Posted: December 30th, 2021

NRNP 6675 Nurse Practitioner Professional Issues

Week 1: Nurse Practitioner Professional Issues
Psychiatric-mental health nurse practitioners are committed to the assessment, diagnosis, and treatment of psychiatric disorders in individuals and groups through psychotherapy and medication. Since the role of the PMHNP carries such responsibility, it is no surprise that there is a rigorous path to obtain and maintain your PMHNP certification and licensure.
PMHNPs currently have only one choice for certification, which is through the American Nurses Credentialing Center (ANCC). The ANCC offers the “psychiatric/mental-health nurse practitioner (across the lifespan)” board certification (PMHNP-BC). In many states, board certification is a necessary prerequisite to receiving an NP license. Even if board certification is not a requirement for state licensure, it may be a requirement to receive privileges in various hospitals and other health care facilities. Malpractice insurance providers may also require board certification prior to issuing coverage to NPs.
This week, you will review your state specific PMHNP certification and licensure requirements and scope of practice, as well as prescriptive authority issues.

Learning Objectives
Students will:

Summarize nurse practitioner certification and licensure processes
Explain state-specific scope of practice for psychiatric-mental health nurse practitioners
Explain state-specific restrictions or limitations for practice
Explain nurse practitioner prescriptive authority and DEA registration processes
Learning Resources
Required Readings (click to expand/reduce)

PMHNP Study Support Lounge
The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge, where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide collective feedback to the group based on trends, common problems, and common strengths in student posts.

Photo Credit: [Jacob Ammentorp Lund]/[iStock / Getty Images Plus]/Getty Images

As a peer, you are encouraged to provide constructive helpful feedback. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Assignment help – Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like this is a statistically significant predictor of success.

To Participate in this Optional Assignment help – Discussion:

PMHNP Study Support Lounge

Acknowledgment
Practicum Manual Acknowledgment
The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

Field Experience: MSN Nurse Practitioner Practicum Manual
Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.

Assignment help – Discussion: Certification and Licensure Plan
Now that you are in the final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass the national PMHNP certification exam. Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.

Photo Credit: AndreyPopov / iStock / Getty Images Plus / Getty Images

Although a movement called the APRN Consensus Model is attempting to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish an independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.

Another important area to consider and plan for is prescriptive authority. The appropriate board, which may be the medical board, state board of pharmacy, or nursing board, grants prescriptive authority under state law for the appropriate state licensure. The federal government grants the authority to write for a controlled substance, and the Drug Enforcement Administration (DEA) verifies this action through by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.
In this Assignment help – Discussion, you will locate and review the practice agreements in the state in which you plan to practice, identify potential collaboration requirements in your state, and understand the certification and licensing process that you will need to follow.

To Prepare:
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.
Research the following:
How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?
What is the application process for certification in your state?
What is your state’s board of nursing website?
How does your state define the scope of practice of a nurse practitioner?
What is included in your state practice agreement?
How do you get a DEA license?
Does your state have a prescription monitoring program (PMP)?
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?
By Day 3 of Week 1
Post a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.

Read a selection of your colleagues’ responses.

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.
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Scope of Practice

I live and practice in Illinois. The state of IL BON scope of practice for an APRN states this RN has completed education certifying advanced diagnostic skills, and professional judgement which allows for caring for patients and treating illness to improve their health. They may prescribe medications, order labs/tests/medical devices, and assess and diagnose patients. APRNs may counsel, educate, advocate for and delegate for patients (State of IL, n.d.).

Licensure and Certification

To be an APRN in IL, you must already be a RN and have obtained a MSN or post master’s certificate. In order to be licensed, the RN must be fingerprinted and sit for the APRN exam after applying for the test on the IDFPR website. The license costs $125 and is renewed every two years. The APRN can practice license pending with a special permit.

Full Practice Authority

IL APRNs can apply for full practice authority after working 4,000 hours after licensing with a collaborating physician and upon completion of 250 hours of CEs or training. Full practice authority APRNs can prescribe OTCs, legend drugs, and schedule II-V controlled substances. The exception is benzodiazepines and opioids still require consult with a physician (Nurse Practice Act, n.d.).

DEA

An IL APRN working with a collaborating physician can obtain a DEA license and write controlled meds for a 30 day supply with no refills. The APRN applies for a mid-level practitioner controlled substance license. The collaborating doctor fills out a notice of delegated prescriptive authority. In order to prescribe schedule II meds, the medication must not be an injectable, and the nurse must have done 45 graduate level CEs in pharmacology.

BON

The IL board of nursing site is www.idfpr.com/profs/nursing.asp. This site includes the APRN qualifications for licensure, scope of practice, prescription writing authority, physician collaboration agreements, CEUs, mandated reporting information, and much more (State of IL, n.d.).

PMP

IL has a free PMP for prescribers and pharmacies. Schedule II-V drugs which have been dispensed can be viewed online for a year and is archived for 24 months after that. The website is www.ILPMP.org (Illinois Prescription Monitoring Program, n.d.). This site offers 24 hour access to information which can help prevent “doctor-shopping”, polypharmacy, and drug interactions.

Barriers to Independent Practice

I see that not every state has an option for an APRN to practice independently. However, malpractice insurance costs, and the overhead of practicing independently might be cost prohibitive. I also am curious if a PMHNP is able to administer ketamine as that is becoming a more talked about treatment option for major depression.

