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

 

 

In the last decade, there have been a lot of changes to the model of practice of advanced practice registered nurses (APRNs) in Northern America. During the pandemic, legislative changes enabled nurse practitioners (NPs) in some states to act in the role of medical doctors, thereby empowering them to work to their full scope of practice. This has resulted in a higher quality of care, decreased hospitalization rates, improved access to care, and the creation of an improved working environment for direct care providers (McGilton et al., 2023). For the purpose of this discussion post, the practice agreements, process of certification and licensure as an APRN in North Carolina, the scope of practice of nurse practitioners, how to get Drug Enforcement Administration (DEA) license, and controlled substance prescriptive authority for NPs will be summarized. Also, the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in North Carolina will be explained.

Summary of Findings

Certain criteria need to be met before an individual can be licensed as an Advanced Practice Registered Nurse (APRN) in the state of North Carolina. A lot of information on certification and licensure can be found on 
www.ncbon.com
Links to an external site.
, which is the North Carolina Board of Nursing (NCBON) website. One must hold a North Carolina Registered Nurse license or a compact state license that is valid to practice in North Carolina. A master’s or higher degree in nursing must be completed. Additionally, a national certification as a nurse practitioner must be obtained from one of the nationally accredited credentialling bodies, and a registration with the North Carolina Controlled Substance Reporting System (CSRS) is required for those that have prescriptive authority for controlled substances. The North Carolina CSRS exists through the North Carolina Department of Health and Human Services to collect information on dispensed controlled substance prescriptions and make this information available to prescribers and dispensers (North Carolina Department of Health and Human Services, n.d.).

The scope of practice of an APRN in North Carolina required being educationally prepared, nationally certified, and maintenance of competence. The APRN is required to promote and maintain health; prevent illness and disability; diagnose, treat, and manage acute and chronic illnesses; guide and counsel individuals and their families; prescribe, administer, and dispense therapeutic measures, tests, procedures, and drugs; plan for situations beyond the nurse practitioner's scope of practice and expertise by consulting with and referring to other health care providers as appropriate; and evaluate health outcomes (Office of Administrative Hearing, 2019). According to the North Carolina Board of Nursing (2022), nurse practitioners have the approval to prescribe legend drugs and Controlled Substance Schedules II – V, which is consistent with the scope of practice determined by their educational preparation and national certification. Professionals who prescribe controlled substances must fully comply with both North Carolina’s state and federal rules and regulations. A nurse practitioner who administers, dispenses, or prescribes any controlled substance, must be registered with the federal Drug Enforcement Administration (DEA). In North Carolina, this process requires applying for DEA registration, paying the required fees, completing, and submitting DEA for 106.

In North Carolina, an APRN requires a collaborative practice agreement with a licensed physician. Therefore, upon completing an advanced degree and obtaining licensure, an APRN needs to apply for an ‘Initial Approval to Practice’. What this application entails is an active North Carolina Registered Nurse license; the physician’s name, their license number, or email address; and the practice information. After all these have been submitted and approved, the APRN can begin practicing in North Carolina (North Carolina Board of Nursing, n.d.).

Types of Regulations that Exist and the Barriers that May Impact Nurse Practitioner Independent Practice

From the research findings, there are regulations, and some barriers exist that may impact nurse practitioner independent practice in North Carolina. For instance, the scope of practice laws defines the activities and responsibilities that healthcare professionals are allowed to engage in. In North Carolina, there is a need for physician oversight, and there is a need for physician collaboration. Also, we are required to have collaborative practice agreements with physicians. Collaborative Practice Agreement (CPA) is an agreement between the nurse practitioner (NP) and the primary supervising physician addressing how the NP operates the administrative code or rules in their practice (North Carolina Board of Nursing, 2023). These agreements outline the relationship and level of collaboration between the nurse practitioner and the physician. Components that are included in the collaborative practice agreement are the drugs, devices, medical treatments, tests, and procedures that may be prescribed, ordered, and performed by the nurse practitioner. Additionally, prescriptive authority is part of the nurse practitioner approval to practice. A nurse practitioner may prescribe controlled substances; however, the supervising physician must have a DEA registration equal to or greater than the DEA registration of the nurse practitioner that he or she supervises. Finally, regulatory bodies exist to set regulations for APRNs. These boards can influence the level of autonomy nurse practitioners have in their practice in North Carolina.

