Discussion Response

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#1

Advanced Practice Registered Nurses (ARNPs) can have a variety of roles in Iowa. The need to be registered in Iowa to practice in an advanced role. NPs have full independent practice authority. An NP means a nurse with current licensure as a registered nurse in Iowa or who is licensed in another state and recognized for licensure in this state pursuant to the nurse licensure compact. The ARNP is prepared for an advanced role by virtue of additional knowledge and skills gained through a formal advanced practice education program of nursing in a specialty area approved by the board. In the advanced role, the nurse practices nursing assessment, intervention, and management within the boundaries of the nurse-client relationship. Advanced nursing practice occurs in a variety of settings, within an interdisciplinary health care team, which provide for consultation, collaborative management, or referral (www.scopeofpracticepolicy.org 2020). The ARNPs may prescribe drugs as well as narcotics as long as they are registered with the U.S. Drug Enforcement Administration and the Iowa Board of Pharmacy (www.scopeofpracticepolicy.org 2020).  They are also recognized as primary care providers. Just in my town alone, there are several ARNPs that practice in different settings. They are allowed to practice independently in the hospitals, there, they are called hospitalists. They take a full patient load and are the patient’s primary doctor while in the hospital. There are several at clinics and doctor’s offices. Same there, they can practice independently as well. There is also a Veterans clinic in town and that is run by ARNPs, with their main hub in South Dakota. At all of these places, they are able to practice independently as well as prescribe drugs.  
U.S. rural areas have experienced shortages of primary care providers. Nurse practitioners (NPs) are helping to reduce that shortage. However, NP scope of practice regulations varies from state-to-state ranging from autonomous practice to direct physician oversight (www.ncbi.nlm.nih.gov, 2018). Recruiting ARNPs and expanding their scope of practice to include providing diagnoses, prescriptions, treatments, consultations and other services could shift some of the healthcare burdens away from physicians. ARNPs functioning at the level for which they are prepared could help to improve healthcare access disparities in areas with severe physician shortages such as rural areas, where shortages have persisted and are anticipated for the foreseeable future (www.ncbi.nlm.nih.gov. 2018). Maybe the rural areas do not have enough funding for physicians and ARNPs. This is where the advocate could find some funding, talk with whoever will listen, get in contact with the state and federal government for funding. Not saying that the ARNPs know more than the physicians, but it seems that they listen to the patient more and try to find all areas to get the best outcome.
https://www.scopeofpracticepolicy.org 2020. NCLS. Iowa scope of practice policy – State profile.

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#2

In the state of Ohio, the Board of Nursing grants APRNs full authority to practice and regulate their practice. The APRN must practice under a physician. The state of Ohio requires a Standard Care Arrangement between a physician or a podiatrist and the CNP, CNS, CNM, and CRNA (Phillips, 2021). Mental health CNPs and CNSs may only enter a Standard care Arrangement with physicians practicing in psychiatry, pediatrics, or family practice/primary care.
APRNs in the state of Ohio do have the ability to prescribe medications, including controlled substances such as Morphine and Valium. There are guidelines that the APRN must complete and be approved. A 45-hour course within the last five years in advanced pharmacology that includes the legal ethical and fiscal implications of prescribing in Ohio as well as specific instruction related to schedule II-controlled substances, (http://www.ohioaprn.com/prescriptive-authority.html)
In September of 2018, OH State Representative Theresa Gavarone a republican from Bowling Green introduced House Bill 726, “Better Access, Better Care Act”. Gavarone was in support of APRNs to practice independently in the state of Ohio without the Standard Care Arrangement with the physician. Gavarone states, “In no way does the retirement of the Standard Care Arrangement (SCA) preclude voluntary professional collaboration among healthcare providers.  This is another step forward to improve Ohioan’s access to quality healthcare”, (oaapn, 2018).
 
There are many rural areas in the state of Ohio, and this makes it difficult for patients to see their physicians. With APRNs being restricted to contract under a physician this limits care to those rural areas. I work with the Amish community and there was one physician that would go to the homes, when she retired the Amish Community had to find a new physician. Many of them did not go to the home for visits, the patients had to travel over 30 miles for care. When I was able to find a visiting CNP, they did not come to those areas. If APRNs were able to work autonomously the patient’s in the rural areas would have access to better care.
 
Rep. Gavarone is the vice chair of the Ohio House Health Committee that has rejected this bill in the past. There are physicians who are very opposed to House Bill 726. An article written in 2018 opposing House Bill 726 were urged to contact their legislators with their disapproval. Rep. Gavarone wants better access to rural areas. The author of this article states “APRNs would have you believe that HB 726 is about access to care and that if passed, APRNs will flock to underserved areas to provide primary care. The truth is there is nothing, under current standard care arrangements, preventing an APRN from going to a rural community right now. Only 12% of APRNs practice in out-patient settings. Most APRNs are practicing in sub-specialties, not primary care; only an estimated 30% to 35% of APRNs practice primary care,” (Ohio Academy of Family Physicians, 2018). The author believes that this is unsafe and unnecessary practice and the roles of a physician and a nurse are not interchangeable.
House Bill 726 was introduced in the fall of 2018, and after 18 months was defeated. The Ohio State Medical Association called upon their members to contact their elected officials to oppose HB 726. Physicians from all over the state step forward to prevent this bill from passing. The OSMA predicts that the issue will be reintroduced. this year.
 
Phillips, S. (2021). 33rd Annual APRN Legislative Update: Unprecedented changes to APRN practice authority in unprecedented times. The
Nurse Practitioner, 2021 – journals.lww.comOhio
APRNs (2021). The authority to prescribe medications and therapeutic devices. http://www.ohioaprn.com/prescriptive-authority.html
Oaapn, (2018). Contact Legislators Today; Oppose APRN Independent Practice Legislation. APRNs, HB 726.