Respond to what he wrote, be argumentative with the answers, and polite. References, and at least 2 paragraphs.

This discussion investigates the steps, requirements, and instructions related to the certification and licensure process of a Psychiatric-Mental Health Nurse Practitioner in Florida. It will also cover aspects of obtaining a DEA license, prescriptive authority, restrictions on controlled substance prescriptive authority, and the Prescription Drug Monitoring Program – E-FORCSE, a collaborative agreement between doctors and nurses specific to Florida.

The Nurse Practice Act of the Florida State Board of Nursing outlines specific requirements to obtain certification and licensure. One requirement is obtaining a Master's Degree or post-master's degree certification recognized by the Florida Board of Nursing with a graduation date before the application submission. Maintaining an active Florida Registered Nurse license for practice within the state is mandatory. Certification application with the Florida Board of Registered Nursing involves applying via the https://floridasnursing.gov website with supporting documents, such as transcripts, evidence of clinical practice hours, completing a background check, which costs $110, and proof of malpractice insurance (Florida Board of Nursing, n.d.). APRNs can only sit for an examination if a third-party certifying organization has comprehensively checked their academic background and established educational standards. After passing the certification exam, the next step is to submit a license application on the licensing board's website. The Florida Board of Nursing evaluates and verifies the form and certification and sends a confirmation letter after approval (Florida Board of Nursing, n.d.).

The Florida Board of Nursing outlines the scope and limitations of psychiatric nursing practice, prescriptive authority, supervision requirements, and inpatient psychiatric services (Benson, 2021). In Florida, psychiatric mental health nurse practitioners can prescribe psychiatric medications to patients independently as long as they fall within their scope of practice. PMHNPs can prescribe controlled substances II-IV, but only under the supervision of a licensed psychiatrist (Kellams & Maye, 2017, p. 136). Florida law mandates PMHNPs to collaborate with a supervising physician for patient diagnosis and treatment. They cannot serve as treating physicians for patients admitted to inpatient psychiatric facilities but can provide consultations and follow-up care post-discharge. A typical collaboration between physicians and PMHNPs in Florida involves comprehensive treatment plans discussing diagnostic assessments, symptom management strategies, and medication management for complex cases (Stone-Gale, 2023). Florida PMHNPs must stay up-to-date with legislative changes to provide safe and appropriate patient care within their scope of practice.

Since October 2020, the Board of Nursing has initiated registration for autonomous APRN practice applications. To be eligible, individuals had to have acquired at least 3000 hours of practice under physician protocol within the last five years, completed three graduate semester hours, possess an unencumbered license, and have a clean record within the past five years (Benson, 2021). Advanced nursing practice is conducted under Florida Statute §464.0123 (3), allowing the nurse to operate independently without physician supervision or supervisory protocol. Unfortunately, it was approved for APRNs practicing in Family Medicine, General Pediatrics, General Internal Medicine, and Certified Nurse Midwives (Stone-Gale, 2023).

A PMHNP in Florida is authorized to prescribe controlled substances under particular schedules. They can prescribe Schedule II controlled substances, drugs with a high potential for abuse and severe dependency, such as stimulants for ADHD, and some opioids for chronic pain management. Schedule III controlled substances with a moderate to low potential for abuse and dependency, such as testosterone, ketamine, and limited combinations of opioids and non-opioid analgesics. Schedule IV controlled substances have a lower potential for abuse and dependency than II, and III and include some medications for anxiety, sleep disorders, and muscle relaxants. To apply for a DEA license, a nurse must have an active Florida license and pay the registration fee of 731$ for three years (Reynolds et al., 2021).

The E-FORCSE system is a prescription monitoring program that allows Florida healthcare professionals and pharmacists to submit and access information related to controlled substance prescriptions. It provides a database for healthcare professionals to review a patient's controlled substance prescription history, countering abuse and diversion. The system enables healthcare professionals to safeguard patients, manage their care more efficiently, and target those who might need assistance for substance misuse (Perez et al., 2017). State and federal regulations govern access to E-FORCSE to protect patient privacy and confidentiality and only authorized healthcare professionals and pharmacists are granted access to the system. It is crucial to have the appropriate credentials and gain practical experience while working under the supervision of a physician. Current Florida regulations require practitioners to comply with predetermined criteria in their field of competence. Because of this, APRNs often have a limited scope of practice, which gets in the way of their efforts to improve patient care.

