Analysis of APN Practice Regulations in Delaware and New Jersey

Analysis of APN Practice Regulations (Delaware and New Jersey)
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Analysis of APN Practice Regulations (Delaware and New Jersey)
Introduction
APN or APRN mainly entails nurses who have attained advanced levels of skills, training, and certification. These nurses have years of experience in their profession and also happen to have acquired a master’s degree in nursing. There are four types of APRNs, including certified nurse midwives, clinical nurse specialists, nurse practitioners, and certified registered nurse anesthetists (Campaign for Action, 2019). APRNs are a crucial piece of the healthcare sector and perform different roles that help to enhance patient outcomes. ANA (2022) notes that APRNs offer primary care to patients, help manage chronic diseases, and offer healthcare education to patients. In some states, APRNs have the authority to diagnose, treat, and offer prescriptions to patients. Their role in the healthcare sector is critical and greatly impacts the quality of care offered (Woo, Lee, & Tam, 2017). Further, the researchers add that patient satisfaction levels are higher, and healthcare costs are reduced for both patients and healthcare organizations. Htay and Whitehead (2021) echo similar sentiments and further add that APRNs also reduce admission and readmission rates in healthcare organizations. However, like every other profession, there ought to be rules and regulations governing APRNs’ conduct and service provision. So, provided in this paper is an in-depth analysis of Delaware’s APN or APRN’s practice regulations in contrast with New Jersey’s APN or APRN’s practice regulations. Some of the issues that will be addressed include board certifications and renewal, collaborative agreements, prescriptive authority, restrictions for APRNs, hospital privileges, nursing compact, and palliative end-of-life.
Background Information
Concerning nursing and APRNs, Delaware makes a case for one of the most progressive states in the U.S. First, Delaware was already a member of the original Nurse Licensure Compact before it transitioned to the enhanced Nurse Licensure Compact or the eNLC (Fink, 2018). Secondly, Delaware already signed and became a part of the APRN Compact as of the 4th of August 2021 (NCSBN, 2021). From these two statements above, Delaware appears to seemingly be quite progressive and with a commitment to helping enhance the state’s and nation’s public health. Further, Delaware also granted APRNs full practice authority to prescribe medication and establish treatment plans for patients, which is also a testament to the state’s progressive nature. On the other hand, New Jersey has been slow to react to the changes that have been happening. It took more than 20 years for New Jersey to join the NLC. According to NCSBN (2021), New Jersey joined the NLC in November 2021. Considering the bureaucracy and slow progress it took for New Jersey to join NLC, the chances are high that the state will take a bit of time before joining the APRN Compact. Therefore, APRNs in New Jersey will be forced to move to other APRN Compact states for them to acquire an APRN multistate licence.
Regarding nursing rules and regulations in Delaware, the Delaware Board of Nursing is mandated to adopt policies and oversee all nurses in the state by the Delaware Nurse Practice Act (DNPA). As indicated by Huynh and Haddad (2022), the Nurse Practice Act is territorial, which means that every state has its own NPA. From the NPA, the Boards of Nursing harness the power to institute and regulate the practice. In Delaware, the Board of Nursing is responsible for developing and adopting rules and regulations, developing professional standards, and adjudicating complaints against healthcare professionals in the state (Delaware.gov, 2022). The Board of Nursing in Delaware is also responsible for nursing licensure in the state. Delaware.gov (2022) states that the Board of Nursing is mandated to license all advanced practice registered nurses, registered nurses, and practical nurses. The General Assembly of Delaware saw it fit to mandate the Board of Nursing as the state’s sole regulator of the nursing profession. Aside from the above, the Board of Nursing also has the authority to issue licenses to APRNs from outside the state or even outside the country (Justia, 2022). However, this is subject to meeting the board’s requirements and qualifications (Justia, 2022). From the above, Delaware’s commitment to ensuring efficiency and enhancement of care quality is indeed evident.
Like Delaware, New Jersey’s rules and regulations governing APRNs and other nurses in the state are enforced by the New Jersey Board of Nursing. The New Jersey Board of Nursing oversees all nurses within the state. The responsibilities of the board are similar to Delaware’s board and include developing the rules and regulations for nurses, regulating licensure of nurses, and accrediting nursing education schools and programs. According to the New Jersey Division of Consumer Affairs (2022), the New Jersey Board of Nursing is also responsible for investigating and prosecuting nurses in the state. Further, subject to confirmation by the Board, an APRN from outside New Jersey could be certified and allowed to work in the state if they meet the board’s requirements (New Jersey Division of Consumer Affairs, 2022).
