How do you get certified and licensed in your state?
I live in the State of Maryland which has afforded and extended full practice to qualified Nurse Practitioners (NPs) that meet this state requirements. According to American Association of Nurse Practitioners (2020), States that offer full practice and licensure laws permit all NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate/manage treatments. This Association further reports that treatment methods include prescribing medications and controlled substances under the exclusive licensure authority of the Maryland Board of Nursing (MBON). Therefore, the NPs in this state have the privilege of using their license to provide full extensive care.
Advanced practice status in Maryland is granted based on education and certification. In order to become licensed in this state qualified, NPs have to follow specific steps to be able to utilize these privileges afforded them. Applicants must verify certain initial criteria before they can apply for License as a NP in Maryland. These criteria include a holding a current Maryland license that is in good standing to practice as a registered nurse or a multistate licensure privilege to practice as registered nurse; graduating from a Board-approved accredited graduate level program for nurse practitioners at the Masters’ level or higher; passing a NP board exam and holding a current national certification from the American Academy of Nurse Practitioners National Certification Board (AANPNCB) or other national certifying body recognized by the Maryland Board of Nursing; Submitting a completed application for certification as a nurse practitioner for each area of specialization to the MBON; and Demonstrate written and oral competency in the English language (Advance Practice Registered Nurse License Requirements in Maryland, 2021).
What is the application process for certification in your state?
Certification must be obtained from the board of Maryland before a NP can practice in this state. The application process for NPs certifications in the state of Maryland involves several pivotal steps. 1) The application process involves providing a Maryland RN number that can be verified that the applicant holds a valid Registered Nurse license in the state of Maryland. Applicants may also provide a current valid Compact Current State RN License. 2) The applicant must complete the Certification application thoroughly and correctly. 3) The applicant must complete the Declaration of residence form which proves that he/she has been and is a residence of Maryland. 4) The applicant must provide sealed official transcripts of the courses taken during the NP program. 5) The applicant must also provide Copy of current national certification or letter of eligibility to take the certification exam (Maryland Board of Nursing, 2021).
What is the primary nurse licensure office resource website in your state?
The primary nurse licensure office resource website for the State of Maryland is: https://mbon.maryland.gov/Documents/np_application.pdf
How does your state define the scope of practice of a nurse practitioner?
The State of Maryland had extended practice to the qualified Nurse practitioners. The scope of practice includes performing comprehensive physical assessment of patients, certifying to the Department of Transportation that an individual needs special consideration for certain health reasons, examining and determining if a patient is pregnant or has given birth to a child, completing the date of birth and medical information required on a birth certificate, completing a death certificate, filing a replacement death certificate, establishing medical diagnosis for common short-term and chronic stable health problems, issuing a “do not resuscitate order” (DNR) on a Maryland Emergency Medical Services form, ordering, performing, and interpreting laboratory and diagnostic tests, ordering and performing diagnostic, therapeutic, and corrective measures, prescribing drugs, providing emergency care, referring patients to appropriate licensed physicians or other health care providers as needed, certifying that the utility client has a serious illness or the need for life-support equipment; and witnessing an advance directive (Maryland Board of Nursing (2021).
What is included in your state’s practice agreement?
According to Maryland Board of Nursing (2021), Maryland was the first state to join the National Nurse Licensure Compact (NLC) in 1999. NLC allows a nurse licensed in a compact state to practice across state lines in another compact state without having to obtain a license in the other state This allows nurses with a multistate license to be able to practice in any of the twenty-five NLC participating states fully (Maryland Board of Nursing (2021).
How do you get a Drug Enforcement Agency (DEA) license?
Nurse Practitioners has the responsibility to administer, prescribe and dispense any controlled substance. Therefore, they must be registered with the Federal Drug Enforcement Administration (DEA) in order perform these tasks legally. In order to get a DEA license in the state of Maryland, the NP applicants have to firstly apply for a Maryland State Controlled Dangerous Substances Registration (CDS) with the Office of Controlled Substances Administration (OCSA). Prior to applying for CDS each applicant must register with the Prescription Drug Monitoring Program (PDMP). Registration with PDMP is done on the CRISP website at https://crisphealth.org/ (Maryland Department of Health-Public Health Services-Office of Controlled Substances Administration, 2021).
