Discussion Board Response
Prepare a discussion board response for two posts below.
Discussion board#1
Compare and contrast two (2) Nurse Practice Acts addressing the following:
Identify each state:
The two states that will be compared are Kentucky and Tennessee.
Outline the APRN Title:
Kentucky – Advanced practice registered nurse (APRN) is a registered nurse who is licensed to engage in advance practice registered nursing pursuant to KRS 314.042 and certified in at least one population focus, such as certified nurse practitioner, certified registered nurse anesthetist, certified nurse midwife, or clinical nurse specialist, (Kentucky Board of Nursing, 2023).
Tennessee – Advanced practice nurse (APN) in Tennessee is a licensed registered nurse who has a master’s degree or higher in a nursing specialty and has a national specialty certification as a nurse practitioner, nurse anesthetist, nurse midwife, or clinical nurse specialist, (Tennessee Board of Nursing, 2023). The four recognized categories for advanced practice nurses are Clinical Nurse Specialist, Nurse Anesthetist, Nurse Midwife, and Nurse Practitioner, (Tennessee Board of Nursing, 2023).
Discuss the APRN Scope of Practice including prescriptive authority:
The scope of practice is used to describe the services that a qualified health professional is deemed competent to perform and to undertake while keeping within the terms of their professional license, as well as the who, what, where, how, when, and why of nursing practice, (American Nurses Association, n.d.). The scope of practice is the legal authority for the regulation of a professional to practice, i.e., it sets certain boundaries, (Kentucky Board of Nursing, 2023). Kentucky is a reduced practice state, which means the state practice and licensure laws reduce the ability of nurse practitioners to engage in at least one element of their practice, (Kentucky Board of Nursing, 2023). The legal scope of practice includes prescribing treatment, drugs, devices, and ordering diagnostic tests, (Kentucky Board of Nursing, 2023). Prescribing of drugs is defined and limited by statute, (Kentucky Board of Nursing, 2023). APRNs can prescribe medications, but they have to follow the KRS in which the medication is categorized in, such as certain scheduled drugs can only be prescribed in limited quantities, (Kentucky Board of Nursing, 2023).
Tennessee is a restricted practice state, which means state and licensure laws restrict the ability of nurse practitioners to engage in at least one element of practice, (Tennessee Board of Nursing, 2023). This state does require nurse practitioners to be supervised by a physician and defines the supervising physician are a licensed and actively practicing physician who has accepted the responsibility for supervising nurse practitioners, (Tennessee Board of Nursing, 2023). This supervising physician must be available at all times to the NP for consultation, must have experience or expertise in the same area as the NP, and a written protocol must be in place and outline acceptable standard of patient care, (Tennessee Board of Nursing, 2023). Once every ten business days, the supervising physician has to review the NP’s charts if medically indicated, when a controlled substance has been prescribed, or if requested by the patient, (Tennessee Board of Nursing, 2023). NPs are allowed to prescribe medications with physician supervision and after a required certification process is completed by the NP, (Tennessee Board of Nursing, 2023).
List the APRN education requirements:
Kentucky – The Kentucky Board of Nursing requires a registered nurse to complete a post-basic nursing education program and must hold either a master’s degree or post-mater’s certificate from a college or university that awards APRN credits, (Kentucky Board of Nursing, 2023).
Tennessee – The Tennessee Board of Nursing requires a registered nurse to obtain a graduate degree in a nurse practitioner role, (Tennessee Board of Nursing, 2023).
Describe required national certification:
Kentucky – A current national certification recognized by the Kentucky Board of Nursing must be obtained. National Board Certification and Recertification for Nurse Anesthetists, America Midwifery Certification Board; Certified Nurse Practitioner in Acute and Primary Care for Adults, Adult Gerontology Acute and Primary Care, Adult Psych Mental Health, Family, Gerontological, Neonatal, Pediatric Acute and Primary Care, Psych Mental Health Across the Lifespan, and Women’s Health; Clinical Nurse Specialist in Acute Care Across the Lifespan, Adult, Adult Gerontology, Adult Psych Mental Health, Child/Adolescent Psych Mental Health, Gerontology, Neonatal, Pediatric, and Psych Mental Health Across the Lifespan are recognized by the KBN.
