Maryland Nurse Practitioners Certification and Licensing

  • Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are:

My State practice is Maryland and its licensure laws allows all NPs to practice to the full extent meaning that the NPs evaluate patients; diagnose, order and interpret diagnostic tests (American Association of Nurse Practitioners, 2020).  Besides, APRNs are able toinitiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the Maryland board of nursing (American Association of Nurse Practitioners, 2020).

  • How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?
  • In the state of Maryland, in order to be certified one must complete a Board-approved graduate-level APRN program culminating in a master’s degree or post-master’s certificate before applying for APRN certification in Maryland. Requirements for Maryland education programs for advanced practice registered nurses may be found here (graduatenursingedu.org, 2021)
  • What is your state’s board of nursing website?

https://mbon.maryland.gov/Pages/default.aspx

  • How does your state define the scope of practice of a nurse practitioner?

Maryland nurse practitioners have Full Practice Authority after the passage of the Full Practice Authority Act bill of 2015 signed by the governor in May 12, 2015 (Binner,2015).

This bill allows NPs to practice to the full potential of their education and training. It denotes that NPs are only under the authority of the Board of Nursing, can practice without the supervision of another member of the healthcare team, and do not need an official procedure stating their intention to collaborate with this team.

Moreover, the new bill removes the requirement of the attestation agreement and also allows new graduate NP applicants seeking their initial certification to identify an experienced Maryland certified nurse practitioner or licensed physician to act as a mentor for the first 18 months of practice (Binner,2015)

  • What is included in your state practice agreement?

In the state of Maryland, a nurse practitioner may practice only in the area of specialization in which certified and may independently perform the following functions and not limited to:

  • A comprehensive physical assessment of patients
  • Order, perform, and interpret laboratory and diagnostic tests, order and perform diagnostic, therapeutic, and corrective measures;
  • Prescribe drugs;
  • Provide emergency care
  •  Refer patients to appropriate licensed physicians or other health care providers as needed

Finally, nurse practitioner has a right and obligation to refuse to perform any delegated act, oral or written, if in the nurse practitioner’s judgment, it is unsafe or an invalidly prescribed medical act.

                      How do you get a DEA license?

The obtention of a DEA license in Maryland is done in two steps. First, candidates must apply for a Maryland State Controlled Dangerous Substances Registration (CDS) with the Office of Controlled Substances Administration (OCSA)and once approved, the candidate must then apply for Federal DEA license which requires the state license number (University of Maryland, n.d.)

  • Does your state have a prescription monitoring program (PMP)?

The state of Maryland has a prescription monitoring program which is a core component of Maryland’s comprehensive strategy for reducing prescription drug abuse throughout the State (Maryland.gov, n.d.)

  • 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?

Physician involvement required for NP prescriptive authority for the first 18 months of practice in Maryland. In Maryland, Nps are allowed to prescribe schedule II -schedule IV control substance drug (Maryland.gov, n.d.)

References:

Binner,M.(2015). Maryland nurse practitioner now have full practice authority. What does that mean. Retrieved from

graduatenursingedu.org (2021) Steps to Becoming an APN in Maryland. Retrieved from

https://www.graduatenursingedu.org/maryland/

 Maryland.gov (n.d.) Advanced Practice Registered Nursing: Nurse Practitioners. Retrieved from  https://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx

Maryland.gov (n.d.). Maryland Prescription Drug Monitoring Program.  Retrieved from https://health.maryland.gov/pdmp/Pages/Home.aspx

University of Maryland (n.d.). DEA License Information. Retrieved from https://research.umd.edu/dea-license-info

https://mbon.maryland.gov/Pages/default.aspx

It very encouraging to know as a future NP that Maryland is one of the State which has eliminate  collaborative agreement with physician. I live in NJ and working in NJ as NP require to have joint protocol with a collaborating physician who is licensed in NJ prior to prescribing any medications or medical advice. NJ is not a full practice authority State and the requirement for APN to have joint protocol with physician limit their ability to adequately care for their patients (New Jersey division of consumer affairs, 2021). The collaborative agreement costs employers, physicians and hospitals and the Board of Nursing and Bord of physicians an immeasurable amount of time and money (Maryland Academy of Advanced Practice Clinicians, 2020). Eliminating the collaborative agreement allow for more flexibility with employers to utilize NPs where they are needed throughout organizations without a formal change in writing to be approved by both board. There are severe shortage of primary care provider in Maryland and by removing collaborationg protocol helps those highly qualified NPs to participate in the planning and implementation of health care reform and for increasing access to high quality care.

