NRNP 6675 Walden University

I’m working on a nursing discussion question and need guidance to help me learn.

Read and Reply to Responses from 2 of your classmates:

-Week 1 Topic: Certification and Licensure Plan

  • Share an insight from having viewed your colleagues’ posts.
  • Suggest additional actions or perspectives.
  • Share insights after comparing state processes, roles, and limitations.
  • Suggest a way to advocate for the profession.
  • Share resources with those who are in your state.
  • -2 paragraph response for each classmate
  • -4-to-5 sentences each paragraph
  • -APA 7

– Student #1 Response

-The Arkansas State Board of Nursing (ASBN) provides several resources for Advanced Practice Registered Nurses (APRN) and for those seeking licensure. The ASBN Update, a magazine that is published several times each year, provides articles and updates on changes that affect the nursing profession including APRNs and is available in print and online. Information on license status, laws and rules, education, licensing, forms, and advance practice is available at the ASBN website https://www.ark.org/bon/licensure/status.php.

Prior to applying for licensure as a Psychiatric Mental Health Nurse Practitioner (PMHNP), the Registered Nurse must hold a current RN license in AR or a compact state, graduate for an approved APRN program, and pass the American Nursing Credentialing Center (ANCC) PMHNP certification exam. As part of the Department of Health website, the steps to apply for APRN by initial licensure by exam are detailed (Arkansas Department of Health, 2017). After a profile is created on the Arkansas Nurse portal, the application should be complete and required documents uploaded including licensure history from www.nursys.com, a notarized statement on company letterhead that a minimum of 2000 hours was completed as a RN, educational history including graduation date, and copy of national certification. Fingerprinting, and state and federal background checks are required to be completed no more than 12 months of applying for licensure. The university will need to send the official transcript to ASBN. As verification is required of passing the certification exam, the certificating agency must mail or e-mail verification directly to ASBN. Prior to completing the certification exam, a temporary permit, which is valid for six months, may be applied for with verification of eligibility to sit for the certification exam. If verification is received of a passing the certification exam, a license will be issued. The temporary permit will be revoked if the certification exam is not passed.

In Arkansas, an APRN must be employed to apply for Prescriptive Authority as a Collaborative Practice Agreement (CPA) and Quality Assurance Plan (QA) must be submitted with the application (Arkansas Department of Health, 2017). The Collaborative Practice Agreement includes which categories of controlled substances that the APRN is allowed to prescribe and must be initialed by the collaborating physician and the APRN and the location of 24-hour emergency services (McKinney, 2021). Although there must also be a Prescriptive Protocols in place that are reviewed yearly, these should not be sent to ASBN unless requested (Arkansas Department of Health, 2017). A DEA application may be Some category of drugs that might be included in the CPA for a PMHNP in AR may include categories III-V and stimulants after initiated by physician. Suboxone training and waiver may be completed and would require a collaborative agreement. The physician also must initiate any stimulant dosage changes. DEA application may be completed after the APRN license is and Prescriptive Authority Certificate number is received. After receiving a DEA number, a copy of the card must be submitted to ASBN. Arkansas does participate in the prescription monitoring program (PMP).

I was surprised that the scope of practice in Arkansas is vague and just talks about physician collaboration, has completed national certification, and practices with advanced knowledge and skills (Buppert, 2021). A barrier to practice for APRNs in AR is that it has limited or reduced practice and requires collaborative practice (American Association of Nurse Practitioners, 2020). During the 2021 assembly, some advances were made as APRNs with 6,240 hours of practice with a collaborative agreement can now apply for full practice authority (Tedford, 2021). Also, APRNs can now be recognized as a primary care provider in AR.

References

Arkansas Department of Health. (2017). ASBN-ADV practice registered nurse initial by exam.

https://www.healthy.arkansas.gove/programs-services/topics/arsbn-adv-practice-rn-initial

American Association of Nurse Practitioners. (2020). State practice environment.

https://www.aanp.org/advocacy/state/state-practice-environent

McKinney, S. (2021, March). CPAs, QAs, and prescriptive protocols….oh my! ASBN

Update, 25(2). http://www.digitaleditiononline.co/publication/?i=699831

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.).

Jones & Bartlett Learning.

