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NEW YORK STATE ADVANCED PRACTICE REGISTERED NURSE
SCOPE OF PRACTICE AND PROTOCOLS
Rebecca Hegel and Valerie SalazarState University of New York: Institute of Technology
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Learning Objectives
By the end of this presentation, participants will be able to:
1. State how to locate the scope of practice guidelines for the APRN practicing in NYS
2. Identify at least one acceptable protocol text for practice
3. Describe how to advocate for future increases in APRNs Scope of Practice
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Scope of Practice
“Legal definition of a profession in the statutes or regulations that define the profession and the niche it fills in the array of health practitioners. As such, the limits (or opportunities) presented by legal language is of primary importance to individuals and organizations considering exactly what a nurse, a physician, a dentist, a veterinarian, a naturopath or a physical therapist can be expected or allowed to do generally” (Robert Wood Johnson Foundation, 2011, para 1).
Reference: Robert Wood Johnson Foundation (2011).
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NYS APRN Scope of Practice
DefinitionEducation
Professional RoleAccountabilityResponsibility
Reference: Title VII, Article 139 of New York State Education Law of 1988
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Scope of PracticeNurse Practitioner Association: NYS
Varies from practice to practice and state to state depending upon each practice and state’s regulations.
Is defined by law Practices CANNOT expand the scope as
defined by law, but individual practices may limit the scope
(Nurse Practitioner Association-New York State, 2009)
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Role of the APRN Definition
Article 139 NYS Education Law §6902: NPs diagnose illnesses and physical conditions
and perform therapeutic and corrective measures within a specialty area of practice, in collaboration with a physician qualified to collaborate in the specialty involved and in accordance with a written practice agreement and written practice protocols
A PRACTICE PROTOCOL TEXT shall be selected from an approved list and FILED WITH the division of Professional Licensing Services
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Education
APRNs must complete a registered nurse program designed to prepare graduates as Nurse Practitioners OR; Certification as a Nurse Practitioner by a
national certifying body acceptable to NYS Dept. of Ed.
Completion of not less than three semester hours (or the equivalent) in pharmacology
Prescriptive privilege
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Professional Role and Accountability
NPs are primary care providers who practice in ambulatory, acute and long term care settings and provide nursing and medical services WITHIN THEIR PRACTICE SPECIALTY to individuals, families, and groups.
Certification, periodic peer review, clinical outcome evaluations, a code for ethical practice, evidence of continuing professional development, and maintenance of clinical skills demonstrates accountability
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Responsibility
Changing needs in society and health care require the NP role to advance. APRNs are responsible for advancing our role while ensuring the preservation of established professional standards
This is accomplished by connecting with professional organizations and participating in health policy activities at the local, state, national and international levels
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Areas of Specialty
Adult HealthFamily Health Gerontology NeonatologyObstetricsOncology
Pediatrics Perinatology Psychiatry School Health Women’s Health Holistic & Palliative
care
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Scope of Practice Laws
Autonomous practice NO
Primary Care Provider YES
Independent Prescribing
NO
Reference: Barton Associates (2013)
Order physical therapy
YES Sign death
certificate YES
Sign handicap parking permit
YES Sign workers comp
claims NO
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Collaborative Agreement
Required to: Establish a
collaborative agreement with 1 physician prior to beginning practice
Submit Verification of Collaborative Agreement and Practice Protocol to NYSED within 90 days of beginning professional practice.
Include provisions for referral and consultation, coverage for absences of either the NP or the collaborating MD.
Possible review of patient records every 3 months by collaborating MD
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Protocol Text
Required to identify a protocol text
NYS has an approved list of texts your official practice protocol must reflect the specialty
area of practice as identified on your SED nurse practitioner certificate.
Reference: NYSED, 2012. License requirements: Nurse practitioner
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. (2008) Pediatric primary care (4th ed.). Philadelphia, PA: Saunders
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2007) Primary care: The art and science of advanced practice nursing (2nd ed.). Philadelphia, PA: F. A. Davis Company.
