Exploring the Role of Nurse Practitioners; Are Services Limited by at the State or Federate Level?

Exploring the Role of Nurse Practitioners; Are Services Limited by at the State or Federate Level?


This study analyzes the roles of nurse practitioners and the extent to which they practice them in the United States as well as individual States. In the beginning, it explores the restrictions which Medicare, Federal as well as States government subjects advanced practice registered nurses (APRN) to, in their practices. Also, there is an analysis of the roles which APRN plays to help patients and hospitals save treatment costs. APRN goes through education programs, which equips them with skills to practice primary health care. They can diagnose, treat and make prescriptions similar to specialists. However, the Federal and States governments restrict most of those roles. For example, there are some states, which allow APRN to prescribe drugs while others do not. The few roles which remain for the nurses like managing patient’s conditions helps to save costs of regular visits as well as an admission in hospitals. There are still chances available to make the cost of health care low, once Medicare gives APRN freedom to practice within their abilities.

Keywords: Nurse, Specialist, Doctor, Treatment, Patient, Hospital, Practitioner, Services, Diseases


Exploring the Role of Nurse Practitioners; Are Services Limited by at the State or Federate Level?

Advanced practice registered nurses (APRN) are nurses with advanced education and specialization in different health care areas. The categories include nurse anesthetists who work in the surgical field and nurse midwives who work in women and the related field of reproduction. US regulations on health require nurses to have at least a master's degree for them to qualify as APRN. They train on assessment, prescription of medicine, diagnose as well as managing patients. The training is similar to those of physicians and therefore, can offer primary health care. Despite their abilities to carry out such duties, there are restrictions from different authorities. In the US, the federal and States governments, as well as Medicare, regulates treatments, diagnosis and prescriptive roles of the nurses. The regulations disadvantage the hospitals and patients because of the limited number of doctors whose salary is high in comparison to APRNs. This study analyzes the restrictions of APRN from Medicare, Federal and States governments as well as their roles to see how they would save patients and hospitals treatments cost as well as improve health outcomes.

Restrictions for APRN

Although the federal state has laws restricting APRN from some practices, individual states make their policies. Individual hospitals also institute regulations on the scope of APRN. There are some states, which recognizes APRN as primary healthcare providers and therefore, allows them to carry out any duty without restriction (Andrew Scanlon et al., 2014). Some states on the other hand partially acknowledge the ability of the nurses and thus give them partial right to carry out doctor's roles. They only allow them to perform the duties when the attending doctor allocates them. Also, the APRN in those states can perform some duties up to certain levels. The last category is that of states which do not allow APRN to play specific roles regardless of the circumstance. APRN can only be present when their supervisors are attending the patients to help them.

Drug administration Prescriptive Authority

One of the limited perceptive roles is on drugs. The federal and various states have different levels through which NP can prescribe, administer, administer or even dispense drugs to Patients. The Drug Enforcement Administration (DEA) divides prescription drugs into four categories on the bases of their effect and addiction in human. The classes are schedule 2/2N, 3/3N, 4/4N as well as 5/5N. The first category 2/2N is highest in dependence with a probability of having severe mental and physical side effects (Subramanian, & Moreno, 2014). The intensity of addiction and side effects reduces with numbers, 5/N5 being the list in effect. Different states have different regulations on the level of drugs NP should prescribe. There are those states, which allow APRN to administer, procure and even prescribe all of the four categories without restrictions. Such states include Hawaii, Arizona, and Colorado (Subramanian, & Moreno, 2014). Those states like Colorado consider APRN as primary healthcare providers and therefore have full right to prescribe any of the drugs. However, for the nurses to work independently without supervision, they must work under preceptorship within a given duration of time given in terms of hours. In Colorado, for example, nurses are supposed to work under supervisions for 1800 hours after which they can prescribe any drug without restrictions.

There are other states which only allow NP to prescribe only when in collaboration with a physician. One such state is Florida where the ARNP prescribes drugs subject to practitioner approval (Phillips, 2016). Where the ARNP need to order or dispense controlled substances, they must make those arrangements with their supervisors. Another regulation to prescription is based on the level of academic qualifications. APRN should have a certificate that leads to a master's degree in a clinical specialty area and training in a particular practitioner skill. The state also restricts the prescription of substances related to psychiatric mental health. Other States do not allow APRN to prescribe drugs at all. Examples of such states include Missouri and Georgia (Phillips, 2016).   In those states, APRN must collaborate with their supervisors to prescribe the controlled substances.

Physical Examination and Admission

The federal government allows APRN to see new patients without any restrictions. However, different states have different policies on the issue. There are some states, which enable the APRN to see new patients without any restrictions. Some of those states include Hawaii, Idaho, and Colorado. However, there are other states, which will only allow APRN to attend to new patients with authority form their supervisors (Saria et al., 2014). The nurses can call the supervisor and request to see the patient on behalf. In those states, doctors can authorize nurses to see patients when they are not available. Examples of such states with reduced responsibility to attend patients for the first time include Pennsylvania, New York, and New Jersey. There is another category of states, which do not allow APRN to see patients for the first time even with authority from the supervisors. The only time when the APRN can see patients in such states is when they collaborate with the doctor (Mumford, 2018). The doctor must be present and make a diagnosis for the patient alongside the one done by the APRN. Such states with full restrictions include North Carolina, Oklahoma, Michigan, and Massachusetts (Yee, Boukus, Cross, & Samuel, 2013).


Referrals and Orders

The federal government, through the Medicare & Medicaid Services, does not allow APRN to write orders or make referrals for patients (Yee et al., 2013). The claim from the two bodies is that nurses write prescriptions and make referrals that create financial and logistic challenges when it comes to reimbursements. However, there are some states, which allow the APRN to make orders and referrals without restrictions. The states recognize APRN to have the ability to handle such cases have gone through the required training. Once the nurses make such requests, doctors do not have to check and confirm them. Examples of such states include Wyomia, Washington, and Vermont (Yee et al., 2013).

In other states, APRN has partial right to admit and write laboratory orders related to patients. The APRN can admit with directions from the supervising doctor. The attending doctor gives an order or delegation to the nurse through word of mouth or writing (Yee et al., 2013). In addition to the delegation, the doctor signs the admission forms at the time of patient discharge. Where there are no such signs, the APRN and the attending doctor can fail to get their payments through the Medicare (Yee et al., 2013). Examples of such states include Pennsylvania, Ohio and New York. The third category of states is those, which do not give APRN any right to make patient orders or referrals. Medicare does not make payments of such requests made by the nurses. However, they can b

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