses (APNs) in Arizona and New Jersey has evolved, resulting in distinct backgrounds for APNs in each state. In Arizona, the Arizona State Board of Nursing (AZBN) was established in 1952 as The State Board of Nursing Registration and Nursing Education, and the name was later changed in 1964. It was responsible for regulating APNs in 1979, initially focusing on nurse practitioners (NPs) (Arizona State Board of Nursing, 2023). Subsequently, in 1994, the AZBN expanded its regulatory scope to include clinical nurse specialists (CNSs). On the other hand, in New Jersey, the New Jersey Board of Nursing (NJBN) was established in 1912 and began regulating APNs in 1987, with NPs being the first group of APRNs to be licensed. The regulation of CNSs followed suit in 1995

Advanced Practice Nurse Requirements and Board Certification

Advanced practice nurses (APNs) are highly skilled registered nurses (RNs) who have received advanced education and training in a specific area of nursing practice. APNs may specialize as nurse practitioners (NPs), clinical nurse specialists (CNSs), or nurse anesthetists (CRNAs). Individuals must obtain national certification from a recognized certifying body to practice as an APN (Wheeler et al., 2022). The most commonly recognized certifying bodies for APNs include the American Nurses Credentialing Center (ANCC), the American Academy of Nurse Practitioners (AANP), and the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). National certification is a prerequisite for APN licensure.

Aspiring APNs must apply to the relevant state nursing board where they wish to practice to obtain an APN license. While specific requirements for APN licensure vary by state, they generally include possessing a current RN license, national certification, proof of education and training, and a passing score on the APN licensure exam (Wheeler et al., 2022). APN licenses are typically valid for two years and must be renewed regularly. Renewal involves completing a designated number of continuing education credits and paying a renewal fee.

Individuals who want to become an APN in Arizona must hold a Master’s degree in nursing (MSN) from an accredited program, possess national certification from bodies like the ANCC, and complete 500 hours of supervised clinical practice in the intended APN role. Additionally, a pharmacology course with at least 45 hours of instruction in the clinical management of drug therapy is required (Arizona State Board of Nursing, 2023). In contrast, becoming an APN in New Jersey requires an MSN degree from an accredited program, national certification, and completion of a post-master certificate program in advanced practice nursing. The certificate program entails at least 30 credits covering pharmacology, clinical assessment, and advanced practice nursing theory. Furthermore, individuals must have completed 750 hours of supervised clinical practice in their intended APN role.

Collaborative Agreements

In some states, APNs may need to establish a collaborative agreement to exercise prescriptive authority. Zhang and Patel (2021) define a collaborative agreement as a legal document that allows APNs to prescribe medications under the supervision of a licensed physician. The specific requirements for collaborative agreements differ from state to state but involve a signed agreement between the APN and the physician, copies of the APN’s national certification and state license, and copies of the physician’s state license.

In Arizona and New Jersey, Advanced practice nurses (APNs) who possess the authority to prescribe medications must have a collaborative agreement with a licensed physician in their respective states. This agreement must be in writing and signed by the APN and the physician (Zhang & Patel, 2021). Additionally, it needs to be renewed every two years. The collaborative agreement in Arizona must include specific details such as the names and contact information of the APN and the physician, the scope of practice for the APN, the availability of the physician for consultation, the communication process between the APN and the physician, and the process for reviewing and updating the agreement.

Similarly, in New Jersey, the collaborative agreement should contain the names and contact information of the APN and the physician, the scope of practice for the APN, the availability of the physician for consultation, the communication process between the APN and the physician, the process for reviewing and updating the agreement, the APN’s obligation to inform the physician of any changes in their practice, and the APN’s commitment to maintaining a copy of the agreement in their practice setting.

Prescriptive Authority

Advanced practice nurses (APNs) who possess prescriptive authority can prescribe medications to patients in Arizona and New Jersey. However, the extent of their prescriptive authority is contingent upon their specific license type and the regulations established by the state in which they practice. In Arizona, APNs with prescriptive authority enjoy a broad range of prescribing privileges. They are authorized to prescribe all categories of medications, which include Schedule II controlled substances (Zhang & Patel, 2021). Notably, they are not obligated to maintain a collaborative agreement with a physician, although it is encouraged for optimal patient care.

On the other hand, New Jersey imposes certain limitations on the prescriptive authority of APNs. APNs with prescriptive authority in this state are permitted to prescribe medications; however, they are prohibited from prescribing Schedule II controlled substances (Zhang & Patel, 2021). APNs in New Jersey must establish and maintain a collaborative agreement with a physician to prescribe any medications. As more states acknowledge the value of APNs and their capacity to deliver high-quality and cost-effective care, the extent of their prescriptive authority will continue to expand.

