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

 

Discuss social determinants of health. What are they and how do they contribute to the development of disease? Describe the chain of infection. What are some ways community health nurses can break this chain? Provide specific examples.

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook

  

A. Windshield Survey 

The Windshield Survey is comprised of general qualitative observations that give you a snapshot of the community that you can capture as you drive/walk through the community. The demographic data can be obtained online, through the public library, county or township administration buildings. Please address the following in a narrative format following APA guidelines: 

1. Geographical description

 Boundaries, geographical, political, or economic, how is it seen. 

 Housing an zoning 

 Sign of decay 

2. Health Resources 

a. Type of services available: health department, private MD, dentist, hospital clinic, 

b. pharmacy, health promotion, mental health 

c. School and occupational health services 

d. Official and voluntary services 

e. Self help and support groups 

f. Service organizations, faith-based programs 

g. Stores (grocery, retail, drug, dry cleaning, etc. 

h. Transportation 

3. Citizen safety and protective services 

a. Police and fire 

b. Shelters for victims of abuse 

c. Others: neighborhood watch etc. 

4. Services provided by senior citizens senior centers, meals on wheels, transportation, day care, long term care. 

 a. Parks and recreational areas 

5. Community welfare services beyond city/state aid as provisions for emergency food, shelter and clothing. 

Below please see the rubric that will be used to grade your survey and due date instructions.

Assignment must be presented in an essay style using APA format in the required Arial 12 font with minimum of 1000 words. Due date is Saturday May 12 @ 11:59PM in the discussion tab of the black board for grading. 

If you are unable to comply with the due date, please contact me via e-mail at least 3 days before the due date. Extra time will not be granted after the due date has passed. This assignment will be grade based on the assignment rubric.

  

  

  

Imagine that, for about a year, your nursing unit has been involved in an intensive campaign to improve patient satisfaction scores with pain management. You are getting good data from your patients, as the length of stay on this inpatient geriatric medical nursing unit is only about 6 days. Your hospital does 100% survey to inpatients, and the response rate is about 25%, which is higher than it has been. This notwithstanding, the percent of “patient very satisfied” (top box), with a score of 5, has been in the low 70s. The national benchmark for medical surgical units like yours is about 85% very satisfied. Of all the units in your hospital, your unit is the lowest scoring on this HCAPHS survey. But as your unit is the only geriatric medical nursing unit in the hospital, you’d always thought it was the nature of the patient population.

You have been the day shift representative to the QI team, and the scores on your unit are posted monthly. Here are the numerous strategies that have been tried on your unit and the timeframes.I

Examine the strategies and interventions tried in your unit and consider the following questions: a) Were the strategies effective in creating a sustainable change on your nursing unit, and 

b) To what extent can your nurse manager and CNO count on your unit exceeding the national benchmark in the next quarter, the next year? 

That is, does this run chart have some predictive ability?

Does the run chart support the nursing unit’s decision to celebrate? 

To what extent can the leadership be confident that the trend will continue?

Based on the scenario, explain what was done successfully and where improvement was needed in the quality improvement process. Identify the performance improvement tools, and explain how they contributed to the outcome.

Respond in 4-5 paragraphs 450-550 words 

Support your response with references from the Resources and professional nursing literature. Your posts need to be written at the capstone level 

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Chicago, IL: Health Administration Press.

• Chapter 4, “Evaluating      Performance” (pp. 79-118)
• Chapter 5, “Continuous      Improvement” (pp. 119-142)
• Chapter 6, “Performance Improvement Tools”      (pp. 143-174)

Note: Although Chapter 4 is previously assigned reading, please review it in preparation for this week’s material.

Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed.). St. Louis, MO: Mosby.

• Chapter 19, “Building Effective Teams” (pp.      335-356)

Microsoft. (2016). Use charts and graphs in your presentation. Retrieved from https://support.office.com/en-gb/article/Use-charts-and-graphs-in-your-presentation-c74616f1-a5b2-4a37-8695-fbcc043bf526

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality and Safety, 20(1), 46–51

 

Download the Week 2 Self-Assessment of the AACN Essentials  (Links to an external site.) Follow the directions on the form. Note your total score. Next, review this article:

Kramer, M., Schmalenberg, C., Maguire, P., Brewer, B., Burke, R., Chmielewski, L., … Meeks-Sjostrom, D. (2009). Walk the talk: Promoting control of nursing practice and a patient-centered culture. Critical Care Nurse, 29(3), 77–93. https://chamberlainuniversity.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edswsc&AN=000266533800011&site=eds-live&scope=site   (Links to an external site.)

After you have completed your self-assessment, answer the following questions:

1. Describe the relationship between the AACN Essentials and your new-found knowledge about Patient Centered Care. Are there opportunities for you to improve?
2. Essential VIII: Professionalism and Professional Values discusses professional standards of moral, ethical, and legal conduct. Review the Professional Integrity Module-Academics and Practice at the beginning of the course (the first module). Then reflect on your own beliefs and values as they relate to professional nursing practice.
3. Discuss implications of professional nursing integrity and academic integrity.

At least 2 references with in text citation.