In this scholarly paper, you are assigned a U.S. State and will write relevant APN statutes from the Nurse Practice Act and APN Rules and Regulations-New Jersey APN Versus State of Louisiana APN
APN Practice Regulations: State of Louisiana versus New Jersey APN
Advanced practice nurses (APNs) have undergone advanced training to enhance their knowledge, skills, and experience in nursing. Contrary to registered nurses that only offer nursing care to patients, APNs have acquired the needed competencies to diagnose patients, perform procedures, prescribe medications, and treat patients (Kleinpell et al., 2019). Upon completing the advanced training and educational requirements, APNs are given an opportunity to work with a high level of autonomy in the provision of care.
The APNs are also entitled to additional certification that would see them make critical medical decisions, without the assistance of a doctor (Black, 2022). The regulations on the scope of practice and the requirements for certification of APNs vary from one state to the next (Parker & Hill, 2017). With the expansion of the healthcare system, a significant increase in the number of APNs is desired for the attainment of universal health coverage. However, there is a need for regulation of their practices to ensure they offer quality care that would address significant if not all the challenges in the healthcare sector.
This paper presents a comparative analysis of the APN practice regulations in Louisiana and New Jersey states. The discussions are centered on the certification and license renewal requirements for each state. Also, the difference in practice including medical decision authority, and privileges are discussed.
Background Information
A considerable number of registered nurses in Louisiana have attained advanced roles in the provision of care. APNs are very instrumental in the provision of primary care to patients. It is reported that more than 70% of the APNs in Louisiana offer primary care, in relation to 12% of the physicians that are engaged in primary treatment in the state (Potter, 2021). The high number of APNs in primary care provision justifies their relevance and significance in advancing the attainment of universal health care in the state.
According to Potter (2021), APNs in Louisiana have specialized in the provision of acute care, neonatal and psychiatric care to patients. These nurses are also involved in the provision of family care, all of which are classified under primary care for patients. However, it is reported that APNs in Louisiana are involved in addressing other health-related issues. Their roles have been categorized as clinical specialist nurses, nurse practitioners, certified mid-wife, and certified nurse anesthetists (Louisiana State Board of Nursing, 2020). Certified clinical nurses offer advanced nursing care to patients in both acute and chronic medical states.
On the other hand, nurse practitioners are involved in the diagnosis, medical assessment, and treatment of the patient (Black, 2022). Clinical anesthetists offer anesthesia to patients before surgical procedures, as well as take part in the control and management of pain. Lastly, the specialist in midwifery is involved in the provision of gynecology services, low-risk labor management, and prenatal and neonatal care. All the APNs undertaking different roles in Louisiana are required to work in tandem with a physician, through consultation and referrals during practice.
The roles of APNs in New Jersey, however, differ since they are involved as either clinical nurse specialists or nurse practitioners. APNs in New Jersey mostly operate in ambulatory settings; however, recent developments have seen them involved in the provision of care in acute settings (Gerolamo et al., 2014). Clinical nurse specialists are involved in the diagnosis and management of both episodic and chronic illnesses.
They are mandated to order a diagnosis of various illnesses as well as prescribe medications with the aim of preventing illnesses and promoting quality health. APNs practicing in New Jersey undertake the said roles without the direct supervision of a physician, however, they are required to form a joint protocol collaboration with a physician, to oversight their decisions when prescribing medications.
APN Certification Requirements
New Jersey APN Versus State of Louisiana APN
The Louisiana state board of Nursing has the sole mandate of licensing individuals qualified to work as APNs. The board offers examinations to the individuals who are certified as APNs in the four roles of nurse practitioner, clinical nurse specialist, certified nurse midwife, and certified registered nurse anesthetist, upon successful completion of the examinations (Louisiana State Board of Nursing, 2018). On the other hand, the New Jersey Board of Nursing has the obligation of certifying and licensing APNs in the state. Contrary to Louisiana state where the board offers certification in four main APN roles, New Jersey state certifies APNs in three main categories, nurse practitioners, certified registered nurse anesthetists, and clinical nurse specialists.