Tennessee – A current national certification recognized by the Tennessee Board of Nursing is required and has to be as a nurse practitioner, nurse anesthetist, nurse midwife, or clinical nurse specialist, (Tennessee Board of Nursing, 2023).
Let’s explore the NCSBN Consensus Model. Use the Implementation Status link on the NCSBN Consensus Model website to review the following information.
Identify the goal of the NCSBN Consensus Model:
The goal of the NCSBN Consensus Model is to provide guidance for states to adopt a uniform approach in regulating APRN roles, education, certification, accreditation, and licensure, (NCSBN, 2022).
How does your state’s Nurse Practice Act compare to the NCSBN Consensus Model?
The Nurse Practice Acts are sets of laws that have been enacted to protect the public, specify the scopes of practice for registered nurses, advanced practice registered nurses, nurse attendants, and licensed practice nurses or vocational nurses, (Brous, 2021). The NCSBN is attempting to make a uniform role for the APRN in all states pertaining to the roles, education, certification, accreditation, and licensure. Therefore Kentucky is much closer than Tennessee as far as this APRN role goes. Kentucky allows the APRN to do much more than Tennessee, but neither are full practice authority states.
Which states are in full compliance with the Consensus Model?
The following states are in full compliance with the Consensus Model with 28 points: Alaska, Oregon, Idaho, Montana, Kansas, Hawaii, Guam, Wyoming, Utah, Nevada, New Mexico, North Dakota, Minnesota, West Virginia, Delaware, Connecticut, Vermont, Northern Mariana Islands, and Rhode Island, (NCSBN, 2022).
Which states are the least compliant?
The following states are the least compliant with less than 14 points: Tennessee, Pennsylvania, New York, and New Jersey, (NCSBN, 2022).
What are the educational requirements identified by the NCSBN Consensus Model for all APRNs?
The educational requirements set forth by the NCSBN Consensus Model are: formal education with a graduate degree or post-graduate certificate that is awarded by an academic institution and accredited by a nursing or nursing-related accrediting organization recognized by either the U.S. Department of Education or the Council for Higher Education Accreditation, (NCSBN, 2022).
How does the educational requirements at NKU compare with those identified in the NCSBN Consensus Model for APRNs?
NKU’s educational requirements are in line with the NCSBN. NKU offers a formal education with a graduate degree and they are accredited by the Commission on Collegiate Nursing Education.
References:
American Nurses Association. (n.d.). Scope of Practice. https://www.nursingworld.org/practice-policy/scope-of-practice/.
Brous, E. (2021). Nursing licensure and regulation. In Mason, D.J., Dickson, E., McLemore, M.R., & Perez, G.A (Eds.), Policy and politics in nursing and health care (8th ed.)., p. 381-387). Elsevier.
Kentucky Board of Nursing. (2023). Advanced practice registered nurses. https://kbn.ky.gov/Pages/advanced-practice-registered-nurse.aspx#:~:text=%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B,on%20file%20with%20the%20Board.
National Council of State Boards of Nursing. (2022). APRN consensus model. https://www.ncsbn.org/nursing-regulation/practice/aprn/aprn-consensus.page.
Tennessee Board of Nursing. (2023). Advanced practice nurses. https://www.tn.gov/health/health-program-areas/health-professional-boards/nursing-board/nursing-board/about.html.
Discussion board #2
Compare and contrast two (2) Nurse Practice Acts addressing the following:
a) Identify each state
The 2 states identified in this online discussion will be Kentucky and Ohio.
b) Outline the APRN Title
According to the Kentucky Board of Nursing (2023a), the advanced practice registered nurse (APRN) title is categorized as follows. An APRN has 4 different types of roles 1) certified nurse practitioner (CNP), 2) certified registered nurse anesthetist (CRNA), 3) certified nurse midwife (CNM), and 4) clinical nurse specialist (CNS). Per the Kentucky revised statuses (KRS) 314.011, an APRN can practice in their additional scope of practice only after the successful completion of a nursing educational program which is focused only on one population focus (Kentucky Board of Nursing, 2023b).
