01 Sep Discussion: Certification and Licensure Plan
8591Respond to two of your colleagues (see below) on 2 different days in one or more of the ways listed below. (2 pages/ response and 5 references/ response)
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.
Respond to #1
Certification and Licensure in Arknasas
How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?
The first step in obtaining certification and state licensure is to successfully graduate from a post-baccalaureate program that is approved by the Arkansas State Board of Nursing. The graduate level program must meet board standards and include coursework in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology. After completing the program, along with appropriate clinical hours, the nurse earns national certification by passing the examination for board certified Advanced Practice Psychiatric Mental Health Nurse Practitioner. Verification of successful certification exam scores, RN licensure, official transcript, and criminal background check are then required to apply for state APRN licensure. The Arkansas State Board of Nursing also requires proof that the applicant has worked as a registered nurse for a minimum of two thousand hours for completed application.
What is the application process for certification in your state?
The Arkansas State Board of Nursing honors national certification granted by American Nurses Credentialing Center (ANCC). According to the ANCC website, https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/ eligibility to take the board certification exam includes an active RN license, completion of graduate program (including 500 clinical hours). The ANCC will issue certification once the validation of education form is signed by faculty, verification of degree/transcript are met., and the applicant has successfully passed the certification exam. The certification should be submitted to the Arkansas State Board of Nursing in order to apply for APRN licensure.
What is your state’s board of nursing website?
Arkansas nurses can find all information related to licensure and certification processes at https://www.healthy.arkansas.gov/programs-services/topics/arkansas-board-of-nursing. This website is also used to find current updates, protocols, prescriptive authority agreement, continuing education, file complaints, and contact information.
The website, https://www.healthy.arkansas.gov/programs-services/topics/arsbn-adv.-practice
is specific to the Advanced Nurse Practitioner in the state of Arkansas. This website, as well as, https://law.justia.com/codes/arkansas/2016/title-17/subtitle-3/chapter-87/subchapter-3/section-17-87-310 were helpful in finding the following information in this discussion, regarding requirements and limitations for APRNs in Arkansas.
How does your state define the scope of practice of a nursing practitioner?
Arkansas is a reduced practice state. This means that the state practice and licensure laws reduce the nurse practitioner’s ability to engage in at least one element of practice. The state law requires a career-long regulated collaborated agreement for the nurse practitioner to provide care. According to AR Code § 17-87-310 (2016), A collaborative practice agreement shall include, but not be limited to, provisions addressing: (1) The availability of the collaborating physician for consultation or referral, or both; (2) Methods of management of the collaborative practice, which shall include protocols for prescriptive authority; (3) Coverage of the healthcare needs of a patient in the emergency absence of the advanced practice registered nurse or physician; and (4) Quality assurance.
What is included in your state practice agreement?
According to the Arkansas State Board of Nursing, a Collaborative Practice Agreement must include a collaborating physician that has a current AR license to practice under the Medical Practice Act and an unrestricted DEA number for APRNs who prescribes controlled substances. This physician must have appropriate training within the scope and specialty as the APRNs practice. The physician must also be available for consultation and/or referral. The APRN needs a statement regarding protocols for Prescriptive Authority and a statement that the “APRN’s prescribing will be limited to the area of education preparation and certification.” A Quality Assurance Plan and a plan for emergency health care coverage if the APRN or collaborating physician is absent. If the Collaborative Practice Agreement is terminated, the APRN must notify the Board within seven days in writing.
How do you get a DEA license?
A DEA number is required to prescribe Schedules II-V controlled substances. Before applying for a DEA certificate, the nurse must receive full Advanced Practitioner Registered Nurse licensure and a Prescriptive Authority Certification number. One does not automatically receive Prescriptive Authority with the issuance of your APRN license. To apply for Prescriptive Authority, a Collaborative Practice Agreement and a Quality Assurance Plan need to be downloaded in the Nurse Portal application link. This link is located within the Arkansas State Board of Nursing website, https://www.arsbn.org/nurse-portal. After obtaining full APRN licensure and Prescriptive Authority Certification number, the application for DEA certification may be completed. Directions for applying for a DEA number are provided on the Arkansas State Nursing Board website. The DEA registration link is located under the Advanced Practice tab. Once a DEA card number has been issued, a copy must be submitted to the Arkansas State Board of Nursing.
