NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility

Chamberlain University NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility              

Whether one passes or fails an academic assignment such as the Chamberlain University NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility              

The introduction for the Chamberlain University NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility              

After the introduction, move into the main part of the NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility              

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility              

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility

In the state of New Jersey Nurse practitioners practice with reduced authority. You have the ability to work independently in treating patients but require a physician in order to prescribe medications through a collaborative agreement. In NJ a supervising physician is necessary in order for the NP to prescribe medications. By law the NP can assess, diagnose, order testing like labs or other diagnostics, provide end of life care, sign POLST forms, and pronounce death (New Jersey Division of Consumer Affairs, 2015). According to Cadmus et.al. (2021) there is a serious issue with access to primary care in 13 of 21 counties in NJ and barriers to NP practice contributes to the issue. In 2010 the Patient Protection and Affordable Care act assisted 20 million people to get access to health insurance. This increased the demand for provider access as new conditions were diagnosed and much of the population now required maintenance care of chronic illnesses. For the state of NJ the existing barriers only limit NPs from practicing within the full extent of their license (Cadmus et. al., 2021). Collaboration agreements in NJ limit NP ability to practice through requirement for a physician to supervise the NP’s prescriptive authority, without actually requiring involvement of the physician in the patient’s care or a sign off. This can impose financial burdens on the APN when contracts are broken (Cadmus et. al., 2021). Full practice authority would increase provider accessibility and reduce financial burdens on NPs. According to Cadmus et. al. (2021) it is projected through the U.S. Census Bureau from 2013 to 2025 there will be a 14.1% shortage of primary care physicians in the state of NJ. With full practice authority, NPs can open their own practices, offering more accessibility to patients and reducing the impact on emergency departments from patients seeking primary care. In New Jersey we have a few urgent care centers but with full authority access, more practices can be opened.

Prescriptive Authority

Under the supervision of a physician, they can prescribe medications (New Jersey Division of Consumer Affairs, 2015). For the prescription of dangerous controlled medications, the APN is required by law to register to apply with the Drug Enforcement Agency (DEA) and controlled and dangerous substance (CDS) to gain permission through licensure. Once the license number is obtained, the APN will apply for a DEA number. All APNs can prescribe level 2 to 5 controlled substance medications following a 6 hours course completion and application to the federal DEA. Prescription blanks with prescriber name, address, and information printed on specialized paper is required by NJ law to prevent changes to the 5 prescription once printed (New Jersey Division of Consumer affairs, 2015). In order to maintain your prescriptive authority in the state of NJ you must have a written collaborative agreement with a physician which is to be reviewed and signed each year. APNs need to keep their licensure up to date (ANA, 2023)

Educational Requirements-

It is required that a nurse practitioner graduate from an MSN program with clinical rotations. The program included a 45 hour pharmacology course that is approved by the NJ board of nursing equaling to a 3 credit graduate course that is accredited by a national accredited agency. NPs need to obtain 30 CEUs related to their choice of advanced practice scope, pharmakinetic, pharmadynamic principles of clinical application, and use of pharmacological agents in prevention of illness. The CEUs are required within 5 years of the application for prescriptive authority (New Jersey Division of Consumer Affairs, 2015). 

Licensure requirements-

NJ licensure is determined through state recognition requirements. This includes having a current RN license without restrictions, nationally recognized certification, and proof of graduation from an advanced MSN or DNP nursing program. The cost of licensure is $100 non-refundable fee with a certification fee of $80/160 depending on the expiration of the RN license. RN licensure must be in good standing, with a passed criminal background check, uploaded, current fingerprints done electronically in order to complete application (New Jersey Division of Consumer Affairs, 2015). The nursing board requires official transcripts to be submitted in order to process applications in a timely fashion. A requirement to keep the NP licensure is active certification. Proof of CEUs and practice house are needed to certify (New Jersey Division of Consumer Affairs, 2015). ach certification exam is given according to chosen specialty and the NJ board requires the highest level examination be taken. 17 certification agencies are recognized by the board of nursing and accredited. The cost of certification is $365 for non-member and $290 for members of the American Nurses Association (ANA, 2022).

