New York State Advanced Practice Registered Nurse Scope of Practice and Protocols

1. New York State Advanced Practice Registered Nurse Scope of Practice and Protocols Rebecca Hegel and Valerie Salazar State University of New York: Institute of Technology

2. Learning Objectives By 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

3. 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).

4. NYS APRN Scope of Practice Definition Education Professional Role Accountability Responsibility Reference: Title VII, Article 139 of New York State Education Law of 1988

5. 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)

6. 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

7. 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

8. 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

9. 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

10. Areas of Specialty • Adult Health • Family Health • Gerontology • Neonatology • Obstetrics • Oncology • Pediatrics • Perinatology • Psychiatry • School Health • Women’s Health • Holistic & Palliative care

11. 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

12. 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

13. 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.

14. 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

15. Practice Issues • Scope and Standards of Practice • State Law and Regulation • Institutional Policies and Procedures • Self-Determination • Professional Liability and Risk Management Concerns

16. 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

17. Implications Nurse 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

18. 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

19. Class Participation 1.) If I am unsure if an action falls within my legal scope of practice, I should: a. call NYSED @ (518) 473-3817 ext. 120 b. email nursebd@mail.nysed.gov c. write to NYSBON at NYS Education 89 Washington Avenue-Education Building State Board for Nursing Second Floor, West Wing Albany, NY 12234 d. call the NPA @ (518)348-0719 e. email the NPA info@theNPA.org

20. Class Participation 2. A good protocol text for practice would be: a. ANA Code of Ethics b. ANA Nursing Scope and Standards of Practice c. Burns and Grove-Pediatric Primary Care d. AACN: Guide to NP curriculum

21. Class Participation • 3.) What can I do to promote the expansion of the APRNs scope of practice? a. join my local NPA b. call President Obama directly at the Whitehouse @ (202) 456-1111 c. participate in professional networking d. get involved with health policy activities

22. Additional Reading • http://www.nursingworld.org/EspeciallyForYou/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

23. 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

24. 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