- Discuss your state NP community in terms of scope of practice. Include your state’s scope of practice for NPs, including: level of independence of practice, prescribing authority, any limitations of practice, process for obtaining licensure in your state, certification and education requirements for licensure.
As per section 394.455(35) of the Florida Statutes (F.S.), the term “Psychiatric nurse” refers to an advanced practice registered nurse certified under section 464.012. This individual must hold a master’s or doctoral degree in psychiatric nursing, possess national certification as a psychiatric mental health advanced practice nurse, and have at least two years of clinical experience post-master’s degree while working under a physician’s supervision (Florida Board of Nursing, 2019). Advanced Nurse Practitioners (ANPs) can practice independently within certain parameters, which primarily involve Scope of Practice Restrictions and Collaborative Practice Agreements. Scope of Practice Restrictions, prevalent in states like Florida, may limit ANPs’ ability to provide certain types of care or prescribe medications without oversight from physicians. Furthermore, Collaborative Practice Agreements, required by many states, impose administrative burdens and restrict ANPs’ autonomy (Florida Board of Nursing, 2019). For example, in Florida, Nurse Practitioners (NPs) are mandated to have collaborative agreements with supervising physicians, presenting challenges, especially in rural areas where finding collaborating physicians can be challenging. Shortages of collaborating physicians, exacerbated by factors such as rural locations, low reimbursement rates, or high demand for physician services, further compound this issue. Florida operates under a restricted practice model for NPs, as of the latest update in September 2021. This model necessitates that NPs work under physician supervision and maintain collaborative practice agreements with supervising physicians. Regarding prescribing authority for NPs in Florida, they have the authority to prescribe medications, including controlled substances, but must adhere to state regulations and the guidelines outlined in their collaborative practice agreements with supervising physicians. The specific privileges and limitations on prescribing may vary depending on the agreement between the NP and their collaborating physician. A Drug Enforcement Administration (DEA) number is necessary for writing prescriptions (Diversion Control Division | Welcome, 2024).
2.If you live in a restricted or reduced practice state, how has patient care been impacted in your local community by these barriers? For instance, is the ED used for primary care? Are the EDs overcrowded with long wait times? Are there urgent care clinics readily available? Is there adequate access to primary care? If you live in a full practice, how has an independent practice of the APN resulted in improved patient access to healthcare?
Living in Broward County, Florida, boasts a diverse population encompassing various socioeconomic backgrounds. Previous research indicates that disparities in race, gender, and income level contribute to the improper utilization of emergency departments. Studies have shown that women tend to have higher rates of non-emergent ED visits compared to men, whereas men exhibit higher rates of emergent primary care-treatable and emergent preventable visits (Williams & Haffizulla, 2021). In an effort to enhance access to primary care, Ambetter from Sunshine Health, a product provided by wholly owned subsidiaries of Centene Corporation (NYSE: CNC), serving under-insured and uninsured individuals through the federal Health Insurance Marketplace, and Broward Health, recognized as one of the nation’s top 10 largest public health systems, have announced a collaborative agreement aimed at bolstering healthcare accessibility in Broward County (Dow Jones Institutional. 2023). To alleviate the strain of ED overutilization on the healthcare system, it is imperative for healthcare providers to educate at-risk populations on appropriate ED utilization (Williams & Haffizulla, 2021). Granting nurse practitioners greater autonomy in practice can contribute to reducing the burden on EDs. Through this partnership, a broader segment of the population will gain access to Broward Health’s innovative and top-quality care, available at its five hospitals and over 50 locations (Dow Jones Institutional. 2023). This collaboration promises to significantly enhance access to care for individuals who would otherwise struggle to obtain it.
3.How does access to NPs impact any healthcare disparities?
Access to nurse practitioners (NPs) profoundly influences healthcare disparities. With improved access to primary care through NPs, essential services such as preventive care, health education, and management of chronic conditions are readily available. Their presence addresses the scarcity of primary care physicians in underserved areas, enhancing healthcare accessibility for residents who might otherwise confront barriers due to geographical distance or inadequate provider availability (Williams & Haffizulla, 2021). Furthermore, NPs contribute cultural competency and language proficiency, bridging communication gaps between healthcare providers and patients from minority backgrounds. This fosters better health outcomes by ensuring culturally sensitive care aligned with patients’ beliefs, practices, and linguistic preferences. NPs also adopt a holistic care approach, considering not just physical health but also mental, emotional, and social factors impacting well-being. This comprehensive approach proves especially beneficial for populations grappling with multiple healthcare disparities, such as individuals experiencing homelessness or those managing co-occurring mental health and substance use disorders (Denisco, 2015). Moreover, NPs play an important role in health promotion and disease prevention within communities. Through screenings, vaccinations, and health education initiatives, they mitigate the onset of chronic diseases and advocate for healthier lifestyles, particularly among populations with limited access to healthcare resources.
References
Denisco, S. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Jones & Bartlett Learning.
Diversion Control Division | Welcome. (2024). Deadiversion.usdoj.gov. https://deadiversion.usdoj.gov/index.html
Dow Jones Institutional. (2023, Dec 07). Ambetter from Sunshine Health and Broward Health Enter New Partnership to Provide Better Access to Healthcare for Floridians in Broward County. [Press Release]. https://chamberlainuniversity.idm.oclc.org/login?qurl=https%3A%2F%2Fwww.proquest.cLinks to an external site. om%2Fwire-feeds%2Fpress-release-ambetter-sunshine-health- broward%2Fdocview%2F2899411915%2Fse-2%3Faccountid%3D147674
Florida Board of Nursing. (2019). Florida Board of Nursing – Licensing, Renewals & Information. Floridasnursing.gov. https://floridasnursing.gov/
Williams, C. A., & Haffizulla, F. (2021). Factors associated with avoidable emergency department visits in Broward County, Florida. Cureus, 13(6). https://doi.org/10.7759/cureus.15593