Prior to undertaking the examinations, an individual must hold a registered nurse license from the Louisiana State Board of Nursing. Individuals who hold RN licenses from other states are required to apply for endorsement of their licenses by the state of Louisiana. (Louisiana State Board of Nursing, 2018). On the other hand, individuals who are not licensed as registered nurses are required to undertake the licensure examinations. For international students who completed their nursing degree in other countries, it is required that they undertake the CGFNS qualifying examinations, that are offered by the commission of graduates of foreign nursing schools.
Similarly, the New Jersey State Board of Nursing requires that an individual holds a valid New Jersey RN to qualify for the APN role. Endorsement of the licenses held by individuals from other states is also encouraged in New Jersey (New Jersey Board of Nursing, 2019). Also, international students are required to undertake CGFNS examinations to qualify for the role as in the case of Louisiana state. However, New Jersey additionally, requires that the students also undertake a test to assess their English proficiency, to qualify for the role. In both states, individuals must hold RN licenses relevant to each of the states as the initial requirement for becoming a licensed APN in the state.
Registered RN in Louisiana and New Jersey are required to undertake advanced courses in nursing to become APNs. These courses must be offered by accredited colleges and universities. The nursing boards in each of the states have approved several institutions that can offer courses in advanced nursing. Undertaking the course in an institution outside the board approval lists will require that it is reviewed, and approval granted to its extent of credibility.
Louisiana APN
In Louisiana, accredited institutions are required to offer programs that encompass courses such as advanced pharmacology, advanced pathophysiology, management of health care status, advanced assessment, and diagnostic reasoning, as well as preceptorship that includes 500 highly supervised clinical hours in direct patient care (Louisiana State Board of Nursing, 2018).
On the other hand, the accreditation board in New Jersey requires that individuals complete at least 39 hours in a pharmacology course. The board also requires that an individual complete 6 contact hours in pharmacological therapy offered by an institution that is certified by New Jersey Commission for Higher Education. Undertaking a course in pharmacology enhances the prescriptive authority of an individual, thus a major requirement for APN licensing in both states.
Specialization, through undertaking a master’s program in nursing, and a Doctor of Nursing Practice are also major requirements for the attainment of an APN license in both Louisiana and New Jersey states. These advanced nursing degrees enhance the competency of individuals in the provision of primary care, medical diagnosis, and patient treatment (Black, 2022). Besides the identified majors, both states also indicate that an individual can undertake other advanced courses in nursing including nursing education, leadership in nursing, and nursing administration, to qualify for the APN role.
Louisiana APN
Louisiana nursing board requires that individuals are certified in their APN role, prior to obtaining a license. The certification is achieved through examination, where an individual undertakes exams offered by accredited bodies (Louisiana State Board of Nursing, 2018). In Louisiana, certification programs on the general APN role are offered by the American Nurses Credentialing Centre, the American Academy of Nurse Practitioners, the Pediatric Nurse Certification Board, and Oncology Nursing Certification amongst other bodies (Louisiana State Board of Nursing, 2020).
Relatedly, the New Jersey nursing board requires that eligible candidates for APN undertake certification examinations to be licensed in their respective roles. Such examinations must be offered by a certified institution as recognized by the National Commission for Certifying Agencies and the American Board of Nursing Specialties. Attainment of certification in any of the APN roles is a requirement that must be achieved by individuals to qualify for an APN license in the two states.
Licensed APNs are required to renew their licenses after every year. Renewals are done between the months of October and December; however, late payments are allowed up to January, but with additional costs. APNs are required to maintain their certification and renew their license (Louisiana State Board of Nursing, 2018). Individuals with prescription rights must complete 12 hours in pharmacotherapeutics, relative to their area of specialization to qualify for renewals. 3 of the hours must be focused on substance use management, treatment for addiction, and prescribing best practices.
