Apn Rules and Regulations: New Jersey and Pennsylvania

An Advanced Practice Nurses are nurses who has completed graduate level training (masters in nursing or Doctorate in Nursing). They take history, perform physicals, order and interpret diagnostic tests. They treat mental and physical conditions. NPs identify diseases and give treatments, including prescribing medications. They can operate as primary providers and treat patients of different ages, depending on their specialty (pediatrics, adults, geriatric etc). This is a comparison of Pennsylvania and New Jersey rules, regulations and practice environments for advanced practice nurses.

According to the International Council of Nurses, an APN is a “registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which would be determined by the context in which he/she is credentialed to practice” (December 2011). In the United States, the NPs can be nationally certified in areas of practice, but their profession is state regulated, therefore the scope of practice and care provided by NPs varies widely from state to state.

Scope of Practice of Advanced Practice Nurse. Minimum requirements. In Pennsylvania, Registered Professional Nurse may become certified in area of specialty as Certified Registered Nurse Practitioner after completing masters or post-masters nurse practitioner program approved by Pennsylvania Board as similar to that certification. The nurse must have a current certification in the area of expertise and have professional liability insurance.

A nurse licensed as a nurse practitioner by another states or country can apply for certification by endorsement in PA, but is required to hold a certification in the specialty area in which the nurse is looking to certify in PA State. Certified Registered Nurse Practitioner (CRNP) is a professional licensed in the state of Pennsylvania, certified by the Board in area of specialty and holds a current national certification. Nurse may not practice if the nursing license is inactive, lapsed, expired, revoked or suspended.

(The Pennsylvania Code, 2012). New Jersey holds similar requirements within its nursing regulations. APN has to graduate from accredited program and successfully complete examination from a national agency , has to have an RN license and obtain a certification as an Advanced Practice Nurse. The requirements are similar: a master’s degree in nursing or certification program offered as post masters study with focus on an advanced practice and particular specialty. The education has to be completed within two years prior to recording of application.

It has to include minimum of 39 hours related to pharmacology with 6 of them connected to controlled medications and addiction prevention. (New jersey Administrative Code Title 13). What is needed to maintain the license? According to Pennsylvania Code 21, CRNP’s certification and prescriptive authority approval expires along with registered nurse license on biennial basis. The CRNP is required to: pay the required renewal fee, maintain a nursing license and have at least 30 hours of approved ongoing education within the 2 years before renewal date.

An hour of continuing education is 50 minutes and it is provided by nursing, medical and pharmaceutical organizations. CRPNs may receive a continuing education credit for correspondence and independent courses, up to 4 hrs for teaching, precepting, and lecturing, and for publishing work in a professional journal. It is noted that the Board can disregard the required continuing education in case of sickness or adversity, but the request for the waiver has to be provided within 90 days before the end of the licensing cycle.

Inactive status CRPNs do not have to obtain continuing education hours during the period of inactive status. In order to renew prescriptive authority, CRNP has to complete no less than 16 and up to 30 hours of continuing education in pharmacology (within each 2 year cycle). New Jersey law also requires biennial certificate renewal which coincides with registered professional nurse licensure renewal, but inactive status requires meeting biennial continuing education at the time of reinstatement. Prescriptive Authority.

CRPN may prescribe and dispense drugs in Pennsylvania if he/she completed 45 hours of advanced pharmacology course work within their training, and completes at least 16 hrs of continuing education related to pharmacology in each 2 year period. CRPN also has to observe standards set by the Medical State Board in relation to controlled medications and the PA Department of Health. CRNP is required to maintain DEA registration number.

A CRNP can prescribe and dispense drugs within the practice area, but cannot prescribe under any circumstances medication such as gold compound, radioactive or oxytocic agents. CRNP can prescribe Schedule II controlled substances (up to 3 day supply) and has to notify collaborating physician with 24 hrs of such decision. CRNP can prescribe Schedule III or IV medications for up to 30 day supply.

CRNP cannot in state of Pennsylvania, write prescription for a Schedule I controlled medications and drugs which are not accepted by the Food and Drug Administration in the US. CRNP may write prescription orders on prescription blanks, or give them verbally.

Collaborative agreement, signed between a CRNP and a cooperating physician contains agreement to the particulars of the care of the CRNP patients and includes prescribing drugs.

New Jersey also addresses medication administration, but not is such details as Pennsylvania law. It allows advance practice nurse to prescribe, dispense and order medications and ”devices” in agreement with protocols developed between advance practice nurse and collaborating physician and standards of practice. The APN can only use New Jersey prescription blanks and is required to write medication quantity in words in case of controlled dangerous substances.

APN is required to obtain and maintain both, a federal DEA number and a state-controlled dangerous substance number. APN is required to complete once in a lifetime, a 6-hour course on controlled substances and their prescribing. (Legislative Update, 2012).

