Posted: September 4th, 2023

BY DAY 6 OF WEEK 1
Respond to at least two of your colleagues on 2 different days 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.
Colleague 1
• Review practice agreements in your state.
• Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.
• How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?

Policies for Nurse Practitioners differ from state and shockingly in states which are right next to each other. Most times those polices are changed but it requires a lot of lobbying for change to make that happen. In the state of Georgia a nurse practitioner cannot practice independently but requires a supervising physician, and a written protocol agreement between both parties for the nurse practitioner to practice. The written protocol agreement outlines what parameters of practice the physician delegates to the nurse practitioner including appropriate drugs, diagnostic studies, medical devices, and medical treatments. This form is then submitted to the Georgia Composite Medical Board (GCMB) for review and approval (Georgia Composite Medical Board, 2023).

• What is the application process for certification in your state?
Once a nursing national license is obtained after passing the licensing exam either with the American Nurses Credentialing Center (ANCC) or The American Association of Nurse Practitioners (AANP), a state license can be applied for through the Georgia Board of Nursing under the Secretary of State for Georgia for review and approval (Georgia Board of Nursing, 2023).

• What is your state’s board of nursing website?
The state board of nursing website for Georgia state is Georgia Board of Nursing which can be accessed via www.sos.ga.gov/georgia-board-nursingLinks to an external site.

• How does your state define the scope of practice of a nurse practitioner?
In the state of Georgia the scope of practice for nurse practitioners includes practice authority, prescriptive authority, Nurse practitioners identified as primary care providers, and authority to sign providers orders for life-sustaining treatment or POLST forms. In Georgia state a nurse practitioner can practice autonomously but not independently meaning that they need a protocol agreement between a physician and a nurse practitioner designating what the nurse practitioner can do including practice and prescriptive authority. Nurse practitioners cannot be identified as a primary care providers in Georgia, and is not authorized to sign a POLST form (Georgia Scope of Practice Policy, 2023).

• What is included in your state practice agreement?
The written protocol agreement outlines what parameters of practice the physician delegates to the nurse practitioner including appropriate drugs, diagnostic studies, medical devices, and medical treatments. This form is then submitted to the Georgia Composite Medical Board (GCMB) for review and approval (Georgia Composite Medical Board, 2023).

• How do you get a DEA license?
In the state of Georgia, in order to get a DEA license an application must be completed with the United State Department of Justice, and Drug Enforcement Agency’s Diversion Control Division website for review and approval. The form number for nurse practitioners is form 224, and the $888 application fee is non-refundable. Once approved, the license is good for three years at which point a renewal application is required (United States Department of Justice, 2023).
• Does your state have a prescription monitoring program (PMP)?
Yes the state of Georgia has the Georgia Prescription Drug Monitoring Program which is an electronic database uses to monitor prescribing and dispensing of controlled substances which is managed by the Department of Public Health. This is used to prevent duplicative prescribing, and overprescribing of controlled substances, and protect the patients risk of misuse of drugs (Department of Public Health, 2023).
• How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
The nurse protocol agreement outlines what schedule drugs the nurse practitioner is allowed to prescribe, and which of those schedule drugs the physician designates to the nurse practitioner who the agreement is with. In Georgia, a nurse practitioner can only prescribed schedule 3-5 drugs. Only physicians are allowed to prescribed schedule 1-5 (Georgia Composite Medical Board, 2023)

