The Evolution of Advanced Practice Registered Nurses (APRNs) in North America

Posted: April 4th, 2019

Respond to what he wrote, be argumentative with the answers, and polite. References, and at least 2 paragraphs.

In the last decade, there have been a lot of changes to the model of practice of advanced practice registered nurses (APRNs) in Northern America. During the pandemic, legislative changes enabled nurse practitioners (NPs) in some states to act in the role of medical doctors, thereby empowering them to work to their full scope of practice. This has resulted in a higher quality of care, decreased hospitalization rates, improved access to care, and the creation of an improved working environment for direct care providers (McGilton et al., 2023). For the purpose of this discussion post, the practice agreements, process of certification and licensure as an APRN in North Carolina, the scope of practice of nurse practitioners, how to get Drug Enforcement Administration (DEA) license, and controlled substance prescriptive authority for NPs will be summarized. Also, the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in North Carolina will be explained.
Summary of Findings
Certain criteria need to be met before an individual can be licensed as an Advanced Practice Registered Nurse (APRN) in the state of North Carolina. A lot of information on certification and licensure can be found on www.ncbon.comLinks to an external site., which is the North Carolina Board of Nursing (NCBON) website. One must hold a North Carolina Registered Nurse license or a compact state license that is valid to practice in North Carolina. A master’s or higher degree in nursing must be completed. Additionally, a national certification as a nurse practitioner must be obtained from one of the nationally accredited credentialling bodies, and a registration with the North Carolina Controlled Substance Reporting System (CSRS) is required for those that have prescriptive authority for controlled substances. The North Carolina CSRS exists through the North Carolina Department of Health and Human Services to collect information on dispensed controlled substance prescriptions and make this information available to prescribers and dispensers (North Carolina Department of Health and Human Services, n.d.).
The scope of practice of an APRN in North Carolina required being educationally prepared, nationally certified, and maintenance of competence. The APRN is required to promote and maintain health; prevent illness and disability; diagnose, treat, and manage acute and chronic illnesses; guide and counsel individuals and their families; prescribe, administer, and dispense therapeutic measures, tests, procedures, and drugs; plan for situations beyond the nurse practitioner’s scope of practice and expertise by consulting with and referring to other health care providers as appropriate; and evaluate health outcomes (Office of Administrative Hearing, 2019). According to the North Carolina Board of Nursing (2022), nurse practitioners have the approval to prescribe legend drugs and Controlled Substance Schedules II – V, which is consistent with the scope of practice determined by their educational preparation and national certification. Professionals who prescribe controlled substances must fully comply with both North Carolina’s state and federal rules and regulations. A nurse practitioner who administers, dispenses, or prescribes any controlled substance, must be registered with the federal Drug Enforcement Administration (DEA). In North Carolina, this process requires applying for DEA registration, paying the required fees, completing, and submitting DEA for 106.
In North Carolina, an APRN requires a collaborative practice agreement with a licensed physician. Therefore, upon completing an advanced degree and obtaining licensure, an APRN needs to apply for an ‘Initial Approval to Practice’. What this application entails is an active North Carolina Registered Nurse license; the physician’s name, their license number, or email address; and the practice information. After all these have been submitted and approved, the APRN can begin practicing in North Carolina (North Carolina Board of Nursing, n.d.).
Types of Regulations that Exist and the Barriers that May Impact Nurse Practitioner Independent Practice
From the research findings, there are regulations, and some barriers exist that may impact nurse practitioner independent practice in North Carolina. For instance, the scope of practice laws defines the activities and responsibilities that healthcare professionals are allowed to engage in. In North Carolina, there is a need for physician oversight, and there is a need for physician collaboration. Also, we are required to have collaborative practice agreements with physicians. Collaborative Practice Agreement (CPA) is an agreement between the nurse practitioner (NP) and the primary supervising physician addressing how the NP operates the administrative code or rules in their practice (North Carolina Board of Nursing, 2023). These agreements outline the relationship and level of collaboration between the nurse practitioner and the physician. Components that are included in the collaborative practice agreement are the drugs, devices, medical treatments, tests, and procedures that may be prescribed, ordered, and performed by the nurse practitioner. Additionally, prescriptive authority is part of the nurse practitioner approval to practice. A nurse practitioner may prescribe controlled substances; however, the supervising physician must have a DEA registration equal to or greater than the DEA registration of the nurse practitioner that he or she supervises. Finally, regulatory bodies exist to set regulations for APRNs. These boards can influence the level of autonomy nurse practitioners have in their practice in North Carolina.