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Implications
As a licensed professional, it is your responsibility to practice within the scope of your abilities and as authorized by New York law. If you practice outside your personal scope of competence or outside of what is allowed by New York law, you could be charged with professional misconduct.
Reference: NYSED (2012). Practice information: Frequently asked practice questions
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Practice Issues
Scope and Standards of Practice State Law and Regulation Institutional Policies and Procedures Self-Determination Professional Liability and Risk Manageme
nt Concerns
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Implications
Reimbursement guidelines
Certification Nursing Homes Hospice Durable Medical
Equipment Prescriptive
authority Medicaid Medicare
Women's Health Pregnancy
Termination Private Institutions DNR orders Death certificates No fault Chemotherapy Home Health Care
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Implications
Nurse Practitioners are authorized to: Prescribe medical regimens
to be executed by a registered professional nurse.
Direct the performance of professional services by licensed practical nurses.
Reference: NYSED (2012). Commissioners regulations. Part 64.
DIRECT NURSING CARE
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FAQ’s
Not supervised by a physician
Collaborating MD is responsible for chart reviews
Submission of practice protocol is only required once:
Form 4NP
Multiple collaborative agreements are not required
Financial agreements between collaborating physician and NP
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Class Participation
1.) If I am unsure if an action falls within my legal scope of practice, I should:
a. call NYSED @ (518) 473-3817 ext. 120b. email [email protected]. write to NYSBON at
NYS Education89 Washington Avenue-Education BuildingState Board for NursingSecond Floor, West WingAlbany, NY 12234
d. call the NPA @ (518)348-0719e. email the NPA [email protected]
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Class Participation
2. A good protocol text for practice would be:
a. ANA Code of Ethicsb. ANA Nursing Scope and Standards
of Practicec. Burns and Grove-Pediatric Primary
Cared. AACN: Guide to NP curriculum
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Class Participation
3.) What can I do to promote the expansion of the APRNs scope of practice?
a. join my local NPAb. call President Obama directly at the
Whitehouse @ (202) 456-1111c. participate in professional networkingd. get involved with health policy activities
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Additional Reading
http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses/Scope-of-Practice-2/Scope-of-Practice/Scope-of-Practice-Domains-and-Questions.pdf
http://www.op.nysed.gov/prof/nurse/nursepracticefaq.htm
Scope of Practice & APRN video speech http://www.nursingworld.org/
FunctionalMenuCategories/AboutANA/Nursing-Video-Gallery/K-Daley-Speech-NSNA.html?a&s=5:58&e=6:08
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Resources
American Association of Nurse Practitioners
American Nurses Association The Nurse Practitioner Association of New
York State The New York State Education
Department: Office of Professions
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References Barton Associates (2013). NP scope of practice laws. Retrieved from http
://www.bartonassociates.com/nurse-practitioners/nurse-practitioner-scope-of-practice-laws /
Christian, S., Dower, C., & O’Neil, E. (2007). Overview of nurse practitioner scopes of practice in the United States-Discussion. Retrieved from http://futurehealth.ucsf.edu/Content/29/2007-12_Overview_of_Nurse_Practitioner_Scopes_of_Practice_In_the_United_States_Discussion.pdf
New York State Education Department (2012). Commissioners regulations. Part 64, nursing. Retrieved from http://www.op.nysed.gov/prof/nurse/part64. htm
New York State Education Department (2012). License requirements: Nurse practitioner. Retrieved from: http://www.op.nysed.gov/prof/nurse/np.htm#proc
New York State Education Department (2012). Practice information: Frequently asked practice questions. Retrieved from http://www.op.nysed.gov/prof/nurse/nursepracticefaq.htm
The Nurse Practitioner Association: New York State (2009). The nurse practitioner resource guide (4th ed.). Retrieved from http://www.thenpa.org/associations/1031/PIG%20Revised%20August%202011%20FINAL.pdf
Robert Wood Johnson Foundation (2011). Laws are not the only barriers to scope of practice. Retrieved from http://www.rwjf.org/en/blogs/human-capital-blog/2011/10/laws-are-not-the-only-barriers-to-scope-of-practice.html