Charting a Path To Achieve Health Equity Discussion Paper

Advanced nurse practitioners offer primary care services to patients and populations. Various state agencies and organizations have implemented measures to support advanced nurse practice and ensure the safety and wellbeing of the general public. State boards of nursing in different states have standards of practice that ensure that nurse practitioners adhere to the standards of practice (Wheeler et al., 2022). In Florida, nurse practitioners work independently if they attain minimum requirements such as clinical hours and experience after completing a physician’s prescribed hours of supervised experience. The prescriptive authorities may be limited or restricted in some states depending on the state board standards for nursing practice. In other states, nurse practitioners are required to practice under the direction or supervision of the physician in their entire practice experience and may be required to maintain a collaborative experience (Peters & Marnie, 2022). In addition, restrictive or limited practice complicates the ability of advanced nurse practitioners to prescribe controlled substances and requires adherence to some protocols that aim at protecting the public. Charting a Path To Achieve Health Equity Discussion Paper

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Research by Hassmiller and Wakefield (2022) indicates that addressing the needs of patients through ensuring health equity requires increasing the supply of healthcare resources and attaining equal and effective access to healthcare resources. Therefore, advanced nurse practice is one of the unique opportunities nurses can utilize to promote health and wellbeing among diverse individuals and populations. Nursing professionals have a role in addressing the underlying healthcare gaps through supporting evidence-based decision-making. Thus, state boards of nursing and other healthcare stakeholders need to initiate mechanisms for expanding access and utilization of healthcare resources, developing health policies, and improving professional experience. Advanced nurse practitioners need to actively develop policies and standards of practices in different states, especially where restricted practice exists. Charting a Path To Achieve Health Equity Discussion Paper

References

Hassmiller, S. B., & Wakefield, M. K. (2022). The future of nursing 2020–2030: Charting a path to achieve health equity. Nursing Outlook, 70(6), S1-S9. https://doi.org/10.1016/j.outlook.2022.05.013

Peters, M. D., & Marnie, C. (2022). Nurse practitioner models of care in aged care: A scoping review protocol. JBI Evidence Synthesis, 20(8), 2064-2070. https://doi.org/10.11124/jbies-21-00286

Wheeler, K. J., Miller, M., Pulcini, J., Gray, D., Ladd, E., & Rayens, M. K. (2022). Advanced practice nursing roles, regulation, education, and practice: A global study. Annals of Global Health, 88(1). https://doi.org/10.5334/aogh.3698

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. Charting a Path To Achieve Health Equity Discussion Paper

Response 1

APRN regulations in Florida & Hawaii vs California & Alabama

In Florida, APRNs have the authority to practice within the full scope of their education and experience, but they are required to establish a supervisory protocol with a licensed physician. This means that they must collaborate with a physician, which includes chart reviews and meetings as needed (floridanursing.gov, 2023) For example, a nurse practitioner in Florida might need to collaborate with a physician to prescribe certain medications or treatments. In Hawaii, APRNs also have the authority to practice within the full scope of their education and experience. However, they do not have a mandatory collaboration agreement with a physician. Instead, they need to submit a written plan of collaboration, which outlines the conditions under which they will collaborate with a physician or other healthcare providers (cca.hawaii.gov, 2023) For instance, an APRN in Hawaii may collaborate with a physician for consultations on complex cases. Charting a Path To Achieve Health Equity Discussion Paper

In both Florida and Hawaii, APRNs have the legal authority to provide primary care services, diagnose and treat medical conditions, order and interpret diagnostic tests, and prescribe medications.  An APRN in Florida and an APRN in Hawaii are both providing care to patients with chronic conditions, such as diabetes. They have similar responsibilities, including conducting physical examinations, diagnosing diabetes, and prescribing insulin. However, the application of regulations differs:

In Florida, the APRN would need to ensure they have a supervisory protocol with a collaborating physician. They may consult with the physician about insulin dosage adjustments and complex cases, but they have the autonomy to manage most aspects of diabetes care (floridanursing.gov, 2023.). Charting a Path To Achieve Health Equity Discussion Paper

In Hawaii, the APRN would not have a mandatory collaboration agreement but would have a written plan of collaboration. They might collaborate with a physician for specific cases, such as when a patient’s diabetes becomes difficult to manage or if there are complications. Otherwise, they can independently manage and adjust insulin therapy for their patients (cca.hawaii.gov, 2023).

In Florida, ARNPs are required to have a collaborative practice agreement with a supervising physician to prescribe controlled substances, including Class II drugs. This means that they cannot prescribe these medications independently but must collaborate with a physician who has agreed to oversee their prescribing activities (floridanursing.gov, 2023). In Hawaii, ARNPs are not required to have a collaborative practice agreement with a physician to prescribe controlled substances, including Class II drugs. However, they must have a written plan of collaboration with a physician or healthcare provider to outline the conditions under which they will collaborate (cca.hawaii.gov, 2023) ARNPs in Florida may prescribe Schedule II controlled substances for a 7-day supply for the treatment of acute pain. For the treatment of non-acute pain, ARNPs may only prescribe a 30-day supply of Schedule II drugs (State Practice Environment, n.d.). Hawaii’s law does not specify strict limitations on the duration of prescriptions for Schedule II drugs. However, ARNPs must follow the standard of care and professional guidelines when prescribing any medication, including controlled substances (State Practice Environment, n.d.). Charting a Path To Achieve Health Equity Discussion Paper