NR 506 Week 6 Assignment: Scope of Practice and Patients Healthcare Accessibility 

NR 506 Week 6 Assignment: Scope of Practice and Patients Healthcare Accessibility

NR 506 Week 6 Assignment: Scope of Practice and Patients Healthcare Accessibility

Scope of Practice and Patient’s Healthcare Accessibility

Discussion

Purpose

The purpose of this assignment is to identify the scope of practice in one’s state, including level of independence of practice, prescribing authority, any limitations of practice, process for obtaining licensure in your state, certification, and education requirements for licensure.  Next, students will discuss how the level of independence of practice in their state, i.e., reduced, restricted or full practice, affects patients’ access to care in their local community.

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Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to: 

• Understand NP practice as defined by law (CO2)
• Determine legislation as defined by legislation, statutes and regulations (CO2)
• Identify barriers to ensuring patient’s rights (CO3)

Due Date: Wednesday by 11:59 pm MST of Week 6

Initial responses to the discussion topic must be posted by Wednesday 11:59 pm MT. Two additional posts to peers and/or faculty are due by Sunday at 11:59 pm MT.  Students are expected to submit assignments by the time they are due.

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday of week 6, regardless of the number of days late. NOTHING will be accepted after 11:59 pm MT on Sunday (i.e. student will receive an automatic 0).

Total Points Possible: 100

Preparing the Discussion

1. Discuss your state NP community in terms of scope of practice. Include your state’s scope of practice for NPs, including:
   • Level of independence of practice **In California, NPs are required to practice under Standardized Procedure Guidelines. If CA is your intended practice state, please provide details on how Standardized Procedures Guidelines are developed in California and an example of a California SPG.
   • Prescribing authority
   • Any limitations of practice
   • Process for obtaining licensure in your state
   • Certification and education requirements for licensure.
2. If you live in a restricted or reduced practice state, how has patient care been impacted in your local community by these barriers? For instance, is the ED used for primary care?  Are the EDs overcrowded with long wait times?  Are there urgent care clinics readily available? Is there adequate access to primary care?  If you live in a full practice, how has an independent practice of the APN resulted in improved patient access to healthcare?
3. How does access to NPs impact any healthcare disparities?
4. A scholarly resource must be used for EACH discussion question each week.

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Category	Points	%	Description
DISCUSSION CONTENT
Scope of practice and NP requirements	30	30%	Provides relevant evidence of scholarly inquiry of their state’s NP scope of practice. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
Practice barriers and access to healthcare	30	30%	Provides relevant evidence of scholarly inquiry of whether their state is a reduced, restricted or full practice state and the impact on the local community with respect to healthcare access. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
Healthcare disparities	15	15%	Provides relevant evidence of scholarly inquiry of how access to NPs impacts healthcare disparities. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
	75	75%	Total CONTENT Points= 75 pts
DISCUSSION FORMAT
Interactive Dialogue	20	20%	4 Required Elements: Responds a minimum of two other posts to peers and/or faculty in the threaded discussion; Responses to peer/faculty are substantive (adds importance, depth, and meaningfulness to the discussion) Responds to all direct questions from faculty (if no question asked directly, student responded to questions posed to the entire class) Summarizes what was learned from the lesson, readings, and other student posts for the week. The summary could be included in one of the three minimum posts.
Grammar, Syntax, Spelling, & Punctuation	5	5%	Grammar, syntax, spelling, and punctuation are accurate.
	25	25%	Total FORMAT Points = 25 pts
	100	100%	DISCUSSION TOTAL= 100 pts

