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?


Advanced practice registered nurses (APRN) are nurses with advanced education and specialization in different categories. The categories include nurse anesthetists who work in the surgical field and nurse midwives who work in women and the related field of reproduction. In the US, a nurse must have at least a master’s degree to become an APRN. They train on assessment, prescription of medicine, diagnose as well as managing patients. They can, therefore, perform the same duties as doctors to offer primary healthcare. 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, restrict the nurses in different ways from carrying out some of those duties like prescriptions. Most of those restrictions disadvantage the hospitals and patients because the number of doctors is low and the salary they need 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. There are also policies, which hospitals make towards 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. 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 perform 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 restricted 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 addiction with a probability of having severe mental and physical side effects. The intensity of addiction and side effects reduces with numbers, 5/N5 being the list in effect. The restriction varies depending on the state. 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. 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.

Other states have restrictions to prescription under physician collaboration. One such state is Florida where the ARNP prescribes drugs subject to practitioner approval. Where the ARNP need to order or dispense controlled substances, they must make those arrangements with their supervisors. An additional restriction to prescription is on the requirement to have a certificate in a program, which 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. Another category of states is those, which do not allow APRN to prescribe drugs at all. Examples of such states include Missouri and Georgia.   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. The nurses can call the supervisor and request to see the patient on behalf. The states allow doctors to give nurses the authority 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. 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.

Referrals and orders

The federal government, through the Medicare & Medicaid Services, does not allow APRN to write orders or make referrals for patients. The claim from the two bodies is that the nurses cannot write orders and make referrals a situation, which creates financial and logistic challenges in hospitals. 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 such requests are made, the doctors do not have to check and confirm them. Examples of such states include Wyomia, Washington and Vermont.

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. In addition to the delegation, the doctor signs the admission forms at the time of patient

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