Full Practice Authority On Floridian Nurse Practitioners

In the Texas, state law prohibits Advanced Practice Registered Nurses (APRNs) including nurse practitioners (NPs) from practicing to the full extent of their education and clinical ability. Currently, Texas law requires than an APRN receive approval from an individual physician prior to engaging in the practice of advanced nursing. This type of complex regulatory scheme is outdated and restricts patients’ access to care, creates geographic disparities in services, and unnecessarily increases health care costs. For example, current law requires APRNs to meet periodically face-to-face with a supervising physician; with few physicians choosing to practice in rural areas, many APRNs who are willing to work in rural areas are essentially forbidden from delivering care to these underserved areas.

First, the state licensure regulates NP practice and it has been a big issue since NPs are not able to practice to the fullest extent despite of their education and training. NPs practice is regulated by state licensure and only about one-third of the nation has adopted full practice authority licensure and practice laws for NPs (Hain & Fleck, 2014). The American Association of Nurse Practitioners (AANP) reports that, under a full practice authority model, NPs are still required to meet

State law is made up of two different forms: statues and regulations (Buppert, 2015). Under the established rules and regulations, an ARNP can: (a) monitor and alter drug therapies; (b) initiate therapies for certain diagnosis’; (c) perform additional functions as may be determined by rule; (d) and order diagnostic tests and appropriate therapies (The Florida Legislature, 2016). A practitioner licensed under chapters 458, 459 or 466, must maintain supervision for directing certain course and medical treatment (The Florida Legislature, 2016). Within the context of advanced nursing practice and the Florida Statues chapter 464.003(2), an ARNP may diagnosis, treat, alter medication regimes, diagnose, prescribe and operate, which are approved by a joint committee composed of three members appointed by the Board of Nursing, three members appointed by the Board of Medicine and the State Surgeon General or his/her designee (The Florida Legislature, 2016). On the other hand, the federal government regulates nurse practitioner practice through statutes passed by Congress and regulations (Buppert, 2015). According to Buppert (2015), federal law can override state law, and when federal and state law conflict with one another, federal law usually triumphs. Due to these state and federal statutes and regulations, this can impose a huge threat and impact to NP practice since the BON and the Nurse Practice Act usually help

This paper explores the perception of clinical practitioners to the change in policy related to the advanced practice registered nurse (APRN) full practice authority. The author conducts a one-on-one, open-ended interview of 5 nurse practitioners and 5 physicians licensed to practice in Maryland on their perceptions of the recent passage of the Advanced Practice Registered Nurse Full Practice Authority. A literature review was conducted in a policy report by the professional nursing organization, and discussion within the peer-reviewed article supported an overview, regulatory differences among 50 states, including the District of Columbia. Their policy implication for enhancing APRNs role nationally. The author discusses a critical component

These organizations developed the Consensus Model document in 2008 to unify practice, identify APRN clinical roles, identify the acceptable titles to for NPs, and define the requirements for general practice and licensure. Note to mention that laws and regulations statute on the APN scope of practice may vary by states, whereas some adhere to full scope of practice, other to reduced practice, or restricted practice. For instance, the state of Florida defines advanced registered nurse practitioner as a licensed person with ability to practice professional nursing and certified to in advanced or specialized nursing practice (Buppert, 2011). The four advanced clinical specialized roles include certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialist, and nurse practitioners (Buppert, 2011). In terms of licensure, 46 states out of 50 require nurse practitioners to pass a certification exam. The Florida Board of Nursing requires certification by an appropriate specialty board and graduation from a program leading to a master’s degree (Buppert,

Insurers are less likely to reimburse APRN’s in states that mandate physician supervision. Nurses need to push for reform of the regulations governing APRN;s.

After attending the Arizona State Board of Nursing meeting through live stream on September 18, 2015 at approximately eleven in the morning, I had the opportunity to witness how the board enforces all the rights and regulations of the Nurse Practice Act and upholds the requirements set for each standard. The board consists of the board president Randy Quinn, RN, MSN, CRNA, the boards vice president Carolyn Jo Mccormies, RN, MS, FNP-BC, Kathryn Busby, J.D., Public Member, Lori A. Gutierrez, BS,RN-C,DON-CLTC,CBN, Terri Berrigan, LPN, C-AL who is the board secretary, Patricia Johnson, LPN, M. Shawn Harrell, RN, MS, Charleen Snider, BSN,RN , Dr. Kimberly A. Post, DNP,MBA/HCM,RN,NEA-BC, and Leslie Dalton, MSN, RN. Nine out of the ten board member were in attendance and conducting rulings in this particular meetings.

