Professional Nursing and State-Level Regulations
Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.
It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.
Resources
Be sure to review the
Learning Resources
before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
· Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
· Consider how key regulations may impact nursing practice.
· Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.
By Day 3 of Week 5
Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.
By Day 6 of Week 5
Respond to at least
two of your colleagues
* on two different days and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples.
*Note:
Throughout this program, your fellow students are referred to as colleagues.
Learning Resources
Required Readings
· Short, N. M. (2022).
Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.
· Chapter 7, “Government Response: Regulation” (pp. 147–173)
· American Nurses Association. (n.d.).
ANA enterprise
Links to an external site.
. Retrieved September 20, 2018, from http://www.nursingworld.org
· 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 careLinks to an external site.
.
Nursing Outlook, 65(6), 761–765.
· Halm, M. A. (2018).
Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing
Download Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing
.
Worldviews on Evidence-Based Nursing, 15(4), 272–280. doi:10.1111/wvn.12291
·
National Council of State Boards of Nursing (NCSBN)Links to an external site.
. (n.d.). Retrieved September 20, 2018, from https://www.ncsbn.org/index.htm
· Neff, D. F., Yoon, S. H., Steiner, R. L., Bumbach, M. D., Everhart, D., & Harman J. S. (2018).
The impact of nurse practitioner regulations on population access to careLinks to an external site.
.
Nursing Outlook, 66(4), 379–385.
· Peterson, C., Adams, S. A., & DeMuro, P. R. (2015).
mHealth: Don’t forget all the stakeholders in the business caseLinks to an external site..
Medicine 2.0, 4(2), e4.
Required Media
· Walden University, LLC. (Producer). (2018).
The Regulatory Process [Video file]. Baltimore, MD: Author.
· Walden University, LLC. (Producer). (2018).
Healthcare economics and financing [Video file]. Baltimore, MD: Author.
· Walden University, LLC. (Producer). (2018).
Quality improvement and safety [Video file]. Baltimore, MD: Author.
Please also include responses with a reference to the collogues below:
Ashley Bowman
Mar 26 4:59pm
Manage Discussion by Ashley Bowman
Reply from Ashley Bowman
Main Post
Advanced Practice Registered Nurses (APRNs) regulation varies significantly between Tennessee and Maryland, particularly in key areas such as prescriptive authority and scope of practice. In Tennessee, APRNs must maintain a collaborative practice agreement with a supervising physician to have prescriptive authority, and they are required to complete 30 hours of pharmacology education every two years (National Conference of State Legislatures, n.d.). The state also mandates a separate DEA registration for controlled substances and requires a three-year supervised prescribing period before considering any reduction in physician oversight. In contrast, Maryland grants APRNs full independent prescriptive authority without physician oversight, requiring only 15 hours of pharmacology CEUs per renewal period. Maryland APRNs can independently prescribe Schedule II-V controlled substances without a supervised prescribing period requirement.
The scope of practice regulations also demonstrates significant differences between these states. Tennessee maintains stricter oversight by requiring written collaborative practice agreements that define the APRN’s scope and mandatory documentation of physician collaboration. Tennessee regulations stipulate that physicians must review 20% of charts every 30 days and impose geographic restrictions on the distance between APRNs and their collaborating physicians. Maryland, however, grants full practice authority without physician oversight, allowing APRNs to diagnose, treat, and prescribe independently (Feeney, 2024). Maryland has no geographic restrictions on practice location or chart review requirements.
These regulatory differences manifest in distinct practical applications for APRNs. In Tennessee, an APRN must establish and maintain a collaborative agreement with a physician, document regular chart reviews and meetings with their collaborating physician, maintain detailed prescribing logs for controlled substances, and submit supervision agreements to the Board of Nursing (Zhang & Patel, 2023). Conversely, an APRN practicing in Maryland can establish an independent practice without physician agreements, is responsible for maintaining their clinical documentation standards, must adhere to state prescribing guidelines independently, and reports directly to the Board of Nursing for practice oversight (For Nursing et al., 2021).
