Every state in the country has its own set of rules that regulate and govern the practice of nursing. Each individual state also has a board of nursing that is responsible for regulating its own nurse practice act (Huynh & Haddad, 2020). The State of Michigan does not have a stand-alone Nurse Practice Act (2020). Instead, we have a consolidated practice act that is formally titled the Occupational Regulation Sections of the Michigan Public Health Code, PA 368 of 1978; this practice act covers 25 health occupations.
1. The State of Michigan requires collaboration with a physician. NPs may be delegated tasks and functions by the physician if those tasks fall within their scope of practice. However, APRNs are “allowed to make calls or go on rounds in private homes, public institutions, emergency vehicles, ambulatory care clinics, hospitals, intermediate or extended care facilities, health maintenance organizations, nursing homes, or other healthcare facilities without restrictions on the time or frequency of visits by a physician or the APRN and without physician delegation and supervision” (Scope of Practice). I personally think that our scope of practice should be opened up a little more than it was and I was glad to see that strides have been being made in that direction to give APRNs more autonomy. That being said, I think that collaboration with a physician can also be beneficial because it gives us another person with more education to help work through some patient cases that we might need another opinion and more expertise on. I think there should be a national standard to break down some of the differences between states on this matter.
2. In 2016, a new bill was passed in Michigan to include APRNs in the role of “prescriber.” That means that APRNs can prescribe nonscheduled medications without delegation or supervision from a physician. However, the law still requires that scheduled medications and classes II-V must be delegated by a physician. Therefore, APRNs have to have a prescribing agreement with a physician to provide prescriptive authority. I believe that APRNs should be allowed to become autonomous in their role of “prescriber.” The doctor, unfortunately, is not always available and sometimes prescriptions need to be written in the here and now. I think that APRNs across the board should have to put in a certain amount of hours and then be able to earn autonomous prescribing ability.
3. In the State of Michigan, APRNs are allowed to prescribe classes II-V of medications if delegated by a physician. They may prescribe unscheduled drugs without delegation (Michigan Legislature). I think that APRNs should be allowed to prescribe all classes of drugs without delegation or supervision by a physician. We are required to take pharmacology and pathophysiology classes and pass boards that give us credibility. As providers, it would give us more room to work with patient and treat them instead of having to ask a supervising physician who is not as familiar with the patient or their history and case.
4. Rashes are a common reason for people to visit healthcare providers. Rashes can come in all shapes and sizes with all manner of characteristics. It’s important to undertake a thorough history and physical exam in order to narrow down causes and come up with an accurate diagnosis. Sometimes the treatment plan will be easy to come up with because it’s a common finding such as poison ivy or diaper rash (Arcangelo & Peterson, 2017). In these cases, the NP will be able to work alone. Other times, the rash may point to something more serious or be harder to diagnosis. In these instances, it would be beneficial to call on the expertise of others and place a consultation. The purpose of using a collaborative care model is to provide complete, excellent care for the patient. By including doctors, nurses, and specialties like dieticians or pharmacists, patient outcomes can be improved.
Huynh, A. P., & Haddad, L. M. (2020, July 25). Nursing Practice Act. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK559012/.
Scope of Practice. MAFP. https://www.mafp.com/scope-of-practice/.
Michigan Board of Nursing. (2020). https://www.michigan.gov/lara/0,4601,7-154-89334_72600_72603_27529_27542-59003–,00.html.
Michigan Legislature. Michigan Legislature. http://www.legislature.mi.gov/(S(f4bt3t4ju5z44m4zb0b3sjna))/mileg.aspx?page=getObject
Arcangelo, V. P. & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams &Wilkins.
Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:
- Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a collaborative agreement, and explain why/why not.
- Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.
- Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.
- Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.
Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.