How does access to NPs impact any healthcare disparities? 

According to Nikpour et. al. (2022) adult patients enrolled in Medicare and Medicaid have higher rates of diseases like coronary artery disease and diabetes resulting in twice as many hospitalizations. Nikpour et. al. (2022) conducted a Nurse practitioner primary care organizational climate questionnaire with 189, 420 patients with Coronary artery disease or diabetes enrolled in Medicare and Medicaid. 470 practices in PA, NJ, CA, and FL were involved in the study. Results reflected higher odds of hospitalization for patients living in poor environments who were dually eligible for Medicare and Medicaid (Nikpour et.al., 2022). With increasing patient conditions that require ambulatory care, primary care, and hospitalization, there will be a demand for providers. Nurse practitioners have the training and ability to fill a void for provider care and help to address health conditions worsened by disparities. States that reduce the NPs ability to practice at full authority have higher incidences of health care disparities (Nikpour et. al., 2022).

References:

American Nurses Association (2022). Advanced Practice. https://www.nursingworld.org/advancedpractice.

American Medical Association. (2021). State Law Chart: Nurse Practitioner Prescriptive Authority.
https://www.ama-assn.org/system/files/2020-02/ama-chart-np-practice-authority.pdf

Cadmus, de Cordova, P. B., Weaver, S., & Ravichandran, A. (2020). Access to Care in New Jersey: Making the Case for Modernizing Legislation. Journal of Nursing Regulation, 11(1), 36–41. https://doi.org/10.1016/S2155-8256(20)30059-4

New Jersey Division of Consumer Affairs (2015). Advanced Practice Nurse Certification.
https://www.njconsumeraffairs.gov/nur/Pages/APN-Certification.aspx. Assessed 06/8/2023

Nikpour, Brom, H., Mason, A., Chittams, J., Poghosyan, L., & Carthon, M. B. (2022). BETTER NP PRACTICE ENVIRONMENTS REDUCE HOSPITALIZATION DISPARITIES AMONG DUALLY ENROLLED PATIENTS. Innovation in Aging, 6(Supplement_1), 64–65. https://doi.org/10.1093/geroni/igac059.257

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Sample Answer 2 for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility

Nurse Practitioners (NPs) in the state of New Jersey undertake a nursing program in an institution accredited by the New Jersey Commission on Higher Education (New Jersey Board of Nursing, 2022). The state’s Nursing Practice Act determines nursing procedures. Nurse The scope of practice for NPs practicing in the state of New Jersey is reduced practice. Reduced practice means that the NP is allowed to perform some of his or her scope of practice without the physician’s supervision (Clarke, 2023). The restrictions allow the NPs to operate their own practices or prescribe certain categories of medications. They seldom involve the NP’s capability to order tests or diagnose medical conditions. For instance, the NP may be part of a practice that involves the supervision of a physician rather than running his or her own practice, but within the practice, can carry out duties with relative autonomy. Legal documentation calls the NPs ‘licensed independent practitioners,’ but there are limitations. They can diagnose and treat patients without the supervision of a physician. Neither does medical documentation created by NJ NPs require a physician’s signature. NPs in the state are licensed and regulated by the Board of Nursing. Concerning ethical and legal issues, the state law holds NPs independently accountable for all the care they provide and not the supervisor or collaborating Medical Director.

Certification, Education, and Licensure

Application for Certification

The NP in New Jersey is one among the various categories of Advanced Practice Nurses. A nurse practitioner is eligible for certification upon successful completion of a course of study and examination in an advanced practice nursing specialty credentialed by a national certifying agency (New Jersey Board of Nursing, 2022). The agency may be accredited by the American Board of Nursing Practice or the National Commission for Certifying Agencies. To apply for certification as an NP, the applicant completes an application form and submits it together with proof of successful completion of the educational and examination requirements of an APN as spelled out in the NJAC, and current and legitimate active certification. A fee is paid to obtain the license.

