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Respond to at least  two of your colleagues in one or more of the ways listed below.

· Share an insight from having viewed your colleagues’ posts.

· Suggest additional actions or perspectives.

· Share insights after comparing state processes, roles, and limitations.

· Suggest a way to advocate for the profession.

· Share resources with those who are in your state.

1. First reply to

PMHNP-BC

          The purpose of this post is to review practice agreements in my state, Maryland. I will identify whether Maryland requires physician collaboration or supervision for nurse practitioners and, if so, what those requirements are. I will research and report on how to get certified and licensed as an Advanced Practice Registered Nurse (APRN) in Maryland; what is the application process for certification in Maryland, and what is your state’s Board of Nursing website? I will further research how Maryland defines a nurse practitioner's scope of practice and what Maryland’s practice agreement is. I will determine how you get a DEA license and whether Maryland has a prescription monitoring program (PMP). I will determine how Maryland describes a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules nurse practitioners are authorized to prescribe.

          Most information is available on the Maryland Board of Nursing web page, Advanced Practice Registered Nursing: Nurse Practitioners (Maryland Board of Nursing [MBON], 2023). There are many links to the most asked questions and resources available. Maryland defines an advanced practice nurse as advanced practice registered nurse (APRN) means a registered nurse who is certified by the Board as a certified nurse midwife; a certified registered nurse anesthetist; a certified nurse practitioner; or a clinical nurse specialist (CNS) (eLaws, 2023).

Application Process – Maryland

          The application in Maryland requires the APRN to complete the Certification application and Declaration of Residence form, submit sealed official transcript(s), and include a copy of current national certification or letter of eligibility to take the certification exam. The application indicates the requirement to have a mentor for 18 months, and the COMAR indicates the mentor must have at least three years of active experience. The mentor can be either a nurse practitioner or a physician. I have a mentor selected who has been very helpful through the program and in professional practice. The national certification examination is required for a Maryland license. Currently, there is one place to access the examination, and that is through the American Nurses Credentialing Center.

          The application process for the national certification is online and can be completed at any time. You can select a testing date once the educational verification has been completed and validated. The field support office at Walden is familiar with the request process and will electronically transmit your transcript. You may upload an unofficial copy of your transcript. Unofficial copies may be used for review purposes, but an official transcript showing degree conferred and a conferral date is required for a certified status and must be sent to ANCC. An application fee may have a discount if you are a member of the American Association of Nurse Practitioners.  

Scope of Practice

          The scope of practice varies from state to state. Maryland is full practice authority (FPA), allowing NPs to independently diagnose, treat, and prescribe without physician involvement (Yang et al., 2020). There is a push to have the NP have interstate agreements to allow more flexibility to treat patients across state lines. An NP must apply for licensing in each state where they treat patients. I am fortunate to practice in Maryland with a full scope of practice rights. This has allowed me to treat more patients as a family nurse practitioner. Maryland allows APRNs to prescribe all medications, including narcotics (MBON, 2023).

DEA license and Prescription Monitoring Program (PMP).

          I have my DEA license. I applied for the DEA license once I became an APRN in Maryland. You must register in Maryland before you can register for the federal DEA. Further, Maryland does require all practitioners to register with CRISP to complete PMP. There is a brief tutorial to complete before the practitioner can complete the registration for the Maryland PMP. I have found the PMP very helpful and have denied prescriptions for opioids and benzodiazepines in the past few months from patients with multiple prescribers prescribing duplicate medications.

Barriers

          For an inexperienced NP, you may not have the ability or confidence to make quick decisions. Barriers included policy restrictions on the practice, poor physician relations, poor administrator relations, and others' lack of understanding of the APRN role (Schirle et al., 2018). One of the reasons I left my first NP position was due to a lack of support and knowing the policies and procedures. It was assumed that I should have known the treatment decisions since I was an NP. The lack of support from the interdisciplinary team was overwhelming. I was able to learn quite a bit but always felt as though my license was possibly in jeopardy. I now work with other NPs that assist in supporting, guiding, and educating.

 

References

eLaws. (2023). Sec. 10.27.07.01. Definitions, chapter 10.27.07. the practice of the nurse practitioner, subtitle 27. board of nursing, part 4., title 10. Maryland Department of Health, code of Maryland regulations. Code of Maryland Regulations. 

Maryland Board of Nursing. (2023). Advanced practice registered nursing: Nurse practitioners. 

Schirle, L., Norful, A. A., Rudner, N., & Poghosyan, L. (2018). Organizational facilitators and barriers to optimal APRN practice: An integrative review. Health Care Management Review, 45(4), 311–320. Retrieved May 30, 2023, from 

Yang, B., Johantgen, M. E., Trinkoff, A. M., Idzik, S. R., Wince, J., & Tomlinson, C. (2020). State nurse practitioner practice regulations and US health care delivery outcomes: A systematic review. Medical Care Research and Review, 78(3), 183–196. Retrieved May 30, 2023, from 

2. Second reply to

Texas APRN Certification Process

Texas has particular qualification and licensing criteria for Advanced Practice Registered Nurses (APRNs). Texas requires various stages and considerations to become a qualified and licensed APRN. Texas practice agreements should be reviewed first. This state requires nurse practitioners to work with a "supervising physician." The supervising physician must be named in the APRN's practice agreement and accessible for consultation. The nurse practitioner and supervising physician's agreement and practice setting will determine cooperation needs (Sheehan et al., 2021). Apply to the Texas Board of Nursing (BON) to become an APRN in Texas. The application procedure usually includes filling out a form, giving evidence of schooling and national certification, and paying expenses. The Texas BON website is excellent for learning about certification standards and processes.

The Texas BON sets nurse practitioners' scope of practice in Texas. The board authorizes nurse practitioners to examine, diagnose, order, and interpret diagnostic tests and begin and oversee treatment programs, including prescription drugs. Prescriptive authority demands an extra step. As illustrated by Fil et al. (2020), Nurse practitioners must apply online for a Texas Drug Enforcement Administration (DEA) license. DEA registration is needed to prescribe restricted drugs. The Texas BON verifies DEA registration. The Texas Prescription Monitoring Program (PMP) exists. It is a Texas-wide computerized database of prohibited drug prescriptions. Nurse practitioners must follow PMP requirements while prescribing restricted medications (Goudreau, 2022). Texas nurse practitioners may prescribe drugs from the Texas Controlled Substances Act's schedules. Nurse practitioners might prescribe different programs depending on their practice expertise and partnership agreement.

To become a certified and licensed APRN in Texas, persons must complete cooperation criteria, apply to the Texas Board of Nursing, receive a DEA license, and adhere to the state’s-controlled drug prescription standards. To fully comprehend and comply with Texas's certification and licensing procedures, examine the Texas BON website and other trustworthy sources.

Reference

Fil, S. L., Champion, J. D., & Christiansen, B. (2020). Perceptions of disaster management knowledge and skills among advanced practice registered nurses. Journal of the American Association of Nurse Practitioners, Publish Ahead of Print. 

Sheehan, A., Jones, A., McNerlin, C., Iseler, J., & Dove-Medows, E. (2021). How advanced practice registered nurse practice barriers impact health care access in Michigan. Journal of the American Association of Nurse Practitioners, 33(9), 739-745.

Goudreau, K. A. (2022). Updates on the Implications for Practice: The Consensus Model for Advanced Practice Registered Nurse Regulation. Health Policy and Advanced Practice Nursing: Impact and Implications, 73.