- Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
- Consider how key regulations may impact nursing practice.
- Review key regulations for nursing practice of your states/regions board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion..
By Day 3 of Week 5
Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.
Respond to these 2 posts with references:
Discussion Board week 5- Professional Nursing and State-Level Regulations
NURS – 6050N Policy and Advocacy for Improving Population Health
Dr. Amber Cook
Each state board of nursing has the right to have regulatory restrictions for the protection of the public. While deciding to go back to school to obtain an advanced practice degree looking through the state regulations and how they differ was interesting. I live in rural NW, Missouri, about thirty minutes from the Iowa state line. As an RN, the nurse licensure compact allows nurses to practice in multiple states that all states surrounding Missouri are a part of (Nurse Licensure Compact, 2020). Unfortunately, after obtaining my PMHNP, the regulations differ quite a bit between Missouri and Iowa.
Firstly Iowa allows nurse practitioners to practice independently within their degree specialty, which is considered full-scope practice. In Iowa, the APRN may prescribe medications to treat patients with the nurses’ specialty and independently prescribe controlled substances up to level two as long as they hold a current license and are registered with controlled substance acts (Iowa Board of Nursing, 2020). In Missouri, the APRN must have a collaborative practice agreement with a physician to see patients. Also, nurse practice cannot prescribe controlled substances unless directly stated in the collaborative practice agreement. If stated, the APRN must have prescription authority, proof of 300 hours of precepted pharmacological experience, and 1,000 practice hours (Board of Nursing, 2020).
Another regulation that differs between Iowa and Missouri is the authorization signature for a patient to receive a medical marijuana identification card. The stipulations of medical diagnosis for the need for medical marijuana remain similar between states. Still, in Missouri, a nurse practitioner cannot sign the authorization form (Board of Nursing, 2020). Iowa laws allow nurse practitioner physician assistants, MD/DO, and podiatrists to sign the health care practitioner attestation (Iowa Board of Nursing, 2020).
(2020). Retrieved from Iowa Board of Nursing : https://nursing.iowa.gov/
Board of Nursing . (2020). Retrieved from Missouri Division of Professional Registration: https://www.pr.mo.gov/nursing.asp
Nurse Licensure Compact. (2020). Retrieved from NCSBN: https://www.ncsbn.org/nurse-licensure-compact.htm.
Karen Chase, PMHNP student
NURS 6050: Policy and Advocacy for Improving Population Health
Dr. Amber Cook
December 20, 2020
Main question post
Board of Nursing Regulations
Michigan advanced practice registered nurses (APRNs) have been fighting for full prescriptive authority for a long time. Michigan does not have a nursing practice act. Instead, regulations directing APRNs come from the Public Health Code 1978, which also governs 25 other health professions (Nurse Practitioner Schools, 2020). Michigan nurses celebrated a win in 2017 with the signing of MI HB 5400. This bill gives Michigan APRNs authority to prescribe non-scheduled medications, perform hospital rounds, make independent house calls, and order speech and physical therapy without a collaborating physician. They still need a collaborating physician to prescribed controlled substances in schedules two through five. As a delegated act, the controlled prescriptions require both names and DEA registration numbers of the physician and the APRN (Michigan Legislature, 2017). In comparison, Minnesotas APRNs have full prescriptive authority (Minnesota Board of Nursing, n.d.). They can prescribe any medication, controlled or non-controlled, without a collaborating physician. They also have full authority to practice without the oversight of a collaborating physician. They do not require a collaborating practice agreement.
Granting APRNs the legal authority to practice within the full scope of their education and experience will ease the healthcare provider shortage, reduce healthcare costs, increase patient access to care, and allow the APRNs to utilize their knowledge and skills to the full advantage (Nurse Practitioner Schools, 2020). APRNs must keep fighting for their rights as part of the collaborative healthcare team. APRNs need to be active in the political process to ensure continued progress towards this goal (Milstead & Short, 2019).
In Michigan, APRNs can adhere to MI HB 5400 by learning about the specific changes to the regulations. They must renew their collaborating agreement annually or when any changes to the agreement are needed. It is important to know which medications are considered controlled and uncontrolled and to know the schedules. For example, in 2019, Michigan changed gabapentin to a schedule five controlled drug to combat the opioid epidemic (Department of Licensing and Regulatory Affairs, 2019).
Department of Licensing and Regulatory Affairs. (2019, January 9). Gabapentin scheduled as
controlled substance to help with states opioid epidemic. https://michigan.gov/lara/
Michigan Legislature. (2017, April 9). Public Health Code Act 368 of 1978: 333.17211a
Advanced practice registered nurse; authority to prescribe nonscheduled prescription
drug or controlled substance. https://legislature.mi.gov/(S(au34kb10nbx0fbhmhac50qc))/
Milstead, J.A., & Short, N.M. (2019). Health policy and politics: A nurses guide (6th ed.).
