Week 1 _ discussion_ certification and licensure plan

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**THIS DISCUSSION IS DIVIDE IN TWO PARTS –

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MAIN DISCUSSION POST BY WEDNESDAY 11/30/2022 BEFORE 8:00 PM EST

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TWO REPLIES BY FRIDAY 12/2/2022 BEFORE 8:00 PM EST


Discussion_Week 1_CERTIFICATION AND LICENSURE PLAN (FLORIDA)

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.

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 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.


Instructions:

· Review practice agreements in your state. – Florida

· 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 (Florida)?

· What is the application process for certification in your state (Florida)?

· What is your state’s board of nursing website (Florida)?

· How does your state define the scope of practice of a nurse practitioner?

· What is included in your state (Florida) practice agreement?

· How do you get a DEA license?

· Does your state (Florida) have a prescription monitoring program (PMP)?

· How does your state (Florida) describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

Post a summary of your findings on your state (Florida) 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.


Resources:

· American Association of Nurse Practitioners. (2020). 

State practice environment
 Links to an external site.
. https://www.aanp.org/advocacy/state/state-practice-environment

· On the map on the webpage, click on your state and review. After you complete the PMHNP Program, pass the certification exam, and get a job, you will need to revisit this website to apply for the privilege to practice as an APRN with your state Board of Nursing.

· American Psychiatric Association. (2020). 

Telepsychiatry
 Links to an external site.
. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry

· Buppert, C. (2021). 
Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.

· Chapter 1, “What Is a Nurse Practitioner?”

· Chapter 2, “Nurse Practitioner Scope of Practice”

· Chapter 3, “State Regulation of the Nurse Practitioner Practice”

· Chapter 4, “Federal Regulation of the Nurse Practitioner Profession”

· Chapter 5, “Prescribing”

· Centers for Disease Control and Prevention. (2020). 

Using telehealth to expand access to essential health services during the COVID-19 pandemic
 Links to an external site.
. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html

· Centers for Medicare & Medicaid Services. (2019). 

National provider identifier standard (NPI)
 Links to an external site.
. https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand

· The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

· Drug Enforcement Administration Diversion Control Division. (2020). 

Registration
 Links to an external site.
. https://www.deadiversion.usdoj.gov/drugreg/index.html

· This site contains information about applying for your DEA registration number. This number is required for writing prescriptions.

· After completing PMHNP Program and passing the PMHNP certification exam, complete the DEA application to request prescriptive privileges. Your DEA number will be renewable every five years.

· National Panel for Psychiatric Mental Health NP Competencies. (2003). 

Psychiatric-mental health nurse practitioner competencies
 Links to an external site.


. National Organization of Nurse Practitioner Faculties (NONPF).  https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/imported/PMHNPcomps03.pdf

· Stewart, J. G., & DeNisco, S. M. (2019). 
Role development for the nurse practitioner (2nd ed.)
Jones & Bartlett Learning.

· Chapter 1, “Historical Perspectives: The Art and Science of Nurse Practitionering”

· Nurse Practitioner Core Competencies

· Nurse Practitioners’ Unique Role

· Chapter 13, “Quality, Safety, and Prescriptive Authority”

· Substance Abuse and Mental Health Services Administration. (2020). 

Become a buprenorphine waivered practitioner
 Links to an external site.
. https://www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/apply-for-practitioner-waiver

· This site contains information about applying for a practitioner waiver to prescribe or dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA 2000).

· After you obtain a Drug Enforcement Agency (DEA) number and completed 24-hour medication-assisted treatment (MAT) waiver training, you may apply to Substance Abuse and Mental Health Services Administration
 (SAMSHA) for MAT waiver to be able to prescribe Schedule III, IV, or V opioid drugs for the maintenance and detoxification treatment of opioid use disorders relapse prevention.

· Zakhari, R. (2021). 
The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.