State Differences in Practice

In Arizona, advanced practice nurses (APNs) enjoy full practice authority, allowing them to practice independently without physician supervision. They are authorized to diagnose, treat, and prescribe medication for patients in all healthcare settings, such as hospitals, clinics, and private practices (Arizona State Board of Nursing, 2023). In contrast, APNs in New Jersey have limited practice authority. Although they can diagnose and treat patients, they must establish a collaborative agreement with a physician to have prescription privileges (Cadmus et al., 2020). This collaborative agreement must be renewed every two years, highlighting the ongoing need for physician involvement in prescribing medications. Beyond variations in practice authority, there are additional state-specific requirements for APNs in Arizona and New Jersey. For instance, APNs practicing in Arizona must hold a master’s degree in nursing, while APNs in New Jersey are expected to possess a doctorate in nursing.

APNs Restrictions Between the Two States

APRNs enjoy full authority in Arizona, allowing them to practice independently without physician supervision. This autonomy allows them to diagnose patients, provide treatment, and prescribe medications across various healthcare settings such as hospitals, clinics, and private practices. On the other hand, New Jersey has imposed limitations on APRNs’ practice authority. While they can diagnose and treat patients, APRNs in this state must establish a collaborative agreement with a physician to prescribe medications (Cadmus et al., 2020). This agreement is required to be renewed every two years, ensuring ongoing collaboration between APRNs and physicians. Beyond the differences in practice authority, Arizona and New Jersey may also diverge in their education, certification, and licensing requirements for APRNs. In Arizona, APNs are mandated to hold a master’s degree in nursing; in New Jersey, a doctorate in nursing is required for APRN licensure.

Hospital Privileges

Advanced practice nurses (APNs) have the opportunity to obtain hospital privileges by going through the hospital’s credentialing process in Arizona. This process encompasses several steps, including submitting necessary documentation such as education records, certification details, and relevant experience (Wheeler et al., 2022). Additionally, APNs are required to undergo a background check. Once the hospital grants APNs hospital privileges, they are allowed to practice independently within the boundaries defined by their license and the policies and procedures of the hospital.

Moving on to New Jersey, APNs in this state also have the option to seek hospital privileges through the hospital’s credentialing process. However, there is a distinct requirement that sets New Jersey apart. APNs in this state must establish a collaborative agreement with a physician to be eligible for hospital privileges. This collaborative agreement needs to be approved by the medical staff at the hospital (Wheeler et al., 2022). Once the APN has been granted hospital privileges, they are empowered to practice independently within the limitations specified by their license, the terms of the collaborative agreement, and the policies and procedures of the hospital. It is worth noting that in Arizona and New Jersey, APNs granted hospital privileges are generally expected to participate in ongoing professional development through continuing education. Additionally, their practice undergoes periodic reviews to ensure the quality and efficacy of their care. These measures help maintain the standards and competency of APNs within the hospital setting.

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Nursing Compact

The nurse licensure compact (NLC) is an interstate compact designed to facilitate the practice of advanced practice nurses (APNs) across multiple states. By participating in the NLC, APNs can practice in other NLC states without obtaining a separate license for each state. Currently, 30 states, including Arizona and New Jersey, are part of the NLC. APNs must fulfill certain requirements to be eligible for participation in the NLC (American Nurses Association, 2021). First, they must be licensed as APNs in their home state. Additionally, they must hold a current national certification. Furthermore, APNs must pay a one-time application fee and an annual renewal fee.

Once the APN meets these requirements, they can apply for a multistate license through the NLC website. Upon approval, the NLC will issue a multistate license to the APN, enabling them to practice in all participating states. The NLC offers significant advantages to APNs who desire to practice in multiple states. By eliminating the need to obtain separate licenses for each state, the NLC saves APNs time and money (American Nurses Association, 2021). It also simplifies finding employment in different states, as APNs can readily expand their practice without the burdensome licensing procedures that would otherwise be required.

Palliative/End-of-Life Care for APN

Advanced practice nurses (APNs) are responsible for palliative and end-of-life care in Arizona. They are authorized to provide comprehensive care, which includes managing medications, addressing pain and symptom management, and offering counseling services (Wheeler et al., 2022). APNs in Arizona also have the authority to pronounce death and sign death certificates without needing a collaborative agreement with a physician. This autonomy allows them to deliver essential care and support to patients and their families during this sensitive time.

