Thread:
Discussion Week 1
Post:
Discussion Week 1
Author:
Adebisi Ademakinwa
Posted Date:
June 2, 2022 12:54 AM
Status:
Published
Michigan: Practice Agreement Model
Although I currently live in Indianapolis Indiana I am moving to Detroit Michigan in November and that is where I intended to practice my profession. APRN’s scope of practice in Michigan is modified on March 22nd, 2017 and it was stated among other privileges that APRNs have independent authority on non-controlled substance drugs. The APRNs can receive, request, or prescribe those medications without physicians’ delegation. Nevertheless, APRNs’ authority is delegated by a physician when dealing with controlled substances. Michigan’s licensing law prevents APRNs to require a permit for controlled substances. Without a physician’s delegation authority, the APRNs can recommend physical therapy and they can visit private homes and render services without restriction.
Physician Collaboration
To be compensated with Medicare and Medicaid in the state of Michigan, APRNs are mandated to have a collaborative agreement with the physicians which can also be extended to a third party. It is therefore paramount for APRNs to critically analyze all the requirements necessary before inducting as a provider by insurers (Michigan Department of Community Health, 2021). The state of Michigan law does not recognize the nursing practice as a branch of medical practice and as such, is not dependent on physician delegation or supervision. Categorically, APRN’s scope of practice is embedded in such a way that it should be educationally and experimentally prepared not for supervision or delegation but for collaboration
.
Certification and Licensing of APRNs in Michigan
At a graduate level, the clinical nurse is licensed as RNs (Nursing Licensure, org, 2021). The state certification is dictated by the national certification. The state of Michigan recognizes three specialty areas for APRNs which are nurse-midwife, specialist, practitioners, and anesthetist. State public code indicated that advanced learning should dictate the professional certification.
The precondition for leading positions has been given to third-party agencies like institutions.
Certification Application Process
It is mandatory for APRNs to have an RN license together with an approved national certification from a competent agency to be eligible for candidature. An eligible applicant is required to apply online to the licensing and Regulatory Affairs (LARA). The state of Michigan Board of Nursing encourages applicants to apply through their website www.michigan.gov/miplus.
Scope of Practice of a Nurse Practitioner
The state of Michigan law does not recognize nurse practitioners as primary care providers but they are not required to be delegated when NPs prescribed non-scheduled medications. Notwithstanding, the NP required physician delegation for scheduled II to V known as controlled medications
Obtaining a DEA License in Michigan
In the state of Michigan, the DEA license is only obtainable with a controlled substance. Online application is required with a non-refundable fee of $224 charged with the submission of the application with the exemption of current university students. The application form is suitable for schedule II to V while a separate application with supplemental information on the resume, and protocol is necessary for schedule I controlled prescriptions
.
Prescription Monitoring Program PMP
The prescription monitoring program (PMP) in the state of Michigan is known as the Michigan automated prescription system (Maps). This system is used to monitor schedules II to V known as controlled substances. Providers use this index to determine patient risk, negate drug abuse, and use it as a yardstick at a patient-provider and pharmacy. Michigan mandated that physicians know how to initiate MAPs into the clinical workflows.
Nurse Practitioner’s Controlled-Substance Prescriptive Authority
According to the state of Michigan law, the NPS can only prescribe controlled drugs in schedules II to V under the watch of a physician. A nurse anesthetist is not considered under this law. The identification permit number, the name, and signature of the physician and the practitioner should be in writing with a valid date. It is expedient for the authorization to be renewed annually, with the original copy with the physicians and the duplicate copy given to the NP.
NP Drug Schedules Prescribed by NP
The NP should prescribe drug schedules according to the physician’s delegation. It is noted that the NP cannot prescribe scheduled drugs beyond the quantity serving of 30 days. The NP is required to have a DEA licensure for a mild-level controlled medication despite the fact that the prescription is solely based upon the authorizing physician’s controlled substance license.
References
LARA (2021). Michigan Professional Licensing User System. Retrieved 2 June 2021 from https://www.michigan.gov/lara/0,4601,7-154-89334_72600_85566—,00.html
Michigan Department of Community Health (2021). Nurse Practitioner / Physician Agreement. Retrieved 2 June 2021 from https://www.michigan.gov/documents/mdch/Dch-1575-Nurse_Practitioner-Physician_Agreement-08-07_205314_7.pdf
NursingLicensure.org (2021). Advanced Practice Registered Nurse Requirements in Michigan. Retrieved 2 June 2021 from https://www.nursinglicensure.org/np-state/michigan-nurse-practitioner/
Discussion week 1
Post:
Discussion week 1
Author:
Paulinah Adegbehingbe
Posted Date:
June 2, 2022 12:49 AM
Status:
Published
NURS 6675
Week One Discussion
Main Post
Practice Agreement
A practice agreement is a document outlining this joint practice relationship between the nurse practitioner and physician. As nurse practitioners (NPs) gain autonomous prescribing status in more states, their ability to work interprofessional with the physician through collaborative practice agreements will increase collaborations can improve patient care, and enable the team to care for more patients(Funk, Weaver, Benbenek & Anderson,2019)
Getting certified and licensed as an Advanced Practice Registered Nurse (APRN) in
Maryland.
In Maryland, an advanced practice nurse must hold an RN license, either in Maryland or in another nurse compact state, must complete a Board-approved nurse practitioner program (Maryland Nurse Practitioner Programs) and pass a Board-approved examination. Advanced practice status is granted on the basis of education and certification. Certification will vary by specialty. Some advanced practice roles are broad, encompassing a number of possible sub-specialties. The licensing agency has somewhat more flexibility in accepting clinical nurse specialist certifications than certifications in other advanced practice roles. There have been a number of recent changes, including passage of the Full Practice Authority Act of 2015, a law impacting the practice of nurse practitioners (Nursing licensure,2022).