Educational Requirements for Certification

A nurse practitioner is eligible for certification after completing a master’s degree in nursing from a nursing school accredited by a nursing accreditation association recognized by the US Department of Education or a master’s degree in nursing with a post-master’s program focused on a specialty in advanced in nursing from an accredited nursing accreditation association recognized by the US Department of Education (New Jersey Board of Nursing, 2022).. The applicant is further, among other requirements, expected to have completed a 3-credit level course in pharmacology or 45 hours of pharmacology as well as 6 contact hours in pharmacology that addresses controlled dangerous substances during the master’s program (New Jersey APRN Licensure, 2023). Upon completion of the program, the NP will successfully sit for the advanced practice examination in their area of specialty administered by the national certifying agency accredited by the American Board of Nursing Specialties and/or the National Commission of Certifying Agencies.

For NPs certified in a different state, NJ State does not require such an NP to meet the exam requirements of NJAC, especially when the educational requirements are similar. But academic transcripts and verification of certification are required as proof that the educational and certification requirements were met by the NP

Licensure

Practice licenses in New Jersey are issued by the New Jersey Board of Nursing (New Jersey APRN Licensure, 2023). To apply for a license to practice in New Jersey as an NP, the NP is required to be a holder of an unencumbered RN license and to submit verification of an RN license. Applicants from other states who wish to apply for an RN license may do so by endorsement.

An NP in NJ is required to obtain and maintain an active current license from the Board of Nursing. No person licensed to engage in nursing practice can practice if his or her license is suspended, revoked, surrendered, or expired (New Jersey Board of Nursing, 2022). The license is renewed biennially by paying the renewal fee and completing a form provided by the Board.

To qualify for licensure, the NP applicant is required to submit an original copy of his or her transcript sent to the Board from the institution attended. The transcript must have details of the applicant’s date of graduation as well as the degree awarded. The applicant is also required to submit proof of a valid national certification.

Prescriptive Practice

The NP in New Jersey has the authority to prescribe medications or place orders for medications and devices. However, this can only be done in collaboration with a physician through a joint protocol (New Jersey APRN Licensure, 2023). It is a requirement that such a collaborating physician is also licensed to practice in New Jersey State, except when employed by a federal institution like the VA (New Jersey Board of Nursing, 2022). The collaborating physician is not necessarily required to practice with the NP on-site. They can collaborate by maintaining communication via phone or e-mail. The NP and the physician sign and maintain a joint protocol that outlines the collaborative relationship annually. Within the protocol, the NP may give a prescription for Schedules II, III, IV, and V controlled substances following a successful application for Controlled Dangerous Substance registration (New Jersey APRN Licensure, 2023). The NPs may also place requests for, receive, and dispense pharmaceutical samples. The prescriptions written by the NP must contain information for both the NP and the collaborating physician. Typically, the NP is required to successfully take a one-time, six-hour course in the prescription of controlled substances.

Practice Limitations

Since NPs in New Jersey operate under reduced practice, their licenses allow them to exercise prescriptive authority. But they are still required to be involved in career-long collaborative practice agreements with physicians. The agreements set out the specific limits of the NP with regard to one or more areas of practice, inclusive of prescriptive authority (New Jersey APRN Licensure, 2023). NPs in New Jersey, by reason of limitations, cannot practice independently using skills, knowledge, and tools they have gained through either training or experience. Presently, NJ lawmakers are considering implementing legislation that allows NPs to prescribe independently in line with the National Academy of Medicine’s long-term goal of having all states implement full practice structures. This will enhance the NP’s level of responsibility and involvement in complex decision-making processes as equipped by their training. 

Effect of Reduced NP Practice on Patient Care in NJ

The reduced practice structure is a major barrier to patient access to care as well as health outcomes (Cadmus et al., 2020). This is because it reduces patient access to primary care providers. Consequently, the number of ED visits is higher. Studies have revealed that permitting NPs to practice without the oversight of a physician increases patient access to primary care providers and reduces ED visits. This is because APRNs have the requisite education, skills, knowledge, and experience for both basic and comprehensive primary care services and are not only more readily available buts also ideally positioned to enhance access to care. This can significantly reduce health disparities, and lower the cost of care (Bosse et al., 2017). States that require NPs to work under the oversight of physicians have a 28% incidence of ED visits compared to 7% in states where nurses have full practice license structures (McMichael et al., 2019).

