Week 1 Main Discussion Post—
Summary of findings
Laws that govern nurse practitioner (NP) definition, scope of practice, and prescriptive authority, along with any requirements for physician collaboration, are governed by state legislature (Buppert, 2021). In South Carolina, the state Board of Nursing (BON) has the authority to govern NP practice. Requirements for becoming certified and licensed in SC include holding an active RN license, obtaining a graduate-level degree in an NP role, and passing a national certification exam (American Association of Nurse Practitioners [AANP], 2020). The application process is managed by the state board of nursing online through the state’s labor, licensing, and regulation (LLR) website found at llr.sc.gov.
The South Carolina Legislature (South Carolina Legislature, n.d., 40 section) defines the scope of practice for a nurse practitioner in the Nurse Practice Act as “ (5) “Advanced Practice Registered Nurse” or”APRN” means a registered nurse who is prepared for an advanced practice registered nursing role by virtue of additional knowledge and skills gained through an advanced formal education program of nursing in a specialty area that is approved by the board. The categories of APRN are nurse practitioner, certified nurse-midwife, clinical nurse specialist, and certified registered nurse anesthetist. An advanced practice registered nurse shall hold a doctorate, a post-nursing master’s certificate, or a minimum of a master’s degree that includes advanced education composed of didactic and supervised clinical practice in a specific area of advanced practice registered nursing. APRNs must achieve national certification within two years post-graduation. An APRN may perform those activities considered to be the practice of registered nursing or advanced practice consisting of nonmedical acts, such as population health management; quality improvement or research projects within a health care system; and analysis of data and corresponding system recommendations, revisions, developments, or informatics. An APRN also may perform specified medical acts pursuant to a practice agreement as defined in item (45). (40) “Nurse Practitioner” or “NP” means a registered nurse who has completed an advanced formal education program at the master’s level or doctoral level acceptable to the board, and who demonstrates advanced knowledge and skill in assessment and management of physical and psychosocial health, illness status of persons, families, and groups. Nurse practitioners who perform medical acts must do so pursuant to a practice agreement as defined in item (45).”
The state of South Carolina has an in-depth Nurse Practice Act which covers many aspects of practice including definitions, criminal records, license requirements and renewal, initial certification exam, demonstration of continued competency, and code of ethics (South Carolina Legislature, n.d.). The state’s practice agreement is a written agreement developed by an NP and collaborating physician to establish the medical aspects of care that are to be provided by the NP and must contain a way for evaluation to ensure patient safety and quality of care in accordance with state and federal laws (Buppert, 2021).
A DEA license is required for healthcare providers who prescribe controlled substances. The DEA will assign an NP a DEA number as a mid-level practitioner if the NP has a practice site, if state law permits, and the NP has no felony on record (Buppert, 2021). South Carolina requires physician collaboration and poses restrictions for prescribing controlled substances. Schedule II nonnarcotic substances can be prescribed for up to 30 days and schedule II narcotic substances must not exceed a 5-day supply with exceptions being hospice or palliative care instances not exceeding a 30-day supply (South Carolina Legislature, n.d.).
Recent legislative and advocacy activities include a senate bill which passed in May 2021 passed which authorizes APRNs and Pas the ability to issue orders for home health care (AANP, 2020). The Myrtle Beach, SC, area has a nurse practitioner advocacy and continuing education group that meets monthly called Grand Strand Advance Practice Nurse Association which offers membership to APRNs in the area along with NP students who are close to graduation.
South Carolina is a restricted practice state and requires physician delegation, supervision, and collaboration for NP practice. The state board of medical examiners must review cases when a supervising physician has more than three NPs practicing under their license (AANP, 2020). A specific barrier in South Carolina is the lack of access to medical care and health professionals in rural areas along with a short supply of statewide primary care physicians. Adopting full scope of practice in SC can be associated with improved access to care, especially in rural areas (Kandrack et al., 2019). If the growing supply of NP practitioners in the workforce is optimally utilized, access to health care especially for racial and ethnic minorities can be improved dramatically (Poghosyan & Carthon, 2017). Additional research is needed surrounding the heated debate on policy reform that grants full state-level NP scope of practice in all states and additional work is needed to align practice and policy efforts with healthcare accessibility (Patel et al., 2018).
Surprising Research Findings
The lack of consistency state to state regarding APRN scope of practice is alarming and surprising, as well as the lack of a clear scope of practice in some states. Clarity is essential for an NP to practice safely and confidently. With the aging population in the United States along with the challenges of rising healthcare costs and growing disease burden, NPs bring high-quality care and have a strong potential to vastly increase access to care and help address the healthcare challenges of the future.
American Association of Nurse Practitioners. (2020, October 15). AANP state fact sheet: South Carolina. email@example.com. Retrieved August 31, 2021, from https://www.aanp.org/advocacy/south-carolina
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett.
Kandrack, R., Barnes, H., & Martsolf, G. R. (2019). Nurse practitioner scope of practice regulations and nurse practitioner supply. Medical Care Research and Review, 78(3), 208–217. https://doi.org/10.1177/1077558719888424
Patel, E. Y., Petermann, V., & Mark, B. A. (2018). Does state-level nurse practitioner scope-of-practice policy affect access to care? Western Journal of Nursing Research, 41(4), 488–518. https://doi.org/10.1177/0193945918795168
Poghosyan, L., & Carthon, J. (2017). The untapped potential of the nurse practitioner workforce in reducing health disparities. Policy, Politics, & Nursing Practice, 18(2), 84–94. https://doi.org/10.1177/1527154417721189
South Carolina Legislature. (n.d.). South Carolina code of laws: Nurse practice act. scstatehouse.gov. Retrieved August 31, 2021, from https://www.scstatehouse.gov/code/t40c033.php