· Chapter 2, “The Role of the Psychiatric-Mental Health Nurse Practitioner: Regulations and Scope of Practice”

· Chapter 3, “Theoretical Foundations of Care and Nonpharmacological Therapies”


Instructions:

Respond to your colleague 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. (Florida)

**minimum of three (3) scholarly references are required for each reply cited within the body of the reply & at the end**

Reply # 1

Ada Offor

Summary

How to get certified and licensed as an Advanced Practice Registered Nurse in Georgia

The Georgia Board of Nursing is the association that grants licenses to Advanced Practice Registered Nurses (APRNs) in Georgia. Georgia does not participate in the agreement on nurse licensure; hence, the APRNs must also be licensed as registered nurses (RNs) in Georgia. A future Georgia APRN must possess a master’s degree or higher educational qualifications in the advanced practice role. The curriculum will provide training for the specific position and include advanced pharmacology education (Georgia Board of Nursing, 2020). The state administrative code also specifies extra specialty-specific academic qualifications. At least two clinical nurse specialists’ nursing degrees must entail clinical practice. Advanced physical assessment and advanced physiology courses are required. At least two psychiatric nursing courses that include clinical practice are required of clinical nurse specialists in mental health and psychiatry.

Application Process for Certification in Georgia

The application process for becoming a certified nurse in Georgia involves the following:

· Getting a graduate Degree in Georgia.

· Earning their National certification in Georgia.

· Applying for authorization in Georgia (Georgia Board of Nursing, 2020).

· Renewing one’s license in Georgia.

Georgia State’s Board of Nursing Website

Georgia Board of nursing’s website is 
http://www.sos.state.ga.us/plb/rn
 Links to an external site.
, where most nurses apply for their certification authorization.

Scope of Practice of a Nurse Practitioner in Georgia

In Georgia State, nurses are only permitted to accept activities compatible with their training, knowledge, competencies, and abilities (Georgia Board of Nursing, 2020). Given their primary duty is to provide their patients with safe treatment, the state’s scope also requires nurses in Georgia practice to adhere to this rule.

Georgia State’s Practice Agreement

The Georgia practice agreement covers the doctor-physician assistant relationship of supervision, the physician assistant’s scope of authority, and the circumstances of the physical examination and patient evaluation (Georgia Board of Nursing, 2021).

Getting A DEA License in Georgia

A nurse practitioner (NP) must be registered with the federal drug enforcement administration to administer, prescribe, or dispense any prohibited substance and obtain a DEA license. According to the American Association of Nurse Practitioners (2020), to get an official order form, a nurse must apply on the United States (US) Department of Justice website, contact the DEA Registration Unit, and mail in a completed DEA Form 222a.

Prescription Monitoring Program in Georgia

Georgia has a prescription drug monitoring program. An electronic database is utilized to track the prescription and dispensing of prohibited medications in Georgia State’s prescription drug monitoring program. The program provides physicians with vital information about a patient’s history of controlled substance prescriptions. Pharmacists and prescribers can access it to view information on specific users’ controlled drug prescriptions.

Description of a Nurse Practitioner’s Controlled-Substance Prescriptive Authority and That Nurse Practitioner Drug Schedules Are Nurse Practitioners Authorized to Prescribe in Georgia.

NPs are permitted to prescribe drugs from schedules III to V. It should be on a form that includes, among other things, the APRN and delegating physician who are parties to the nurse protocol agreement, the patient’s name and address, the drug ordered, directions regarding the dosage of the drug or use of the device, and be signed by the advanced practice registered nurse (Georgia Department of Public Health., 2021). NPs do not have the authority to prescribe any legal drugs under Schedule II. Nothing in the Code section, except oral contraceptives, and prenatal vitamins, which may be refilled for 24 months, should be translated as providing a platform for any APRN to draft a prescription drug order for a Schedule I or II controlled substance or to approve or permit refills of any medication for a time longer than 12 months after the date of the first order.

Types of Regulations and Barriers Impacting Nursing Independent Practice in Georgia State

The two primary laws and regulations governing nursing practices in Georgia are monitoring and prescribing laws. In supervision law, nursing practitioners in Georgia must work under medical supervision and collaborate according to nursing protocol. The doctor agrees to be accessible for prompt consultation with the nurse practitioner and grants the NP permission to execute medical acts in this protocol, which is a written document. One NP and one medical doctor (MD) must concur with the nursing protocol agreement before signing it.