After the CDS registration is approved, NP applicants can then apply for the Federal DEA license using their State license number. Application for the DEA license can be done online at the U.S. Department of Justice website. Applications can also be mailed in. For the mailed in method of application, applicants can call the DEA Headquarters Registration Unit toll free at 800-882-9539 to request a physical copy of the order form. Forms will be mailed within 10 working days. Completed application forms (DEA Form 222a) are expected back to the Justice department within 30 days after each shipment of the forms to the Registration Unit, P.O. Box 28083, Washington, D.C. 20038-8083 (U.S Department of Justice Drug enforcement Administration, 2021).
How does your state describe a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
Qualified and approved NPs in the State of Maryland may independently prescribe and dispense drugs, devices and Schedules II-V controlled substances. For the first 18 months of practice. (COMAR 10.27.07.02 (A)(4)) physician involvement is required for NP prescriptive authority. To prescribe controlled substances, the NP must have a Maryland Drug Control Number (American Medical Association, 2021)
In what legislative and advocacy activities are your state nurse practitioner organization(s) involved?
According to Nurse Practitioner Association of Maryland (2021) one of actions of nurse practitioners is to be involved in the political environment by helping influence positive actions taken by the legal authority. Nurse practitioners in Maryland have been politically organized, legislatively active, and widely effective. These NP organizations roles have been strongly involved with campaigning and petitioning the legislature to increase the role NPs so that they might more fully advocate for patients and increase access to health care (Nurse Practitioner Association of America (2021)
For example, organization National Association of Pediatric Nurse Practitioner -MD -Chesapeake is active in Monitoring pediatric health-related bills introduced at the state and local levels during the Maryland General Assembly session. They offer letters and testimonies in support of or in opposition of bills that are being monitored at local and state levels. Here support or opposition to bills is guided by the National Association of Pediatric Nurse Practitioners (NAPNAP) National Health Policy Agenda (National Association of Pediatric Nurse Practitioners MD: Chesapeake, 2021).
Another Maryland organization, The Nurse Practitioner Association of Maryland (NPAM) serves as the voice of Nurse Practitioners in Maryland. The mission of the NPAM is to advocate and ensure comprehensive policy and regulatory foundation that defends and enables nurse practitioners to provide manageable, high quality healthcare by utilizing the fullest extent of nurse practitioner scope of practice during this process (Nurse Practitioner Association of Maryland, 2021).
American Medical Association (2021). State law chart: Nurse Practitioner Prescriptive Authority. Retrieved from https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-prescriptive-authority.pdf
Nurse Practitioner Association of Maryland (2021) The Legislative and Clinical Practice Environment in Maryland. Retrieved from https://www.npamonline.org/page/34
American Association of Nurse Practitioners (2020). Practice Environment Details. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment
Advance Practice Registered Nurse License Requirements in Maryland (2021). Retrieved from https://www.nursinglicensure.org/np-state/maryland-nurse-practitioner/#education
Maryland Board of Nursing (2021). Criteria for Nurse Practitioner Certification & Instructions for the applicant. Retrieved from https://mbon.maryland.gov/Documents/np_application.pdf
Maryland Board of Nursing (2021). Nurse Practitioner — Scope and Standards of Practice. Retrieved from https://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx
University of Maryland. Division of Research (2021). DEA License Information. Retrieved from https://research.umd.edu/dea-license-info
Maryland Board of Nursing (2021) Nurse Licensure Compact. Retrieved from https://mbon.maryland.gov/Pages/msl-compact-states.aspx
U.S Department of Justice Drug enforcement Administration (2021). Registration Procedures (University of Maryland Division of Research, 2021).
Maryland Department of Health-Public Health Services-Office of Controlled Substances Administration (2021). Practitioner Instructions. Retrieved from https://health.maryland.gov/ocsa/Documents/Applications%20Instructions%20(Pra.Revised%209-25-2018).pdf
National Association of Pediatric Nurse Practitioners MD: Chesapeake (2021). Legislation. Retrieved from https://community.napnap.org/marylandchesapeake/legislation
Discussion: Certification and Licensure
Now that you are in your final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass a national AGPCNP certification exam. Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.
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Although there is a movement called the APRN Consensus Model to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.
Another important area to consider and plan for is prescriptive authority. Prescriptive authority is granted under state law by the appropriate board. The board granting prescriptive authority may be the medical board, state board of pharmacy, or nursing board for the appropriate state licensure being pursued. The authority to write for a controlled substance is granted at a federal level and is verified through the Drug Enforcement Administration (DEA) by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.
