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Reply to each post with a 1 well-developed paragraph including references
Initial post question:
Identify the issue you think is most important regarding APRN credentialing and licensure?
What barriers or challenges have slowed the progress of advanced practice registered nursing?
Identify a current legislative policy on the local, state, or national level that will influence policies APRN practice.
Support all responses using at least one scholarly source other than your textbook.
Use national guidelines and evidence-based research when applicable.
Students may enhance responses with an example, either from personal experience or from the media, which illustrates and supports ideas.
Post 1: Precious
Problems in advanced practice nursing are mostly related to the extent of nursing practice; among them, inconsistent state standards and regulations for APRN certification and licensure pose the greatest challenge. In numerous places, regulatory intervention impedes the capacity of nurse practitioners (NPs) to completely perform their scope of practice. This includes issues with advanced practice registered nurses’ scope of practice, certification, regulation, and liability (Blair, 2018). Interestingly, several states continue to restrict NPs’ ability to practice to the full extent of their licenses despite strong evidence in favor of full practice authority; this is leading to delays in the attainment of autonomy for APRNs areas. The autonomy of advanced practice nurses is impeded by legislative and federal impediments, namely in prescriptive authority.
Although APRNs are allowed to prescribe drugs in every state, there are certain differences, including physician participation requirements, delegation, and restrictions on prescriptions for restricted substances (Blair, 2018). The independence that nurse practitioners have in their preferred practice site is greatly impacted by full practice authority legislation, which is presently enacted in 22 states and Washington, D.C. Each measure presents different requirements for moving to independent practice based on state considerations (Gero, 2019). The degree of autonomous practice is ultimately determined by the credentialing procedures used by various institutions for APRNs applying for clinical privileges. These procedures are governed by hospital regulations as well as state laws. Practice agreements become essential to the credentialing process in places where a supervising or cooperating physician is required (Blair, 2018).
Post 2: Mary
The most important issue regarding APRN credentialing and licensure is that every state has its own regulations, rules, and requirements, creating inconsistency. There are no national guidelines for providing consistency in the expectations of credentialing standards. According to Blair (2018), “certification in nursing has been murky, with no uniform standards” (p. 194). The issue with licensure is that there is so much concern about allowing APRNs more practice authority because our profession is disjointed nationally. Some states have full practice authority or limited practice authority, while others, like California and Texas, are restricted, requiring direct physician oversight. The barriers and challenges that slowed the progress of advanced practice nursing are due to healthcare policy regulations. According to Blair (2018), “The variation in state’s scope of practice (SOP) laws for APRNs are cited as a barrier to access to care” (p. 166). There continues to be resistance from legislation and physicians to expand the scope of practice for APRNs due to trust in patient safety.
A current bill in California is Assembly Bill 890, signed by Governor Gavin Newsom, which created two new categories for Nurse Practitioners: 103 NP and 104 NP (California Board of Registered Nursing, n.d.). These two categories are a gateway towards California transitioning from a restricted practice state to a full practice authority. The 103 NP category indicates that the NP works in a group setting with at least one physician and surgeon within the population focus and training of their national certification (California Board of Registered Nursing, n.d.). The 104 NP provision allows the NP to work independently within the population focus of their certification but without requiring a physician collaboration (California Board of Registered Nursing, n.d.). However, the 104 NP provision is not available for application until 2026, but the 103 NP is available at this time. The 103 NP provision allows NPs to work without standardized procedures in a group setting. The requirement is a three-year minimum of experience as a 103 NP before becoming eligible to apply for the 104 NP provision. This bill is promising in expanding APRN’s ability to provide more healthcare access and fill in the gap from physician shortages.
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