ESSAY: Differentiate the Major Regulatory Restrictions on NP Practice

Purpose:
NPs have scopes of practice that are regulated by state laws, boards of nursing, boards of medicine and reimbursement that may differ depending on your location. There are several sources of restrictions to NP practice such as state laws and federal regulations which include who may prescribe controlled substances and which substances NPs can prescribe, as well as the various reimbursement agencies. It is essential that the NP be fully informed of what they are allowed to do by law (state and federal) or by other regulatory organizations. These regulations vary widely from state to state. Consequences of practicing outside your scope of practice may be anything from a fine, suspension or revocation of your license, civil lawsuit, or even criminal charges.
Directions:
• Use the provided template to compare and contrast the three major regulatory practice models for NPs: Supervisory, Collaborative, and Independent.
• Please keep this assignment in the template format provided.
• This Assignment requires credible and up to date resources for each category.
• Include in each model at least one state that represents the scope of practice you are discussing.
o For example, Florida requires a supervisory relationship with a physician along with a practice agreement, formulary, and protocols.
• In order to apply and receive a DEA license to prescribe controlled substances, you must be approved by the state you are practicing in to prescribe these medications

ANSWER

Differentiate the Major Regulatory Restrictions on NP Practice

Topic	Supervisory Practice	Collaborative Practice	Independent Practice
List the name of a State that is representative of each regulatory model.	Florida	Alabama	Arizona
Evaluate how each model affects the NPs scope of practice? (Include, if applicable, the use of protocols, formulary, written agreements, direct versus indirect supervision, referral policy, patient care, review of medical documentation, and payment reimbursement).	Florida requires that an Advanced Registered Nurse Practitioner should only carry out medical activities of diagnosis, treatment and operation in accordance with the agreed protocols between ARNP and the osteopathic dentists or physicians, or Florida licensed medical doctor (American Medical Association, 2015). The terms of agreement between the ARNP and the physicians should not only be identified in the written protocol but also should be observed by the prudent care providers under such circumstances. A general supervision is required by the physicians unless different levels are set for particular cases.	The collaborating physicians are required to provide directs and oversight, they must be available to the NP over telecommunication, or radio (American Medical Association, 2015). Moreover, they are required to be available for referrals and consultation from the NPs. When engaged in off-site services, the protocols provided should be specific on the circumstances and should be accompanied by a written verification concerning the after hour services, direct medication interventions offered in the event of emergency, referral and the physicians availability in case of consultations (American Medical Association, 2015).  The collaborating physician is required to present a ten percent of the hours scheduled by the NP and he or she is required to visit the site of practice at quarterly intervals. However, the nurse is limited to an agreement of 120 collaborative hours in a week (American Medical Association, 2015).	In Arizona the scope of practice of NPs include analyzing data, synthesizing and assessing clients. Therefore, NPs are required to carry out the task of referral of patients to physicians at other care providers but the protocol requires that such referrals should protect the welfare and health of the patient (American Medical Association, 2015). In case a condition occurs that is beyond the NPs compression, they are mandated to do consultations with other physicians at other healthcare providers.
How does model of practice serve as a barrier to access to care?	The collaboration protocols may limit the number of services offered to patients. There are no details on review of medical documentation, and payment and therefore, the quality of services offered may not be possible to evaluate and medical documentation which guarantee’s quality services is not properly articulated. This makes it hard to audit the quality of services offered.	The collaboration of the physician as required by Alabama may distance the patient from the nurse through setting a minimum care time as 10 percent (American Medical Association, 2015).  Additionally, the site collaboration may create a relaxed and limited health care delivery due to lose control at quarterly intervals (Kaplan, 2015).	Because patients are required to be referred other levels of medical care, the Arizona model may create a barrier to indoor patients needing indoor services. It may also hinder the delivery of services whose skills and knowledge is beyond that of the NPs within that area.
Compare/contrast the prescriptive privileges of each model and example State.	The level of prescriptive privileges in Florida is up held from a general supervision approach. However, there are guiding protocols that physicians should strictly observe in his or her practice.	The prescriptive authority in this case is more robust compared to that of Arizona but equally the same to that of Florida. The collaborating physician oversights the activities of NP to ensure they are available for consultations.  Alabama and Arizona emphasizes of consultations among the nurses for quality health care while Florida capitalizes of supervisory (Hain & Fleck, 2014).	In Arizona, the protocols only guarantee the welfare and health safety of the patients. On the contrary, the nurses are subject to any supervision or control unless it is consultancy (Hain & Fleck, 2014).
Compare/ Contrast how each model impacts payer status for the NP.	The NP as seen in the Florida is directly under the control of the written protocol. Also, prudent health care providers are treated the same under these protocols.	The NP in Alabama is more of consultations and referrals. The NPs has the privilege to perform the activities off site however this must be accordance with the written protocols (American Medical Association, 2015). Thus, the NPs in this	In Arizona NPs are the primary care providers and their job is to refer patients to physicians and other health care providers in case such a referral will improve patient health and welfare.
Compare/Contrast how these models may impact NP job satisfaction.	Since the NP are in the directly controlled by the written protocol they have a room to synthesize and interpret their decisions and course of action, this provides a room for consultations, referrals, and maintain focus on primary healthcare services focused of patient welfare and health. Thus, NPs are equally motivated compared to Arizona.	The NPs in Alabama are likely to be fairly motivated. This is because their work involves referrals and unprivileged on site activities. Therefore, the onsite supervision, coupled with protocols and excessive oversight is likely to demotivate them.	The NP in Arizona are likely to be highly motivated compared to Alabama and Florida, this is because they are primarily involved in the provision of primary care under direct consultations of other health care providers with a central objective of improving patient’s health and welfare (American Medical Association, 2015).