Essay Example on Nurse Practitioners: A Comprehensive Overview of Scope of Practice

A General Overview of Nurse Practitioners' Scope of Practice

The implantation of Obamacare aimed to elevate the health-seeking behavior in the U.S with more focus on the primary care sector. Providers of primary care offer preventive healthcare services to reduce the worsening of chronic conditions as well as reducing the number of regular medical challenges in hospital settings (Traczynski & Udalova, 2018). With an increasing number of patients with chronic diseases and the specialization of physicians, certified NPs are now playing a critical part in the provision of primary care. Traczynski and Udalova (2018) suggest that the rise of NPs as primary caregivers helps in reducing the problems that arise in primary care since they have the likelihood to practice in rural areas as opposed to physicians (Ortiz et al. 2018). Also, some states allow NPs to render services and carry out the prescription of drugs with physicians' supervision, thus making them be independent primary providers of health. Therefore, laws regarding the scope of practice stand as essential policy tools that make states influence preventive care, medical costs, and accessibility of medical services in remote areas (Traczynski & Udalova, 2018). According to Traczynski and Udalova (2018), the independence of NPs results in higher healthcare utilization in areas with few physicians and lower healthcare accessibility costs.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

NPs Prescriptive Authority in Hawaii and Florida

In Hawaii, NPs are allowed to practice autonomously from professional physicians and provide services based on the State's Board of Nursing licensure regulations. According to 457-8.6 of Hawaii statutes, NPs have the authority to avail drug prescriptions, schedules, and advisories for controlled substances (Hawaii.gov, n.d). In some cases, NPs can also prescribe medical devices only if these prescriptions are within the specialty of NPs as per Rules 16-89-122 of Hawaii Administrative Statutes (Scope of Practice, 2020). The state of Hawaii recognizes NPs as first-line providers of health services, as described in Hawaii statutes 431:10A-125 (Scope of Practice, 2020). More specifically, NPs are recognized by health insurance organizations as primary care providers if the insurance policy of patients calls for a primary caregiver selection. In Florida, prescription authority is restricted by the Board of Nursing of Florida (Florida Board of Nursing, 2016). Besides, NPs in Hawaii with prescriptive authority as per 457-8.6 are allowed to dispense uncontrolled substances, in addition to issuing over the counter drugs to patients under primary care (Hawaii.gov, n.d). Medicines administered by NPs with prescriptive authority include over-the-counter medications, controlled substances, and legend drugs (Board of Nursing, 2016).

Unlike Hawaii, NPs in Florida practice restricted prescriptive powers autonomously in primary healthcare settings, which includes family wellness, as well as pediatric and internal medicine, as indicated by regulation Fla. Stat. 464.0123. A NPs may offer a prescription of drugs and schedules II-V as per Fla. Stat. 464.012 for controlled substances only if the practitioner practices autonomously (Scope of Practice, 2020). Similar to the case in Hawaii, NPs are recognized by Florida state as first-line providers, which imply that they have licensure under chapter 458, 459, or 464 (Scope of Practice, 2020). They have the mandate to offer health services to clients without a referral from other healthcare settings. Therefore, it is essential to note that though NPs in both states practice prescriptive authority, those in Florida have a restricted practicing authority. However, the nursing board has received requests to allow them full prescriptive powers. The process of authorization is still ongoing.

A bill dubbed HB 423 that recommended NPs to be issued with prescriptive authority was made law in 2016. The law allowed these practitioners to offer a prescription of drugs even for controlled substances provided there was sufficient supervision (FANA, 2016). Before this bill became law, NPs were required to possess written protocols from medical doctors and dentists to order diagnostic tests, to diagnose and to provide occupational and physical therapy (Kaplan, 2016). The written protocol provides regulations regarding the prescription of controlled substances. NPs in Florida are allowed to prescribe drugs and controlled substances as long as the practitioner graduated with a degree and a master's qualification (Florida Board of Nursing, 2016). Also, NPs' prescription authority for controlled substances must adhere to the 7-day caveat but does not include prescription of psychotropic medical substances to children below the age of 18 years.