Some of these regulations pose a major barrier that may impact the nurse practitioner’s ability to practice independently. To begin with, the scope of practice restrictions can be very challenging because it limits the ability to provide care independently. Also, due to the collaborative practice agreements that are needed from a physician, we experience a lot of opposition from physician associations and groups. They cite that they have concerns about patient safety and the need for the role of physicians in the health care team. To add to these barriers, there are challenges as to how the public perceives the role and capabilities of nurse practitioners. Patient and public understanding of the role and capabilities of nurse practitioners can influence the acceptance of independent practice. Educating the public about the training and expertise of nurse practitioners is very crucial for acceptance. Nurse practitioners may also face challenges in being recognized by insurance providers and receiving reimbursement for their services at the same rate as physicians. According to Barnes et al. (2017), in a lot of states, nurse practitioners are reimbursed less than the physician rate, varying from 75% to 100% of physician rates. A lot of legislative processes are ongoing to have nurse practitioners receive 100% reimbursement from Medicare. Currently, reimbursement is only provided at about 85% of the physician rate in most states (Bischof & Greenberg, 2021).

All this information did not come as a surprise to me because during this program, we have been required to carry out research findings on related issues. This has enlightened me to the state regulations for the scope of practice of nurse practitioners in my state. I have educated myself on these requirements and learned a lot from my preceptors and senior colleagues in the field of psychiatric mental health. I believe that I am well prepared for all these upon completion of my degree.

Conclusion

The United States is experiencing shortages of primary care providers, and NPs offer the potential to moderate these shortages (Barnes et al., 2017). As advanced practice registered nurses, it is important to stay updated with the latest regulations and developments in our individual states regarding nurse practitioner practice. It is therefore advisable to consult the state Board of Nursing and other relevant authorities for the most current and accurate information for legal practice.

References

Barnes, H., Maier, C. B., Sarik, D. A., Germack, H. D., Aiken, L. H., & McHugh, M. D. (2017). Effects of regulation and payment policies on nurse practitioners’ clinical practices. Medical Care Research and Review, 74(4), 431–451. 
https://doi.org/10.1177/1077558716649109
Links to an external site.

Bischof, A., & Greenberg, S. A. (2021). Post COVID-19 reimbursement parity for nurse practitioners. Online Journal of Issues in Nursing, 26(2). 
https://doi.org/10.3912/ojin.vol26no02man03
Links to an external site.

McGilton, K. S., Haslam-Larmer, L., Wills, A., Krassikova, A., Babineau, J., Robert, B., Heer, C., McAiney, C., Dobell, G., Bethell, J., Kay, K., Keatings, M., Kaasalainen, S., Feldman, S., Sidani, S., & Martin-Misener, R. (2023). Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatrics, 23(1). 
https://doi.org/10.1186/s12877-023-03798-1
Links to an external site.

the North Carolina Board of Nursing. (2022). Prescribing. Retrieved August 29, 2023, from https://www.ncbon.com/practice-nurse-practitioner-prescribing#:~:text=Nurse%20Practitioner%20approval%20includes%20prescriptive,educational%20preparation%20and%20national%20certification.

North Carolina Board of Nursing. (2023). Collaborative practice guidelines. Retrieved August 29, 2023 from https://www.ncbon.com/practice-nurse-practitioner-collaborative-practice-guidelines#:~:text=Required%20components%20of%20the%20CPA,performed%20by%20the%20nurse%20practitioner.

North Carolina Board of Nursing. (n.d.). Advanced practice registered nurse. Retrieved August 27, 2023, from 
Advanced Practice Registered Nurse | North Carolina Board of Nursing (ncbon.com)
Links to an external site.

North Carolina Department of Health and Human Services. (n.d.). NC Controlled Substances Reporting System. Retrieved August 29, 2023, from https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-use-services/north-carolina-drug-control-unit/nc-controlled-substances-reporting-system

Office of Administrative Hearing. (2019). Scope of practice. Retrieved August 27, 2023, from 
http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0802.html
Links to an external site.

 

. Analyze the subjective portion of the note. List additional information that should be included in the documentation.Analyze the objective portion of the note. List additional information that should be included in the documentation.Is the assessment supported by the subjective and objective information? Why or why not. Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

 Primary Task Response: Within the Discussion Board area, write 250–300 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

Library Research Assignment

Discuss the following points regarding the evolution of total quality management concepts:

• Prior to the advent of the total quality management concept, what was senior management’s typical approach toward quality?
  • In your discussion, provide an example showing management’s typical approach toward quality.
• What has led to the more comprehensive strategic view of total quality management?
• What are the benefits of a more comprehensive strategic view? Please support your discussion with an example.