Finally, the legal landscape for NPs is constantly changing as the status of NPs as providers improves on a national level. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes will significantly impact your scope of practice as a nurse practitioner.
For this Discussion, you examine professional issues for your state, including certification and licensure, scope of practice, independent practice, prescriptive authority, and legislative activities.
- Review practice agreements in your state.
- Identify whether your state requires physician collaboration or supervision for nurse practitioners and, if so, what those requirements are.
- Research the following:
- How do you get certified and licensed in your state?
- What is the application process for certification in your state?
- What is the primary nurse licensure office resource website in your state?
- How does your state define the scope of practice of a nurse practitioner?
- What is included in your state’s practice agreement?
- How do you get a Drug Enforcement Agency (DEA) license?
- How does your state describe a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
- In what legislative and advocacy activities are your state nurse practitioner organization(s) involved?
By Day 3
Post a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on 2 different days in one or more of the ways listed below.
- Share an insight from having viewed your colleagues’ posts.
- Suggest additional actions or perspectives.
- Share insights after comparing state processes, roles, and limitations.
- Suggest a way to advocate for the profession.
- Share resources with those who are in your state.
The process for a nurse practitioner graduate student, once completed a board approved Master of Science in Nursing Program with specializing as a nurse practitioner, there are precise steps to accrue certification and licensure. Once the graduate completes the program and obtains a letter of eligibility to take a board approved examination, either through the American Nurses Credentialing Center (ANCC) or American Academy of Nurse Practitioner Board Certification (AANPBC), the student must create an online account with either examination, request official transcripts, and complete an education validation form prior to examination day (Leik, 2017). These are based on the specialty programs such as Family Nurse Practitioner or Adult and Gerontology Nurse Practitioner. A pediatric or acute care nurse practitioner will have other guidelines for the specific examination. Once an examination is passed, the applicant may complete an application for Nurse Practitioner Certification. The applicant then must provide the Maryland Board of Nursing with a mentor, either a physician or nurse practitioner in good standing, that will provide mentorship for eighteen months for first time certifications or out of state applicants.
Governing of a nurse practitioners license is the responsibility of the Maryland Board of Nursing. The website http://mbon.maryland.gov provides information for many health care certifications and licensures. The website provides resources for registered nurses, certified nurses assistants, advanced practice nurses, and electrologists. This will be the official site for renewal procedures, disciplinary action protocols, and information regarding state practice acts.
As set forth by the Code of Maryland Regulations (COMAR), a nurse practitioner may perform within the scope of practice which includes comprehensive physical exams, complete birth certificate date, time, and medical information, death certificate time and date, establish diagnosis for chronic medical health problems, issue “do not resuscitate orders on emergency medical services forms, order and interpret laboratory and diagnostic tests, prescribe drugs, perform emergency care, make appropriate referrals to providers, and witness advanced directives (Schrader, 2017). Any nursing association also has access to each states scope of practice, providing resources and information to nurse practitioners regarding standards and regulations.
Maryland is a full practice state. According to American Association of Nurse Practitioners (2021) full practice encompasses the state and licensure allowing full practicing authority through diagnosing, ordering laboratory and diagnostic tests for interpretation, managing treatment, and prescribing medication which includes controlled substances. Controlled substances are prescribed through providers that have an active, unencumbered Drug Enforcement Agency (DEA) number. Obtaining a DEA number is by online or paper, DEA Form 224. The application to the Department of Justice should also include the supervisory agreement from a physician or nurse practitioner and application fee for midlevel provider of $888.00, valid for three years (US Dept of Justice, n.d.). Once registered with an official DEA number, Maryland requires all providers to register with the Prescription Drug Monitoring Program (PDMP) that supports safe and effective prescribing of controlled dangerous substances, storing data from prescribers of dispensing habits to ensure the public is safe from the harmful effects of prescription drug addiction (Maryland Department of Health, n.d.). Nurse Practitioners in Maryland have the authority to prescribe Controlled Dangerous Substances scheduled II-V. NP licensure requires coursework in advanced pharmacology, advanced pathophysiology, and advanced physical assessment.
The various associations that exist for a multitude of health care careers, it is the community of nursing that encompasses many. The American Nurses Association, the American Association of Nurse Practitioners, International Council of Nurses, American Academy of Nursing, National League for Nursing, and the list goes on. Specific to Maryland is the Nurse Practitioner Association of Maryland, established in 1992, that advocates and protects for nurse practitioners concerning policies, regulatory foundations, and high-quality abilities for full scope of practice (Nurse Practitioner Association of Maryland, n.d.). The associations are good ways to get involved in healthcare legislature because of the affiliation with government offices and the ability to get involved in lobbying, especially on the behalf of the nurse practitioner profession.