Colleague 2
How Do You Get Certified and Licensed as an
Advanced Practice Registered Nurse (APRN) in North Carolina?
The process overview is that you must first get your Master’s in Science degree from an accredited program such as the American Nurses Credentialing Center (ANCC) or the American Association of Nurse Practitioners (AANP). Once it is recognized you have completed the program, you will apply through the NCBON and submit the required documents (official transcripts from Walden University). A criminal background check will be required, and because NC is non-independent, you will need to seek a Collaborative Practice Agreement (CPA) with a supervising physician. Finally, you must register to prescribe controlled substances with the NC Department of Health and Human Services (NCDHHS); it will require additional paperwork and fees.
Once licensed, you must renew your APRN license every two years and retain continuing education credit hours, specifically in pharmacotherapeutics, due to prescriptive authority.
What is North Carolina’s Board of Nursing Website?
https://www.ncbon.com/licensure-listing-advanced-practice-registered-nurse-aprn-advanced-practice-registered-nurse-aprn-requirementsLinks to an external site.
How Does North Carolina Define the Scope of Practice of a Nurse Practitioner?
APRN is the “umbrella” title for registered nurses who are APRNs with an advanced formal education program required for recognition to practice in a specialty route of an NP role. APRNs have acquired clinical knowledge and skills that allow for greater autonomy. APRNs are responsible and will be accountable for health promotion/maintenance, assessment, diagnosis, medication management, and psychotherapy for patients.
What is Included in North Carolina’s Practice Agreement?
APRNs in NC must have a CPA and a legal agreement for a working relationship between the two roles. The NCBON and the NC Medical Board regulate APRNs.
How Do You Get a DEA License?
The Drug Enforcement Administration (DEA) license will allow you prescriptive authority as a new healthcare provider. You must complete a form on the DEA’s website, www.deadiversion.usdoj.govLinks to an external site., and submit it with the required supportive documents.
Does North Carolina Have a Prescription Monitoring Program (PMP)?
Yes, NC uses the Controlled Substance Reporting System (CRCS), a statewide electronic database that tracks the state’s prescriptions and dispensing of controlled substances. It is designed to provide patient safety and identify potential misuse, diversion, or drug interactions. It also helps protect prescribers against potential drug abusers to ensure appropriate prescribing practices. The NCDHHS regulates it.
How does North Carolina Describe a Nurse Practitioner’s Controlled-
Substance Prescriptive Authority and What Nurse Practitioner Drug
Schedules Are Nurse Practitioners Authorized to Prescribe?
The NC-controlled prescriptive authority is in the NC General Statues (Chapter 90, Article 9, Section 90-18). The NC Medical Board and the NCBON established it. Due to the CPA requirement, APRNs have limited prescriptive authority without a CPA agreement to prescribe only Schedule III-V. If there is a CPA with a supervising physician, APRNs can prescribe Schedule II-V.
Conclusion
NC APRNs have limited autonomy, and from my experience in the last three clinical, it appears to be a useless money pit that MDs abuse. My preceptors have explained that they have not needed to utilize their supervising MDs and have had to pay at least a $1,000/month fee each month. A bill was passed to override this, but it has yet to be signed by the governor. It was part of the expansion for Medicaid that passed but was excluded before it passed. How frustrating! I’ve contemplated working remotely for another independent state, but I must look further into it.

_____________________________-
Thank you for sharing your insights on the requirements for becoming an APRN in Georgia and North Carolina. It is helpful to have this information so that we can better understand the different paths that are available to us.

I agree with you that the requirements for APRNs in North Carolina seem to be more restrictive than those in Georgia. In particular, the requirement for a collaborative practice agreement (CPA) with a supervising physician seems to be a major barrier to autonomy for APRNs in North Carolina. I understand that you have been frustrated by this requirement, and I can see how it would be difficult to justify paying a monthly fee to a supervising physician when you do not feel that you need their assistance.

I am glad to hear that a bill has been passed to override this requirement, and I hope that the governor will sign it soon. In the meantime, I think it is important for APRNs in North Carolina to continue to advocate for their profession and to educate the public about the value of APRN-led care. We need to make it clear that APRNs are highly qualified and capable healthcare providers who are ready to take on more responsibility.

I am also interested in the possibility of working remotely for an independent practice in another state. This is something that I will need to look into further, but it is definitely something that I am considering.

Thank you again for sharing your insights. I appreciate your help in learning more about the requirements for APRNs in Georgia and North Carolina.

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