Certification and Licensure Plan
The nursing profession involves making a difference in society through health promotion, disease prevention, and the provision of information on how to cope with illnesses. The process of actualizing nursing goals involves completing several steps from nursing education to nursing licensure. Every state in the United States has a different list of nursing licensure requirements. A nursing plan should include an in-depth analysis of the scope of practice and the prescription monitoring program (PMP), among several others. Thus, the paper provides a personal certification and licensure plan in Massachusetts, including the application process, the definition of the scope of practice, the prescription of controlled substances, the PMP, and the process for procuring a DEA license.
Scope of Practice
Nurse Practitioners refer to nurses that provide health care services to people throughout their life. They provide a wide variety of services that include but are not limited to counseling services, disease prevention, health promotion, diagnosis and management of diseases, and health education. NPs provide care to patients in different healthcare settings such as nursing facilities, at home, in hospitals, or ambulatory care settings that include public health clinics (Buppert, 2021). The scope of practice is understood best under three policies: practice authority, prescriptive authority, and the identification of NPs as primary care providers. Additionally, state laws allow NPs to sign death certificates in an event where reasonable attempts have been made to contact a supervising physician without success (Buppert, 2021). They can also sign handicap parking permits for disabled patients. An overview of the scope of practice of NPs in Massachusetts is that it is less restrictive but not as extensive as those in other states in the country.
Prescriptive Authority and Supervision
Supervision and prescriptive authority are the primary concern for NPs across the U.S. For a long period, NPs in Massachusetts were required to have specific physician supervision to meet the statutory prescriptive requisites. The state also allowed NPs to hold their independent license to practice and is held liable for their practice so long as one works with a designated physician. NPs in Massachusetts are allowed to expand their scope of practice since they are not required to work under the supervision of a physician. The only difference existed when prescribing where they were required to have a collaborative practice agreement with a physician. The physician was not required to be on-site during a consultation, which means NPs can practice to their full potential. However, the onset of the coronavirus pandemic forced the state to reverse its rules. It is recognized as one of the few states that have provided NPs with prescription authority without a physician to help provide care during the pandemic. The new mandate was signed into law legislation by Governor Charlie Baker (Japsen, 2021). The permanent mandate provides NPs with the authority to provide care while expanding the scope of practice for NPs. Nonetheless, NPs in Massachusetts experience prescription limitations. The state requires that a physician should supervise prescription practices (Staff Writers, 2021). NPs are prohibited from scheduling class II drugs to family members unless it is an emergency. They are also prohibited from self-prescribing several medications, including schedule II, III, and IV drugs.
Nurse Practitioner Certification and Licensing in Massachusetts
Nursing students in Massachusetts must achieve specific requirements before they acquire certification. The requirement involves education requirements. The initial step involves acquiring a nursing registration to practice nursing in the state of Massachusetts. The registration process includes completing a bachelor’s degree in nursing followed by an NCLEX examination (Advanced practice registered nurse requirements in Massachusetts, n.d.). For nurses who hold a valid RN license from another state, an individual must apply for a nursing license in Massachusetts. The second step involves the completion of a graduate program
A prospective NP in the state must complete a nursing program in the intended category. An important aspect to consider is that an accrediting agency in the state must accredit the program. For advanced practice nurses, a nurse needs to have advanced coursework in pharmacotherapeutics, assessment, and pathophysiology. Secondly, certification requirements in Massachusetts are unique. NP must acquire certification via agencies that are recognized by the Massachusetts Board of Registration in nursing. The board is responsible for protecting Massachusetts citizens’ welfare, health, and safety through the consistent application of regulations and statutes governing nursing education and practice. The agencies must achieve the standards of the board rules described under section 4.02. Each specialty has a specific board that oversees the certification of an NP. NPs should acquire certification from the American Academy of Nurse Practitioners (AANP), the American Association of Critical-Care Nurses (AACN), Pediatric Nursing Certification Board (PNCB), or National Certification Corporation (NCC). Thus, NPs must acquire the proper certification to practice in Massachusetts.
Every NP in the state must comprehend the application process to facilitate the acquisition of the proper certification. All authorization materials are provided by the Massachusetts Board through the Professional Credential Services Inc. (PCS). Consequentially, NPs can acquire certification application forms through the PCS website. The process also includes presenting the official transcripts that must be sent to PCS from the issuing institution. For nurses that were previously licensed in another state, they need to incorporate their license verification, while those that have been credentialed must provide proof of their verification status (Advanced practice registered nurse requirements in Massachusetts, n.d.). The state allows NPs to apply for NP authorization and reciprocity so long as the licensing process should be complete before being provided with NP authorization. Notably, nurses need to understand state statutes and regulations before applying to ensure they meet all the criteria. For instance, every NP should recognize that the application fee is $150. Another important fact is to consider is that the state allows NPs to renew their licensing early if they are near the renewal cycle. It is essential to note this since the state, under PCS rules, cannot issue NP authorization when the license is expiring within ninety days (Advanced practice registered nurse requirements in Massachusetts, n.d.). A section of the PCS website asks questions concerning having a Good Moral Character (GMC). Applicants that provide an affirmative answer must send supporting documentation to the Massachusetts Board directly. Nurses can exclude the GMC part since it is only completed after the application.