References

Nurse Practice Act. (n.d.). IL General Assembly. https://ilga.gov/legislation/ilcs/ilcs4.aspDocName=022500650HArt %2E+65&ActID=1312&chapterID=24&seqstart=165000000&seqend=17850000

Illinois Prescription Monitoring Program. (n.d.). IL PMP Login. https://www.ILPMP.org

State of Illinois. (n.d.). State of Illinois | Department of Financial & Professional Regulation. https://www.idfpr.com/profs/nursing.asp

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2nd Example

Certification and Licensure Plan

Certification and Licensure Plan
Advanced practice registered nurses treat and diagnosed, manage chronic diseases, advise the public on health issues, and continuously advance their education to remain ahead of technological, methodological, and other developments in the nursing field. These educational advancements contribute to certification and licensure to be able to diagnose and treat patients. APRN certification is beneficial since it helps to showcase skills and comprehension to practice on a particular specialty. On the contrarily, licensure authorizes the scope of practice of the various nurses practitioners.
Licensing and certification in Illinois
Different states have various procedures that advanced practice registered nurses have to adhere to be certified and licensed. In Illinois, a potential advanced practice nurse must have a graduate degree and complete the educational program required for certification. Advanced practice registered nurses have an opportunity to seek licensure in a second specialty, in this case, they are required to complete a second degree in the related field. Moreover, in Illinois, a registered nurse practitioner who has graduated from an advanced practice program and has applied for the national qualifying examination may be allowed to practice pending certification (American Association of Nurse Practitioners ( AANP),n.d.).
The licensing agency will require the registered nurse seeking licensure and certification to submit official graduate transcripts and a copy of the qualifying certification. The applicants who have been licensing in other states will be required to provide official verifications from the original state of licensure, current state, and the state that the individual has been practicing in the previous five years. The applicant will be required to pay the application fee of $125, and the individual who applies for credentialing in more than one category pays for the respective categories.
Scope of practice for nurse practitioners in Illinois
Nurses practitioners who meet certain requirements are allowed to work without a formal relationship with a doctor. However, they are not allowed to prescribe medications such as opioids without the supervision of a doctor, and they are not allowed to sign death certificates. The advanced practice nurse seeking full prescription is required to have an APRN license number and notarized attestation signed by the APRN with the completion of at least 250 hours of continued education and notarized attestation of 4000 hours of clinical experience( AANP,n.d.). The state practice agreement requires a career-long regulated collaborative agreement with other healthcare providers for nursing practitioners to provide patient care and limits one or more elements nurse practitioners practice.
DEA License in Illinois and prescription monitoring program
The DEA licensure process usually takes approximately two months. The DEA registration process takes one month and a half or even longer if schedule1 drugs are involved. The practicing healthcare practitioner is required to meet the state licensing requirements, apply for the DEA registration, pay the application fees and renew the DEA license as required. The healthcare provider needs to have a license to practice medicine, license for controlled substances. After meeting the requirements, the healthcare practitioner can send the application via email or online. The nurse practitioner is required to pay nonrefundable fees. Prescription monitoring programs are essential in regulating the prescription of drugs in the states. In Illinois State, the Illinois Prescription Monitoring Program is responsible for collecting controlled substance prescriptions dispensed in the state(Illinois Department of Human Services ( IDHS),n.d.). This program is part of the Illinois Department of Human Services. In Illinois, Advanced practice nurses are required to practice under a collaborative agreement unless they are working in exempt settings. Advanced practice nurses are allowed to prescribe Schedule II and Schedule V controlled medications. The prescription of Schedule II narcotic drugs such as opioids is done with consultation with a physician.
Regulation and barriers
The prescriptive authority of advanced registered practice nurses’ regulation limits the scope of APRNs. In Illinois, nurses practitioners are practicing under a collaborative agreement with other healthcare practices. Advanced registered practice nurses should be allowed to have full authority of practice. Full prescriptive authority gives the nurse practitioners more power to impact the quality of healthcare. With Full prescriptive authority, the nurse practitioners are able to prescribe medication without the lengthy process of approval by the physician. Lack of full prescriptive authority is a major barrier that impacts access to healthcare services (Dillon & Gary,2017). However, what surprised me is that although the nursing practitioners in Illinois are expected to work in collaborative agreement, there are exemptions, and other advanced practice registered nurses can be allowed to practice when awaiting certification.
Conclusion
Advanced practice registered nurses are required to complete various programs to be certified and licensed to diagnose and treat patients. Besides, they are required to have a DEA license to prescribe controlled substances to the patients. Therefore, they need to be aware of the certification and licensure requirements in their respective states. Moreover, the full prescriptive authority of the nurses should be enhanced to promote access and delivery of quality healthcare services to the patients.

References
American Association of Nurse Practitioners ( AANP). (n.d.). Illinois. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/illinois
Barton, M. J., Hannum, B. C., Lindsey, M., & Towle, T. (2021). The Path Toward Full Practice Authority: One State’s Strategy. The Journal for Nurse Practitioners, 17(2), 147-152. https://www.sciencedirect.com/science/article/pii/S1555415520305134
Dillon, D., & Gary, F. (2017). Full practice authority for nurse practitioners. Nursing administration quarterly, 41(1), 86-93. https://www.ingentaconnect.com/content/wk/naq/2017/00000041/00000001/art00014
Illinois Department of Human Services ( IDHS). (n.d.). IDHS: Illinois expands prescription monitoring program to help combat prescription drug abuse. IDHS: Illinois Department of Human Services. https://www.dhs.state.il.us/page.aspx?item=64070

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