State-Specific Regulations on NPs Paper Example

Introduction

Nurse practitioners are used for filling existing gaps between service need and care capacity for various states including Arizona and Ohio. However, they are guided by unique state-specific regulations. NPs mainly enter primary care but are guided by some state-of-practice laws that regulate them on various requirements including education, prescriptive authority, and physician involvement among others (Gadbois, Miller, Tyler & Intrator, 2015). For Ohio, the practice authority requires the NP to work alongside other physicians and only work in their line of specialty. The prescriptive authority requires them to prescribe drugs in the presence of a physician. The NPs in Ohio are also required to be primary care providers for providing preventive and primary care services in line with their field of specialization. On the other hand, Arizona requires its NPs to practice limitlessly as far as they are authorized by the State Board of Nursing. They are also allowed to prescribe drugs without any supervision, as long as they are within the population. NPs in Arizona also work as primary care providers and are not limited to their population of focus, as long as they work within their area of specialization.

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Regulatory barriers that exist for NPs in Arizona and Ohio

Nurse Practitioners in Ohio cannot provide certain medical services to their population including treatment, diagnosis, and prescription unless they are approved by the Prescriptive Authority Agreement (PAA) through a senior doctor. by submitting a subset of their charts to physicians for review. They are only allowed to admit patients to the hospital according to a bill signed in 2014. On the other hand, even though Arizona is addressing its barriers, it has been a challenge to deal with antiquated regulations for a period of time. This barrier prevents most of the graduate NPs to provide nursing care to patients.

Progress

The Institutes of Medicine of the National Academy of Science has created various initiatives to phase out outdated regulations and barriers to nursing practice. One of the initiatives is the SB1473, a modest regulation that ensures autonomy for Nurse Practitioners. The institution is also enhancing collaboration among healthcare professionals through such legislation. On the other hand, Ohio is also striving to let its NPs operate without unnecessary regulatory barriers through its General Assembly (Glans, 2018). One of the successful initiatives in Ohio is the 2014 bill that allows Nursing Practitioners to admit patients to the hospital.

Remaining solutions

For both states, nurses are not allowed to certify patients as home health care eligible but have been given the mandate to allow for hospital admission. However, home health care would work best, especially without the presence of a physician. The lack of access to specialty home medical care has been a barrier that needs to be addressed for the states. Additionally, Nurse Practitioners are excluded from Medicaid initiatives. Lower incentives are provided to Nurse Practitioners by Medicaid compared to Medicare. Furthermore, independent nurse practitioners have excluded from the incentives hence the ineffectiveness of the program especially where NPs serve in their communities. Therefore, the inclusion of independent NPs in the Medicaid initiative is missing but should be necessary to both them and the community.

Professional opportunities available

Career opportunities are available for advanced nurse practitioners since NPs are equally important in health systems just like doctors and physicians. Through pursuing careers, they can reach advanced levels that include additional roles. It is education that limits them to providing certain primary care services or even practicing independently. Additionally, NPs have the opportunity to fully partner with physicians and other healthcare professionals in the redesigning of their state's health care system (Mccomiskey, et al., 2018).

An ethical issue for an NP

One of the ethical issues in nursing practice is disclosing medical conditions. A family could demand that the patient should not be told the truth about the condition, leading to a dilemma. The nurse is supposed to hold on to the value of truth-telling in such a case. One of the ways to address this dilemma amongst other ethical issues is holding on to self-regulation (Hunt, 1995). As an NP, I have the responsibility of setting and enforcing the rules to nursing. I would establish the values and standards for education and practice leaned and enforce them as well. However, in my practice, I would still maintain public-interest over self-interest to better address the ethical issue.

Profession and professionalism issues

Profession for APNs refers to the status of inter-profession and intra-profession challenge. On the other hand, a profession for RNs refers to the encounter with more ethical and philosophical changes in the healthcare settings that create better environments for nurses. Professionalism for APNs refers to the ability to apply their professional concepts at the healthcare settings while following set regulations to ensure productivity. On the other hand, professionalism for the RN is the ability to adhere in all roles and practice in the healthcare institutions, to the standards of practice offered by the ARNNL to ensure accountability, knowledge, visibility, and ability to address ethical issues.

Historical factors contributing to the development of advanced practice nursing roles

Before the start of APRN, there was a shortage of primary care physicians. It was at the late 1950s that Registered Nurses were recruited to administer primary care. This led to the creation of Medicare and Medicaid in 1965. Various education programs were instituted to make sure that RNs and APNs were knowledgeable enough to offer primary care. As a result, they were more knowledgeable hence, required certification and various laws to govern them. After registration, professional identity was mandatory hence, the founding of organizations such as the American College of Nurse Practitioners (ACNP). Later, the Affordable Care Act was passed and presently, various states have a full scope of practice.

References

Gadbois, E. A., Miller, E. A., Tyler, D. & Intrator, O. (2015). Trends in State Regulation of Nurse Practitioners and Physician Assistants, 2001 to 2010. Med Care Res Rev. 72(2): 200-219.

Glans, M. (2018). Publications - Research & Commentary: Expanded Role for Nurses Could Help Address Ohio's Primary Care Shortage. Retrieved from https://www.heartland.org/publications-resources/publications/research--commentary-expanded-role-for-nurses-could-help-address-ohios-primary-care-shortage

Hunt, G. (1995). Ethical issues in nursing. London: Routledge.

Mccomiskey, C., Simone, S., Schofield, D., Mcquillan, K., Andersen, B., Johannes, S., & Weichold, A. (2018). Professional advancement for advanced practice clinicians. Journal for Nurse Practitioners, 14, 12-17.