According to the Ohio Board of Nursing (2023a), the APRN title is categorized as the follows. Like Kentucky, the APRN has 4 different types of roles 1) CRNA, 2) CNM, 3) CNS, and 3) CNP.
c) Discuss the APRN Scope of Practice including prescriptive authority
The Kentucky Board of Nursing very clearly outlines the scope of practice (SOP) regarding prescriptive authority for the APRN. A physician and an APRN must establish a collaborative agreement to prescribe medications. The collaborative agreement prescription authority (CAPA) outlines requirements for APRNs entering this collaboration with a physician. Regarding the APRN Prescriptive Authority for Non-Scheduled Drugs (CAPA-NS), there is a required CAPA. Regarding the APRN prescriptive authority for Controlled Substances (CAPA-CS), the law does not mandate a CAPA. The APRN and physician may use any form if it meets all the expectations of the KRS. APRNs must be familiar with both the CAPA-NS and CAPA-CS forms. They will need to be filled out by the APRN and physician and sent into the Kentucky Board of Nursing (Kentucky Board of Nursing, 2023c).
When prescribing a controlled substance, the APRN must enter a CAPA with a physician. As stated before, there is not just one form that can be utilized for this requirement. The chosen CAPA-CS must be uploaded to the Kentucky Board of Nursing portal prior to prescribing controlled substances (Kentucky Board of Nursing, 2023d).
The APRN scope of practice including prescriptive authority for Ohio is very similar to that of Kentucky’s but there are some differences noted in the legislature. According to the Ohio Board of Nursing, APRN prescribers, at a minimum must include the first 4 alphanumeric characters of the ICD-1- medical diagnosis code on controlled substance prescriptions. Pharmacy will then enter this information into Ohio’s Automated Prescription Reporting System (OARRS). The nurse must regularly use OARRS, maintain a standard of care arrangement with one or more collaborating physicians, maintain quality assurance provisions obligated in Ohio’s laws and Rules, prescribe in accordance with nursing rules and standards, maintain registration with the Drug Enforcement Administration (DEA) and complete at least 12 hours biannually in advanced pharmacology (Ohio Board of Nursing, 2023b).
After analyzing the scope of practice in both Kentucky and Ohio, per the Kentucky Board of Nursing (2023b) and the Ohio Board of Nursing (2023a), there are some notable similarities and differences between the 2 states. In Ohio, the APRN title is a nurse who maintains a current and valid RN license who authorizes the practice of nursing as an APRN and maintains 1 of the 4 defined APRN roles such as a CRNA, CNS, CNP and/or CNM. The Kentucky definition is less confusing to understand. The APRN title is the act of nursing that is additional to just the RN role. These acts are provided by a RN who is licensed as an APRN. In Ohio, the APRN can prescribe drugs including schedule III-V controlled substances only when in a collaboration with a physician. If the patient has a terminal illness, then the APRN can prescribe schedule-II controlled substances, but the initial prescription, dose and duration must be prescribed by the collaborating physician. In contrast, in Kentucky, after 4 years the APRN can prescribe drugs independently. If the APRN in Kentucky decides to practice independently then they can no longer prescribe schedule II-V controlled substances. In both states, the APRN is a recognized primary care provider. In both Kentucky and Ohio, the APRN must receive their education and training through an accredited education program but unlike in Ohio, the Kentucky APRN must receive education that is specific to their specialty.
d) List the APRN education requirements
For the state of Kentucky, an APRN must maintain a current and active RN license, current APRN license, and a current national certification in a Kentucky Board of Nursing approved patient population foci (Kentucky Board of Nursing, 2023a).
