Description
Two Advanced Practice Registered Nurse Board of Nursing Regulations Comparison
Nurse practitioners have come a long way, with Idaho in 1971 being the first state to legally recognize the nurse practitioner’s scope of practice of diagnosing and treatment (Milstead & Short, 2019). Since then, many states have pursued their own regulations of nurse practitioner’s scope of practice. I am working on becoming a psychiatric mental health nurse practitioner in California. For the longest time, I have heard that nurse practitioners cannot practice independently and only under a physician’s supervision. Although this is true, there are big changes that have occurred earlier this. Gov. Newsom signed Assembly Bill 890 in September 2020, and it took effect in 2023. The bill added two new categories of NPs, 103 NP and 104 NP (California Board of Registered Nursing, 2022). Now, psych nurse practitioners and many other specialized nurse practitioners can apply for 103 NP licenses, which enables them to work under a physician and surgeon without standardized procedures. After three years of having 103 NP licenses, the NP can apply for 104 NP to practice solo. Therefore, the earliest date a psych NP can practice solo in California is 2026. This is good news for me because there will be less restrictions. On the other hand, other states do not have this regulation. For example, in the state of Colorado, any nurse practitioner can practice freely to diagnose and treat patients without having to collaborate or work under a physician’s supervision (Nurse Practitioner Scope of Practice: Colorado | ThriveAP, n.d.)
One positive California has over other states like Colorado is the medication prescriptive authority. In California, psych nurse practitioners can administer, dispense, and prescribe schedule II – V. This means that psych NP can prescribe substances with high abuse potential, such as amphetamine, codeine, and hydrocodone, under physician supervision (NP Prescriptive Authority by State | NurseJournal, 2023). In the state of Colorado, Psych NP can prescribe schedule III – V, which are less abuse potential drugs like Tylenol with codeine. On top of the limitation, Colorado requires that the nurse psych NP for 1800 hours of preceptorship in order to prescribe (Nurse Practitioner Scope of Practice: Colorado | ThriveAP, n.d.).
Application of Regulations to APRN Practice
Up to this year, 2023, the regulation of working independently as a nurse practitioner in California was a bit limiting because it undermines the potential of a highly skilled and experienced veteran nurse practitioner. I understand the immense responsibility of being an independent provider and the requirements to be successful and practice safely. Still, at a certain point, a well-educated and experienced nurse practitioner can do very well within their scope of practice to provide patient care independently. That is why I highly agree with the new regulation of 103 NP and 104 NP. This is like a three-year residency for medical doctors before they can get full licensure to practice on their own. The idea for 103 NP and 104 NP mimics that, and rightfully so, Nurse practitioners should undergo extensive training before working independently.
A good example and the step I will take as a psych NP is to work in a psychiatric medical group setting with psychiatrists and therapists for a minimum of three years. The initial part is to write up a plan of the scope of practice, prescriptive medication management within scope, etc. Build the experience, knowledge and skills in that three year until I feel comfortable. I can work independently once I feel ready and confident knowing that I can practice safely.
References
California Board of Registered Nursing. (2022). Assembly Bill 890. Www.rn.ca.gov.
https://www.rn.ca.gov/practice/ab890.shtml
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide
(6th ed.). Jones & Bartlett Learning.
NP Prescriptive Authority By State | NurseJournal. (2023, October 2). Nursejournal.org.
https://nursejournal.org/articles/nurse-practition…
Nurse Practitioner Scope of Practice: Colorado | ThriveAP. (n.d.). Provider.thriveap.com.
https://provider.thriveap.com/blog/nurse-practitio…
