Every state in the US has laws that guide the practice of nursing, which are defined in the Nursing Practice Act (NPA). Each state and territorial nursing board interprets these laws into regulations that guide the practice of nursing care with subsequent power to enforce them. Virginia board of nursing stipulates the rules and regulations for the practice of APNs, which comprise the education, licensure, certification, and practice. APNs prior to licensure are required to have a clinical experience encompassing a postgraduate healthcare delivery directly to patients in line with a practice agreement with the patient care team physician (Nieminen et al., 2018). In partnership with the board of medicine, the nursing board provides the regulations governing nurse practitioners’ licensure and provides APNs with a joint license.
The two boards provide for continuous collaboration and consultation among nurse practitioners and physicians, including the development, periodic review, and revision of a written, electronic practice agreement between the patient care teams and joint evaluation of the services delivered. Every nurse practitioner is required to maintain appropriate consultation and collaboration with a patient care team physician, a certified registered nurse anesthetist practices under the stewardship of a licensed doctor of medicine, osteopathy, podiatry, or dentistry. In contrast, a medical examiner nurse practitioner is required to work with a doctor of medicine or osteopathic medicine appointed as a medical examiner.
Applicants licensed as nurse practitioners under the laws and statutes of another state and who meet the qualifications for licensure required in the commonwealth are issued a license by endorsement. They may practice without a practice agreement with a patient care team physician. Such applicants must provide an attestation to the boards that they have completed at least five years of full-time clinical experience as determined by the boards in the state in which they were licensed. The boards also may jointly offer temporary licensure to APNs pending the outcome of the next specialty examinations (Carter & Kauder, 2016). In the event that a patient care team physician dies, becomes disabled, surrenders their license, retires from active practice, has license revocation, or suspension from the board. Suppose a nurse practitioner cannot enter into a new agreement with another patient care team physician. In that case, the APN may continue to treat patients without a physician for an initial period not exceeding sixty days as long as they prescribe those drugs initially authorized by the practice agreement with a physician. Further, the nurse practitioner is required to have access to appropriate input from appropriate healthcare workers in complex clinical situations, patient emergencies, and referrals.
The statute further provides that every certified nurse midwife shall practice in accordance with the boards’ regulations and in line with the standards for midwifery practice set by the American college of nurse-midwives. Those with less than a thousand hours of practice are attached to a nurse midwife who has practiced for more than two years before getting into a practice agreement with a licensed physician. In addition, those who have practiced for a thousand hours as a certified nurse midwives may practice without an agreement upon receipt of attestation from the senior nurse midwife. APNs authorized to practice without a practice agreement are required to practice within the scope of the clinical and professional training and to be consistent with applicable standards of care, consult and collaborate with other healthcare workers, and establish a referral plan for complex medical conditions to appropriate physicians and members of the medical team (Carter & Kauder, 2016).
The New Jersey Board of nursing incorporates similar statutes in the licensure and practice of APNs in its state as those utilized by the Virginia Board of nursing. Before practicing in New Jersey, a nurse practitioner must complete an education program, including pharmacology, and pass a written examination approved by the board. APNs for certification renewal is required to present satisfactory evidence detailing the completion of all continuing education requirements per regulations adopted by the board (DeNisco, 2021). Advanced practice nurses in New Jersey are permitted to undertake roles done by registered nurses by law, initiating laboratory and diagnostic tests, prescribing medications and devices, including referrals to other licensed health care professionals in accordance with joint protocols developed by the collaborating physician and the advanced practice nurse, collaborate with a physician to initiate an order for a dangerous substance.
The nurse practitioner is further required to prescribe on a New Jersey prescription blank, signs their name on the prescription, and print their name and certification number alongside the patient’s name and name, address, and telephone number of the collaborating physician. The physician is needed to be present or readily available through electronic communication. The advanced practice nurses must also complete additional six contact hours of continuing professional education in pharmacology in relation to controlled substances alongside pharmacologic therapy and addiction management and prevention in tandem with regulations prescribed by the New Jersey board of nursing (DeNisco, 2021). However, this requirement is not required in APNs’ practice in Virginia state, which requires only pharmacologic education to provide certification, licensing, and practice.
The patient care physician and nurse practitioner agreement are subject to the joint board of nursing and medicine.
Furthermore, the joint protocols put in place by the collaborating physician and the advanced nurse practitioner should conform to standards adopted by the Director of the Division of Consumer Affairs in Virginia state. Both Virginia and New Jersey boards of nursing exclusively manage the certification, licensing, certification, and practice and undertake disciplinary action against advanced practice nurses violating the states’ acts and statutes (DeNisco, 2021). Similarly, the boards set standards for professional conduct, set examination and certification fees, and determine if the requirements of another state are substantially equivalent to those of the said state concerning the certification of APNs.
New Jersey nursing board also requires that the commissioner of health and senior services, through the administrative procedure act, establishes the periods of time within which the charts and records of patients managed by advanced practice nurses in an inpatient should be reviewed by the collaborating physician and the advanced practice nurse which is not well stipulated in the statute for APNs practicing in the state of Virginia. Both states’ statutes recognize APNs as primary care providers whose professional practice circumvents the provision of primary care, including obstetrical, gynecological care, geriatric, pediatric, family medicine, and internal medicine (Nieminen et al., 2018). Finally, both state laws provide Advanced practice nurses maintain a regulated joint protocol and working agreement with a physician for at least a single element of APN practice to ensure patients are provided with quality, accessible, and affordable health care.
Carter, E. A., & Kauder, N. B. (2016). Implementing a Sanctioning Reference System for the Virginia Board of Nursing. Journal of Nursing Regulation, 7(1), 21–26. https://doi.org/10.1016/s2155-8256(16)31037-7
DeNisco, S. M. (2021). Advanced practice nursing : essential knowledge for the profession. Jones & Bartlett Learning.
Nieminen, A.-L., Mannevaara, B., & Fagerström, L. (2018). Advanced practice nurses’ scope of practice: a qualitative study of advanced clinical competencies. Scandinavian Journal of Caring Sciences, 25(4), 661–670. https://doi.org/10.1111/j.1471-6712.2011.00876.x
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