Burlington, MA: Jones & Bartlett Learning
Minnesota Board of Nursing. (n.d.). Advanced practice registered nurse (APRN) licensed
Nurse Practitioner Schools. (2020, October 26). Michigan nurse practitioners: The fight for full
practice authority. https://nursepractitionerschools.com/blog/michigan-np-practice-
- Review the Resources and reflect on the web article Big Data Means Big Potential, Challenges for Nurse Execs.
- Reflect on your own experience with complex health information access and management and consider potential challenges and risks you may have experienced or observed.
By Day 3 of Week 5
Post a description of at least one potential benefit of using big data as part of a clinical system and explain why. Then, describe at least one potential challenge or risk of using big data as part of a clinical system and explain why. Propose at least one strategy you have experienced, observed, or researched that may effectively mitigate the challenges or risks of using big data you described. Be specific and provide examples.
RE: Discussion – Week 5
Big Data Risks and Rewards
Data interpretation is happening every moment of the day, whether a person realizes it or not. Having a large pool of data can be extremely useful if it is integrated in a meaningful way. According to Wang et al. (2018), pooling big data can improve the quality and accuracy of clinical decisions. Where I work, and probably at any healthcare facility, profit is always the end game. I see data used by our chief financial officer (CFO), along with our admissions team, when they send out their weekly forecast. This shows how many patients are discharging, how many new patients we are expecting, and our current census. Having the data organized is critical as it shows the admission coordinator if they need to do more outreach to bring in new patients. It also shows them if we have beds available to accommodate the influx of new patients. It directly relates to me as it is used for staffing needs. Having this data is critical to the operation, but it wouldnt be as useful if it hadnt been aggregated into a succinct template to access the information at a glance (Thew, 2016).
However, pooling large amounts of data comes with risk as well. When more data is collected, the organization will more storage as well. Storage comes at a cost, and patient privacy could be jeopardized if those costs are cut (Wang et al., 2018). Our system was recently hacked at the corporate level with ransomware. Having all of our data in a central location turned out to be a poor decision. Our patient and employee data was compromised. It is critical to have proper IT security in place when dealing with large amounts of data.
An interesting idea to mitigate the threat of something like ransomware happening again is to divide data into blocks that are dispersed amongst several virtual servers (Levitin, 2019). This way, the attacker wouldnt have access to the data by hacking into a single database or server. Along with dividing the data, an early warning detection system would also be useful to detect a breach (Levitin, 2019).
Big data aggregation comes with risks and benefits. By mitigating some of the risks by increasing security protocols, data can be collected and stored in a secure way, ensuring patient and user confidentiality.
Levitin, G., Xing, L., & Huang, H.-Z. (2019). Security of Separated Data in Cloud Systems with Competing Attack Detection and Data Theft Processes. Risk Analysis?: An Official Publication of the Society for Risk Analysis, 39(4), 846858. https://doi-org.ezp.waldenulibrary.org/10.1111/ris…
Thew, J. (2016). Big data means big potential, challenges for nurse execs. Retrieved December 27, 2020 from https://www.healthleadersmedia.com/nursing/big-dat…
Wang, Y., Kung, L., & Byrd, T.A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3-13.
RE: Discussion – Week 5
Information professionals, specifically in a hospital setting, look at big data sets for budgeting, staffing, patient admissions and discharges, etc. Data can be computed for all areas that help a hospital run efficiently. According to Tishgart (2012), more data means more knowledge and opportunities for organizations to take that data and benefit from it. (McGonigle & Mastrian, 2018) This is partially true, since the purpose of storing this data is to learn and improve, but anytime you are dealing with technology and large amounts of data, there can be pitfalls as well.
Some benefits of using big data in a clinical system are the improvement of patient outcomes, since big data helps us to see what is working well for our patients, and any areas we are falling short in. If med errors or patient incidents are occurring frequently, big data sets can help see a bigger picture of what is causing these issues, like noticing that these incidents are occurring on days the floor is short staffed. Another benefit of big data is for budgeting, because although we are there to care for patients, it is still a business that needs to make a profit. The big data sets can show where cutbacks need to occur, and what departments need more money to run efficiently.
Anytime technology is involved, errors and setbacks are a possibility. A con of big data sets is the risk of a security breech. My workplace was experienced a cyber attack back in 2016, where patient and employee information were compromised. The hackers requested a ransom in return for the computer system. During this time, we operated under the Emergency Operations Plan, where paper charting was used during this time. Since this happened, the organization upgraded security measures and made changes to email and internet access throughout the change. Inservices were provided to all employees to avoid phishing and ransomware, and how to recognize potential threats. Homomorphic encryption can be used to hinder third parties from accessing data, as well as storing data in several servers to make it more difficult to access sensitive information.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-dat…
Wang, Y., Kung, L., & Byrd, T. A. (2018). Big data analytics: Understand its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3-13.