Milstead and Short (2019) state that the evolution of APRN practice across the United States has been inconsistent because the U.S. Constitution gives states the right to establish laws governing professionals and occupations. As a result, scopes of practice, and regulatory standards are unique to each state. My home state is Georgia. There are two regulations that stood out to me during my research. APRN’s in Georgia must be given prescriptive or delegated authority by physicians to prescribe medications. However, APRNs are never allowed to prescribe schedule-II controlled substances (Georgia Government, 2021). These drugs are things like hydrocodone, morphine, and codeine. Secondly, APRNs in Georgia are required to have a practice agreement that requires the delegating physician to be available for consultation with the APRN when needed. This agreement also states that delegating physicians must conduct reviews of the charts of patients treated by APRNs (Georgia Government, 2021).
Across the country in California, APRN charts are not required to be reviewed or signed by the supervising physician. California was one of the first states to legally recognize APRNs as primary care providers. APRNs are also allowed to prescribe drugs (including schedule-II controlled substances) within the confines of the agreed-upon practice agreement. The regulations mentioned above apply to practitioners that have the legal authority to practice within their education and experience. These regulations are set as guidelines to protect the license of the APRN as well as for the protection of the patients. According to the American Association of Nurse Practitioners (2019) to ensure that APRNs are prepared to provide care to the full scope of their practice, they can engage in continuing education, remain active in their roles, and remain up to date on regulations. This ensures safe and competent practice.
The practice of APRN is essentially defined by the Nursing Practice Act (NPA) and governed by the Board of Nursing (BoN). The practice is also impacted by different laws and regulations. These rules and regulations may differ from state to state, but all of them seek to regulate the activities and conduct of APRNs so as to ensure the interest and safety of the public (Neff et al., 2019). Because these laws and regulations vary from one state to the other, APRNs have to explicitly understand their practice scope as provided within the state of practice.
In my state, Nurse Practitioners (NPs) are governed under the NPA and they have to register with the Prescription Drug Monitoring Program so as to be allowed to prescribe Schedule 2-5 drugs. However, in Georgia, NPs are not governed under the NPA, but rather under the Public Health Code. According to Georgia Board of Nursing (n.d.), NPs in the state can independently prescribe nonscheduled medications, but need a physician to cosign prescription for Schedule II-IV medications. Certified Nurse Midwife (CNM) is another nursing specialty where regulations vary between my state and the state of Georgia. While CNMs in my state are allowed to practice independently of physicians, in Georgia, these nurses are required to be in partnership with physicians when providing patient care.
The regulations are set as guidelines for nurses to protect their title and offer protection to the public. As such, the regulations apply to APRNs with legal authority to practice within the full scope of their training, experience, and education. In compliance with these regulations, APRNs ensure that they meet the required continuing educational training every licensing year and their licenses remain current and active.