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

 

Note: You are required to complete this discussion before submitting the unit assignment.

For this discussion, complete the following:

1. Describe the background of your study.

2. Demonstrate how answering your research question will advance scientific knowledge base.

3. Discuss the implications and contributions of your study to your specialization.

4. Be sure to include in-text citations from the academic literature on your chosen topic.

Once you have received feedback from other learners, complete the unit assignment based on your revised discussion post. 

Readings

Use your Qualitative Inquiry and Research Design text to complete the following:

Review Chapter 3, “Designing a Qualitative Study.” Focus on the subsection, “The Design Structures of a Plan or Proposal.”

Read Chapter 6, “Introducing and Focusing the Study,” pages 127–146. 

      a.  Focus on the following subsections:  

              1. “Introducing and Focusing the Study.”

              2. “The Research Problem Statement.”

Review Percy, Kostere, and Kostere’s 2015 article, “Generic Qualitative Research in Psychology,” from The Qualitative Report, volume 20, issue 2, pages 76–85.

Library Search

Use the library to conduct a brief literature review related to your chosen topic, in preparation for describing the background and addressing how the research  question will advance the scientific knowledge base. You will use this literature review in the unit discussion.

Read the Transcript –  Qualitative Research Proposal 

This illustration help to guide you as you develop the various components of your course project. Boxcars are added to the train as you progress through the course. Each boxcar provides information regarding the development of

individual components of a research proposal.

INTRODUCTION – Advancing Scientific Knowledge, Implications, and Contributions

When choosing a topic for the development of a qualitative study, it is essential that the topic meet the criteria of advancing scientific knowledge within the academic discipline. The issues that need to be addressed are the following:

Will the study advance the scientific knowledge base?

Is the study grounded in the discipline?

Does the study address something that is not known, something that is new or different from prior research, something that extends prior research, or something that fills a gap in the existing literature?

What are the theoretical and practical implications of the study?

How does the study contribute to the discipline?

OBJECTIVES

To successfully complete this learning unit, you will be expected to:

1. Identify components of scientific merit (advances the knowledge base, contributes to theories, and meets the hallmarks of good research).

2. Critically evaluate the individual components of scientific merit of research studies.

3. Demonstrate how answering a specific research question will advance scientific knowledge base.

 Do Not use Citations please

Instructions: Read the Case Study below and discuss the questions that follow: 

Aron, a single father, is raising his daughter on his own.

“Naomi is a good girl, you know?” She does her homework, and she likes hanging out with me. She even laughs at my jokes still, but sometimes I worry that she’s going to become anorexic or something,” he says. “She’s not overly thin or anything, but she just doesn’t eat like I think she should. Breakfast is the toughest time. We end up yelling at each other every morning before school with me running behind her as she heads downstairs and out the front door of our building, and me yelling, ‘Here! At least take this!’ and I stuff a banana or an apple in her backpack, while she yells, ‘Dad, you’re embarrassing me!’ Sometimes I look up, and, oh man, she’s right. Sometimes there are other kids at the corner waiting for the bus and here she is, my sweet little Naomi with her crazy dad grabbing at her backpack! Poor baby, but it drives me crazy that she won’t eat!”

1.      As soon as the nutritionist mentions breakfast, Aron throws his hands up and says, “No, don’t even talk about it, man! Breakfast is like our worst thing! She’s such a picky eater, and mornings are her worst time.” What advice can you offer?

2.      Aron’s income is 25% below the poverty level for the United States. He asks, “How do I find out if Naomi is eligible for reduced-price school lunches?” What might you advise Aron?

3.      As it turns out, Naomi does qualify for reduced-price lunches at her school. However, things don’t go very well. She often comes home from school hungry. Aron, who can find only part-time work 3 nights a week, meets her at the door most days and is distressed, he says, to find that “her stomach is actually growling, and she’s all weak and listless. She’s asked if she can go back to packing a lunch, even though my lunches aren’t very good. Usually, all we have in the cupboard is some pantry food such as peanut butter, saltines, and raisins.” When he asks her why she wants “our lousy lunch stuff,” she says, “Everybody sees who gets the ‘poor kid’ lunches. I get made fun of.” 

Suppose you are the school nurse at Naomi’s school. Brainstorm about ways you might support students like Naomi.

Consider the role and responsibilities of school nurses—on the levels of both the individual child and the family, as well as their influence on their particular educational system and the community at large.

 

Tutor MUST have a good command of the written English language

There needs to be in text citation and at least 150 words

DQ 2

Evidence-based practice and standardized clinical guidelines have improved organizations and the ability of providers to provide the care with the highest level of evidence to each patient. Describe one pharmacological agent with a protocol/clinical guideline that is used. Discuss how this protocol may not take into consideration genetic variations. What can be done to tailor care to each patient while providing standardized treatments?