Comparison between Nurse Practitioners' Prescriptive Authority in Hawaii and Florida

Advanced practice registered nurses (APRNs) and NPs help states meet their primary healthcare needs, especially those residing in rural areas and all other people enrolled under the Affordable Care Act (RWJF, 2015). The outdated nursing laws and policies being used by states that are yet to issue nurses with prescriptive authority keep NPs from engaging in full extent nursing activities, thus hindering the provision of primary care needs to the ailing population (RWJF, 2015). Such outdated laws also restrict NPs from providing primary care services in rural areas, thus making primary health inaccessible to underserved populations. Since Hawaii gave NPs the authority to prescribe drugs, considerable benefits in the form of affordable healthcare, and access to primary care needs in rural and underserved areas became a reality. These are some of the significant milestones experienced in states that legalized NPs to have prescription powers in the United States.

One of the most critical implications of NP's prescriptive authority in Hawaii is the increased provision and access of primary healthcare needs to civilians following the influx of NPs practicing prescriptive authority (RWJF, 2015). According to the Agency for Healthcare Research and Quality (AHRQ), among the 50 states, Hawaii is among the top 10 with the best healthcare quality while Florida is among the bottom 10 with poor quality of health (AHRQ, n.d). The state of Hawaii legitimized the prescription powers of NPs in 2009, allowing nurses to provide primary care, especially to patients living in far-flung rural areas in Hawaii and underserved regions (Alexander & Schnell, 2019). This law made the number of NPs with powers to prescribe drugs in Hawaii state to increase from 193 registered in 2009 to 383 who registered by 2013 (Alexander & Schnell, 2019). Prescriptive authority as legislation provided solutions for the inadequate primary healthcare providers that existed in the past. Initially, Hawaii had a documented lack of providers of primary care needs on all its islands, and this challenge was particularly serious among small populations residing in the rural island of Hawaii (Alexander & Schnell, 2019). As of 2013, LeVasseur et al. (2015) indicated that Hawaii had 14,384 NPs, and only 383 of those were registered nurses in the state. In this regard, the NPs ratio to the patients was 1 per 1000 patients in all the islands of Hawaii. Based on these shortfalls, the Health Resources and Services Administration (HRSA) indicates that Hawaii is going to face a shortage of 3311 NPs (LeVasseur et al. 2015), which justifies the necessity for full prescription powers for NPs.

In Florida, NPs have limited abilities when it comes to providing primary care to the state's residents. It is the case because they practice prescriptive authority only on controlled substances and need to secure costly partnerships with physicians and medical doctors to offer prescriptions to basic medical needs. According to the Florida Center for Nursing, (2016), as of 2015, Florida had 18,337 registered nurses; however, the numbers had fallen from 24,671 in 2007. As such, this implies that the scope of practice in Florida cannot be compared to that of Hawaii because nurses in Hawaii have full independence to practice prescriptive authority without the supervision of physicians. Conversely, the limited scope of practice for NPs in Florida implies that access to health care services is only limited to areas where physicians are available and responsive to medical demands. These guidelines are contained in the Nurse Practice Act of Florida, particularly in 464.001-464.027 (The Florida Senate, 2017). Also, the second part of the Certified Nursing Assistant 464.002 requires nurses to observe safe practices as anything beyond the regulations found in 464.003 endangers public health. In most unfortunate cases, residents living in rural areas may not access responsive and quality primacy care. That is the case because nurses attending to them require physicians' approval to get access to diagnostic tests because they have a limited scope of practice based on the Nurse Practice Act section 464.001-464.027 of Florida (The Florida Senate, 2017).

The restricted scope of practice of NPs in Florida limits access to medical care among the residents of the state because state laws regulating the operation of NPs are strict compared to other states like Hawaii. The reluctance of Florida state to give full independence to NPs is also raising costs incurred in the form of medical insurance and additional expenses incurred during the process of medical provision (Toney-Butler & Martin, 2019). Toney-Butler and Martin (2019) illustrate that these costs come in the form of expensive collaboration costs with doctors, costs incurred by insurance companies in the provision of primary care needs, and costs incurred by logistics and associated costs that avail physicians for supervision. Also, Altman et al. (2016) support these sentiments by stating that a shortage of NPs as a result of the limited scope of practice limits access to primary care, leads to skyrocketing costs of healthcare and a lessening life-quality among the residents of Florida. LeVasseur et al. (2015) also sensitized that changing laws that license full independence of NPs reduce the costs of primary care and increases access to primary care, as demonstrated by states that legalized full autonomy of NPs.

Conclusion

Full prescription authority and full independence are essential aspects of transforming healthcare delivery in the United States. Hawaii is an excellent case of stat...