I currently live in South Carolina, and I have chosen Hawaii as my comparison state for this discussion post. The two regulations I will be comparing are full practice authority (FPA), and prescriptive authority. Hawaii offers nurse practitioners (NP) the opportunity to practice within their full scope of practice. In addition to FPA, Hawaii has been identified as one of the highest paying NP locations, and has adopted a user friendly welcoming approach for practicing NP’s that wish to relocate and seek a license by endorsement. It’s also a beautiful island with a notable rural population including veterans that have limited access to healthcare facilities and resources.
In Hawaii, NP’s are able to practice independently from physicians and practice under licensure authority of the State Board of Nursing. In contrast, NP’s in South Carolina are required to create a practice agreement with a physician who must be readily available for consultation. I would best describe the South Carolina practice agreement as a “liability” prenuptial agreement between the physician and the NP. It is a document that must clearly define and outline how consultations will be
completed, including backup options if the physician is not readily available, medical conditions for which therapies may be initiated, continued, or modified, drug therapies that may be prescribed, and the list of points of care continues. The protocol must outline information for delegated medical acts and a description of how consultation with the physician is provided. The practice agreement must be reviewed annually with the physician.
Nurse Practitioners in Hawaii are authorized to independently prescribe prescription drugs and Schedules II-V controlled substances. In Hawaii, NP’s can prescribe medical devices if within the NP’s specialty. In South Carolina, NP’s can prescribe drugs, including Schedules II-V, and devices that are within their specialty as long as they are listed in the written protocol developed by the NP and the supervising physician.
NURS 6050 Discussion Professional Nursing and State-Level Regulations SAMPLE Discussion
The concern regarding health professional shortages in primary care and mental health has become a national concern. Nurse Practitioners have the education, knowledge, and experience to provide comprehensive care while improving access to care, filling care gaps in healthcare disparities, and improving healthcare costs (Bosse et al, 2017). States with restrictive NP scope of practice regulations interfere with the ability to improve access and quality of care in their states. According to Reagan and Salsberry (2013), the combinations of notable increase in healthcare provider demand, within the context of NP restricted practice, should illicit significant amounts of pressure on state legislatures to broaden the scope-of-practice laws. A study examining the impact of state-level scope-of-practice regulations and the growth in numbers of nurse practitioners presented a troubling result of provider shortages in the most restricted areas (Reagan & Salsberry, 2013). If the answer to the healthcare provider shortage crisis is increasing NP’s, someone needs to let the restrictive states know so they can start making changes now.
NURS 6050 Discussion Professional Nursing and State-Level Regulations SAMPLE References
Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017).
Position statement: Full practice authority for advanced practice registered nurses is necessary
to transform primary care. Nursing Outlook, 65(6), 761–765. https://doi.org/10.1016/j.outlook.2017.10.002
CHAPTER 457 nurses – Hawaii. Hawaii Legislature. (2014). Retrieved September 28, 2021, from
Reagan, P. B., & Salsberry, P. J. (2013). The effects of state-level scope-of-practice regulations on
the number and growth of nurse practitioners. Nursing Outlook, 61(6), 392–399. https://doi.org/10.1016/j.outlook.2013.04.007
South Carolina Legislature . (2017). Code of laws – title 40 – chapter 33 – nurses. Retrieved September 28,
2021, from https://www.scstatehouse.gov/code/t40c033.php.
NURS 6050 Discussion Professional Nursing and State-Level Regulations SAMPLE 2
Advanced practice registered nurses (APRN) are a vital part of the health system of the United States. The APRNs are prepared by education and certification to assess, diagnose, and manage patient problems, order tests, and prescribe medications (NCSBN, n.d.). APRNs bring holistic and patient-centered, and family-centered approaches to the prevention and management of complex health and behavioral issues addressed in various care settings across the life span. They work collaboratively with physicians and other health workforce members to optimize patient care and health (Bosse et al., 2017).
