NEW YORK STATE ADVANCED PRACTICE REGISTERED NURSE SCOPE

OF PRACTICE AND PROTOCOLS

Rebecca Hegel and Valerie SalazarState University of New York: Institute of Technology

Learning ObjectivesBy 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

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).

NYS APRN Scope of Practice

DefinitionEducation

Professional RoleAccountabilityResponsibility

Reference: Title VII, Article 139 of New York State Education Law of 1988

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)

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

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

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

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

Areas of SpecialtyAdult HealthFamily Health Gerontology NeonatologyObstetricsOncology

Pediatrics Perinatology Psychiatry School Health Women’s Health Holistic & Palliative

care

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

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

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.

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

Practice Issues Scope and Standards of Practice State Law and Regulation Institutional Policies and Procedures Self-Determination Professional Liability and Risk Manageme

nt Concerns

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

ImplicationsNurse 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

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

Class Participation1.) 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 nursebd@mail.nysed.govc. write to NYSBON atNYS Education89 Washington Avenue-Education BuildingState Board for NursingSecond Floor, West WingAlbany, NY 12234d. call the NPA @ (518)348-0719e. email the NPA info@theNPA.org

Class Participation2. 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

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

Additional Reading http://www.nursingworld.org/EspeciallyFor

You/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

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

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