In the context of the current Florida regulations, attaining the required credentials and gaining practical experience while working under physician supervision is imperative. These regulations often lead to APRNs encountering limitations within their scope of practice, hindering their efforts to enhance patient care. In this dynamic healthcare landscape, it remains utmost for Florida's Advanced Practice Registered Nurses (APRNs) to enthusiastically embrace the concept of prescriptive autonomy. Recognizing their pivotal role in patient care, APRNs can proactively lead the movement toward legislative changes aimed at achieving full practice authority. By skillfully navigating healthcare policies, they can ensure that their contributions are optimized to improve the well-being of the communities they serve (Unruh et al., 2018).

provide further suggestions on how their database search might be improved. use 2 sources 

The PICO(T) question is, “Among hospitalized patients, does using two identifiers compared to one reduce medical errors?” My clinical issue of interest is the reduction of medical errors. Medical errors are gaps in care that bear potential or actual capacity to harm the patient, such as inaccurate diagnosis and incomplete diagnosis (Aljabari & Kadhim, 2021). These have the ripple effect of inappropriate investigations and treatment, then adverse care outcomes (Aljabari & Kadhim, 2021). Some solutions to medical errors include proper identification of patients, thorough history taking, and comprehensive physical examination. One evidence-based method for patient identification is using two identifiers rather than one (Mroz et al., 2019). Therefore, I am prompted to investigate whether using two identifiers compared to one among hospitalized patients reduces medical errors.

Search results discussion 

Regarding my search results, 19,600 articles appeared on the initial original search. As I added search terms such as two identifiers, one identifier, medical errors, and hospitalized patients using Boolean operators such as AND, NOT, and AND NOT, the number of articles appearing kept reducing. At first, they declined to 18,500, then to 17,200, and so on, in a declining trend.

Strategies to optimize database search on my PICO(T) question 

There are several strategies I can apply to optimize how effective a database search is while searching my PICO(T) question. These include having a specific search question, using Boolean operators, using more specific keywords, and using fewer synonyms (Degbelo & Teka, 2019). An example of a particular question is a PICO(T) question, which narrows down to a particular population, intervention, control, outcome, and timing. A more specific example is my PICO(T) question that reads, “Among hospitalized patients, does the use of two identifiers compared to one identifier reduce medical errors?” Besides, examples of Boolean operators are OR, AND, NOT, and AND NOT (Degbelo & Teka, 2019). Specific keywords, like particular search questions, direct the search further, optimizing it to give the best results. An example of keywords in my case includes “hospitalized patients,” “two identifiers,” “one identifier,” and “reduce medical errors.” Lastly, using fewer synonyms helps fetch more search results, broadening your search outcome and choosing relevant resources (Degbelo & Teka, 2019). Applying such strategies helps to make the search process more effective and thorough.

References

Aljabari, S., & Kadhim, Z. (2021). Common barriers to reporting medical errors. The Scientific World Journal, 2021, 1–8. https://doi.org/10.1155/2021/6494889Links to an external site.

Degbelo, A., & Teka, B. B. (2019). Spatial search strategies for Open Government Data. Proceedings of the 13th Workshop on Geographic Information Retrieval. https://doi.org/10.1145/3371140.3371142Links to an external site.

Mroz, J. E., Borkowski, N., Keiser, N., Kennel, V., Payne, S., & Shuffler, M. (2019). Learning from medical error: Current directions in research and practice on medical error prevention. Academy of Management Proceedings, 2019(1), 18084. https://doi.org/10.5465/ambpp.2019.18084symposiumLinks to an external site.  

 

After studying Module 2: Lecture Materials & Resources, submit the following:

• Starting with the precursor substance tyrosine or tryptophan, draw three diagrams showing how the various enzymes convert this substance to serotonin, dopamine and norepinephrine.

Submission Instructions:

• Your diagrams must be hand-drawn. Scan your diagrams and submit them as an attachment of an image file or PDF. 
• Follow APA 7th Edition formatting guidelines for graphs and figuresLinks to an external site.
• Complete and submit the assignment by 11:59 PM ET on Sunday.
• Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
• You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

See attached report