NR506NP WK6 Scope of Practice Discussion_MAR20

NR506NP WK6 Scope of Practice Discussion_MAR20

Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeScope of PracticeDiscuss your state NP community in terms of scope of practice. Include the your state’s scope of practice for NPs including: • Level of independence of practice • Prescribing authority • Any limitations of practice • Process for obtaining licensure in your state • Certification and education requirements for licensure.	30 ptsExcellent Provides relevant evidence of scholarly inquiry of their state’s NP scope of practice. Uses valid, relevant, and reliable outside scholarly sources to contribute to the threaded discussion. 27 ptsV. Good Provides some relevant evidence of scholarly inquiry of their state’s NP scope of practice. Uses some valid, relevant, reliable outside scholarly sources to contribute to the threaded discussion. 25 ptsSatisfactory Discussions use sparse scholarly inquiry and does not state scholarly inquiry of their state’s NP scope of practice. Little valid, relevant, or reliable outside scholarly sources are used to contribute to the threaded discussion. Demonstrates little understanding of the topic. 15 ptsNeeds Improvement Discussions do not use scholarly inquiry and does not state scholarly inquiry of their state’s NP scope of practice. The posting uses information that is not valid, relevant, reliable, or scholarly. 0 ptsUnsatisfactory Discussion did not include criteria.	30 pts
This criterion is linked to a Learning OutcomeFull vs. Restricted PracticeIf you live in a restricted or reduced practice state, discuss how patient care has been impacted in your local community from these barriers. If you live in a full practice state, discuss how independent practice of the APN resulted in improved patient access to healthcare.	30 ptsExcellent Provides relevant evidence of scholarly inquiry of whether their state is a reduced, restricted or full practice state and the impact on the local community with respect to healthcare access. Uses valid, relevant, and reliable outside scholarly sources to contribute to the threaded discussion. 27 ptsV. Good Provides some relevant evidence of scholarly inquiry of whether their state is a reduced, restricted or full practice state and the impact on the local community with respect to healthcare access. Uses some valid, relevant, reliable outside scholarly sources to contribute to the threaded discussion. 25 ptsSatisfactory Discussions use sparse scholarly inquiry and does not state scholarly inquiry of whether their state is a reduced, restricted or full practice state and the impact on the local community with respect to healthcare access. Little valid, relevant, or reliable outside scholarly sources are used to contribute to the threaded discussion. Demonstrates little understanding of the topic. 15 ptsNeeds Improvement Discussions do not use scholarly inquiry and does not state how scholarly inquiry of whether their state is a reduced, restricted or full practice state and the impact on the local community with respect to healthcare access. The posting uses information that is not valid, relevant, reliable, or scholarly. 0 ptsUnsatisfactory Discussion did not include criteria.	30 pts
This criterion is linked to a Learning OutcomeAccess & Healthcare DisparitiesDiscuss how access to NPs impact healthcare disparities.	15 ptsExcellent Provides relevant evidence of scholarly inquiry of how access to NPs impacts healthcare disparities. Uses valid, relevant, and reliable outside scholarly sources to contribute to the threaded discussion. 14 ptsV. Good Provides some relevant evidence of scholarly inquiry of how access to NPs impacts healthcare disparities. Uses some valid, relevant, reliable outside scholarly sources to contribute to the threaded discussion. 12 ptsSatisfactory Discussions use sparse scholarly inquiry and does not state scholarly inquiry of how access to NPs impacts healthcare disparities. Little valid, relevant, or reliable outside scholarly sources are used to contribute to the threaded discussion. Demonstrates little understanding of the topic. 8 ptsNeeds Improvement Discussions do not use scholarly inquiry and does not state how scholarly inquiry of how access to NPs impacts healthcare disparities. The posting uses information that is not valid, relevant, reliable, or scholarly. 0 ptsUnsatisfactory Discussion did not include criteria.	15 pts
This criterion is linked to a Learning OutcomeInteractive DialogueMust demonstrate the following elements: • Responds a minimum of two other posts to peers and/or faculty in the threaded discussion; • Responses to peer/faculty are substantive (adds importance, depth, and meaningfulness to the discussion) • Responds to all direct questions from faculty (if no question asked directly, student responded to questions posed to the entire class) • Summarizes what was learned from the lesson, readings, and other student posts for the week. The summary could be included in one of the three minimum posts. (4 required elements)	20 ptsExcellent Demonstrated all elements for the Criterion 18 ptsV. Good Missing 1 element for the Criterion 17 ptsSatisfactory Missing 2 elements for the Criterion 10 ptsNeeds Improvement Missing 3 elements for the Criterion 0 ptsUnsatisfactory Missing 4 elements for the Criterion	20 pts
This criterion is linked to a Learning OutcomeGrammar, Syntax, Spelling, & PunctuationAPA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.	5 ptsExcellent 0-1 errors in grammar, spelling, syntax, and APA noted. 4 ptsV. Good 2-4 errors in grammar, spelling, syntax, and APA noted. 3 ptsSatisfactory 5-7 errors in grammar, spelling, syntax, and APA noted. 2 ptsNeeds Improvement 8-9 errors grammar, spelling, syntax, and APA noted. 0 ptsUnsatisfactory Post contains 10 or greater errors grammar, spelling, punctuation, and/or APA or repeatedly makes the same errors after faculty feedback.	5 pts
This criterion is linked to a Learning OutcomeParticipation	0 ptsDiscussion late penalty deductions A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday by 11:59PM MST, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). 0 ptsTotal Participation Responses A 10% penalty will be imposed for not entering the minimum number/type of interactive dialogue posts OR not posting on the minimum required number of days. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).	0 pts
Total Points: 100