On the other hand, APNs practicing in New Jersey are expected to complete 30 contact hours on opioid abuse and addiction management to qualify for license renewal which is done every two years. 1 of the hours should be focused on opioid prescription while 2 hours assigned to end-of-life care. APNs that are authorized to prescribe are mandated to undertake an additional 6 hours in pharmacology centered on the control and management of substance use (New Jersey Board of Nursing, 2019). These additional educational requirements are evident in every state and are included as renewal requirements to ensure that the advanced competencies of APNs are maintained over the years.
Prescriptive Authority and Collaboration Agreement
New Jersey APN Versus State of Louisiana APN
Both New Jersey and Louisiana states have reduced the nature of APN practice. As much as the APNs operating in the two states have prescriptive authority, they are mandated to work under the guidance and oversight of a physician. The idea is to ensure that the APN offers quality services to all patients (Kleinpell, Myers & Schorn, 2023). APNs practicing in Louisiana must make a new application to get the prescription authority, though they are still expected to act under the guidance of a physician. The collaboration between the APNs and the physician is needed to offer guidance to the APNs in their prescription role and when making critical medical decisions.
As much as the collaborative agreement between the APNs and the physician is believed to achieve better health outcomes, there are issues associated with the regulation. The reduced nature of APNs’ practice in Louisiana has been a stamping block towards the full realization of the professionals’ benefits. According to Potter (2021), while the APNs are highly educated, the Louisiana practice regulations and law tend to limit their full utilization of competencies in addressing healthcare issues and challenges.
There are limitations and restrictions that only authorize them to offer certain services while limiting their engagements in other APN practices (Black, 2022). The most significant limitation is the requirement for a collaborative engagement, that obligates the APNs to collaborate with a physician in their provision of care (Louisiana State Board of Nursing, 2018). The implications are a significant decline in the capacity and abilities of APNs to offer extensive services, especially in underserved regions.
Louisiana APN
Further, the need for collaboration between an APN and a physician has triggered the gaps and delays reported in the provision of care in Louisiana, especially to patients in rural areas. According to the Louisiana nursing practice Act, section 37, APNs are required to incur costs to maintain their collaborative association with the physician. In some instances, they fail to obtain full reimbursement for the services offered by the physician. The results are a lack of positive collaboration between the professionals, discouraging the APNs from proceeding with further engagements. Such gaps cause serious delays in the provision of care, mostly in underserved regions where the need for quality primary care is greatest.
Similarly, in New Jersey, APNs work under the authority of a physician, though only for the prescription of medication. APNs operating in the state are required to contract and collaborate with a physician prescribing medication for patients with acute and mental illnesses (New Jersey Board of Nursing, 2019). The APNs are however allowed to offer primary care for the patients, including their diagnosis and initiation of a treatment plan for the management of the condition. As much as there is a reduced practice mode of regulation embraced in New Jersey, the opportunity for APNs to work under minimal supervision has enhanced their ability to offer quality care with minimal barriers and practice limitations.
Mixed responses have, however, been presented on whether the medical decision authority of the APNs should be advanced in states with reduced nature of APN practice. Physicians argue that they are more qualified and have advanced knowledge that makes them better professionals in leading the team involved in the provision of care (Black, 2022). On the contrary, the advocates for the abolition of the restrictions assert that while APNs may have spent fewer years in school than physicians, their constant engagement in practical training has advanced their experience and skills in the field (Germack, 2021).
Again, other states have abolished the laws that mandated APNs to work under physician oversight, and the resulting benefits, including expansion in health coverage, have been profound (Kleinpell et al., 2019). The states of New Jersey and Louisiana should consider making changes, such as giving the APNs full authority in every patient-care decision, if they are to address the issues of disparities and access to quality care, especially in underserved regions.
Differences in Practice Regulations-New Jersey APN Versus State of Louisiana APN
APNs practicing in both Louisiana and New Jersey states have prescriptive authority, though under collaboration with a physician. Both states adopt a reduced form of policy, where APNs can only make prescription decisions under the oversight of a physician (Louisiana State Board of Nursing, 2018). In Louisiana, a physician can only collaborate with at most 4 APNs at any given time. Also, the physician can only collaborate with APNs who are specialized in a similar practice (Louisiana State Board of Nursing, 2020). Similarly, APNs practicing in New Jersey can only give prescriptions under the collaboration of a physician. In the two states, it is mandatory that the prescriptions contain both the names of the APN and the physician, marking the major restrictions of the APNs practicing in the States.