Conclusion

NPs must always have a clear understanding of the state laws and regulations that affect their practice. NPs in New Jersey operate under the reduced structure. However, lawmakers are considering implementing the full practice structure in order to enhance quality and access to care.

References

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761-765.

Cadmus, E., de Cordova, P. B., Weaver, S., & Ravichandran, A. (2020). Access to Care in New Jersey: Making the Case for Modernizing Legislation. Journal of nursing regulation, 11(1), 36-41.

Clarke, M. E. (2023). Nurse Practitioner Practice Authority: A State-by-State Guide. NurseJournal. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/

McMichael, B. J., Spetz, J., & Buerhaus, P. I. (2019). The association of nurse practitioner scope-of-practice laws with emergency department use. Medical care, 57(5), 362-368.

New Jersey APRN Licensure. (2023). New Jersey Nurse Practitioner Licensure Steps – 2023. https://www.nursepractitionerlicense.com/nurse-practitioner-licensing-guides/new-jersey-nurse-practitioner-licensure-steps/

New Jersey Board of Nursing. (2022). NEW JERSEY ADMINISTRATIVE C ODE T ITLE 1 3 L AW AND P UBLIC S AFETY C HAPTER 3 7. https://www.njconsumeraffairs.gov/regulations/Chapter-37-New-Jersey-Board-of-Nursing.pdf

Sample Answer 3 for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility

When I graduate with my master’s degree in nursing and my certificate in Family Nurse Practitioner, I intend to practice as an advanced practice nurse in the state of Illinois. Nursing in Illinois is governed and guided by the Illinois Nurse Profession Act. Those who wish to become Advanced Practice Nurses must adhere to the Practice Act’s requirements for development, licensing, and training. (Illinois Nurse Practice Act) states that to qualify for a specialized license, a nurse practitioner must graduate from an advanced practice nursing program. In Illinois, a nurse practitioner must also hold a license as a registered nurse and pass a background check. As part of the IDFPR’s accreditation program, nurses are granted licenses, observed, and instructed while being assessed for their competency to provide quality healthcare. In addition, the IDFPR holds nurse practitioners accountable for their actions and for the health of their patients. Illinois students must complete 80 hours of continuing education (CE) every two years (Illinois Nurse Practice Act). A wide range of advanced nursing topics is covered in Illinois’ advanced nurse training program (AANP, 2018), including health assessment and pathophysiology. The Illinois Nurse Practice Act allows nurse practitioners who have completed 4,000 hours of clinical practice and 250 hours of continuing education to order genuine medications alone (Illinois Nurse Practice Act). Nursing practitioners may only prescribe benzodiazepines and Schedule II narcotics following consultation with a physician. Illinois nurse practitioners are permitted to prescribe restricted substances for a period of up to 30 days (AANP, 2018). A collaborating physician must authorize additional refills if the patient requires them (AANP, 2018). Nursing practitioners in Illinois are limited in their practice, so they must be supervised by physicians (AANP, 2018). According to the AANP, the state restricts independent practice. After achieving national certification with the department, an advanced practice nurse may practice with full authorization without a written collaborative agreement after completing 250 hours of continuing education and/or training and at least 4,000 hours of clinical practice. Providing 250 hours of continuing education and/or training along with 4,000 hours of clinical practice (Illinois Nurse Practice Act) and having at least 4,000 hours of clinical practice. Using administrative codicils allows nurse practitioners to enhance their licensure and practice as primary care providers. The scope of practice for advanced practice nurses encompasses assessment, diagnosis, treatment, teaching, ordering, performing, and interpreting diagnostic tests and procedures. In Illinois, a large metropolis, increased numbers of people diagnosed with covid-19 posed numerous obstacles during the pandemic, with primary care professionals in short supply. During this time, many providers have found that the independence and complete practice of APNs have allowed them to reach a greater number of patients without burning out. Telemedicine has also been embraced by nurse practitioners, helping clinicians to reach more rural areas or places with a shortage of healthcare providers. A medical center of health at the University of Chicago was shut down by the governor of Illinois during the pandemic. Nursing faculty members stepped in at this point to support the transition from face-to-face care to telehealth. With an international pandemic, we are short of nurse practitioners due to the epidemic (Diegel-Vacek et al., 2021). NPs in this high-poverty region have a limited scope of practice, making it difficult for them to provide services. Rural areas or places with a shortage of healthcare providers are more likely to require Nurse Practitioners. Health inequities, chronic illness burdens, medical costs, and national health rankings are higher in states that limit nurse practitioners’ practice authority (Issues at a glance: Full practice authority, as of 2021). According to research, NPs’ treatment has fewer needless hospital readmissions, fewer possibly avoidable hospitalizations, more patient satisfaction, and fewer unnecessary emergency room visits than patients treated by physicians (Diegel-Vacek et al., 2021).