For the state of Ohio, an APRN must establish and maintain the following minimum requirements 1) a current and active Ohio RN license, 2) an earned masters or doctoral degree with a major in a nursing specialty will automatically qualify that individual to sit for examination for their certification approved by the Board 3) the nurse must hold a minimum of one current national certification in a nursing specialty/population foci approved by the Board, 4) all CNCs, CNPs, and CNPs must provide proof of 45 hours of contact hours in advanced pharmacology approved by the Board. These credit hours must be completed no longer than 5 years before submitting application for APRN licensure, 5) for CNMs, CNSs and CNPs, the nurse must provide proof of prescriptive authority and 2 credit hours in prescribing law approved by the board, and 6) submit a complete APRN license application with all related fees paid (Ohio Board of Nursing, 2023a).
e) Describe required national certification
A national nursing certification is an official document that proves your education, skillset, and experience as a nursing professional. These documents must be earned and can help demonstrate to employers that the individual has met the best standards of care set by that organization. The national certifications recognized by the Kentucky Board of Nursing are the American Association of Critical Care nurses, National Board of Certification & Recertification for Nurse Anesthetists, American Academy of Nurse Practitioners, American Midwifery Certification Board, American Nurses Credentialing Center, National Certification Corporation, and Pediatric Nursing Certification Board (Kentucky Board of Nursing, 2023e).
Ohio’s national nursing certification list follows the same structure as Kentucky’s. The above-mentioned national certifications are valid for Ohio as well. If an applicant intends to use a different certification, the nurse must inquire if it is approved by the Ohio Board of Nursing to avoid an invalid APRN application when submitted for review (Ohio Board of Nursing, 2023a).
Let’s explore the NCSBN Consensus Model. Use the Implementation Status link on the NCSBN Consensus Model website to review the following information.
a) Identify the goal of the NCSBN Consensus Model.
The goal of the National Council of State Boards of Nursing (NCSBN) is to unify all medical practitioners, state and national lawmakers and the non-medical and medical public on what exactly the APRN’s role is. The NCSBN wants to support the APRN’s scope of practice and capability to practice to the full extent of their training, knowledge, and qualifications (Consensus Model for APRN Regulation, 2023).
b) How does your state’s Nurse Practice Act compare to the NCSBN Consensus Model?
The NCSBN consensus model is similar to Ohio’s Nurse Practice Act. In this model, there are also 4 roles identified 1) CRNA, 2) CNM, 3) CNS, and 4) CNP. The APRN identity is made up of these 4 roles. The NCSBN identified 6 unique population foci. The 6 foci are family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related or psych/mental health. The APRN must be a graduate of an accredited nursing program that must include three separate graduate-level courses in advanced physiology/pathophysiology, health assessment and pharmacology including appropriate clinical experience in their chosen specialty. When all educational requirements are met, the APRN then can sit through a national competence to be licensed. Once a valid a current license is held by the nurse, then they must follow a continued competence program. Once licensed as independent practitioner in 1 of the 4 identified roles of the APRN and at least 1 of the 6 identified population foci then all following education, certification and licensure must be in alignment with their designated role (Consensus Model for APRN, 2023).
Ohio’s Nurse Practice Act appears to be vaguer in comparison to the NCSBN definition of the APRN’s role. Although there are similarities, the NCSBN model has been the most concise explanation of the APRN’s role after much research. Per Ohio’s Nurse Practice Act, the same 4 roles are recognized 1) CRNA, 2) CNS, 3) CNM, and 4) CNP. In Ohio, a CNP or CNS mut have an agreed upon standard care agreement with a physician either in person or via electric communication. The designated physician in a standard care agreement must be always available to the CNP or CNS for communication of care. To be licensed, the APRN must hold a current and active RN license, a graduate degree in an CNP role and hold at least 1 nursing certification (Ohio Board of Nursing, 2023a).
c) Which states are in full compliance with the Consensus Model?
There is a lot of room for improvement for all 50 states to get in 100% compliance with the NCSBN Consensus Model. Less than half of all states are in full compliance with the NCSBN Consensus Model for APRNs. The states and territories in compliance are Oregon, Idaho, Nevada, Montana, Wyoming, Utah, New Mexico, North Dakota, Minnesota, West Virginia, Delaware, Connecticut, Rhode Island, Hawaii, Alaska, Washington D.C., Guam, and the Mariana Islands (NCSBN Leading Regulatory Excellence, 2023).
d) Which states are the least compliant?