Some of these regulations pose a major barrier that may impact the nurse practitioner’s ability to practice independently. To begin with, the scope of practice restrictions can be very challenging because it limits the ability to provide care independently. Also, due to the collaborative practice agreements that are needed from a physician, we experience a lot of opposition from physician associations and groups. They cite that they have concerns about patient safety and the need for the role of physicians in the health care team. To add to these barriers, there are challenges as to how the public perceives the role and capabilities of nurse practitioners. Patient and public understanding of the role and capabilities of nurse practitioners can influence the acceptance of independent practice. Educating the public about the training and expertise of nurse practitioners is very crucial for acceptance. Nurse practitioners may also face challenges in being recognized by insurance providers and receiving reimbursement for their services at the same rate as physicians. According to Barnes et al. (2017), in a lot of states, nurse practitioners are reimbursed less than the physician rate, varying from 75% to 100% of physician rates. A lot of legislative processes are ongoing to have nurse practitioners receive 100% reimbursement from Medicare. Currently, reimbursement is only provided at about 85% of the physician rate in most states (Bischof & Greenberg, 2021).
All this information did not come as a surprise to me because during this program, we have been required to carry out research findings on related issues. This has enlightened me to the state regulations for the scope of practice of nurse practitioners in my state. I have educated myself on these requirements and learned a lot from my preceptors and senior colleagues in the field of psychiatric mental health. I believe that I am well prepared for all these upon completion of my degree.
Conclusion
The United States is experiencing shortages of primary care providers, and NPs offer the potential to moderate these shortages (Barnes et al., 2017). As advanced practice registered nurses, it is important to stay updated with the latest regulations and developments in our individual states regarding nurse practitioner practice. It is therefore advisable to consult the state Board of Nursing and other relevant authorities for the most current and accurate information for legal practice.
References
Barnes, H., Maier, C. B., Sarik, D. A., Germack, H. D., Aiken, L. H., & McHugh, M. D. (2017). Effects of regulation and payment policies on nurse practitioners’ clinical practices. Medical Care Research and Review, 74(4), 431–451. https://doi.org/10.1177/1077558716649109Links to an external site.
Bischof, A., & Greenberg, S. A. (2021). Post COVID-19 reimbursement parity for nurse practitioners. Online Journal of Issues in Nursing, 26(2). https://doi.org/10.3912/ojin.vol26no02man03Links to an external site.
McGilton, K. S., Haslam-Larmer, L., Wills, A., Krassikova, A., Babineau, J., Robert, B., Heer, C., McAiney, C., Dobell, G., Bethell, J., Kay, K., Keatings, M., Kaasalainen, S., Feldman, S., Sidani, S., & Martin-Misener, R. (2023). Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatrics, 23(1). https://doi.org/10.1186/s12877-023-03798-1Links to an external site.
the North Carolina Board of Nursing. (2022). Prescribing. Retrieved August 29, 2023, from https://www.ncbon.com/practice-nurse-practitioner-prescribing#:~:text=Nurse%20Practitioner%20approval%20includes%20prescriptive,educational%20preparation%20and%20national%20certification.
North Carolina Board of Nursing. (2023). Collaborative practice guidelines. Retrieved August 29, 2023 from https://www.ncbon.com/practice-nurse-practitioner-collaborative-practice-guidelines#:~:text=Required%20components%20of%20the%20CPA,performed%20by%20the%20nurse%20practitioner.
North Carolina Board of Nursing. (n.d.). Advanced practice registered nurse. Retrieved August 27, 2023, from Advanced Practice Registered Nurse | North Carolina Board of Nursing (ncbon.com)Links to an external site.
North Carolina Department of Health and Human Services. (n.d.). NC Controlled Substances Reporting System. Retrieved August 29, 2023, from https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-use-services/north-carolina-drug-control-unit/nc-controlled-substances-reporting-system
Office of Administrative Hearing. (2019). Scope of practice. Retrieved August 27, 2023, from http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0802.htmlLinks to an external site.