Reference- 

American Association of Nurse Practitioners. (2018). State practice environment. Retrieved https://www.aanp.org/advocacy/illinoisLinks to an external site.

Diegel-Vacek, L., Cotler, K., Reising, V., & Corbridge, S. J. (2021). The transition of nurse practitioner faculty practice and student clinicians to telehealth: Response to the covid-19 pandemic. 

Illinois Department of Financial and Professional Regulation. (n.d.). Advanced practice nurse- controlled substance license. Retrieved from https://www.idfpr.com/Forms/Online/(309)%20APN%20Controlled%20Substance%20User%20Guide.pdf

Illinois Nurse Practice Act, 225 ILCS 65/. Retrieved from http://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1312&ChapterID=24Links to an external site..

Sample Answer 4 for NR 506NP Week 6: Scope of Practice and Patient’s Healthcare Accessibility

Level of independence & limitations

NJ allows limited APN practice. The APN must enter a joint protocol with a collaborating physician to prescribe medications. The joint protocol is the basis for regulating what the NP can and cannot prescribe however, the Board of Nursing is the authority over the APN practice. APNs can refer patients to physical therapy, provide proof of disability, sign Provider Orders for Life-Sustaining Treatment (POLST), and sign death certificates for patients for whom they were the primary provider. APNs cannot sign Do Not Resuscitate (DNR) orders (APNNJ, n.d.). APNs can consult with patients via in-person, telephone, or other means of communication.

Prescriptive Authority

There must be a written agreement between the APN and collaborating physician regarding what the APN can prescribe and what devices can be used. The agreement must be kept onsite where the APN practices. Although the joint protocol exists, the APN is solely responsible for their practice and the physician cannot be held liable. The physician must hold an NJ license unless the APN works for a federal agency such as the VA. The physician must be readily reachable to the APN (NJBON, 2022).

Prior to prescribing any medications, the APN must take a detailed history, complete a physical exam, educate, and schedule follow-up care. The APN can prescribe control substances from classes II-IV within the joint protocol. Control medications must be monitored through the Prescription Monitoring Program (PMP) and random urine tests need to be collected once a year. All prescriptions must be completed on NJ prescription pads except for those in long-term care facilities or via electronic transmissions (NJBON, 2022).

License Requirements

            Once the candidate has passed the national board certification they can apply for licensure in NJ. To request an application from the New Jersey Board of Nursing (NJBON), the candidate must have a current NJ RN license, must hold a university degree related to advanced practice nursing, and have national certification. The application will require a signature in front of a notary republic, an original passport photo, birth certificate or US passport, authorization for a criminal background check, official transcripts sent directly to the board, official APN certification, proof of six contact hours completed in pharmacology related to controlled dangerous substances and a $100 fee. The NJBON requires APNS to have completed three pharmacology courses within five years of the application. The APN license is renewed biennially with an application, current national certification, fees, and renewal of RN license with 30 contact hours of continuing education with two hours related to end-of-life care (NJBON, 2022).

Education Requirements

NPs in NJ are permitted to practice in various work environments post-licensure. These locations include clinics, inpatient and outpatient settings, and every age group. To sit for national board certification, the registered nurse (RN) must have completed a master’s or doctorate from an accredited program in NP study as such Psychiatric-Mental Health Nurse Practitioner (PMHNP) (ANCC, 2022). The candidate must hold a current RN license, have practiced for one year, and have a bachelor’s degree to receive entry into a master’s program. All NP programs require clinical or practicum hours and credits to be completed. Programs are generally 24 to 28 months in length and require more than 500 practicum hours (Chamberlain University, 2022). The American Nurses Credentialing Center (ANCC) currently regulates which candidates can take the PMHNP national board certification.

