NR 506 Week 6 Scope of Practice and Patient’s Healthcare Accessibility

Sample Answer

In the state of New Jersey Nurse practitioners practice with reduced authority. You have the ability to work independently in treating patients but require a physician in order to prescribe medications through a collaborative agreement. In NJ a supervising physician is necessary in order for the NP to prescribe medications. By law the NP can assess, diagnose, order testing like labs or other diagnostics, provide end of life care, sign POLST forms, and pronounce death (New Jersey Division of Consumer Affairs, 2015). According to Cadmus et.al. (2021) there is a serious issue with access to primary care in 13 of 21 counties in NJ and barriers to NP practice contributes to the issue.

In 2010 the Patient Protection and Affordable Care act assisted 20 million people to get access to health insurance. This increased the demand for provider access as new conditions were diagnosed and much of the population now required maintenance care of chronic illnesses. For the state of NJ the existing barriers only limit NPs from practicing within the full extent of their license (Cadmus et. al., 2021). Collaboration agreements in NJ limit NP ability to practice through requirement for a physician to supervise the NP’s prescriptive authority, without actually requiring involvement of the physician in the patient’s care or a sign off. This can impose financial burdens on the APN when contracts are broken (Cadmus et. al., 2021).

Full practice authority would increase provider accessibility and reduce financial burdens on NPs. According to Cadmus et. al. (2021) it is projected through the U.S. Census Bureau from 2013 to 2025 there will be a 14.1% shortage of primary care physicians in the state of NJ. With full practice authority, NPs can open their own practices, offering more accessibility to patients and reducing the impact on emergency departments from patients seeking primary care. In New Jersey we have a few urgent care centers but with full authority access, more practices can be opened.

Prescriptive Authority

Under the supervision of a physician, they can prescribe medications (New Jersey Division of Consumer Affairs, 2015). For the prescription of dangerous controlled medications, the APN is required by law to register to apply with the Drug Enforcement Agency (DEA) and controlled and dangerous substance (CDS) to gain permission through licensure. Once the license number is obtained, the APN will apply for a DEA number. All APNs can prescribe level 2 to 5 controlled substance medications following a 6 hours course completion and application to the federal DEA.

Prescription blanks with prescriber name, address, and information printed on specialized paper is required by NJ law to prevent changes to the 5 prescription once printed (New Jersey Division of Consumer affairs, 2015). In order to maintain your prescriptive authority in the state of NJ you must have a written collaborative agreement with a physician which is to be reviewed and signed each year. APNs need to keep their licensure up to date (ANA, 2023)

Educational Requirements

It is required that a nurse practitioner graduate from an MSN program with clinical rotations. The program included a 45 hour pharmacology course that is approved by the NJ board of nursing equaling to a 3 credit graduate course that is accredited by a national accredited agency. NPs need to obtain 30 CEUs related to their choice of advanced practice scope, pharmakinetic, pharmadynamic principles of clinical application, and use of pharmacological agents in prevention of illness. The CEUs are required within 5 years of the application for prescriptive authority (New Jersey Division of Consumer Affairs, 2015).

Licensure requirements

NJ licensure is determined through state recognition requirements. This includes having a current RN license without restrictions, nationally recognized certification, and proof of graduation from an advanced MSN or DNP nursing program. The cost of licensure is $100 non-refundable fee with a certification fee of $80/160 depending on the expiration of the RN license. RN licensure must be in good standing, with a passed criminal background check, uploaded, current fingerprints done electronically in order to complete application (New Jersey Division of Consumer Affairs, 2015).

The nursing board requires official transcripts to be submitted in order to process applications in a timely fashion. A requirement to keep the NP licensure is active certification. Proof of CEUs and practice house are needed to certify (New Jersey Division of Consumer Affairs, 2015). ach certification exam is given according to chosen specialty and the NJ board requires the highest level examination be taken. 17 certification agencies are recognized by the board of nursing and accredited. The cost of certification is $365 for non-member and $290 for members of the American Nurses Association (ANA, 2022).

How does access to NPs impact any healthcare disparities?

According to Nikpour et. al. (2022) adult patients enrolled in Medicare and Medicaid have higher rates of diseases like coronary artery disease and diabetes resulting in twice as many hospitalizations. Nikpour et. al. (2022) conducted a Nurse practitioner primary care organizational climate questionnaire with 189, 420 patients with Coronary artery disease or diabetes enrolled in Medicare and Medicaid. 470 practices in PA, NJ, CA, and FL were involved in the study. Results reflected higher odds of hospitalization for patients living in poor environments who were dually eligible for Medicare and Medicaid (Nikpour et.al., 2022).

With increasing patient conditions that require ambulatory care, primary care, and hospitalization, there will be a demand for providers. Nurse practitioners have the training and ability to fill a void for provider care and help to address health conditions worsened by disparities. States that reduce the NPs ability to practice at full authority have higher incidences of health care disparities (Nikpour et. al., 2022).

References

• American Nurses Association (2022). Advanced Practice. https //www.nursingworld.org/advancedpractice.
• American Medical Association. (2021). State Law Chart Nurse Practitioner Prescriptive Authority.
  https //www.ama-assn.org/system/files/2020-02/ama-chart-np-practice-authority.pdf
• Cadmus, de Cordova, P. B., Weaver, S., & Ravichandran, A. (2020). Access to Care in New Jersey Making the Case for Modernizing Legislation. Journal of Nursing Regulation, 11(1), 36–41. https //doi.org/10.1016/S2155-8256(20)30059-4
• New Jersey Division of Consumer Affairs (2015). Advanced Practice Nurse Certification.
  https //www.njconsumeraffairs.gov/nur/Pages/APN-Certification.aspx. Assessed 06/8/2023
• Nikpour, Brom, H., Mason, A., Chittams, J., Poghosyan, L., & Carthon, M. B. (2022). BETTER NP PRACTICE ENVIRONMENTS REDUCE HOSPITALIZATION DISPARITIES AMONG DUALLY ENROLLED PATIENTS. Innovation in Aging, 6(Supplement_1), 64–65. https //doi.org/10.1093/geroni/igac059.257