The Evolution of Advanced Practice Registered Nurses (APRNs) in North America

The dynamic landscape of advanced practice registered nursing (APRN) has witnessed significant transformations over the past decade, particularly in North America. Notably, the recent years have brought about legislative modifications that have empowered nurse practitioners (NPs) to assume expanded roles, including acting as medical doctors in certain states during the pandemic. This shift in practice models has yielded substantial benefits, including enhanced care quality, reduced hospitalization rates, improved healthcare accessibility, and a more conducive working environment for direct care providers (McGilton et al., 2023). In this discourse, we delve into the intricate facets of APRN practice agreements, the certification and licensure process in North Carolina, the scope of practice for nurse practitioners, the acquisition of Drug Enforcement Administration (DEA) licenses, and controlled substance prescriptive authority for NPs. Furthermore, we shed light on the spectrum of regulations governing this domain and the formidable barriers that might impede the independent practice of nurse practitioners in North Carolina.

Credentialing and Licensure in North Carolina: A Rigorous Pathway to APRN Status

Attaining the status of an Advanced Practice Registered Nurse (APRN) in North Carolina entails a meticulous adherence to stringent criteria. A pivotal resource for candidates is the North Carolina Board of Nursing (NCBON) website, where comprehensive information on certification and licensure is available (North Carolina Board of Nursing, n.d.). Aspiring APRNs must possess a valid North Carolina Registered Nurse license or an equivalent compact state license. Furthermore, a master’s or higher degree in nursing is requisite, coupled with national certification as a nurse practitioner from an accredited credentialing body. Moreover, registration with the North Carolina Controlled Substance Reporting System (CSRS) is obligatory for those wielding prescriptive authority over controlled substances (North Carolina Department of Health and Human Services, n.d.). This system, under the aegis of the North Carolina Department of Health and Human Services, consolidates data on controlled substance prescriptions to empower prescribers and dispensers with essential information.

Nurse Practitioner Scope of Practice: Encompassing Expertise and Responsibility

The scope of practice for APRNs in North Carolina is anchored in a robust foundation of educational preparation, national certification, and the ongoing pursuit of competence. The multifaceted responsibilities encompass the promotion of health, illness prevention, diagnosis and management of acute and chronic conditions, counseling of individuals and families, prescription and administration of therapeutic interventions, and collaboration with other healthcare providers in complex scenarios (Office of Administrative Hearing, 2019). Nurse practitioners are vested with the authority to prescribe legend drugs and Controlled Substance Schedules II – V, aligning with the purview determined by their education and certification (North Carolina Board of Nursing, 2022). To exercise this authority, compliance with state and federal regulations, including DEA registration, is mandatory (Bischof & Greenberg, 2021).

Navigating Regulations and Overcoming Barriers

Amid the intricate tapestry of nurse practitioner practice, regulatory frameworks and barriers intricately intersect. One prevailing regulation entails the need for collaborative practice agreements (CPAs) with licensed physicians, stipulating the terms under which nurse practitioners operate within administrative codes and rules (North Carolina Board of Nursing, 2023). Although these agreements enhance collaboration, they can also pose challenges, eliciting concerns about patient safety and the indispensable role of physicians. The scope of practice restrictions, often entailing physician oversight, can curtail independent care provision (Barnes et al., 2017). Addressing these barriers necessitates effective public education about nurse practitioners’ expertise, a level reimbursement playing field with physicians, and continuous advocacy for regulatory reforms that underscore nurse practitioners’ pivotal role in mitigating healthcare shortages (Bischof & Greenberg, 2021).

Conclusion: Shaping the Future of Nurse Practitioner Practice

In the backdrop of mounting healthcare demands and an escalating shortage of primary care providers, nurse practitioners hold immense promise in bridging the care gap (Barnes et al., 2017). In this milieu, APRNs must vigilantly monitor evolving regulations and engage with state boards to remain apprised of the most up-to-date legal frameworks (North Carolina Board of Nursing, n.d.). Nurturing an informed understanding of these intricacies is pivotal for nurse practitioners to navigate a landscape that is not only expanding but also witnessing paradigm shifts in the realm of healthcare provision.

References

Barnes, H., Maier, C. B., Sarik, D. A., Germack, H. D., Aiken, L. H., & McHugh, M. D. (2017). Effects of regulation and payment policies on nurse practitioners’ clinical practices. Medical Care Research and Review, 74(4), 431–451.

Bischof, A., & Greenberg, S. A. (2021). Post COVID-19 reimbursement parity for nurse practitioners. Online Journal of Issues in Nursing, 26(2).

McGilton, K. S., et al. (2023). Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatrics, 23(1).

Office of Administrative Hearing. (2019). Scope of practice. Retrieved from http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0802.html