Reply separately to two of your peer’s posts (See attached peer’s posts, post#1 and post#2). 

I am also attaching “MY INITIAL POST”.

INSTRUCTIONS:

Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource!!

Note: DO NOT CRITIQUE THEIR POSTS, DO NOT AGREE OR DISAGREE, just add new informative content regarding to their topic that is validated via citations. 

  • Your reply posts should compare and contrast your state of Florida compared to another state you are reviewing.

Utilize at least two scholarly references per peer post. 

Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the second one is the reply to my other peer Post #2.

– Minimum of 300 words per peer reply.

Background: I live in South Florida, I am currently enrolled in the Psych Mental Health Practitioner Program, I am a Registered Nurse, I work in a Psychiatric Hospital.

POST # 1 GINA

The purpose of this discussion is to research my state of Rhode Island’s current scope of practice regarding the role of the PMHNP. Also, to discuss if Rhode Island regulations present a barrier to mental health care and any groups or cultures that are impacted by the state’s current scope of practice regulations. Rhode Island is a small but mighty state when it comes to health care. 

Rhode Island Nurse Practitioners have the ability to practice independently with full authority and do not have to collaborate with a physician according to R.I. general laws 5-34-3 (2) (American Association of Nurse Practitioners, 2021; Scope of Practice Policy, 2021). Nurse Practitioners also have full prescriptive authority including all scheduled controlled substances if they are within the role and focus of the population served according to R.I. general laws 5-34-49 (Scope of Practice Policy, 2021). In Rhode Island, Nurse Practitioners can serve as primary care providers according to state law according to R.I. general law 5-34-49 (Scope of Practice Policy, 2021). Psychiatric mental health is one of the recognized specialty areas of Nurse Practitioners by Rhode Island law (American Association of Nurse Practitioners, 2021). According to The National Council of State Boards of Nursing (2021), Rhode Island is one of the few states to have 28 points, and 100 percent implementation of the education, licensure, certification, and accreditation for the APRN consensus model in the United States. 

The current regulations in Rhode Island do not present a barrier to mental health care. Due to the fact that Nurse Practitioners are recognized as primary providers, and can practice independently, it opens many opportunities for patients when they are seeking care. Nurse Practitioners have been shown to increase patient satisfaction, lower healthcare costs, and reduce patient morbidity and mortality (Woo et al., 2017). Rhode Island also has a large network of federally funded health centers that provide a wide array of services to patients across the state (Rhode Island Health Center Association, 2021). Our health centers are accessible in densely populated areas where we have underserved populations, and most of these centers have extensive mental and behavioral health services where Nurse Practitioners are providing the majority of the care to patients. This is positive for underserved groups in Rhode Island. 

References

American Association of Nurse Practitioners. (2021). Advocacy: Rhode Island. Retrieved May 5, 2021 from https://www.aanp.org/advocacy/rhode-island

National Council of State Boards of Nursing. (2021). APRN consensus model. Retrieved May 5, 2021 from https://ncsbn.org/aprn-consensus.htm

Rhode Island Health Center Association. (2021). About the health centers. Retrieved May 5, 2021 from http://www.rihca.org/about-the-health-centers/

Scope of Pract

POST # 2 NGOZY

Current Scope of Practice for the Role of Psychiatric Health Nurse Practitioners in Texas

According to the Texas Board of Nursing, the scope of practice includes activities that an individual health care provider performs in the delivery of patient care. Scope of practice reflects the types of patients for whom the advanced practice registered nurse (APRN) can care; what procedures/activities the advanced practice registered nurse can perform; and influences the ability of the advanced practice registered nurse to seek reimbursement for services provided. Determinants of the scope of practice include advanced practice education in a role and specialty, legal implications, or compliance with the Nursing Practice Act and Board Rules, and scope of practice statements as published by national professional specialty and advanced practice nursing organizations (Texas Board of Nursing, n.d.). 

In Texas, the Psychiatric Mental Nurse Practitioner (PMHNP) has limited practice authority. The current scope of limitations requires that the PMHNP must practice under the supervision of a physician within a 75-mile radius. Physicians can’t supervise more than four nurse practitioners at one time and must review at least 10% of the nurse practitioner’s patient charts randomly each month. Additionally, PMHNPs can only prescribe under a physician’s supervision, cannot prescribe schedule two drugs such as Adderall, Norco, and all prescriptions written by the nurse practitioner must include the supervising physician’s name, address, DEA number, and phone number. Nurse practitioners (NP) in Texas, are not allowed to sign death certificates or handicap permits (Texas Board of Nursing, n.d.). 

State Regulatory Environments on Advanced Psychiatric Nursing Practice as a Barrier to Mental Health Care

The aforementioned regulatory environments present a barrier to mental healthcare in a lot of ways. Although there has been significant progress across states to remove or diminish barriers to the exercise of the full scope of practice by advanced practice registered nurses (APRN), state regulations continue to unnecessarily restrict the APRN practice in Texas. In a desperate bid for Texas Nurse Practitioners to fight for full practice authority, a House Bill 1792 was proposed in 2019 that will allow for full practice authority; however, this proposal is still under deliberation (Texas Board of Nursing, 2014). The limited scope of practice regulation in Texas affects the size and distribution of the broader PMHNP workforce, access to care, health care costs and prices, and innovation in health care service delivery. Common themes include confusion about regulatory requirements and mixed experiences of mandated physician supervision (Phoenix & Chapman, 2020).

Texas law shapes the PMHNP scope of practice. The inability of the state of Texas to support PMHN

ROLE AND SCOPE OF PRACTICE OF PMHNP 1

ROLE AND SCOPE OF PRACTICE OF PMHNP 4

Role and Scope of Practice of PMHNP

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Role and Scope of Practice of PMHNP

The Florida Board of Nursing is the major body that is involved in the regulation of nursing practice in Florida including; the role of PMHNP (Psychiatric-Mental Health Nurse Practitioner). The scope of practice for the PMHNP role in the state of Florida requires a PMHNP to have completed a doctoral or master’s degree, particularly in psychiatric nursing, have a national certification in this specialty area, and have at least two years of clinical experience after completing his/her master’s degree under the physician’s supervision to undertake this role (Florida board of nursing, 2021).

Additionally, PMHNPs in the state of Florida are needed to have an established or supervisory protocol with their supervising psychiatrists and undertake the functions and responsibilities that are specified in this protocol, which may include; administering and prescribing medications (Florida board of nursing, 2021). For instance, PMHNPs in this state who have a supervisory protocol with their physicians might prescribe and administer psychotropic controlled substances to patients with mental disorders (Florida board of nursing, 2021).

However, the recently enacted legislation allows full practice authority to PMHNPs who have three thousand hours or more of experience under the supervision of a psychiatrist (Phillips, 2021). This enables them to practice independently in primary care practices within the state of Florida (Phillips, 2021). To practice independently, PMHNPs are also required to have completed the needed course work in pharmacology and differential diagnosis (Phillips, 2021).

As such, the current regulations do not present any barrier to the delivery and access of mental health services and care. For instance, the recently enacted legislation that provides the PMHNP with full practice authority will help in promoting full access to mental healthcare among individuals in this state.

The cultures or groups that will be impacted by the current scope of practice regulations in this state are rural populations since they constitute the major group that is often underserved. As such, the current regulations will help in improving the accessibility of mental health services and care among rural populations.

References

Florida board of nursing. (2021). Florida board of nursing » advanced practice registered nurse (APRN). Florida Board of Nursing – Licensi