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Scope of Practice and Patient Healthcare Accessibility
The scope of practice for advanced practice nurses differs considerably across states in the U.S. Some states allow their nurse practitioners, based on their level of qualification as advanced registered nurses, to have full practice authority while some have either restricted or reduced practice for their NP communities (Kleinpell et al., 2023). Georgia is one of the states that remains conservative and has not guaranteed its NP community full practice authority. As such, this discussion focuses on the scope of practice for nurse practitioners in Georgia and its effects on access to care for patients.
Scope of Practice for NPs in Georgia
The scope of practice under the state’s Nursing Practice Act developed by the Board of Nursing is restricted meaning that NPs should work under the supervision of a physician (AANP, 2023). The state requires all APRNs to have evidence of current licensure as registered professional nurses in Georgia, a completed board application fee with an official transcript to verify graduation with a master’s degree or higher in nursing, and notification of present national certification from a recognized certifying entity by the board of nursing. The applicant is also required to document at least 500 hours of practice as an APRN and with a master’s certificate in advanced nursing practice (State Board of Nursing, Georgia, 2023). Getting licensure in the state involves meeting the requirements by demonstrating educational, and certification credentials as needed by the different provisions of the state’s Nursing Practice Act. Upon meeting the requirements, NPs can apply for the initial license and subsequently renew as required by the state provisions based on one’s specialty of the four NP roles.
Nurse practitioners do not independently in Georgia due to the restricted practice authority. They must have a collaborative agreement or a “nurse protocol” that allows them to perform medical acts and can be accessible for immediate consultation. The physician signing the protocol is called “delegating physician and must be present for most of the consultations (AANP, 2023). The physician should also review the medical records of all patients treated by the NP and ensure that the NP is onsite as required.
Nurse practitioners did not have the right to prescribe medication in the state until 2006. Georgia was the last state to grant its NP community prescribing authority. However, the prescribing authority of the NP must be captured or outlined in the nurse protocol agreement between the NP and the physician. Furthermore, NPs cannot prescribe Schedule II controlled substances. The NP can also sign their prescriptions without the need for a physician’s signature.
Impact of Restricted Practice on Patient Care
The restricted practice for the NP reduces access to quality care for many patients in the state. Nurse practitioners like certified clinical nurses and midwives are critical to improving access to care and reducing barriers because of their specialization (Johnson et al., 2021). However, restricted practice means that they can practice to the full extent of their training and education, especially their specialty, and have to wait for instructions from their physicians. In their article, Denson et al. (2022) demonstrate that Georgia can benefit from full practice authority for NPs and physician assistants as it will increase access to primary health providers. The shortage of primary care providers affects many areas of Georgia, including the state capital, Atlanta. The article asserts that 149 out of the 159 in the state have a shortage of primary care providers (Denson et al., 2022). Allowing NPs to have full practice authority will address this challenge and improve access for millions of people in the state.
Emergency room crowding and long wait times characterize many facilities in the state; an indication of a serious shortage of primary care providers. Again, urgent clinics may spring up to help patients access healthcare (Yang et al., 2023). As such, the restricted practice environment affects the overall quality of and access to care for many Georgians.
Access to NP and Impact on Healthcare Disparities
Effective access to NP is critical to addressing healthcare disparities, especially among underserved and low-income populations in Georgia. Access ensures that all populations get appropriate care and healthcare resources reducing the burden associated with diseases, particularly chronic conditions. Again, access to NPs ensures that patients and health populations have sufficient information on primary health interventions to reduce disparities (Yang et al., 2021). Therefore, Georgia and other states with restricted and reduced practice should allow NPs to have full practice regimes to reduce disparities.
Conclusion
Georgia remains one of the states that restricts its NPs and requires them to get agreements with delegating physicians to practice. Consequently, the restricted practice authority affects access to care and leads to poor outcomes. Expanding the authority will ensure that patients and health populations get access to healthcare services to improve their outcomes.

References
American Association of Nurse Practitioners (AANP) (2023). Georgia: Information and
Resources for Georgia NPs. https://www.aanp.org/advocacy/georgia
Denson, C. & Timmons, E. (2022 September 15). Addressing Georgia’s Healthcare Disparities:
The Benefits of Full Practice Authority for Nurse Practitioners and Physician Assistants. https://www.georgiapolicy.org/publications/addressing-georgias-healthcare-disparities-the-benefits-of-full-practice-authority-for-nurse-practitioners-and-physician-assistants/
Johnson, C., Nelson, M. & Eades, L. H. (2021). Nurse Practitioner Autonomy in Georgia:
Exploring Barriers to Full Practice Authority. Georgia State University. DOI: https://doi.org/10.57709/24445727
Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to APRN practice:
Policy and regulatory implications during COVID-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9
State Board of Nursing, Georgia (2023). Chapter 410-11 Regulation of Advanced
Practice Registered Nurses: Rule 410-11-.01 Purpose, Definitions, Title, and Authority for Advanced Nursing Practice. https://rules.sos.ga.gov/gac/410-11
Yang, B. K., Johantgen, M. E., Trinkoff, A. M., Idzik, S. R., Wince, J., & Tomlinson, C. (2021).
State nurse practitioner practice regulations and US health care delivery outcomes: a systematic review. Medical Care Research and Review, 78(3), 183-196. DOI: 10.1177/1077558719901216.