References:

New Jersey division of consumer affairs (2021). Advanced Practice Nurse Certification. Retrieved from www.njconsumeraffairs.gov

Maryland Practice of Advanced Practice Clinicians (2020). Maryland nurse practitioner fact sheet. Retrieved from www.maapconline.enpnetwork.com

 Unlike Maryland, nurse practitioners practicing in Texas are only allowed to prescribe controlled substances only if working in collaboration with a physician. This arrangement must be outlined in a formal document signed by both the NP and the MD. The collaborative practice agreement should specifically outline the nurse practitioner’s ability to prescribe controlled substances (TBN, 2017). The nurse practitioner in Texas must practice within 75 miles of the supervising physician.  Physicians may not supervise more than four nurse practitioners at one time.  The supervising physician must also randomly review at least 10 percent of the nurse practitioner’s patient charts each month. Furthermore, they may only prescribe a 30-day supply of medications and are not allowed to prescribe schedule 2 drugs such as Lortab or Adderall (Boyle & Mumba, 2018).  All prescriptions written by the nurse practitioner must include the supervising physician’s name, address, DEA number and phone number.  They are, however, able to sign worker’s comp claims and be officially named primary care providers. The scope of practice for nurse practitioners in Texas is limited.  Locking in your first nurse practitioner position in Texas can be difficult. Due to the long licensing process as well as the steps required to obtain prescriptive authority, some employers looking to fill NP positions require that applicants already have active DPS and DEA numbers (TBN, 2013). To further complicate the NP job search, these registration processes cannot be completed without an overseeing physician, so you will need a job before applying for the ability to prescribe controlled substances. Completing the steps to prescribing as a nurse practitioner in the most timely and complete manner possible will help avoid delays in the job search and onboarding process. Nurse practitioners in Texas do not enjoy as many freedoms as NPs in many other states.  In fact, Texas falls at the lower end of the spectrum regarding the freedoms it offers nurse practitioners. 

                                      References  

American Association of Nurse Practitioners. (2020). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

Boyle, M. K., & Mumba, M. N. (2018). Barriers and Facilitators for Implementing the Nurse Practitioners Full Prescriptive Authority: A Systematic Literature Review.

Texas Board of Nursing. (2013). Obtaining a DEA Number. Retrieved December 4, 2021 from: https://www.bon.texas.gov/applications_obtaining_dea_number.asp.

Texas Board of Nursing. (2017). Texas administrative code: Standards of nursing practice.  http://www.bon.texas.gov/rr_current/217-11.asp

I am excited to learn that Maryland is among the states that gives full practice authority to NP to practice to t the full extent of their education and abilities. Full prescription authority will promote the delivery of efficient and high-quality care to patients. In contrast, Virginia still has restrictive requirement that restrict the nurse practitioner scope of practice, for instance, an NP in VA may not be able to diagnose and treat mental health patient without a collaborative agreement with a license psychiatrist (ANA, 2020). The good news is that nurse practitioners in VA can be granted full practice authority after completing 9000 hours of experience from a license psychiatrist. Currently in the US there is a growing demand to remove all barriers to full practice authority considering the shortage of physician in the medical industry. Promoting the scope of practice of NPs may be an attractive solution to the primary care workforce shortage because they require lower pay and can be trained more quickly and at lower cost than physicians. (Zakhari,2021). A major initiative of the ANA is to protect and advance the scope of practice of NP across the country.  In addition, a recent National Governors Association report recommended that states consider liberalizing state NP scope of practice laws to allow more autonomy in the practice as a way to help meet the growing demand for primary care services (Zakhari,2021). Thanks for contributing such an informative post.

References

American Association of Nurse Practitioners (2020). State practice environment.  https://www.aanp.org/advocacy/state/state-practice-environment#:~:text=State%20practice%20and%20licensure%20laws,the%20state%20board%20of%20nursing.

Delaney, K. R., Drew, B. L., & Rushton, A. (2019). Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey. Journal of the American Psychiatric Nurses Association25(2), 146–155. https://doi.org/10.1177/1078390318777873

Lowe, G., Plummer, V., O’Brien, A. P., & Boyd, L. (2012). Time to clarify–the value of advanced practice nursing roles in health care. Journal of advanced nursing68(3), 677-685.

Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.  

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