Tedford, S. (2021, May). What happened during the Arkansas general assembly of 2021?

ASBN Update, 25 (3). http://www.digitaleditiononline.com/publication/?i=707794

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-Student #2 Response

-To become an Advanced Practice Registered Nurse (APRN) in Texas, you must finish an advanced practice nursing educational program from a university or institution that is accredited to provide graduate degrees. In Texas, A PMHNP is required to have a collaborative agreement which is a written prescriptive delegation consent from a supervising physician (Young & Alton 2019). According to Young & Alton (2019), PMHNP is regulated by Texas Board of Nursing and Texas Board of Medicine and have finally eliminated the requirement that a doctor is on-site to oversee PMHNP at all times. In Texas, a nurse practitioner may prescribe drugs, devices, and controlled substances as outlined in a written practice agreement with a supervising physician (Texasscopeofpractice, 2021). In the state policy, PMHNP’s are recognized as primary care providers. Other entity as well as a managed care organization must make sure that PMHNP’s are available as primary care provider network (Scopeofpracticepolicy,2021).

There are two types of certifications, the American Nurse Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP). To get certified and licensed as an Advanced Practice Registered Nurse in Texas, all documents must be submitted together including a fee of $100 dollars for APRN license and $150 dollars for prescriptive authority are non-refundable. Texas RN license, achievement of an advanced practice nursing education program accepted through the organization and accepted through the Board that fulfills the requirements (TBON,2021). National certification as it pertains to the role and population concentration area with the advanced practice nursing practice educational training with the finishing date on the accreditation no more than four years old. Completion of 400 hours and 20 contact hours of continuing education training both in the advanced practice role within the past 24 calendar months. All these must be submitted online to with the application to the Texas Board of Nursing. The Texas state’s board of nursing website is https://www.bon.texas.gov.

The scope of practice for APRNs in Texas is the task that an individual health care professional does in the delivery of patient care. The advanced practice registered nurse’s scope of practice reflects the types of patients for whom they can care for, what procedures/activities they can perform, and influence’s ability to seek reimbursement for services offered (TBON,2021). For the APRN to be able to prescribe controlled substances in Texas, the three documents needed include an agreement with a collaborating physician, Controlled Substances Registration with the Texas Department of Public Safety (DPS) and A DEA number obtained through the Drug Enforcement Administration. According to the Texas Board of Nursing, the APRN with prescriptive authority and a DEA registration number to prescribe controlled substances are strongly encouraged to register with the PMP through the Texas State Board of Pharmacy (TSBP). A physician must delegate prescriptive authority for controlled substances to the APRN before they can order or sign a prescription. Most APRNs are limited to prescribing a 90-day supply of controlled substances Schedules 3 -5, to ages 2 years and older.

The biggest barrier for PMHNP practicing independently in Texas is restricted practice conditions for Nurse practitioners (Young & Alton 2019). Nurse practitioners with the same educational preparation and national certification may face a host of restrictions when relocating from one state to another, thus limiting their scope of practice (Peterson 2017). The differences in scope-of-practice regulations across all the states have an indirect impact on patient care, as the degree of physician supervision may affect practice opportunities and payer policies for nurse practitioners (Peterson 2017). Federal regulations also place additional barriers to nurse practitioner practice, the Primary Care Health Practitioner Incentive Act, perhaps the most important payment reform to affect nurse practitioners. Nurse practitioners can receive 100% reimbursement for the incident to services, but they cannot do so independently, thereby placing another barrier for the formation of independent practices and access to health care (Peterson 2017).

References

Peterson, M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/

Texas Board of Nursing. (2013). APRN Eligibility. Retrieved from http://www.bon.texas.gov/aprn-eligibility.asp

Texas Board of Nursing. (2013). Requirements for Texas APRN Licensure. Retrieved from https://www.bon.texas.gov/applications_advanced_practice_registered_nurse.asp

Texas Scope of Practice Policy – State Profile. (2021). Retrieved from http://scopeofpracticepolicy.org/states/tx/

Young, C., & Alton, S. (2019). Texas Nurse Practitioner Practice Authority: The Fight for FPA. Retrieved from https://www.nursepractitionerschools.com/blog/texas-np-practice-authority/

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