Does your state have a prescription monitoring program (PMP)
According to the Arkansas Department of Health, APRNs holding a DEA certificate shall register for access to the Arkansas Prescription Monitoring Program (AR PMP) database via the AR PMP website, www.arkansaspmp.com. The AR PMP was created to assist healthcare practitioners in the battle against prescription drug abuse. Act304 (2011) established the AR PMP to be implemented under the direction of the Arkansas Department ofHealth. Prescribers can view their patient’s history of filled prescriptions for controlled substances prior to prescribing a controlled substance. When a pharmacist fills a prescription for a controlled substance (Schedules II-V), this information is sent to the AR PMP data bank. APRNs shall check the information in the AR PMP when prescribing: a) an opioid from Schedule II or Schedule III for every time prescribing the medication to a patient; and b) a benzodiazepine medication for the first time prescribing the medication to a patient and every six months thereafter.
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?
APRNs with Prescriptive Authority must have prescriptive protocols that include indications for and classifications of legend and controlled substances.The protocols must be agreed upon by both the APRN and collaborating physician and signed, dated, and must be updated at least annually. AR Code § 17-87-310 (2016) states that the Arkansas State Board of Nursing may grant a certificate of prescriptive authority to an advanced practice registered nurse who: (1) Submits proof of successful completion of an Arkansas State Board of Nursing-approved advanced pharmacology course that shall include preceptorial experience in the prescription of drugs, medicines, and therapeutic devices; and (2) Has a collaborative practice agreement with a practicing physician who is licensed under the Arkansas Medical Practices Act, § 17-95-201 et seq., § 17-95-301 et seq., and § 17-95-401 et seq., and who has training in scope, specialty, or expertise to that of the advanced practice registered nurse on file with the Arkansas State Board of Nursing. (b) (1) An advanced practice registered nurse with a certificate of prescriptive authority may receive and prescribe drugs, medicines, or therapeutic devices appropriate to the advanced practice registered nurse’s area of practice in accordance with rules established by the Arkansas State Board of Nursing. (2) An advanced practice registered nurse’s prescriptive authority shall extend only to drugs listed in Schedules III — V and, if expressly authorized by the collaborative practice agreement, also to those hydrocodone combination products reclassified from Schedule III to Schedule II as of October 6, 2014.
Conclusion
I am glad that this assignment covered all of these questions. There was more to application processes than I would have thought, such as the plans and protocols needed to apply for Prescriptive Authority. All of the steps in certification and licensure are in a particular order so planning will be crucial. I have learned that Arkansas is a reduced practice state but according to the Arkansas Nurse Practitioner Association and Arkansas State Legislature, negotiations were successful to support bill HB1258. This bill became Act 412 and was approved in March 2021. It will provide a path to prescribing without a collaborative practice agreement after the APRN has provided 6,240 hours of practice. Act 412 also guarantees that the RN and APRN licensure regulation will continue under the control of the Arkansas State Board of Nursing rather than Arkansas State Medical Board. This shows that nurses, lobbyists, committee members, and supportive legislative champions can work together to protect and promote the progression in this field.
https://www.arkleg.state.ar.us/Bills/Detail?id=HB1258&ddBienniumSession=2021/2021R
https://www.healthy.arkansas.gov/programs-services/topics/arsbn-adv.-practice
https://law.justia.com/codes/arkansas/2016/title-17/subtitle-3/chapter-87/subchapter-3/section-17-87-310
Respond to # 2:
nitial Discussion Post
Practice Agreements, Physician Collaboration
According to the American Association of Nurse Practitioners (AANP) (2020), it is extremely important for Psychiatric Mental Health Nurse Practitioners (PMHNPs) to know and recognize their state’s rules and guidelines that determine how nurse practitioners (NPs) should practice. The agency identified three practice areas including full practice, reduced practice and restricted practice permitted by Advanced Practise Registered Nurses (APRNs) around the nation according to the state board of nursing (AANP, 2020). This PMHNP will be practicing in the state of Connecticut (CT). In this state, the nurse practitioner is given the full practice authority by the state board of nursing under the CT department of public health (DPH) including evaluating, ordering diagnostic tests and explaining them, begin and direct interventions in psychotherapy and pharmacology as well as given controlled substances (AANP, 2020; Buppert, 2021; DPH, 2021; Zakhari, 2021). Although the NPs are given the full practise authority, the APRN or Certified Nurse Practitioner (CNP) as the state refers to them must have the early three years or 2000 hours experience with a physician of this state with a joint unity in order to practice (Buppert, 2021 & DPH, 2021). The unity states that in case the NP is not available, the physician will provide care to the patients including discussion, guidelines, evaluating patients progress, as well as APRNs ordering control medications of “schedule II and III” and assess benefits of these medications in addition to evaluating and amending levels, assess laboratory levels and treatments (Buppert, 2021 & DPH, 2021). After three years or two thousand hours, the APRN can practice by him or herself without a physician (DPH, 2021).
