Melissa Hinkhouse

I decided to focus on Michigan (where I live) and the neighboring state of Wisconsin, it is a possibility one day we may relocate. As long as regulatory requirements differ from state to state, each state border represents an obstacle to portability—potentially preventing access to professionals and access to care (National Council of State Boards of Nursing, n.d.). Wisconsin and Michigan are both located within region five.

I first wanted to explore the practicing regulations for both states and what that means as a practitioner. Michigan’s Board of Nursing (B.O.N.) is the regulatory agency for the state in which I reside and plan to practice as a Psychiatric Mental Health Nurse Practitioner. Michigan’s Regulatory Structure is considered Restricted Practice, State practice and licensure laws restrict the ability of N.P.s to engage in at least one element of N.P. Practice. State law requires career-long supervision, delegation, or team management by another health provider for the N.P. to provide patient care (Michigan, 2020). Wisconsin Board of Nursing (B.O.N.), is the regulatory structure for our sister state. Wisconsin’s Regulatory Structure is considered Reduced Practice, State practice and licensure laws reduce the ability of N.P.s to engage in at least one element of N.P. Practice. State law requires a career-long regulated collaborative agreement with another health provider for the N.P. to provide patient care, or it limits the set of one or more elements of N.P. Practice (Michigan, 2020). After reading more into both regulations, it is my understanding in both states as a Nurse Practitioner that I would not be allowed to open my practice. I will always need to be in collaboration with a physician. Neither Wisconsin nor Michigan will recognize a Nurse Practitioner as a primary care provider. Both will allow a Nurse Practitioner to prescribe Schedules II-V controlled substances if delegated by a physician. For example, in either to state, if I were to see a patient that was diagnosed with Attention Deficit Disorder and wanted to prescribe Ritalin, I would have to have my collaborating physician review the chart consult before prescribing the medication. 

           The second regulation I would like to compare is the ability to have a Medical Staff Membership. According to the A.A.N.P., in Wisconsin per rule WI ADC s DHS 124.12 Nurse Practitioners are not permitted to join medical staffs. In the state of Michigan per the A.A.N.P. M.C.L.A. 331.1303 Each board of trustees and subsidiary board may select nurse practitioners for membership on their medical team. I was surprised when I read this regulation: Nurse Practitioners in our hospitals here in Michigan and round with the providers. The cost reduction in medical services alone, I feel, would be substantial enough to disseminate this regulation. A Nurse practitioner working with a physician to see patients in the hospital can lead to more efficient and quality care and provide decreased wait times for patients.

References

Michigan scope of practice policy – State profile. (n.d.). Scope of Practice Policy.

https://scopeofpracticepolicy.org/states/mi/

Michigan. (2020). American Association of Nurse Practitioners. Retrieved June 29, 2020, from

https://www.aanp.org/advocacy/michigan

National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved June 29, 2020, from

 https://www.ncsbn.org/index.htm

Wisconsin scope of practice policy – State profile. (n.d.). Scope of Practice Policy.

Cindy Salbino RE: Discussion – Week 5COLLAPSE

The nursing profession has a foundation that’s built on documents that are called regulations and policies and are designed to ensure patient’s safety. Governed by the board of nursing, the APRN’s practice is defined by the Nurse Practice Act. Although these have basic guidelines, they can vary from state to state.  State laws and regulations can impact some practices, as well as other state nursing boards (State laws and regulations, n.d.).

Two regulation comparisons

Giving nurse practitioners (NP’s) ability to work independently is one of the most controversial subjects today. Allowing NP’s to work according to their degrees and training isn’t always guaranteed.  In my home state of California, we still need to work closely under the supervision of a physician. This is not only limiting our ability to act as a primary provider, is also is confusing to the patients we care for (Staff Writers, 2020). My husband is an Acute Care Nurse Practitioner (AG-ACNP) and he works under the direction of the chief of staff and the Medical Director. Upon my graduation, we are seriously considering moving to Arizona where we can practice independently according to our degree and training.  As per the Arizona Board of Nursing site “Practice Authority for Nurse Practitioner:  Full independent practice authority. NP’s practice under the licensure authority of the State Board of Nursing instead of a licensed physician. Ariz. Rev. Stat. Ann. §32-1601(20)” (“Arizona scope of practice policy – State profile“, n.d.).

Another California regulation that gets in the way sometimes is that we cannot prescribe medications unless these are also approved by a physician.  Even prescription pads have the name of the supervising physician on them.   This sometimes hinders the care that our providers can give.  In the state of Arizona this isn’t the case at all.  NP’s are allowed to prescribe medications according to their population focus (“Arizona scope of practice policy – State profile”, n.d.).    

Another situation we were interested in was to be able to get reimbursed for services by insurance companies. According to the regulations in California, they keep track of RN’s who obtained their psychiatric master’s degree and remain on the board list after being supervised for two years with a qualified doctor. After doing so, these RN’s would be eligible to receive reimbursements directly from health care plans if the care they provide has to do with mental health services to the insured individuals (Psychiatric mental health nurse listing, n.d.). I attempted several times, several different ways to locate this information for the stated of Az. and I was unable to. This is concerning to me since we are considering moving there.

These two regulations that we have in California are a struggle sometimes.  Our night time hospitalists are nurse practitioners and they are restricted with what they can do. They for sure cannot discharge a patient, so that patient would either have to leave against medical advice (AMA), or wait until the morning.  Another issue we have is that they cannot sign for a transfer stating the patient is stable for that transfer. We then need to go and bother the emergency room physician to sign for a patient that they don’t know what’s going on.  We have a good relationship and they trust our judgment, but it still puts them at risk.

If we were to relocate, it would be a better opportunity for us as a family for jobs, and most certainly as professionals for careers.  Practicing independently and able to prescribe medications freely are the two major comparisons that I am concerned about right now. I believe that it would allow us to grow as providers, but in the same sense, we would then be isolating ourselves from any ‘medical back up’ we may need. This could be from anything really from law suits to the benefits of company provided education.  It will definitely be a lot of researching and conversations in the upcoming couple years.

References:

Arizona scope of practice policy – State profile. (n.d.). Scope of Practice Policy. https://scopeofpractice.org/states/az/

Psychiatric mental health nurse listing. (n.d.). California Board of Registered Nursing. Retrieved June 29, 2020, from https://www.rn.ca.gov/pdfs/applicants/pmg-app.pdf

Staff writers. (2020, May 21). California nurse practitioner full practice authority (FPA). NursePractitionerSchools.com. https://www.nursepractitionerschools.com/ blog/California-np-practice-authority/

State law and regulation. (n.d.). ANA. https://www.nursingworld.org/practice-policy/state-law-and-regulation/