Barriers to Independent NP Practice in Massachusetts
Several factors affect the independent NP practice among nurses. For a long period, state licensure and practice prevented NPs from full practice in Massachusetts. Nonetheless, the new law allows them to work without physician supervision. The second set of barriers often involve physician-related issues. Several physician professional organizations in the U.S., such as the American Medical Association, function under the assumption that since physicians undergo a more rigorous and more prolonged medical training, NPs are less capable of offering quality care in the same degree and manner as physicians. Such perspectives might impede the relationships between NPs and physicians, which can hinder the provision of quality care. On numerous occasions, healthcare professionals and physicians often lack knowledge concerning NP’s scope of practice. The problem in Massachusetts is more likely to occur given that NPs have currently received the mandate to operate independently. Although NPs and physicians have similar work goals, a lack of collaboration still exists. Secondly, some institutions follow the traditional medical hierarchal model that acts as a barrier to providing care. The model is less likely to suffice in the future due to the growing aging population and NP shortages. Thus, a lack of knowledge about the role of NPs hinders their ability to deliver care.
Additionally, NPs are more likely to experience barriers to practice because of a lack of support and resistance among physicians and patients. Primary care physicians are more likely to have mixed responses concerning the new legislation. While some will be willing to invite the new mandate, others will reject the expansion of NP roles despite the state’s significant shortage of care providers. The rejection will often involve the assumption that NPs should not be allowed to lead medical homes or receive equal pay are primary care physicians. Moreover, patients are increasingly showing their confidence in working with NPs. However, the increased patient satisfaction does not mean that they prefer nurse practitioners to doctors (Poghosyan, 2018). Mixed reactions about NP practice can hinder their ability to provide care, especially when patients disregard their medical abilities and knowledge. Thus, rejection from primary care physicians and patients might impact NP’s ability to practice independently.
Furthermore, payer policies can impede the abilities of NPs to practice to their full extent of nursing training and licensure. Despite the new law that allows NPs to practice independently, they still experience problems associated with their practice. The initial problem is often associated with reimbursements at a lower rate compared to physicians performing similar operations. Patients and companies often assume that payment should be consistent with the extent of the study period. Consequentially, they assume that physicians should be provided with higher reimbursements than nurses since they undergo lengthier study periods. Secondly, the barriers to care involve some private and public payers that refuse to recognize the new law by denying NPs with direct billing (Poghosyan & Carthon, 2017). Such entities require NPs to bill ‘incident to’ the address of a physician. It means that billing can only be done under the name of a physician. Limiting NPs’ access to funds hinders them from practicing to their full extent. Thus, NPs in Massachusetts are more likely to experience payer policy problems when delivering care.
Transitioning from a nursing student to a nurse practitioner involves completing several steps and acquiring knowledge about the scope of nursing. In Massachusetts, NPs must have completed their undergraduate and graduate programs. They have to follow a set of guidelines and present several verification documents to facilitate the acquisition of state licenses and certification. Massachusetts is among the few states that have provided NPs with the ability to practice independently. It is surprising that despite the new scope of practice mandate, nursing practitioners are still likely to experience several barriers ranging from payer policies to physician-related issues. Therefore, NPs in Massachusetts should be aware of these barriers to practice and identify ways to resolve them.
Advanced practice registered nurse requirements in Massachusetts. (n.d.). Nursing Licensure.org. https://www.nursinglicensure.org/np-state/massachusetts-nurse-practitioner/
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
Japsen, B. (2021, January 4). Massachusetts latest to lift hurdle to nurse practitioners as COVID-19 rages. Forbes. https://www.forbes.com/sites/brucejapsen/2021/01/04/massachusetts-latest-to-lift-hurdle-to-nurse-practitioners-as-covid-19-rages/?sh=6d7ccbab600f
Poghosyan, L. (2018). Federal, State, and Organizational Barriers Affecting Nurse Practitioner Workforce and Practice. Nursing Economics,36(1), 43. https://link.gale.com/apps/doc/A529490142/AONE?u=anon~25a9370&sid=googleScholar&xid=d186e3e8
Poghosyan, L., & Carthon, J. M. B. (2017). The Untapped Potential of the Nurse Practitioner Workforce in Reducing Health Disparities. Policy, Politics & Nursing Practice, 18(2), 84-94. https://doi.org/10.1177/1527154417721189
Staff Writers. (2021, August 4). Massachusetts NPs: The fight for full practice authority. Nurse Practitioner Schools. https://www.nursepractitionerschools.com/practice-authority/massachusetts/
The scope of practice of APRNs in Massachusetts was very informative. You revealed the various requirements that an APRN would need to meet in order to be certified and licensed in the state. In MA, the APRN can provide care to patients, but cannot practice with full authority. This makes it difficult for the group to provide full autonomy to their patients. The APRN in MA can provide care to patients in collaboration with a physician. However, the state has the strictest practice setting in the country and cannot allow it to practice with full authority. Full practice authority for APRNs provides many advantages for communities. One of these is increased access to health care. APRNs, it give patients the option to obtain high-quality health care.
Dubree, M., Jones, P., Kapu, A., & Parmley, C. L. (2015). APRN practice: Challenges, empowerment, and outcomes. Nurse Leader, 13(2), 43–49. https://doiorg.ezp.waldenulibrary.org/10.1016/j.mnl.2015.01.007.
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