I would like to start this post with a caveat. Since I have worked as an RN and mentored PMHNP’s, I have noticed that many statutory regulations, aside from licensure, seem to be on paper only. From my observations, the most defining feature of the scope of practice as a PMHNP in Virginia is the level of trust and confidence between the supervising physician and the nurse practitioner.
Virginia is unique because the APRNs are governed by the Board of Medicine and the Board of Nursing. This is because APRNs are uniquely categorized as “practitioners.” The first APRN regulation of note is that Virginia is not an independent practice state for APRNs. In Virginia, a nurse practitioner must be under direct supervision or have a practice agreement with a physician. Physicians can only have six nurse practitioners under their practice authority. However, a nurse practitioner may apply for a license to practice independently after two years, or 1800 hours per year for two years (Virginia Board of Medicine, 2020).
To apply for a DEA number for controlled substances, the nurse practitioner must have a license in this state and a valid active practice agreement with the physician that includes the level of scheduled medication (Department of Justice, 2021.) Given the complexities and the wait times involved in applying for this and other licensures, many of my friends who have recently graduated choose to work for either the Veterans Administration or another state agency. While the application must ultimately be approved, you’re able to start practicing after you have submitted all the required paperwork for these positions with the federal and state government.
The second APRN regulation of note is Part VII regarding the prescriptive authority of APRNs. This regulation details the steps that an APRN must take to provide an opioid replacement. The western part of Virginia is very similar to West Virginia, which has had an ongoing opioid abuse crisis. This regulation is significant for psychiatric nurse practitioners in the western part of the state. Many psychiatrists are focused on the more acute mentally ill, and the nurse practitioners are left to cover outpatient and addiction services (Virginia Board of Nursing, 2018).
Maryland grants the ability to practice independently and has the nurse practitioner enter into a mentoring agreement with a physician for 18 months (State of Maryland, 2020). This is somewhat of a supervisory period, states such as New York also do the same. In Virginia, nurse practitioners are not granted autonomy and may apply for it after two years.
APRNs may adhere to the regulations listed in a variety of ways, many in the DC metro area have licenses in DC and Maryland. Maryland, Virginia, West Virginia, and Washington DC have very interconnected healthcare systems. The system set up in Maryland, where APRNs are independent but are supervised for the first eighteen months of practice, makes a lot more sense. This seems to be a compromise having the APRN be independent but supervised for a period of time.
Department of Justice. (2021.). Application for Registration Under Controlled Substances Act of 1970. CSA registration tools: Login. Retrieved November 28, 2021, from https://apps.deadiversion.usdoj.gov/webforms2/spring/main?execution=e1s1.
Virginia Board of Medicine. (2020) Virginia Board of Medicine Laws and Regulations. Virginia Board of Medicine – Laws and Regulations. https://www.dhp.virginia.gov/medicine/medicine_laws_regs.htm.
Virginia Board of Nursing. (2018). Laws and Regulations. Virginia Board of Nursing. https://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/LawsRegulations/.
State of Maryland. (2020). Maryland Information and Resources for NPs. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/maryland.
Each state has a board that regulates its APRNs. Like you have stated, APRNs in Virginia are regulated by the Board of Medicine and the Board of Nursing in Virginia. I am surprised to learn that Virginia is not an independent practice state (Bowling et al., 2018). The fact that nurse practitioners in Virginia must be supervised by a physician or have a practice agreement with a physician means that they can not operate independently. As you have stated, this is different for Maryland, where I live, where nurse practitioners can work independently if they sign a mentoring arrangement with a doctor for 18 months. The case where APRNs in the D.C metro region can practice both in D.C, and Maryland increases their opportunities (Evans, 2020). I feel that more states should employ this strategy so as not to limit nurses in terms of geographical areas where they can work.
Bowling, A. M., Cooper, R., Kellish, A., Kubin, L., & Smith, T. (2018). No evidence to support number of clinical hours necessary for nursing competency. Journal of Pediatric Nursing, 39, 27-36.
Evans, K. E. (2020). Executive Director’s Letter of the Maryland Board of Nursing to the Maryland Higher Education Commission Regarding COVID-19 dated March 16, 2020.
One can imagine that safety first is at the core of the decision to have APRNs practice for a period of time to allow practitioners to gain clinical experience which can improved patient outcomes. There are nurses in West Virginia who are working tirelessly and are lobbying lawmakers to assist with passage of full practice authority for APRNs. I support the idea of having an APRN be supervised by a doctor for a short period of time for the sake of patient safety. However, having to be credentialed by two regulatory boards can hinder the NP in many ways, such as having to submit applications and credentialing documents to multiple agencies Two West Virginia nursing leaders win AANP awards (2021).
In New Mexico where I currently reside. APRNs are certified through the board of nursing and PMHNPs are granted the authority to supervise psychologists who wish to prescribe. However, the Board will discipline providers of malpractice. Tate, (2019) writes that although it took time to build an independent practice in West Virginia she was able to grow her practice to where she was able to make a profit and hire other medical and nursing staff. This article showed that although the NP has to be credentialed by multiple agencies and be supervised by doctors, the opportunity to grow and be financially stable is still an attainable goal.
Tate, Teresa, MSN,A.P.R.N., F.N.P.-B.C. (2019). My journey to anchor medical, LLC. West Virginia Nurse, 22(4), 7. Retrieved from https://www.proquest.com/trade-journals/my-journey-anchor- medical-llc/docview/2311878660/se-2?
Two west virginia nursing leaders win AANP awards. (2021). West Virginia Nurse, 24(4), 14. Retrieved from https://www.proquest.com/trade-journals/two-west-virginia-nursing-leaders-win- aanp- awards/docview/2586560502/se-2?accountid=14872
WVNA legislative and policy leaders. (2020). West Virginia Nurse, 23(1), 12. Retrieved from https://www.proquest.com/trade-journals/wvna-legislative-policy- leaders/docview/2343664803/se-2?accountid=14872
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