NR 506 Discussion Paper

NR 506 Discussion Paper

California is among the states that implement restrictive regulations for nurse practitioners (NPs). According to the American Association of Nursing Practitioners [AANP] (2022), restricted practice laws restrict the ability of NPs to engage in at least one element of NP practice. Equally, these regulations require nurse practitioners to establish career-long supervision, delegation, or team management with other healthcare providers, especially certified physicians. In full practice states, nurses can engage in all elements of nursing practice, including evaluating patients, diagnosing illnesses, ordering and interpreting diagnostic tests, and prescribing medications. Conversely, nurse practitioners in restricted states like California face practice limitations that affect their full practice and ability to engage in these elements of nursing practice.

Prescribing authority is one of the highly-regulated elements of nursing practice in California. According to California Nursing Practice Act (n.d.), a registered nurse may dispense drugs or devices upon an order by a licensed physician and surgeon. Equally, this regulation requires nurses to complete training and competency assessment before dispensing self-administered hormonal contraceptives (California Nursing Practice Act, n.d.). Training and competency assessment entails various aspects, including medical standards for ongoing women’s preventive health, contraception options education and counseling, mechanisms for documenting and assessing patient and family history, and utilizing the United States Medical Eligibility Criteria for Contraceptive Use.

Process for obtaining licensure in California

Aspiring nurse practitioners can obtain a nursing license in California by examination or endorsement. Licensure by examination requires applicants to complete a mandatory National Council Licensure Examination (NCLEX-RN®). Equally, all applicants must have completed an educational program that meets all California requirements. On the other hand, licensure by endorsement requires nurses to have a current, valid, and active RN license in other states in the United States or Canada. In the same vein, they must have completed an educational program that meets California requirements and have passed the National Council Licensure Examination or the State Board Test Pool Examination (SBTPE).

Certification and education Requirements for licensure

New nurse practitioner applicants should justify their successful completion of an NP education program that meets all standards set by the California Board of Registered Nursing (BRN). In this sense, they must possess a graduate degree in a clinical field related to nursing, including family practice, women’s health, pediatrics, psychiatry, acute care, and community/public health.

How restricted practice laws impact patient care

Restricted practice laws can result in negative impacts on patient care, considering the role of nurse practitioners as primary care providers. According to Spetz (2018), full practice states that grant a greater scope of practice authority exhibit an increase in the number and growth of nurse practitioners through educational enrollment and migration. Also, these states have a greater provision of primary care and expanded healthcare utilization since nurses can engage in all elements of nursing practice. Conversely, restrictive laws result in care delays, limit the scope of primary care, exacerbate overcrowding due to unfavorable nurse-to-patient ratios, and affect emergency care.

How does access to NPs impact any healthcare disparities?

Geographical disparities and barriers are common among people in underserved rural areas. These disparities affect people’s access to care services and overall healthcare utilization. States with restricted practice laws encounter various challenges that exacerbate these disparities. According to the American Association of Nurse Practitioners [AANP] (n.d.), nurses in full-practice states are more likely to operate in rural and underserved areas, improving NP workforce recruitment and reducing geographical inequalities. Further, full-practice laws can reduce the burden of chronic diseases, address primary care shortages, and curtail care costs.

References

American Association of Nurse Practitioners. (n.d.). Issues at a glance: Full practice authority. Retrieved November 29, 2022, from https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief#

American Association of Nurse Practitioners. (2022). State practice environment. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/state/state-practice-environment

California Nursing Practice Act. (n.d.). Excerpt from Business and Professions Code Division 2, Chapter 6. Article 2 Scope of Regulation. 1–6. https://www.educationandstaffdevelopment.com/wp-content/uploads/2019/07/CA-Nurse-Practice-Act-2.6.2..pdf

Spetz, J. (2018). California’s nurse practitioners: How the scope of practice laws impact care (pp. 1–21). https://www.chcf.org/wp-content/uploads/2018/09/NursePractitionerScopePracticeLaws.pdf

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Requirements:
Discuss your state NP community in terms of scope of practice. Include the your state’s scope of practice for NPs including:
Level of independence of practice **In California, NPs are required to practice under Standardized Procedure Guidelines. If CA is your intended practice state, please provide details on how Standardized Procedures Guidelines are developed in California and an example of a California SPG.
Prescribing authority
Any limitations of practice
Process for obtaining licensure in your state
Certification and education requirements for licensure.
If you live in a restricted or reduced practice state, how has patient care been impacted in your local community from these barriers? For instance, is the ED used for primary care? Are the EDs overcrowded with long wait times? Are there urgent care clinics readily available? Is there adequate access to primary care? If you live in a full practice, how has independent practice of the APN resulted in improved patient access to healthcare?
How does access to NPs impacts any healthcare disparities?
A scholarly resource must be used for EACH discussion question each week.