Despite the restrictions, there are certain privileges that APNs enjoy in their practice. In New Jersey, APNs are allowed to diagnose and treat patients with acute and chronic conditions (New Jersey Board of Nursing, 2019). The APNs are also permitted to order and perform diagnostic tests without the supervision of a physician. In most instances, the APNs in New Jersey work without the direct supervision of a physician.
As such, these physicians are not expected to give guidance while on-site or in person, rather they are required to review the work done by the APNs and offer guidance where necessary (New Jersey Board of Nursing, 2019). The joint protocol collaborative agreement signed between the APNs practicing in the states and their physician is to offer guidance when prescribing medications without interfering with the privilege of the APNs to offer primary care independently.
Such a level of independence in the provision of care is not witnessed in Louisiana. The APNs are expected to work with the physician on-site, who oversight their practices and decisions in the provision of care. APNs practicing in Louisiana are expected to work closely with physicians (Kleinpell, Myers & Schorn, 2023). Diagnosing patients, and offering treatment, including prescription of medications can only be done with the guidance and oversight of a physician (Germack, 2021). The absence of a physician collaborator hinders APNs from practicing, a limitation that is considered a barrier to the achievement of universal healthcare coverage and enhanced access to quality medical care in the state.
New Jersey APN
All APNs practicing in Louisiana and New Jersey are required to have a valid license throughout their engagement. However, in New Jersey, the nursing board has offered privileges to nursing graduates that may allow them to work without licenses (Gerolamo et al., 2014). However, these graduates are required to access a temporary permit to enable them to operate as independent practitioners before they obtain their licenses (New Jersey Board of Nursing, 2019). Failing the examinations in two sittings leads to the revocation of the permit, rendering an individual incapable of the continued provision of primary care.
Nevertheless, the privilege is useful in enabling the state to have access to a considerable number of APNs needed in the provision of quality care to patients (New Jersey Board of Nursing, 2019). Such privilege is not provided for in the context of Louisiana where permits are only offered to registered nurses who have completed the required advanced course. Only registered nurses with 2 years of advanced learning are eligible for a permit as they wait for certification. The implications are further limitations in advancing the role of APNs in the state.
The potential value of the nurse licensure compact was highlighted in the aftermath of the Covid-19 pandemic. During the pandemic, a shortage of medical practitioners was evident in some states, making them suffer from the adverse effects of the virus (Germack, 2021). The existence of the compact permitted individuals to hold a single nursing license that could be applicable in multi-state. The implementation of the Compact rendered the state’s nursing licenses to be valid in different states (Black, 2022).
As much as both Louisiana and New Jersey have implemented the Nurse Licensure Compact, it’s only applicable to registered nurses (Louisiana State Board of Nursing, 2018). Individuals holding an APN license in both Louisiana and New Jersey are not permitted to work as APNs in other states. Rather, they are required to seek the APN licenses of the said states in the event of their relocation.
The continued engagement of APNs in the provision of primary care and their involvement in palliative care is becoming pronounced. Especially, in New Jersey, the APNs are allowed to determine the cause of death of a patient, as well as pronounce the time of death (New Jersey Board of Nursing, 2019). Also, the APNs practicing in New Jersey are allowed to sign death certificates without the indulgence of the collaborating physician. This has made it possible for APNs practicing in the state to offer quality palliative care to patients in their end-of-life stage.
Such a high level of independence is not witnessed in the context of Louisiana. The determination of the cause of death as well as a pronouncement of the same can only be done by a physician (Louisiana State Board of Nursing, 2018). As much as the APNs practicing in the state are allowed to offer primary care including pain management of patients in their end-of-life stage, there are not allowed to confirm or pronounce death. The collaborating physician has the sole made of confirming the death of the patient as well as signing the death certificates. There are thus major differences in APN practice in the two states.