Discussion 1

Every day, people make choices that affect their physical health and wellness. Some choices are influenced by the environment and social factors, which in turn contribute to people’s health outcomes. Healthcare professionals (i.e., physicians, nurses, dietitians, sports medicine, etc.) are responsible for their own health by making decisions and practicing behaviors that enhance their wellbeing. Healthcare professionals also have a responsibility to their clients. While responsibilities may vary among healthcare professionals, it is important the healthcare team is alert to clients’ nutrition problems and needs.

After studying 

Module 1: Lecture Materials & Resources
, answer the following:

1. In one paragraph, give at least 2 examples of how culture, society, politics, or religion influences your nutrition. Discuss the role that food plays in your family or personal life.

2. Navigate to 
Your Digestive System and How it Works: 

https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-worksLinks to an external site.
 View the webpage and share in 1 paragraph at least 1 example of something your learned about the digestive system.

3. Search the internet for 1 example of an over-the-counter medication designed to treat common digestive problems such as heartburn, constipation, diarrhea, and hemorrhoids. Write 1 paragraph describing a) appropriate and inappropriate uses for this medication, and b) adverse health implications associated with misuse and/or overuse of this product.

Discussion 2

Carbohydrates have received a bad reputation, especially when it comes to their role in weight gain. All carbohydrates are not bad and the primary role of carbohydrates in the body is to supply the cells with glucose for energy. One type of carbohydrate is sugar. Some people are unaware that instead of avoiding all sugars, they can choose to include natural sugars found in vegetables, whole grains, legumes, and fruit. On the other hand, most people know that too much fat poses health risks, but may be surprised to learn that too little does, too.

After studying 

Module 2: Lecture Materials & Resources
, answer the following:

1. Navigate to My Plate: 

https://www.myplate.gov/Links to an external site.
 and to the Diabetes Plate: 

What is the Diabetes Plate Method?Links to an external site.
 (diabetesfoodhub.org) then, submit at least 1 paragraph comparing both for

A. similarities

B. differences

C. share who should follow MyPlate and who should follow the Diabetes Plate method?

2. Navigate to the American Heart Association: 

http://www.heart.org/HEARTORG/Links to an external site.
 and to the National Cancer Institute: 

http://www.cancer.govLinks to an external site.
, submit a 1 paragraph analysis on the relationships between dietary fats and the risk of heart disease, cancer, or type 2 diabetes (choose one).

3. Choose a food label from your favorite snack, and take a picture of the Nutrition Facts on the food label. Navigate to the U.S. Food & Drug Administration, “Interactive Nutrition Facts Label: 

https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/#introLinks to an external site.
 Choose one ingredient from your label. Share with the class one (1) health fact and (1) action step you learned about that ingredient in the interactive site.

4. Explain the differences between high-quality and low-quality proteins, and well-balanced vegetarian diets.

Discussion 3

The body manages its energy supply with amazing precision. Consider that many people maintain their weight within about a 10- to 20-pound range throughout their lives. How do they do this? How does the body manage excess energy? How do bones, muscle, fat, fluid, and other tissue influence our body composition? However, overweight, and underweight both result in energy imbalance. Almost 42% of adults aged 20 and above are overweight placing them at risk of developing chronic diseases that affect quality of life.

After studying 

Module 3: Lecture Materials & Resources
, answer the following:

1. Conduct a nutrition/survey interview with 2 athletes and ask them a) what protein or amino acid supplements they use in their diet? and b) why do they use those supplements? Then, navigate to: 

www.quackwatch.orgLinks to an external site.
 and enter the name of the supplement. Provide 1 paragraph with your analysis of the products and what you found out about the products’ nutritional characteristics (see Chapter 5, page 132 of your textbook).

2. Search the internet for a popular weight-loss program (i.e., Jenny Craig, Weight Watchers, etc.), and submit 1 paragraph with the following:

A. describe the diet plan

B. evaluate whether the plan offers a nutritionally reliable way to lose weight or is it a Fad Diet (see Chapter 7, Table NP7-1, page 193 of your textbook)

3. In 1 paragraph, describe type 1 diabetes, type 2 diabetes, and gestational diabetes by providing:

A. characteristics

B. definition

C. causes & symptoms (see Chapter 20, Table 20.2, page 564 of your textbook).