The least compliant states are less than 50% compliant with the NCSBN Consensus Model. The least compliant states are Alabama, Tennessee, Pennsylvania, New York, and New Jersey (NCSBN Leading Regulatory Excellence, 2023).
e) What are the educational requirements identified by the NCSBN Consensus Model for all APRNs?
The educational requirements identified by the NCSBN Consensus Model for APRNs are as follows. The APRN education must be a formal education for a graduate or post-graduate degree awarded by an accredited institution. Nursing program must prepare the graduate for practice in 1 of the 4 identified APRN roles and at least 1 identified population of the 6 identified population foci. A minimum of 3 graduate level courses in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology. Based on the chosen population foci, additional content specific to that role should be integrated into the coursework. Be able to demonstrate competence in the decision-making model, be able to assume responsibility and accountability for health promotion and maintenance, diagnosis, and management of clinical conditions with either pharmacologic or non-pharmacological interventions (Consensus Model for APRN Regulation, 2008).
f) How does the educational requirements at NKU compare with those identified in the NCSBN Consensus Model for APRNs?
The Northern Kentucky University (NKU) educational requirements have many similarities to the NCSBN Consensus Model. NKU (2023) stresses the importance of “critical thinking, specialized knowledge, professional accountability, leadership, advanced communication skills and caring behavior” that are expected from the mastered prepared nurse. The graduate level nurse must be able to use nursing research and theory and apply them to their advanced practice. NKU prepares their APRNs to understand and navigate cultural sensitivity, leadership skills, how to manage resources and how to use best practice standards to improve the nursing profession (NKU, 2023).
NKU fulfills the NCSBN’s requirements of advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology educational requirements. An example of some of those classes on the NKU website are differential diagnosis & management acute disorder, geriatric primary care & pharmacology, and human pathophysiology (NKU, 2023).
The strong resemblance to the NCSBN’s Consensus Model makes sense since the State of Kentucky is 75-96% compliant with this model (NCSBN Leading Regulatory Excellence, 2023)
References
Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. (2008). APRN joint dialogue group report.
https://www.ncsbn.org/public-files/Consensus_Model_Report.pdf
Kentucky Board of Nursing. (2023a). Advanced practice registered nurses (APRN). https://kbn.ky.gov/Pages/advanced-practice-registered-nurse.aspx
Kentucky Board of Nursing. (2023b). Advanced practice registered nurses (APRN) and scope of practice. https://kbn.ky.gov/Practice/Pages/advanced-practice
registered-nurse-and-scope-of-practice.aspx
Kentucky Board of Nursing. (2023c). APRN collaborative agreement prescriptive authority CAPA. https://kbn.ky.gov/Practice/Pages/APRN-Collaborative
Agreement-Prescriptive-Authority-CAPA.aspx
Kentucky Board of Nursing. (2023d). APRN prescriptive authority for prescribing controlled substances .https://kbn.ky.gov/Practice/Pages/aprn-prescriptive
authority-for-prescribing-controlled-substances.aspx
Kentucky Board of Nursing. (2023e). Certification and population foci. https://kbn.ky.gov/General/Pages/certification-and-population-foci.aspx
NCSBN Leading Regulatory Excellence. (2023). APRN consensus implementation status. https://www.ncsbn.org/nursing-regulation/practice/aprn/campaign
for-consensus/aprn-consensus-implementation-status.page
Northern Kentucky University. (2023). Nursing, M.S.N. http://onlinecatalog.nku.edu/preview_program.php?catoid=12&poid=1800&returnto=1217
Ohio Board of Nursing. (2023a). APRN licensure and practice in Ohio. https://nursing.ohio.gov/resources-for-practice-and-prescribing/resources/04-aprn
licensure-and-practice
Ohio Board of Nursing. (2023b). Controlled substances prescription requirements and valid prescriptions. https://nursing.ohio.gov/resources-for-practice
and-prescribing/resources/controlled-substances-prescription-requirements-and-valid-prescriptions
