Week 3 Nurse Practice Act Post and Response
Nurse practitioners (NPs) in the state of Tennessee have restricted practice, which means that they must have supervision by an overseeing physician and are unable to practice independently (AANP, 2022). Nurse practitioners may see patients independently and even open their own practice; however, a physician must review at least 20% of the medical charts and visit the practice site of the NP every 30 days (Tennessee Board of Medical Examiners, 2016).
The Tennessee State Board of Nursing acts as the regulating body for NPs and defines the role and scope of practice for NPs across the state (Tennessee Board of Nursing, 2019). Nurse practitioners have authority to prescribe medications for patients and are expected to obtain a proper medical history, perform a physical examination, and implement a treatment plan for each patient they are prescribing for, which should be documented in the patient\’s medical record (Tennessee Board of Nursing, 2019).
Tennessee nurse practitioners are not limited on the type of medication they can prescribe; however, any controlled substance prescription must be supervised and reviewed by the overseeing physician (Tennessee State Board of Nursing, 2019). In order for Tennessee nurse practitioners to be able to prescribe a controlled substance, they must have a Drug Enforcement Administration (DEA) number, which help to track the amount of high risk controlled substances that are being prescribed (American Medical Association, 2017).
Tennessee representative, Bob Ramsey, and recently introduced the HB0184 bill that would allow for nurse practitioners to have full practice authority within their scope (Tennessee General Assembly, n.d.). This bill would not alter the scope of practice of the nurse practitioner, but instead allow nurse practitioners to prescribe medications and order non-pharmacological therapies without supervision from a physician (Tennessee General Assembly, n.d.).
This bill would greatly improve access to healthcare across the state, especially in rural areas, and nurse practitioners would also gain more confidence knowing their competency and skills are being valued. Rural populations across the United States have experienced reduced access to healthcare for decades, and nurse practitioners help improve access by utilizing their training and knowledge to provide care to under-served populations (Ortiz et al., 2018). While this bill is still awaiting approval, I am hopeful that nurse practitioners in Tennessee will one day gain full practice authority to further improve the well-being of patients within the community.
I am intrigued by the discussions posted by my classmates on the Nurse Practice Act for Tennessee for Advanced Practice Registered Nurses (APRNs). I learned that APRNs should work under the laws and supervision of physicians from Aundrea’s discussion. I also learned that the Tennessee General Assembly/ legislature proposes the statutes and formulates them into law for the APRNs.
Upon hearings, the Board of Nursing of Tennessee adopts the laws to regulate the scope of practice of APRNs. I liked that Aundrea featured the aspect of prescriptive authority of APRNs. I support Aundrea’s argument that ARPNs should have the autonomy to obtain proper medical history, conduct comprehensive physical examinations, and implement treatment plans from Kasey’s discussion post.
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For that reason, I am motivated to learn, increase my skills and expertise and fulfill the Board of Nursing requirements of becoming an APRN as a junior nurse. I also liked that Kasey discussed the HB0184 bill to grant APRNs full authority within their scope of practice. I agree that the mentioned bill and the Consensus Model will be vital towards improving the quality of care and access to health care services, especially in rural areas.
Notably, immense conflicts exist concerning whether APRNs can prescribe drugs and what classes of drugs they are allowed to administer. The Tennessee Drug Control Act of 1989 allows APRNs to order, prescribe and administer schedules II, III, IV, and V controlled substances. However, important factor such as the number of pharmacology units taken during the studies towards becoming advance practitioner should be considered before granting full prescriptive capacity.
The Consensus Model plays crucial role to define the scope of practice of APRNs to decrease the limitations and give nurse practitioners the total capacity to exercise their knowledge and expertise towards quality care. The population’s health care needs continue to become more complex as society evolves (Sánchez-Gómez et al., 2019). Environmental changes and aging populations increase chronic conditions and disability rates.
Therefore, increasing the scope of practice of APRNs fulfils the increasing health care demands. A high level of professional autonomy, research, assessment skills, diagnostic reasoning, and improved decision-making among APRNs will promote care quality across the health care system.
Sánchez-Gómez, M. B., Ramos-Santana, S., Gómez-Salgado, J., Sánchez-Nicolás, F., Moreno-Garriga, C., & Duarte-Clíments, G. (2019). Benefits of advanced practice nursing for its expansion in the Spanish context. International journal of environmental research and public health, 16(5), 680.
Tennessee HBI84 (n.d ). Tennessee Drug Control Act of 1989. Retrieved from https://trackbill.com/bill/tennessee-house-bill-184-nurses-nursing-as-introduced-makes-various-changes-to-the-licensing-of-and-prescribing-authority-for-advanced-practice-registered-nurses-amends-tca-title-4-title-33-title-49-title-53-title-55-title-56-title-63-title-68-and-title-71/1979465/
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