Maryland Certification and Licensure Plan

Summary Findings Based on Questions

The State of Maryland assumes a distinctive modus operandi for nurse practitioners (NPs). The state’s practice agreement delineates the full practice authority bestowed on the professionals. NPs are mandated to assess patients, diagnose, order, and construe diagnostic tests. The professionals are equally authorized to initiate and manage treatments inclusive of prescribing drugs and controlled substances. Nonetheless, this is contingent on licensure by the state board of nursing (AANP, 2021). With full prescriptive authority, the State of Maryland does not necessitate physician collaboration or supervision. According to Kaplan (2015), the requirements got abolished in 2010. Currently, independents NPs are mandated to open their practices. Getting certified and licensed as an APRN in Maryland requires one to wield at least a master’s degree.

The state’s nursing board necessitates one undergo certification in their area of specialty by any of the recommended or approved national credentialing establishments. Usually, it will differ by specialty, with some advanced roles considered broad and encompassing a range of conceivable sub-specialties. Registered nurses (RNs) can obtain certification and licensure by undertaking the NCLEX exam in their home state. The Maryland Board of Nursing relies on numerous regulations like § 8-301 requiring an RN to hold a license only in one-party state at a time and §8-304 necessitating satisfactory proof of the primary region of residence being Maryland. Additionally, certification and licensure may be through an endorsement process for those that have taken the NCLEX exam and are licensed in another state. Nonetheless, verification of identity is mandatory. A license or certificate must have a social security number for certification (Maryland.gov., 2021). Some of this information is enshrined in the State Maryland Board of Nursing website at https://mbon.maryland.gov/Pages/default.aspx.

In the state, NPs scope of practice gets delineated as independent of a physician. This extends to independently assessing, diagnosing, and treating patients free of supervision. These field prerequisites and guidelines that establish NPs’ working relationships are enshrined in the state practice agreement. In getting a DEA license, the nursing board requires all licensed providers to register with the prescription drug monitoring program before acquiring a new or renewing CDS registration. The state wields a Prescription Drug Monitoring Program (PDMP) that augments providers’ ability to manage the advantages and dangers of controlled substances regimens. Importantly, NPs have the power to recommend schedule II-V substances autonomously.

Regulation and Barriers

As the state of Maryland wields full prescriptive authority, there are no restrictive regulations for practice. However, barriers exist with the scope of practice. Peterson (2017) noted that archaic hospital laws still limit nurses’ full-scope practice. In some establishments, NPs from Maryland can find a host of restrictions when relocating to other states. Also, NPs are perceived as underqualified to provide full extent and quality of care that may present challenges for the professionals adapting to their work milieus. Lastly, some physicians and patients sometimes get concerned regarding the education and training level of NPs. The risk of undertrained and under-qualified NPs offering services to patients gets met with opposition.

What Surprised Me

In the context of Maryland, NPs have fewer limitations and barriers to service provision. However, full prescriptive power has its shortcomings that are not addressed. Surprisingly, only a few pieces of literature explore the ramifications of full practice authority. The observation is concerning considering oversight of a fully qualified physician lessens the risks of complications and consequent liabilities. For instance, an inadequately trained NP prescribing wrong drugs or offering insufficient medical care is critical to patient safety. Equally surprising was the realization that despite getting full practice authority, most NPs remain adamant about venturing into their practice and becoming independent business owners. I noted that the hesitancy gets linked to corporate costs that act as a barrier to scale up NP-led undertakings.

References

American Association of Nurse Practitioners (AANP). (2021, August 4). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

Kaplan L. (2015). Maryland’s nurse practitioner full practice authority act of 2015. The Nurse Practitioner, 40(5), 8. https://doi.org/10.1097/01.NPR.0000461956.53786.5b

Maryland.gov. (2021, April 30). Licensure by exam.  https://mbon.maryland.gov/Pages/licensure-by-exam.aspx

Peterson, M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74-81. DOI: 10.6004/jadpro.2017.8.1.6

It becomes a concern after completing this course then the qualified practitioners’ scope of practice becomes an impediment their practice. To make matters worse, Nurse practitioners with the same educational preparation and national certification may face a host of restrictions when relocating from one state to another, thus limiting their scope of practice (Safriet, 2011). That is why it is important for aspiring nurse practitioners to research on their field of choice before starting school. It does appear that restrictive laws could, in some states, force NPs to pay a significant share of practice revenues to their collaborating physicians (Peterson, 2017). Thank you for your post Kelly.

References

Safriet B J. The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.; 2011. Federal options for maximizing value of advanced practice nurses in providing quality, cost-effective health care.

Peterson M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

This is useful information since I’m interested in relocating but, I’m torn between Maryland and California. With the different states come different regulations for the nurse practitioner with California being a restricted practice state (AANP, 2020). I like the fact that in Maryland the nurse practitioner has full prescriptive authority and there’s no restriction for practice (AANP, 2020) is appealing to me as I’m interested at some point in having my own practice. Although, in the House bill, HB0999 there is an amendment that state new graduates are to have a mentor for their first year of practice (Kaplan, 2015) the nurse practitioner can use this time to gain more knowledge and experience.

References

American Association of Nurse Practitioners. (2020).

 http://www.aanp.org/advocacy/state/state-practice-environment

Kaplan, Louise PhD, ARNP, FNP-BC, FAANP, FAAN Maryland’s Nurse Practitioner Full Practice Authority Act of 2015, The Nurse Practitioner: May 15, 2015 – Volume        40 – Issue 5 – p 8 http://doi:10.1097/01.NPR.0000461956.53786.5b

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