The Georgia prescription authority requires that a nurse practitioner’s capacity to prescribe be specified in the nurse protocol agreement between the NP and MD. In Georgia, nursing practitioners cannot administer Schedule II restricted substances. In Georgia, they are allowed to sign their prescriptions without the assistance of a physician. Another practice restriction that also has barriers in Georgia is that nurse practitioners are permitted to sign birth certificates but not death certificates. Surprisingly, while Georgia’s legislation giving nurse practitioners the power to write prescriptions undoubtedly made life easier for NPs, the state still lags behind most others regarding nurse practitioner independence. 

 

References

American Association of Nurse Practitioners. (2020). How to Get Information About Obtaining a DEA Number? https://www.aanp.org/practice/practice-management/business-resources-for-nurse-practitioners/how-to-order-a-dea-number

Georgia Board of Nursing. (2020). Become a Nurse Practitioner in Georgia | APRN License Requirements in GA – NursingLicensure.org. https://www.nursinglicensure.org/np-state/georgia-nurse-practitioner/

Georgia Board of Nursing. (2021) How to Become a Nurse in Georgia | Nurse Licensure in GA | Nursing-School-Degrees.com. https://www.nursing-school-degrees.com/nurse-licensure/become-a-nurse-in-georgia/#:~:text=In%20order%20to%20be%20licensed%20as%20a%20registered

Georgia Department of Public Health. (2022) Prescription Drug Monitoring Program. https://dph.georgia.gov/pdmp#:%7E:text=The%20Georgia%20Prescription%20Drug%20Monitoring


Instructions:

Respond to your colleague 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. (Florida)

**minimum of three (3) scholarly references are required for each reply cited within the body of the reply & at the end**

Reply # 1

Amarachi J. Okafor

The state of North Carolina is a fully restricted practice state which means career-long supervision, delegation or team management is needed by a medical provider in order for the NP to provide patient care (American Association of Nurse Practitioner, 2020). This means in order for a nurse practitioner to practice independently they must collaborate with a medical provider in order to have their own practice which can be a barrier for nurse practitioners who want to have their own practice or practice on their own. Each advanced practice nurse practitioner takes the ANCC to get certified after they have received an authorization to test from their university (North Carolina Board of Nursing, 2022). Then the NP must apply online through the North Carolina Board of Nursing website for licensure (North Carolina Board of Nursing, 2022). Following an application for licensure, an initial first-time approval to practice must be completed in the state of North Carolina and be approved by the North Carolina Medical Board and Board of Nursing prior to employment as a Nurse Practitioner (North Carolina Board of Nursing, 2022). This information that I gathered shocked me because I did not know there was another step after you apply for licensure that must be approved before you can practice. The approval number you receive once your application is accepted is important because that is the number that must be included on all prescriptions written by you as a nurse practitioner in the state of North Carolina (North Carolina Board of Nursing, 2022).

North Carolina has a clear and concise scope of practice for its nurse practitioners who are practicing in state. The scope of practice includes: promotion and maintenance of health, prevention of illness and disability, diagnosing, treating, and managing acute and chronic illnesses, guidance and counseling for both individuals and families, prescribing, administering, and dispensing therapeutic measures, tests, procedures and drugs, planning for situations beyond nurse practitioner’s expertise and consulting with and referring to other health care providers as appropriate and evaluating health outcomes (Bupper, 2021). In North Carolina, nurse practitioners have explicit legal authority to prescribe but with collaboration and are also able to prescribe controlled substances schedules II-V (North Carolina Board of Nursing, 2022). To prescribe controlled substances nurse practitioners must obtain a drug enforcement administration number following registration from the DEA’s website (Drug Enforcement Administration Diversion Control Division, 2020). North Carolina has a prescription monitoring program that focuses on controlled substance reporting (North Carolina Board of Nursing, 2022). There is 50-hour mandatory continuing education hours as a nurse practitioner in North Carolina that must be upheld for your role and prescriptive authority (North Carolina Board of Nursing, 2022).

References

American Association of Nurse Practitioners. (2020). State practice environment. 
https://www.aanp.org/advocacy/state/state-practice-environment
Links to an external site.

Bupper, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.

Drug Enforcement Administration Diversion Control Division. (2020). Registration. 
https://www.deadiversion.esdoj.gov/drgureg/index.html
Links to an external site.

North Carolina Board of Nursing. (2022). Nurse Practitioner. https://www.ncbon.com

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