Certification and Licensure
Regulation is defined as having authority over something that originated from the broad spectrum of legislation (Milstead & Short, 2019). Different states have specific rules, certification, and licensure requirements for advanced practice registered nurses, yet all aim to safeguard the interest of public safety by controlling health professional’s activity. The board of nursing makes these regulations based on the Nurses Practice Act to protect the community by ensuring that healthcare professionals comply with the qualification to enter the profession (Bosse et al., 2017). Also, they are responsible for maintaining appropriate standards of practice continuously.
In Maryland, my home state, the main requirement to be a certified nurse practitioner is to complete a board-approved nurse practitioner program and pass a board-approved examination (Maryland Board of Nursing, 2019). The Maryland Board of Nursing provided the list of approved NP programs around the country, including Walden University. Suppose the program is not on the list. In that case, the NP can apply for approval as long as it is recognized by the US Department of Education or the Council for Higher Education Accreditation. MBON mentioned four approved organizations for board certification, including the American Nurses Credentialing Center, the American Academy of Nurse Practitioners, the Pediatric Nursing Certification Board, and the National Certification Corporation. To apply for a Maryland NP license, the MBON requires a copy of the current RN license, certification application, declaration of resident form, sealed official transcript, copy of the current national certification, or letter to take the eligibility to take the certification exam. An additional requirement made effective October 2015, and applicants must have a Mentor for 18 months from the date of application. The mentor must be a Maryland licensed Nurse Practitioner or Physician with a license in good standing (Maryland Board of Nursing, 2019).
Regarding the scope of practice, NPs are recognized as primary care providers after 18 months of mentorship with a physician or experienced NP upon passing the licensure exam. Maryland NPs can have the full scope of practice without physicians’ supervision, perform functions authorized by law, including but not limited to patient assessments, diagnoses, and ordering and interpretation of laboratory tests (Maryland Board of Nursing, 2019).
To get a drug enforcement administration (DEA) license in the state of Maryland, the NP can apply for a Maryland State Controlled Dangerous Substances (CDS) with the Office of Controlled Substances Administration (OCSA). The NP needs to complete the CDS application form mail to the Maryland Department of Health- Public Health Services Office of Controlled Substances Administration. In Maryland, nurse practitioners have a full prescriptive authority that has no physician involvement and can prescribe drugs from Schedule II, III, IV, and V (Maryland Board of Nursing, 2019).
The Nurse Practitioner Association of Maryland (NPAM) is one of the NP organizations in Maryland with a strong legislative committee that monitors nurse practitioner (NP) practice issues dictated by state law and regulations. The legislative committee has several members all over Maryland, which conducts legislative and advocacy activities such as assessing legislative and regulatory issues that impact NP practice, develop a plan, educate legislators, and enact changes as needed. The organization also develops a legislative agenda, works with NPAM lobbyists to develop legislation, promotes legislation to members, legislators, and the public reviews health-related bills introduced in the legislature by other groups and makes recommendations to NPAM about support or opposition, builds relationships with other health care stakeholders representing nursing, medicine, education, government, business, and the community (Nurse Practitioner Association of Maryland, n.d.).
The majority of the regulations in Maryland are in favor of the NP independent prescriptive and practice authority. However, the only barrier that may impact independent practice is the regulation made effective October 2015 onwards, which states that newly certified NPs should have a physician mentor for 18 months before they can independently practice.
It is interesting how different states differ from each other regarding NP’s independent practice authority. What surprises me is that Maryland NPs have several independent functions aside from prescribing drugs, ordering diagnostic, therapeutic measures. I have discovered that Maryland NPs can complete a death certificate if the deceased was under their care. NPs can also certify to the Department of Transportation that an individual needs special consideration for specific health reasons and can witness an advance directive (Maryland Board of Nursing, 2019). Knowing some other independent functions motivated me to serve my community in the future, knowing how broad the scope of practice of NPs in Maryland is.
Overall, APRNs’ full practice authority plays a significant role in providing citizens high-quality, reliable, and cost-effective healthcare services (Bosse et al., 2017). Michael et al. (2019) stated that the number of Americans 65 and older is projected to be more than double in the next four decades. Thus, the number of medical workforces, specifically primary care providers, will be in demand to cater to the medical needs of our population. Also, the high number of individuals who acquired insurance due to the Affordable Care Act has reported having less access to healthcare due to physician shortage (Bosse et al., 2017). These are just a few reasons that the government should allow APRNs to have a full scope of practice in all states in response to the increasing demand of health care providers to provide access to quality care for all Americans. APRNs are highly qualified health care professionals that undergone extensive education and training. Thus, removing the restrictions will allow nurse practitioners to practice to the full extent in response to the country’s increasing need.
References
Bosse, J., Simmonds, K., Hanson, C., Pucini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761–765. https://doi.org/10.1016/j.outlook.2017.10.002
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett.
Maryland Board of Nursing. (2019). Nurse practitioner: Scope and standards of practice. https://mbon.maryland.gov/Documents/proposed-regs-for-20171113-md-register.pdf
Milstead, J. A., & Short, N. M. (2019). Overview: Economics and finance of healthcare. In Health policy and politics: A nurse’s guide (6th ed., pp. 171–211). Jones & Bartlett Learning.
Nurse Practitioner Association of Maryland. (n.d.). Maryland legislative districts and NPAM legislative committee. https://www.npamonline.org/page/35.