Certified and Licensed as APRN, Scope of Practice
In the state of CT, in order for an individual to receive or apply for an NP license, one must have an active CT registered nurse (RN) license, finish thirty hours of advanced pharmacology, and complete a master’s degree with transcript sent to DPH directly from the applicant’s school (DPH, 2021). The state board of nursing website is https://portal.ct.gov/DPH/Practitioner-Licensing–Investigations/APRN/APRN-Licensure-Requirements. The NP application is done online at https://www.elicense.ct.gov/ with a fee of two hundred dollars (DPH, 2021). Not all, the CT DPH and the state board of nursing state that NPs have the full potential of evaluating, diagnosing, placing diagnostic tests and translating them, and start interventions, reassess and amend and promote positive patient care (DPH, 2021). According to D’Angelo et al (2019), NPs are very capable with their diverse knowledge and experience and must be trained and equipped to be in many areas including the war zones and must be part of scope of practice for APRNs. Buppert (2021), McCoy (2018) and Gibson et al (2020) agree that NPs have the expertise of both “registered nurses and physicians” therefore the need to stretch the scope of practices to help take care of our patients in this increasing and changing healthcare system.
DEA License, Prescription Monitoring Program (PMP)
Drug Enforcement Administration (DEA) license is obtained after an individual has successfully passed the American Nurses Credentialing Center Board Certified exam (ANCC-BC) for PMHNP through the Connecticut Department of Consumer Protection (DCP) under the drug control division (DCP, 2021; DEA, 2020). According to the DEA, prescribers are monitored by the agency through the individual states (DEA, 2O20).
In addition, the state participates in the prescription monitoring program (PMP) under the CT DCP managed by the drug control division (DCP, 2021). In this program, the NP is supposed to verify in the CT Prescription Monitoring and Reporting System (CPMRS) before ordering any controlled substance for a patient (DCP, 2021). The state prefers NPs to order controlled medications electronically, therefore, in case there is no technology, the NPs can order medications but must verify the patients information as soon as possible within 24 hours and must record the reason prescriptions were not ordered electronically and CPMRS was not assess prior to ordering the scheduled medications (DCP, 2021).
What surprised this PMHNP is how many reduced and restricted NP practices in the country considering the need for NPs in many fields of care in these challenging times. As NPs and PMHNPs, it is our responsibility to push forward to expand and gain full scope of practise around the nation and globally to provide access and cost effective healthcare for our patients and their families.
References
American Association of Nurse Practitioners. (2020). State practice environment.
https://www.aanp.org/advocacy/state/state-practice-environment
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones &
Bartlett Learning.
Connecticut Department of Consumer Protection (2021). Drug control division.
https://portal.ct.gov/DCP/Agency-Administration/Division-Home-Pages/Drug-Control-D
ivision
Connecticut State Department of Public Health (2021). License requirements.
https://portal.ct.gov/DPH/Practitioner-Licensing–Investigations/APRN/APRN-Licensure
-Requirements
D’Angelo, M., R., Seibert, D., Wanzer, L., Johnson, H., Alguire, K., Douglas, D., Welder, M.,
D., Romano, C..(2019).Operational readiness: Redesigning advanced practice registered
nurse (aprn) curriculum for an evolving battlefield
https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=7&sid
=fd60c843-112a-4e67-ad47-2dc8c683f9b3%40sessionmgr4008
Gibson, C., Goeman, D., & Pond, D. (2020). What is the role of the practice nurse in the care of
people living with dementia, or cognitive impairment, and their support person(s)?: a
systematic review. BMC Family Practice, 21(1), 1–18.
https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-020-01177-y
Drug Enforcement Administration Diversion Control Division. (2020). Registration.
https://www.deadiversion.usdoj.gov/drugreg/index.html
McCoy, K. T. (2018). Achieving full scope of practice readiness using evidence for
psychotherapy teaching in web and hybrid approaches in psychiatric mental health
advanced practice nursing education. Perspectives in Psychiatric Care, 54(1), 74.
https://doi-org.ezp.waldenulibrary.org/10.1111/ppc.12202
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual.
Springer Publishing Company.
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