Practice and Collaboration agreement According to the Pennsylvania Code, CRPN may work in partnership only with a physician who is currently holding a license to practice in this state. CRPN can practice as a team with a physician as it is agreed in a written agreement, in the limits of CRNPs license.

In Pennsylvania a CRNP can: carry out broad patient assessments , including disability assessments, determine medical diagnosis, order, perform, supervise and interpret diagnostic tests ( within the CRNP specialty and collaborative agreement),order referrals and consultations, develop therapeutic plans of care, perform admissions and discharges, order blood products, dietary, home health, physical therapy and hospice care, give verbal instructions if allowed by health care facilities regulations, carry out the methadone treatment (methadone treatment order must be made by the physician).

Pennsylvania defined collaboration agreement must include all the parties (CRNP, collaborating physician and alternate physician who will grant cooperation for up to 30 days, if the collaborating physician is not accessible). It categorizes practice boundaries, states types of drugs which CRNP can order, and states frequency with which the collaborating physician is required to see the patients with (depending on type and condition of the patient, ongoing or new treatment plans). The collaboration agreement has to be kept “at the primary practice location of the CRPN”.

A copy of the agreement has to be reported to the Bureau of Professional and Occupational Affairs. It has to detail the sum of the liability insurance carried by CRNP and be available for examination at any time and be updated when there are changed made to collaboration agreement. New Jersey law also specifies what “joint protocol” should include: written agreement between nurse and physician addressing practice, recordkeeping, medication prescribing, methods of communication, conditions requiring consultation, periodic review of charts and accessibility of other physician in case of necessary coverage.

New Jersey requires annual review of contract; it does not however clearly define time period for alternative physician collaboration. Palliative care The APN is a key participant in healthcare team to deliver a quality, evidence-based palliative interventions to patients who are living with advanced illnesses. They are legible for federal, state and third party reimbursement as long as they are ANCC-certified in specialty area, regardless of setting (rural, underserved, urban, etc). Pennsylvania as well as New Jersey widely uses APNs within palliative and life limiting illness care. Hospital privileges.

Hospital privileges describe the process of credentialing. During this process an assembled group of physicians will assess education, training and experience of Advanced Practice Nurse and make decision whether to allow privileges and the extend of privileges granted. Pennsylvania Department of Health authorizes hospitals to define the level of clinical privileges, but it allows Advance Practice Nurses to admit and discharge patients from hospitals. New Jersey Nurse Practitioners are also legally allowed to admit patients and obtain hospital privileges, but the authorization is not within the legal statue (The Nurse Practitioner, 2012).

Privileges are given through process within each healthcare organization and do not include discharge permission. At present, there are attempts to change the language to “ensure that all practitioners are granted clinical privileges…including voting rights and full due process”( NJSNA, 2011) and allow the hospitals to use APNs to their full capability. Summary As noted, Pennsylvania and New Jersey laws address and regulate advance nurses’ practice within their state limits and, with some differences, assure that practitioners provide care in the parameters and safety requirements.

Many states continue to change and modify their Advance Practice Nurse regulations and the practitioners must maintain their vigilance and awareness of changing laws in order to comply with regulations and provide high standards of care. References American Psychological Association. (2011). Publication manual of the American Psychological Association (6ed. ). Washington, DC: American Psychological Association Donohue, M. A. T. & Barnett, P. A. (2011) Letter to honorable Marilyn B. Tavenner, Acting Admininstrator Centers for Medicare & Medicaid Services. Department of Health and Human Services.

New Jersey State Nurses Association. Submitted electronically to htt://www. regulations. gov. International Council of Nurses (2011). Nursing matters: Credentialing. Retrieved from: http://www. icn. ch/images/stories/documents/publications/fact_sheets/1a_FS-Credentialing. pdf Joel, L. A. (2009). Advanced practice nursing (2nd ed. ). Philadelphia, PA: F. A. Davis Company New Jersey Administrative Code Title 13 Law and Public Safety Chapter 37: New Jersey Board of Nursing. 2012. New Jersey State Nurses Association (2000). Suggested template. Joint protocols for advanced nurse and collaborating physicians.

Retrieved from : http://www. njsna. org/displaycommon. cfm? an=1&subarticlenbr=33 Pennsylvania State Board of Nursing Licensure Information. Retrieved from: http://www. pacode. com/secure/data/049/chapter21/s21. 282a. html The Pennsylvania Code. Subchapter C. Certified Registered Nurse Practitioners. Retrieved from: http://www. pacode. com/secure/data/049/chapter18/subchapCtoc. html Phillips, S. J. (2012). 24th annual legislative update. The Nurse Practitioner, 37 (1), 23-45. The Pearson Report. (2008). The Amercian Journal for Nurse Practitioners, 12(2), 4-61.

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