            In order to be eligible for the board exam, the candidate must hold a currently active RN license, complete an accredited PMHNP program, and have a minimum of 500 faculty observed clinical hours. The curriculum must include three separate comprehensive graduate-level courses in advanced physiology/pathophysiology across the lifespan, health assessment of all human systems, and advanced physiology including pharmacodynamics, pharmacokinetics, and pharmacotherapeutics. The candidate must have also completed coursework and health promotion maintenance, differential diagnoses, and disease management including prescription of pharmacological or non-pharmacological interventions. The candidate must have completed clinical training in at least two psychotherapeutic treatment modalities. Completed validation of the education form, provide official transcripts, and an application fee of $395 must be submitted (ANCC, 2022).

            After verification, the candidate will receive authorization to test (ATT). The ATT will be used to schedule the board exam. The PMHNP certification must be completed in three hours and has 150 questions. If a candidate fails, the exam can be rescheduled after five days of the original test date however the candidate must wait 60 days to retake the test and there will be a $270 fee. The certification is valid for five years (ANCC, 2022).

            To apply for renewal, the candidate must pay a $375 fee, complete 75 hours of continuing education hours, 125 hours of preceptorship, professional service, 1,000 practice hours, assessment validation, participate in research and publications, and do a presentation (ANCC, 2022).

If you live in a restricted or reduced practice state, how has patient care been impacted in your local community by these barriers? For instance, is the ED used for primary care?  Are the EDs overcrowded with long wait times?  Are there urgent care clinics readily available? Is there adequate access to primary care?

As a former ED nurse, I have witnessed many patients using the ED as primary care. Often these patients report being unable to get a PCP appointment for months and needing care. Many parents would bring their children to ED for fevers and coughs due to pediatrician appointments only being available weeks out. Many patients visit the ED for refills and management of chronic diseases that have not been controlled. Cardiovascular diseases, respiratory diseases, diabetes, and mental health care are the major chronic disease categories. There is research to support the availability of NPs, and PAs will decrease patient dependence on non-urgent ED visits  (Norful et al., 2021).

How does access to NPs impact any healthcare disparities?  

There are many reasons why health disparities exist including, poverty, environmental threats, inadequate access to health care, individual and behavioral factors, and educational inequalities (CDC, 2023). NPs can help with health disparities by providing care in rural areas and having a better cultural understanding. NPs can help to bridge gaps where there are PCP shortages and provide care to patients who would otherwise not receive the care they need. Finally, improving access to NPs can help reduce healthcare disparities by increasing access to care and providing high-quality in underserved and rural communities.

References

American Nurses Association. (n.d.). Federal issues. https://www.nursingworld.org/practice-policy/advocacy/federal/Links to an external site.

American Nurses Credentialing Center. (2022). Psychiatric-mental health nurse practitioner (Across the Lifespan) certification (PMHNP-BC). https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/Links to an external site.

Centers for Disease Control [CDC]. 2023. Health Disparities. https://www.cdc.gov/healthyyouth/disparities/index.htmLinks to an external site.      

New Jersey Advance Practice Nurses. (n.d). New Jersey advanced practice nurses. https://apn-nj.org/Resources/Documents/New%20Jersey%20APNs.pdf

New Jersey Board of Nursing. (2022). Law and public safety. https://www.njconsumeraffairs.gov/regulations/Chapter-37-New-Jersey-Board-of-Nursing.pdf

Norful, A. A., de Jacq, K., Liu, J., Ye, S., Khadka, S., & Poghosyan, L. (2021). The impact of nurse practitioner and physician assistant workforce supply on Medicaid-related emergency department visits and hospitalizations. Journal of the American Association of Nurse Practitioners; J Am Assoc Nurse Pract, 33(12), 1190-1197. 10.1097/JXX.0000000000000542