Discussion comments practicum class
practicum class #1
State laws regulating nurse practitioners in Florida are among the
strictest in the nation. With half of physicians in Florida reaching
retirement age over the next five to ten years and just three percent of
medical students in the state choosing to enter primary care, nurse
practitioners (NPs) are scrambling to increase their scope of practice.
According to the Florida Department of Health and the Florida Board of
Nursing, NPs must be supervised by physicians and this arrangement must
be outlined in writing.
This written agreement contains a clear
outline of duties the NP is allowed to perform. The level of physician
supervision is also specifically identified in the protocol. Different
levels of supervision may be required for different actions on the part
of the Advanced Practice Registered Nurse (APRN). I always believe that
the state of Florida where I live and work has some of the strictest
rules and regulations regarding the APRN’s scope of practice. However, I
was surprised to learn that an APRN can perform a diagnosis without any
supervision by a physician (Florida Board of Nursing, 2021). In
addition to diagnosis, an APRN in the state of Florida can also
independently prescribe some medications including controlled substance
Schedules II-IV (Florida Board of Nursing, 2021). The written physician
protocol determines which prescriptions will require direct physician
prescription in that specific environment.
Lastly, I learned that
NPs practicing in Florida may sign for handicap parking permits
(Florida Board of Nursing, 2021). However, compared to other states,
Florida’s nurse practitioner scope of practice is stricter than most.
It is one of twenty states in the U.S. in which NPs have full practice authority, and do not need to work under the supervision of a physician. They can be their own medical director and may practice independently in their own clinic. Studies have shown that independently-working Family Nurse Practitioners greatly increase accessibility to preventative healthcare for individuals that would otherwise not be capable of getting in to see a physician (Waite, 2019).
Another interesting, and rather new, fact is that even if you have worked as an RN in the emergency department (ED), you cannot work in the ED as an FNP, as this requires an Acute Care certification rather than family practice. This is a new regulation that just recently changed a few years ago. Many of my friends and colleagues that I was working with in the ED had gone on to get their FNP, and our ED hired them on as providers. However, soon after, the state board of nursing changed their policies, and these FNPs that were providing care in the hospital or acute care settings had to go back to get their ACNP certifications. They were allotted a certain amount of time to go back and get their ACNP, otherwise they would be let go from their current position. Although many of them decided to go back and get ACNP certified, just as many of them decided to leave the acute care world and ventured into the ambulatory outpatient world.
A third fact that I was unaware of was that in Arizona, our FNPs can screen for psychiatric illnesses and treat common psychiatric conditions such as depression and anxiety. However, it is not in the scope of practice for an FNP to diagnose or manage other psychiatric illnesses. Although FNPs can diagnose and treat patients with uncomplicated mental illness, such as depression and anxiety, within their scope of practice, they should be aware of areas that fall outside of their scope, such as diagnosing and treating patients with complicated or severe mental illnesses or exceeding prescribing authority for psychiatric medications (Balestra, 2019). They can also screen for attention deficit disorder (ADD), just as they can screen for bipolar disorder, however, a diagnosis for either requires more than a screening tool. An FNP can renew prescriptions for a psych mental health medication, in collaboration with a specialist, but they cannot be the first person to diagnose and initiate medication for complex mental health conditions.