The Full Practice Authority for APRNs (HB 1415/ SB 681) deals with the legislation which will permit Nurse Practitioners (NPs) to practice to the complete magnitude of their education and training. It will also eliminate expensive and difficult regulatory requirements like having contracted delegation arrangements with physicians, and will place NPs under the select supervisory authority of the Texas Board of Nursing (BON). Bill HB 1415 was filed on 02/01/2017 and was “Left pending in committee” as of 04/25/2017. Bill HB 681 was filed on 01/31/2017 and was “Referred to Health and Human Services” as of

The Florida Board of nursing supports state associations such as the FNA which encourages legislation to allow all nurses to practice to the full extent of their education and training. It additionally supports efforts to protect the rights, jobs, wages, pensions, health care coverage, and other benefits of our state-employed health care nurses. Today I will be discussing about my policy brief and providing an in-depth analysis on the issue and how the Florida state board of nursing will contribute to the cause. (Cheryl, 2012).

Healthcare reform continues in a time where a new president has taken office and is attempting to change or “bridge gaps” in health care policy. Currently, NPs are focused on a new shift to prevent disease rather than to solely cure or treat it which is the major difference between physician practice and the nursing profession. NPs receive extensive schooling and clinical practice to achieve full practice rights, however, the restrictions continue. The Florida Association of Nurse Practitioners (FLANP) monitors Florida legislative sessions on regards to the scope of NPs. As of March 7th, 2017, Bills of interest that affect full practice authority in the state of Florida are: “HB 7011 which introduces independent practice for NPs; CS HB129: which allows NPs to be medical directors and gain signature authority; SB 96 which allows NPs to be medical directors and S634/HB 645 which allows NPs to sign Certificates of Involuntary Commitment (Baker Act)” (Florida Association of Nurse Practitioners (FLANP), 2017). If these bills are finally approved all bilingual NPs can address many patients in need of healthcare without any barriers as to which provider they can see.

There should be impartial and fair governing board oversight of APRNs. Access to care should also be improved by authorizing third-party cover of APRN care and allowing patients to select providers of their choice. The healthcare workforce should also be given more support by creating more clinical training and graduate level education opportunities for nurses. The primary goals for these changes include giving APRNs the chance to practice their training and education to full limit, filling the gaps created by physician shortages, and improving

Healthcare reform in the United States (U.S.), continues to be a hot topic in the news. Whether it discusses how the program will be financed, the need to redesign the organization, or how the process of delivering healthcare will be implemented; one thing that is a frontrunner, is the need for registered nurses (RNs) and advanced practice registered nurses (APRNs) to fill the increased demands on the primary care system (Institute of Medicine, & Robert Wood Johnson Foundation, 2011, p. 375). “Several programs and initiatives included in the health reform legislation involve interdisciplinary and cross-setting care coordination and care management services of RNs” (Institute of Medicine, & Robert Wood Johnson Foundation, 2011, p. 377).

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

The APRNs Regulatory Model specializes roles and titles and population foci within a regulatory framework (Hamric, Hanson, Tracy, & O'Grady, 2014). This was implemented to resolve the issue of inconsistent rules, policies and standards of care across states. APN practice is faced with many barriers or obstacles put in place with notion of regulating practice and provision of quality and safe care. This have led to reviewing of the regulations to broaden the spectrum of APN practice as health care is fast evolving. Diverse regulatory criteria like variable accreditation standards, licensing requirements, inconsistent population foci and scopes of practice, represent barriers to optimize APRN function within today’s complex health care system

I found your post to be very informative and effective in describing the barriers that FNPs face in their practice in your State. Being acquainted and familiar with Florida’s Nurse Practice Act (NPA), I was under the impression that Florida had one of the most restrictive in terms of practice for APRNs. However, after reading your thoughtful analysis, I can see that unfortunately we both are in states that place the most barriers to FNPs.