Board Certifications and Renewal
Board certifications and renewal in Delaware and New Jersey happen to share a lot of similarities. According to Delaware.gov (2022), to apply for the APRN certification, one must be a licensed registered nurse in Delaware or in one of the 37 states within the licensure compact. Secondly, one must have the right education to back up their application process. An applicant needs to have a master’s degree to be considered for APRN licensure. Further, one must have a nursing certification from a recognized agency. Delaware.gov (2022) further indicates that one must be experienced in the field of nursing and either showcase proof of having completed 600 hours in two years or 1500 hours in the last five years in a particular program. Attaining these requirements guarantees an applicant certification as an APRN in Delaware. Regarding renewals, APRNs are expected to showcase proof of practice for the past two or five years. For the former, an APRN should have clocked more than 600 hours of practice; for the latter, it ought to be 1500 hours (Delaware.gov, 2022). The last requirement is having graduated from a specialty program in the last two years of their practice. In New Jersey, the procedure is almost the same. To be certified as an APRN in New Jersey, one must have the right education, which means a master’s degree and a graduate-level course in Pharmacology. There is also the requirement to have a registered nurse license and certification in an APRN clinical specialty area. It is crucial to note that the nursing practice license here could be from another state. The renewal process is also quite similar to Delaware’s. An applicant is expected to pay a renewal fee and provide workforce data (NJConsumerAffairs, 2022). Further, one is expected to wait for about a fortnight before their license is processed.
Collaborative Agreements
Collaborative agreements are agreements that help to define the collaborative practice of physicians and APRNs. In Delaware, it is not a necessity for APRNs to have a collaborative agreement because the state has already approved full practice authority for APRNs (Quinn, 2021). After the signing of HB 141, APRNs in Delaware were given full authority to practice to the extent of their training and education. This authority negated the idea of collaborative agreements in the state. However, the above is subject to confirmation that an APRN has practiced for more than two years or managed to work for more than 4,000 hours in their career (Division of Professional Regulation, 2020). In New Jersey, it is a requirement for APRNs to have collaborative agreements because the state is yet to approve full practice authority for APRNs. For example, an APRN does not have prescriptive privileges in New Jersey regardless of their experience in the nursing profession. Therefore, an APRN in New Jersey cannot execute their duties independent of a physician who is licensed in the state of New Jersey (New Jersey Division of Consumer Affairs, 2022).
Prescriptive authority
Prescribing is critical in nursing and requires the attention of care providers and regulating authorities. For APRNs to offer the best service to their clients, they need to be aware of their state’s regulations about prescribing authority. At the same time, APRNs should possess the necessary licenses to prescribe medications. Prescribing authorities in Delaware and New Jersey differ significantly. States are making considerable amendments to the current laws that control the scope of the practice for APNs. The amendments entail the regulation of privileges of independent prescribing for a variety of medical products. The amendments are critical in bringing uniformity within the state regulation of the practice of APNs.
On the one hand, Delaware has joined a list of states giving direct access to APRNs. This is courtesy of two bills that Gov. John Carney signed into Law on 4th August 2021. The first one, HB 141, allows N.P.s and APRNs to practice to the full extent of their training (Campaign for Action, 2021). The Law removes a requirement for them to have an oversight contract with a physician. However, employers and healthcare organizations are free to require it. The Law offers exclusive licensure authority to the Board of Nursing, removing unnecessary barriers. The APRNs with prescriptive authority must complete 10 hours in advanced pharmacology and pharmacotherapeutics. At least three hours of the training must entail substance abuse and more than two hours of controlled substance prescribing practices. The second Law, H.B. 21, includes the state to the APRN interstate licensing compact. This allows multistate licensure once all the seven member states enact the legislation. The APRN compact licensure will facilitate cross-border practice.
On the other hand, APNR in New Jersey has limited prescribing authority. APRNs must have a joint protocol with a collaborating physician licensed in the state, before prescribing any medication or device. In other words, the prescription authority in New Jersey applies when they are collaborating with physicians. The implication is that an N.P. working with a physician can prescribe most drugs to ...