The process of certification, licensure, and prescription abilities is a cumbersome one. I was surprised at how many applications are required. The MBON does layout each process step by step. What feels like a long road a head for upcoming graduates has been paved by our predecessors, which makes networking so necessary to build a foundation of resources and mentors.
American Association of Nurse Practitioners. (2021). State practice environment.
Retrieved August 30, 2021, from https://www.aanp.org/advocacy/state/state-practice-environment
Leik, M. T. (2017). Adult-gerontology nurse practitioner certification intensive review:
Fast facts and practice questions (3rd ed.). Springer Publishing Company.
Maryland Department of Health. (n.d.). Maryland prescription drug monitoring program.
Maryland.gov. Retrieved August 31, 2021, from https://health.maryland.gov/pdmp/Pages/Home.aspx
Nurse Practitioner Association of Maryland. (n.d.). The Nurse Practitioner Association of
Maryland (NPAM) serves as the voice of nurse practitioners in Maryland. npamonline.org. Retrieved September 1, 2021, from https://www.npamonline.org/
Schrader, D. (2017). Maryland Board of Nursing proposed regulations COMAR title 10.
Maryland Department of Health. https://mbon.maryland.gov/Documents/proposed-regs-for-20171113-md-register.pdf
US Department of Justice. (n.d.). Application for registration under Controlled
Substances Act of 1970. Diversion Control Division. https://apps.deadiversion.usdoj.gov/webforms2/spring/main?execution=e1s1
Nurse practitioners are responsible for diagnosing, treating, and managing acute and chronic health conditions, as well as emphasize health promotion and disease prevention (AANP, n.d.). In reviewing guidelines for licensure as a nurse practitioner, I gained valuable information specific to my state requirements. I am a registered nurse in the state of Maryland and will complete the application process to be a nurse practitioner in the state of Maryland. The Maryland Board of Nursing (MBON) is the governing body for nursing in the state and provides a website specific for CRNP resources.
Application and Regulations
To become certified in the state of Maryland as a nurse practitioner, the applicant must hold a current RN license for MD or a compact state RN license and have graduated from a MBON recognized program at a Master’s level or higher (Division of State, n.d). The application process in MD includes completing a CRNP application provided by the MBON which must be typed, providing a copy of certification from either AANP or ANCC, sealed official transcripts, as well as declaration of state of residence by providing a copy of driver’s license. Maryland is a full practice state meaning that the nurse practitioner is able to evaluate and manage patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments. This includes prescribing medications and controlled substances under the exclusive licensure authority of the state board of nursing (AANP, 2019.). Effective October, 2015, Maryland Board of Nursing now requires new CRNP’s to have a mentor for 18 months after certification. This mentor can be a medical doctor or another CRNP (MBON, 2015). As with any licensure, barriers many exist. The regulation by the state of MD for a mentor may present the new NP with a barrier to practice if the NP is unable to find a provider who is willing to be a mentor for that duration of time. While there aren’t any specific requirements that the mentor must complete according to the state, the availability of the provider to support a new NP may be seen as a challenge for the mentor. In researching requirements for NP’s, I was most surprised at the different levels of practice allowed by each individual state. I am thankful I live and work in a full practice state.
A nurse practitioner in the state of MD is able to prescribe and dispense class II, III, IV, and V medications. The practitioner will obtain a DEA from the United States Justice department using form 224, then will provide that certification information to the state office of controlled substances administration. The NP must also register for the prescription drug monitoring program (PDMP) and MD uses the CRISP system to monitor for patient who may be misusing or addicted to prescription medications. All prescriptions prescribed by the NP must be documented in the patient chart including a sample that may be provided to the patient.
Becoming a CRNP requires many classes and hours of clinical time, and having a detailed understanding of state regulations and requirements will help each student be successful in the certification process.
American Association of Nurse Practitioners (n.d.-a). Nurse practitioners in primary care. https://www.aanp.org/images/documents/publication/primarycarepdf
American Association of Nurse Practitioners (2019). State practice environment. https://www.aanp.org/advocay/state/state-practice-environment
Division of State (n.d.). Retrieved from: https://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx
Maryland Board of Nursing (2015). Retrieved from: https://mbon.maryland.gov/Documents/np_application.pdf