Conclusion and Lessons Learnt
Analysis of the APN practice in Louisiana and New Jersey points out some similarities and differences in the requirements and regulations of advanced nurse practitioners. The nursing board in both states has the mandate of providing licenses and regulating the actions of the APNs in both states. Also, APN certification in both states is achieved through examinations offered by certified institutions in each of the two states. As much as there are differences in the number of contact hours required for each of the courses in each state, advanced knowledge in pharmacology is a major prerequisite for APN certification in Louisiana and New Jersey states.
The requirements for obtaining an APN license are nearly the same in the two states. However, the environment of practice varies. While the APNs practicing in Louisiana are expected to work under the supervision of a physician, the extent of supervision by a collaborator is minimal in New Jersey. The APNs practicing in the state are required to engage in a joint protocol collaboration with a physician, however, their control of the actions and decisions of the APNs are minimal, and most evident in the prescription of medication. The Board of Nursing in New Jersey has also offered privileges such as permits for new registered nurses awaiting certification examinations.
In essence, the practice environment offered by the Board of Nursing in New Jersey is overly favorable than that of Louisiana. I am likely to consider practicing as an APN in New Jersey since I will be able to start work, even before completing the certification examinations. Also, APNs practicing in New Jersey enjoy a high level of independence that is desirable in advancing one’s role as an independent practitioner. As much as an APN is mandated to adhere to the protocol of a physician, there is limited supervision of one’s decisions and actions, especially in the provision of care.
Further, the continued educational requirement required of every APN prior to the renewal of the license avails an opportunity for further experience growth. Working as an APN in New Jersey will offer better opportunities to independently attend to the health needs of the population, as well as a chance for further advancement of my career in nursing. This makes New Jersey the most suitable state of choice to practice as an APN nurse.
References
Black, B. (2022). Professional nursing-e-book: concepts & challenges. Elsevier Health Sciences.
Evans, S. (2015). The nurse licensure compact: a historical perspective. Journal of Nursing Regulation, 6(3), 11-16.
Germack, H. D. (2021). States should remove barriers to advanced practice registered nurse prescriptive authority to increase access to treatment for opioid use disorder. Policy, Politics, & Nursing Practice, 22(2), 85-92.
Gerolamo, A. M., Overcash, A., McGovern, J., Roemer, G., & Bakewell-Sachs, S. (2014). Who will educate our nurses? A strategy to address the nurse faculty shortage in New Jersey. Nursing Outlook, 62(4), 275-284.
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Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19. Journal of Nursing Regulation, 14(1), 13-20.
Louisiana Nurse Practice Act, 2018
Louisiana State Board of Nursing (2018). Instructions For Applying for APRN Licensure by Examination, Retrieved from https://www.lsbn.state.la.us/wp-content/uploads/aprn/APRNExamApplication.pdf
Louisiana State Board of Nursing (2018). Instructions For Applying for APRN Licensure by Endorsement, Retrieved from https://www.lsbn.state.la.us/wp-content/uploads/aprn/APRNEndorsementApplication.pdf
Louisiana State Board of Nursing (2020). Rules and Regulations: Professional and Occupational Standards, Retrieved from https://www.doa.la.gov/media/gybngco4/46v47.pdf
New Jersey Board of Nursing (2019). Instructions for Advanced Practice Nurse Certification in New Jersey, New Jersey Office of the Attorney General
Parker, J. M., & Hill, M. N. (2017). A review of advanced practice nursing in the United States, canada, australia and hong kong special administrative region (SAR), china. International Journal of Nursing Sciences, 4(2), 196-204.
Potter, T. (2021). Louisiana nurse practitioners pushing for an end to ‘unnecessary barriers to health care, Daily Advertiser, Retrieved from https://www.theadvertiser.com/story/news/2021/04/29/louisiana-nurse-practitioners-pushing-end-unnecessary-barriers-health-care/4886649001/