Comparing State Regulations of Advanced Practice Registered Nurses
Advanced Practice Registered Nurses (APRNs) are advanced nursing roles that are broken down into four categories: nurse practitioner (NP), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified registered nurse anesthetist (CRNA) (Bosse et al., 2017). For this discussion, I will refer to APRNs only in the role of NP. APRNs work collaboratively with physicians and other multidisciplinary healthcare providers to treat patients in the community (Bosse et al., 2017). The article reports the Board of Medicine (BOM) and Board of Pharmacy governing the scope of APRNs, inevitably limiting their scope of practice. Each state has its regulations for APRNs’ capacity.
For example, Georgia is a restricted practice state for nurse practitioners (American Association of Nurse Practitioners (AANP), 2021). AANP defines restricted practice as laws decreasing NP’s ability to engage in the full scope of practice without the supervision of a medical physician while providing care. Nurse practitioners cannot solely evaluate, diagnose, and care for patients without a licensed medical physician. According to American Medical Association (AMA), nurse practitioners are not authorized to prescribe medications without the involvement or delegation of a medical physician. The article also describes how nurse practitioners can prescribe level III – level V controlled substances, but not level II. Nurses practicing in Georgia adhere to these guidelines by obtaining authorization through hospital contracts or working under physicians’ licenses.
On the opposite end of the spectrum, Washington state grants NPs full scope of practice to evaluate, diagnose, interpret imaging, prescribe medications, and care for patients without the supervision of a physician (AANP, 2017). Washington state also permits NPs to write prescriptions of all medications and controlled substances without medical physicians (AMA, 2021). APRNs in Washington state do not rely on physicians. NPs with education in pharmacotherapy and pharmacokinetics are permitted to write prescriptions, and the board only tracks NPs who can prescribe (AMA, 2021). In a perfect world, states granting full scope of practice to APRNs would absolve many of the community’s barriers to healthcare access. “By 2025, experts estimate a significant shortage of primary care providers in the United States, and expansion of the nurse practitioner (NP) workforce may reduce this burden” (Neff et al, 2018).
While working in the Medical Intensive Care Unit (MICU), I witnessed how under-utilized the NPs are, and as a result, care is delayed and sometimes mismanaged. For example, the NPs have been waiting for the hospital to provide the training to place arterial lines and central lines, so bedside nurses are chasing down physicians and advocating for patients to get the timely care they deserve. Sadly, it comes off as NPs are inferior to physicians, care is impeded, and nursing progress is interrupted. Physicians must share the responsibility of caring for the population with APRNs to prevent the community from suffering.