Similarly, APNs in New Jersey have a vital role in palliative and end-of-life care. They possess the necessary skills and expertise to handle various aspects of care, such as medication management, pain and symptom management, and counseling. However, unlike in Arizona, APNs in New Jersey must establish a collaborative agreement with a physician to pronounce death and sign death certificates (Wheeler et al., 2022). This requirement ensures that APNs work in close partnership with physicians while still being able to deliver comprehensive care to patients.

In Arizona and New Jersey, APNs specializing in palliative and end-of-life care are instrumental in providing comfort and support to patients and their families. They collaborate closely with patients, families, and other healthcare providers to ensure that individuals receive the necessary care to live as comfortably as possible during their final days. By addressing physical and emotional needs, APNs contribute significantly to enhancing the quality of life for patients nearing their journey’s end while offering guidance and solace to their loved ones.

Conclusion

 The regulations regarding advanced practice nurse practice vary between Arizona and New Jersey. While Arizona allows APNs to practice independently and prescribe all categories of medications, New Jersey imposes certain restrictions on the prescription authority of its APNs. Both states, however, require APNs to hold a master’s or doctorate in nursing and obtain national certification. Furthermore, Arizona and New Jersey require APNs to collaborate with a physician to exercise prescriptive authority. Lastly, APNs in both states are integral to palliative and end-of-life care, providing comfort and support to patients and their families.

 References

American Nurses Association. (2021, April). Interstate nurse licensure compact. ANA. https://www.nursingworld.org/practice-policy/advocacy/state/interstate-nurse-compact2/

Arizona State Board of Nursing. (2023, February 12). Advanced practice faqs | Arizona state board of Nursing. Www.azbn.gov. https://www.azbn.gov/licenses-and-certifications/advanced-practice-faqs

Boehning, A. P., & Punsalan, L. D. (2023). Advanced practice nurse roles. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK589698/

Cadmus, E., de Cordova, P. B., Weaver, S., & Ravichandran, A. (2020). Access to care in new jersey: Making a case for modernizing legislation. Journal of Nursing Regulation, 11(1), 36–41. https://doi.org/10.1016/s2155-8256(20)30059-4

Wheeler, K. J., Miller, M., Pulcini, J., Gray, D., Ladd, E., & Rayens, M. K. (2022). Advanced practice nursing roles, regulation, education, and practice: A global study. Annals of Global Health, 88(1). https://doi.org/10.5334/aogh.3698

Zhang, P., & Patel, P. (2021). Practitioners and prescriptive authority. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK574557/

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Assigned State: Arizona

In this scholarly paper, you are assigned a U.S. State (Arizona) and will write relevant APN statutes from the Nurse Practice Act and APN Rules and Regulations. You will compare practice environments between your assigned state and New Jersey.

Template Sample

Introduction

A brief overview of the paper- What will you discuss in this paper? Relevant factors could be the history of the APN role, APN allows for more care, etc. Purpose of the paper/assignment- Why are you writing this paper?

Background

Background of your assigned state for an APN compared to New Jersey as an APN (how did it come to be? )

Advanced Practice Nurse Requirements

Discuss board certification comparing the two states (what is required to sit for the certification exam? Education courses, clinical hours, etc.

Discuss requirements for renewal for APN license and certification

Discuss/analyze the collaborative agreements in both states

Discuss/analyze the prescriptive authority in both states

State Differences in Practice

Analyze restrictions for APRNs between the two states (such as practice independent, dependent, prescriptive authority, etc.)

Analyze hospital privileges and how it works in each state for an APN (what does an APN have to do to get privileges at the hospital? Can APNs get privileges at a hospital?

Analyze the nursing compact for both states for an APN, not an RN

Analyze Palliative/end-of-life care for both states for an APN- What can APNs do in this clinical setting? Medications, pronouncing death, DNR, etc.)

Conclusion

Summary of the key points and highlights of the paper. THis is not a repetition of what you have discussed. What did you learn from this for your future practice?

RUBRIC FOR APRN PAPER

CRITERIA

Percent

Introduction: Brief overview of the paper topic, relevant factors are introduced, and the purpose of the paper assignment is clearly stated.

10

Provide background information for the assigned state in comparison with New Jersey

10

Discuss board certifications and renewal, analyze collaborative agreements and prescriptive authority

20

Analyze restrictions for APRN, hospital privileges, nursing compact, and palliative end-of-life care

20

Conclusion and summary of key points included in the paper

15

Efficacy of writing style, spelling, grammar, and correct use of APA 7th edition with citations. The paper is no longer than 10 pages, excluding the title/reference page excluded.

15

Valid and relevant references (APA 7th edition format) with at least 3 primary sources 5 years or less, other than your book.

10

TOTAL:100