The application process for certification in Maryland
The application process involves submitting an official transcript and a copy of a qualifying certification. The licensing agency will also seek a copy of the RN license (issued by Maryland or another nurse compact state). Applications are to be accompanied by a nonrefundable $50 fee and the applicant must provide a Social Security Number or Federal Tax Identification Number in order to process the application Applications received without SSN or Federal Tax ID are incomplete and may not be processed. This is to comply with the following Federal and State laws: Verification of identity with respect to final adverse actions related to your license or certificate (42 U.S.C. § 1320a-7e(b); Administration of the Child Support Enforcement Program (Md. Family Law Code Ann., § 10-119.3); and, Identification by the Maryland Department of Assessments and Taxation of new businesses in Maryland (Md. Health Occ. Code Ann., § 1-210).
Maryland State’s Board of Nursing Website
The Maryland state board of nursing website is https://mbon.maryland.gov.
Maryland definition of the scope of practice of a nurse practitioner
The scope of practice for the nurse practitioner defines the rules and regulations the NP must follow in practice. It describes the “who,” “what,” “where,” “when,” “why,” and “how” of the NP practice. Nurse practitioners are advanced practice registered professional nurses who are prepared through advanced graduate education and clinical training to provide a range of health services, including the diagnosis and management of common as well as complex medical conditions to people of all ages. The APRN scope of practice includes practice authority, prescriptive authority, and primary care providers.
What is included in your state practice agreement?
Maryland practice agreement includes that nurse practitioners must work in a collaborative relationship for 18 months before being awarded full practice authority. APRNs operate under the supervision of a physician or nurse practitioner who has complete practice authority during this time.
How to get a DEA license in Maryland
Maryland State Controlled Dangerous Substances Registration and a Federal US.DEA Registration is needed before prescribing, dispensing, and conducting research or institutional activities with controlled dangerous substances. To obtain DEA the practitioner must first apply for Maryland CDS from the Office of Controlled Substances Administration (OCSA) before apply for a Maryland State Controlled Dangerous Substances Registration (CDS) with the Office of Controlled Substances Administration (OCSA).
Below are the steps to follow:
Complete the OCSA Researcher Questionnaire
Complete the 3-year practitioner application form
Select Research and appropriate schedule (I – V)
Complete c Fee Exempt Details – Check State and get this signed by the “certifier” Denise Clark, Associate VP for Research
Provide physical address where drugs will be used
List federal DEA license as “pending”
Fill out all other requested information lying for a Federal DEA Registration Number.
Once approved, apply for a Federal DEA license (you will need your state license number)
First-time applications for Researchers should complete DEA form 225 and submit by mail, in order to apply the signature required to have fees waived for the federal application.
Does your state have a prescription monitoring program (PMP)?
There is a Prescription monitoring program in Maryland. The PMP was established to support healthcare providers and their patients in the safe and effective use of prescription drug. It is a core component of the State’s and many local jurisdictions’ strategies for reducing drug-related overdoses.
How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
Prescriptive authority is the ability of healthcare providers to prescribe specific medications, including controlled substances. In Maryland the nurse practitioner’s controlled substance prescriptive authority is described as An NP may independently prescribe and dispense drugs, devices and Schedules II-V controlled substances. Md. Regs. Code §10-27.07.07(Kaplan, 2015).
Post a summary of your findings on your state based on the questions listed above.
Through education and training, NPs are prepared to serve in roles of primary care providers with the potential to make a substantial impact to improve clinical outcomes. Supporting give PMHNPs to fully exploit their potential and utilize their knowledge and skills towards promoting a better healthcare system.
Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state
There are a variety of barriers to PMHNPs practicing independently in Maryland. One of
these reasons are the fear created by the physicians over letting the PMHNPs practice independently physician professional organizations, including the American Medical Association, believe that because physicians have longer and more rigorous training than NPs, nurse practitioners are incapable of providing quality, safe care at the same level as physicians barriers to successful collaboration exist. Lack of knowledge of NPs scope-of-practice has been identified as a barrier to successful collaboration. Additionally, the doctors’ attitude and views towards the NPs as less qualified in diagnosing the various patient and well as ailment issues as compared to them in terms of practice skills and knowledge (Duncan & Sheppard, 2015). Ongoing lack of up-to-date information and/or confusion about the scope of NP practice exists among both health care professionals and the public is also a barrier
Be specific. Also, describe what surprised you from your research. Researching on the question above
The research about the practice as a Nurse Practitioner in Maryland is been supported by the state and the state is part of the 21 states that allow Nurse Practitioner to practice independently. Elimination of the collaborative agreement Practice has not posed any significant health crisis.
References
Duncan, C. G., & Sheppard, K. G. (2015). Barriers to nurse practitioner Full Practice Authority
(FPA): state of the science. International Journal of Nursing Student Scholarship, 2.
Funk, K. A., Weaver, K. K., Benbenek, M., & Anderson, J. K. (2019). Collaborative Practice Agreements Between Nurse Practitioners and Physician. Journal for Nurse Practitioners, 15(7), e139–e1
Mason DJ, Cohen SS, O’Donnell JP, Baxter K, & Chase AB. (2017). Managed care organizations’ arrangements with nurse practitioners. Nursing Economic$, 15(6), 306–314.41. https://doi.org/10.1016/j.nurpra.2019.03.006
Nursing Licensure,(2022).Retrieved from https://www.nursinglicensure.org on May 31st,2022.
