You are also expected to respond to at least two of your peers' original posts !!! Peer 1 discussion: 1. Briefly discuss your state nursing board’s regulation on prescriptive authority and how it...

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You are also expected to respond to at least two of your peers' original posts !!! Peer 1 discussion: 1. Briefly discuss your state nursing board’s regulation on prescriptive authority and how it aligns with the four IOM recommendations of 2011. In the state of Texas, APRNs are able to have prescriptive authority but it must be delegated by a physician (Texas Board of Nursing, 2019). In relation to the IOM recommendations, as APRNs we are technically practicing to an extent of our education but depending on the physician who delegates the authority, the APRN could be restricted in what they could prescribe and therefore can not practice to the full extent (IOM, 2011). I find this very strange in that you could potentially have varying practice of APRNs in the same state. This also could be seen less as a collaborative effort between physicians and APRNs since it is a delegation which goes against the third key point in which nurses should be “full partners” (IOM, 2011).   2. Identify and describe the barriers in your particular state that impede the APRN’s full scope of practice, and why. The barriers that impede a full scope of practice in Texas are the need for physician oversight and also delegation of prescriptive authority. Per the Texas Board of Nursing, "The advanced nurse practitioner acts independently and/or in collaboration with the health team in the observation, assessment, diagnosis, intervention, evaluation, rehabilitation, care and counsel, and health teachings of persons who are ill, injured or infirm, or experiencing changes in normal health processes; and in the promotion and maintenance of health or prevention of illness..." (21 Texas Administrative Code 221.13). As stated above, the need for delegation and physician supervision is not in line with collaboration of healthcare providers or APRNs acting independently per our scope of practice. 3. As a future APRN, what recommendations would you have for improving healthcare access in your state’s rural community with regards to prescriptive authority restrictions? Rural communities suffer the most when limiting the practice of APRNs. Expanding healthcare access by having more primary care providers available such as nurse practitioners and nurse midwives will not only ensure enough providers are available, but it also gives the rural population choices on the type of provider. Many rural hospitals have trouble with staff recruitment, retention, and increasing costs leaving the community having to travel for healthcare. A group in Australia used an on-call after-hours service they termed an NP locum (Jennings et al, 2021). The service is available from Friday evening until Monday morning and serves the rural community for any level of triage and supports the local residential facilities along with patients admitted to acute medical surgical wards. This may be one model we could use to help develop new and better ways to serve these communities. 4. Finally, discuss the following: “Do all APRNs need hospital privileges? Why or why not? This is a very hard question and I believe my answer would change depending on where I practice. I believe that APRNs serving rural communities absolutely need hospital admitting privileges but with that being said, as a family nurse practitioner I believe acute care is out of my scope of practice. As a family nurse practitioner I believe as a primary care provider I should be allowed to have associate privileges which allow reviewing the chart and other records but do not think that writing orders is warranted (Buppert, 2021). Peer #2 1. Briefly discuss your state nursing board’s regulation on prescriptive authority and how it aligns with the four IOM recommendations of 2011. As we all know Texas is not a full practice authority state. Texas is a restricted state. The four IOM recommendations were made to better the nursing field and bring awareness of issues that need to be addressed in our country. Although Texas is so far advanced in many things in this state, we are so behind in the practice of Nurse Practitioners. One of the four IOMs that we are not in compliant with is the need for nurses to practice to the full extent of their education (Future of Nursing). In order for nurse practitioner students to graduate they must have the full extent of prescribing medications. However, Texas does not recognize that ability in real life practice. Texas does not allow schedule two drugs as well (TNP). This poses all sorts of issues but of them are the mental health patients, cancer patients, and those with chronic diseases needing pain medication. Delays can cause increase stays in hospitals and this can increase costs (TNP).  2. Identify and describe the barriers in your particular state that impede the APRN’s full scope of practice, and why. There are many barriers in Texas that impede the APRN from working within their full scope of practice. Of them include APRNs must practice under physician supervision within a 75 mile radius. APRNs are only able to prescribe under a physician's supervision. Schedule two drugs are not allowed to be prescribed by APRNs and they can not sign death certificates (Wofford).  These barriers prevent APRNs from delivering the care and support to the healthcare system that they are trained for. Without being able to prescribe certain medications they wont be able to see a wide range of patients in rural or urban settings. They also will not be able to assist with death certificates which could create a longer wait time for family that is not needed. The barriers are causing increase costs for all and discouraging for the APRNs in the long term.  3. As a future APRN, what recommendations would you have for improving healthcare access in your state’s rural community with regards to prescriptive authority restrictions? According to Portia Wofford, APRNs are more likely to work in rural areas than physicians. They typically work with the underserved more often than physicians would (Wofford). If this is the case, then why wouldn't we want to ensure they have all the tools they need to do their job to the best of their ability. Physicians no doubt are playing a role with the limitations of APRNs when in reality they are hurting themselves. If APRNs are limited to always needing a physician for certain prescriptions, death certificates, etc then physicians will always need to be around the underserved and rural areas which will be more costly and time consuming for them.  4. Finally, discuss the following: “Do all APRNs need hospital privileges? Why or why not? Deciding if all APRNs need hospital privileges is a hard topic for me to agree firm on one side or the other. We have the consensus model that helps us decide a lot of this but there are so many other considerations. As of the current moment nurses of primary care focus are able to treat patients in an acute care setting as long as their patient have similar issues to what they are used to treating (BON). To me this makes since as you would not want a family nurse practitioner to be able to care for a traumatic gun shot victim by theirself. However, in the instance of being able to prescribe certain medications and signing off on death certificates, it seems this would be helpful in hospital settings. I would say the answer would be no after doing much contemplation and research.
Answered 1 days AfterFeb 05, 2022

Answer To: You are also expected to respond to at least two of your peers' original posts !!! Peer 1...

Rudrakshi answered on Feb 06 2022
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RESPONSE TO DISCUSSION POST

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Hi,
I really liked your post about how you identified and stated the barriers that impede the APRN practice scope in Texas. However, I would like to add more about the dimension of your writing where the Texas Board of Nursing may have several scopes of practise, as well as another contribute to the achievement that permits one to practise positions and specializations in the same manner as a professional practising nurse within the specific scope of practise of a senior practising nurse.
I understood that it may be beyond the realm of a practising nurse's professional responsibility. The Board will grasp each healthcare professional responsible for their professional and individual practise areas of development and awareness, and it is crucial to remember this while evaluating candidates.
Next you are absolutely corrected the form of maintaining the health or prevention of illness....
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