The scope of service of APRNs has regulated boards and differ in every state. In Florida, APRNs have a restricted area of practice. APRNs can perform procedures under the supervision of at least one physician, and one example is performing central line insertion in the ICU. The APRNs can only perform central line insertion unless an ICU specialist is present or supervising. Another restriction is the handling of medications. APRNs can prescribe, dispense, administer, or order any drug. However, an advanced practice registered nurse may prescribe or distribute a controlled substance only if the advanced practice registered nurse has graduated from a program leading to a master’s or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills. An APRN in Florida can apply for Autonomous practice by an advanced course registered nurse if they want to practice independently. However, it also has a lot of limitations. The most distinctive is that they can only engage in independent practice in primary care, including family medicine, general pediatrics, and general internal medicine, as defined by board rules (Online Sunshine, 2021). The autonomous practice has regulations in acute care settings like the ICU.
In contrast, NPS does not need physician oversight in Montana but must complete pharmacology and disease management courses. In addition, APRNs who submit a successful application to the Prescriptive Authority can prescribe medications (Maryville University, n.d.). Montana state law also does not require nurse anesthetists to be supervised by physicians.
The increasing health care needs of the public, disparities, and decreasing availability of primary care providers are of concern nowadays. If APRNs are allowed to have FPA can improve health equity while providing care that costs patients, health care systems, and payers less money. Furthermore, APRNs who can work to the full extent of their education and training have more potential to identify creative approaches for solving problems within these systems, which will benefit nursing as a discipline, the larger health care community, and most importantly, the public whom we serve (Bosse et al., 2017).
NURS 6050 Discussion Professional Nursing and State-Level Regulations SAMPLE References
Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761-765.
Florida Board of Nursing. (n.d.). Advanced Practice Registered Nurse (APRN). Retrieved from https://www.floridasnursing.gov/nursing-faqs/advanced-practice-registered-nurse-aprn/
Maryville University. (n.d.). States Granting NP Full Practice Authority. Retrieved from https://www.online.maryville.edu/nursing-degrees/np/states-granting-np-full-practice-authority/
National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved September 20, 2018, from https://www.ncsbn.org/index.htm
Online Sunshine. (2021). The 2021 Florida Statutes. Retrieved from https://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/Sections/0464.0123.html
The Free Library. (n.d.). CRNA independent practice upheld: Montana Supreme Court affirms physician supervision not required for CRNAs. Retrieved from https://www.thefreelibrary.com/CRNA+independent+practice+upheld%3A+Montana+Supreme+Court+affirms
Great post! I like how this discussion topic forces us to explore nursing practice outside of our local bubble. Comparing and contrasting nursing practice acts in different locations encourages us to take a deeper look at why certain restrictions and regulations are in place in some states and not in others. With national undergraduate and graduate nursing education standards and competencies in place via accreditation, in addition to licensing and board requirements, I believe it is fair to say that a nurse or APRN in Florida has the same preparation as a nurse or APRN in Montana. I believe one major thing that holds the nursing profession back in regards to achieving national FPA is our current education standards to practice. I feel like the majority of the class can agree that threats of a needing a BSN to become an RN have been looming since the beginning of our nursing careers. I am aware that this is definitely a standard adopted by specific facilities, professional organizations, and hospital systems, but it is not enforced at the federal level, and presents the same discord in the nursing profession that FPA for APRN’s does. I can easily see FPA opponents using education standards to practice as an argument, and I do feel like this will need to be addressed before we reach national FPA.
A 2017 article discussing degree requirements in nursing highlighted that although the majority of new nursing graduates seeking licensure have an associate’s degree, each year there is an increase of BSN prepared nurses and the trend is currently moving towards a 50-50 split (Clarke, 2017). According to Clarke (2017), barriers to making a baccalaureate degree in nursing a requirement include concerns regarding the possible negative consequences of the gender, racial, cultural, and socioeconomic diversity within the nursing profession. I can see how these concerns are compounded by the projected nursing shortages expected by 2023 (Mancuso & Davidson, 2020). Perhaps national FPA must take place first to increase and enhance nursing’s presence in healthcare policy before undergraduate education standards are tampered with.
Clarke, S. P. (2017). The BSN entry into practice debate. Nursing Made Incredibly Easy!, 15(1), 6–8.
Mancuso, L., & Davidson, P. M. (2020). Thirty Million Strong: What our profession needs to look like in
the upcoming decade. AJN American Journal of Nursing, 120(5), 11. https://doi-
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