The impact of these regulatory differences extends beyond individual practice requirements. The more restrictive environment may affect patient access to care, particularly in rural areas where finding collaborating physicians can be challenging (Kleinpell et al., 2022). Meanwhile, Maryland’s full practice authority model allows APRNs to practice to the full extent of their education and training, potentially increasing healthcare accessibility and efficiency. These contrasting approaches to APRN regulation reflect ongoing debates about the optimal balance between professional autonomy and oversight in advanced nursing practice.
References
Feeney, A. (2024). Nurse practitioner practice authority: A state-by-state guide. NurseJournal.
https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/
Links to an external site.
Open Resources for Nursing, Ernstmeyer, K., & Christman, E. (2021). Scope of practice. In Nursing fundamentals [Internet]. Chippewa Valley Technical College.
https://www.ncbi.nlm.nih.gov/books/NBK591808/
Links to an external site.
Kleinpell, R., Myers, C. R., Likes, W., & Schorn, M. N. (2022). Breaking down institutional barriers to advanced practice registered nurse practice. Nursing Administration Quarterly, 46(2), 137-143.
https://doi.org/10.1097/NAQ.0000000000000518
Links to an external site.
National Conference of State Legislatures. (n.d.). Scope of practice policy: State overview – Tennessee.
https://www.ncsl.org/scope-of-practice-policy/state/tennessee
Links to an external site.
Zhang, P., & Patel, P. (2023). Practitioners and prescriptive authority. In StatPearls [Internet]. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK574557/
Links to an external site.
Grettet Tamarit Guerra
Mar 26 2:11pm
Manage Discussion by Grettet Tamarit Guerra
Reply from Grettet Tamarit Guerra
Advanced Practice Registered Nurses (APRNs) in Florida are regulated by the Florida Board of Nursing with specific rules governing licensure, practice scope, and prescriptive authority. Florida’s APRN regulation is distinct from New York’s in independent practice and practice with physician collaboration.
One of the primary differences is in the requirement of physician supervision. In Florida, APRNs must sign a collaborative practice agreement (CPA) with a physician to provide medical care. However, in 2020, Florida passed a law granting full practice authority to certain APRNs so that they could practice independently without physician oversight, but only under specific conditions, such as having a minimum of 3,000 hours of clinical practice under the oversight of a physician (Reynolds et al., 2021). However, New York gives APRNs full practice authority without requiring a CPA and aligns with the National Council of State Boards of Nursing (NCSBN) model for full practice states(Poghosyan et al., 2020). This means that APRNs in New York can assess, diagnose, interpret laboratory tests, and initiate treatment plans without any restrictions.
Another regulatory difference is in prescriptive authority. In Florida, APRNs can prescribe controlled substances but are restricted from prescribing Schedule II substances for more than a seven-day supply unless they are psychiatric mental health nurse practitioners (PMHNPs) who have additional privileges for psychiatric medications (Buck, 2021). In New York, APRNs have broader prescriptive authority and are not subject to the same seven-day limitation, which gives them more flexibility in managing patients, particularly in chronic pain or psychiatric practice.
These regulations impact APRNs practicing at the full scope of their education and experience. For example, a Florida APRN eligible for independent practice may start their own primary care practice without a CPA, whereas in New York, any APRN may do so with licensure. Similarly, a Florida APRN prescribing controlled substances must strictly adhere to the seven-day rule, weighing compliance and streamlining patient care.
References
Buck, M. (2021). An update on the consensus model for APRN regulation: More than a decade of progress.
Journal of Nursing Regulation, 12(2), 23–33.
https://doi.org/10.1016/s2155-8256(21)00053-3Links to an external site.
Poghosyan, L., Ghaffari, A., Liu, J., Jin, H., & Martsolf, G. (2020). State policy change and organizational response: Expansion of nurse practitioner scope of practice regulations in New York State.
Nursing Outlook, 69(1).
https://doi.org/10.1016/j.outlook.2020.08.007Links to an external site.
Reynolds, A. M., Reynolds, C. J., & Craig-Rodriguez, A. (2021). APRNs’ controlled substance prescribing and readiness following Florida legislative changes.
The Nurse Practitioner, 46(6), 48–55.
https://doi.org/10.1097/01.npr.0000751796.01625.17Links to an external site.
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