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.

tep 1 Read the case scenario.
You are part of an interprofessional team working on an evidence-based project to look at falls in patients with dementia in the long-term care setting. The team was brought together in response to a noted increase in the incidence of falls in residents with dementia over the past three months. One of the recent changes before the increase in falls was a mandate to no longer use physical restraints on residents. Several staff members feel that the use of restraints is a must, and they do not have time to use the restraint alternatives that have been suggested. They also feel they do not have enough time to continuously check on residents. This has caused major issues of concern and has compromised the quality and safety of the residents.

When the team meets together, one of the first items discussed is the clinical question. The team uses the PICO question format to develop the following question:

In patients with a diagnosis of dementia in the long-term care setting (P), how does the use of a comprehensive falls assessment prevention plan that includes restraint alternatives (I) compare with the use of a fall prevention protocol that includes the use of restraints (C) affect the number of falls that occur (O)?

Step 2 Post to the discussion forum.
In your initial response, address the following questions:

1. Determine the best resources to use when conducting a search on the topic. Consider these questions: What databases would be most appropriate? Where would you locate clinical practice guidelines that could be used in the EBP process for this issue?
2. Conduct a search using the resources you identified in Step 2a. What key search terms did you use? What filters did you use?
3. From your search, identify at least three articles that you would consider using in an EBP project such as the one described in the case scenario. If possible, suggest resources that meet the highest level (Level I) of evidence. Why would these sources be most appropriate in determining best practices and supporting clinical decision-making for this issue?

Case Study 3 & 4 (10 Points) 

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy-paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.