Question

APRN scope of practice: Do you anticipate any concerning restrictions to your nursing practice, according to new york state’s regulations for APRN scope of practice?

Answer 1

The American Nurses Association's Committee on Nursing Practice Standard and Guidelines have developed a Professional Nursing Practice Regulation which is otherwise called the APRN scope of practice that clarifies the role and responsibilities of each member associated with the Professional Nursing Practice. These scopes and standards in practice has been developed to explain the "who", "what", "where", "when", "why" and "how" of nursing practice. Often it is seen that there is an issue regarding the distribution of power, authority and work among the members of the nursing practice. This mainly occurs due to undefined and unframed regulations stating roles and responsibilities of the staffs. After the implementation of the APRN scope of practice this issues have been reduced as every staff is aware of his own job description and the consequences of breaking these regulations.

The Advanced Practice Registered Nurses (APRN) scope of practice have also reduced the burden of carrying multiple licenses. It provides a multi-state licensure that allows the nurses to practice and communicate with nurses across the states lines both physically and electronically. It eliminates the concept of one license per state.

With the implementation of the APRN scope of practice, the nurses are bound to work within their scope of service and to perform function, duties and responsibility that has been designated to them. In some circumstances this may compromise the nurses clinical and critical thinking and may cause hinderance in performing her job tactfully. For example: There are many incidences in which nurses have to act out of her job description to save a life or render a quality service. In an emergency when doctor is not around and responding to your calls, you need to take certain decisions based on your skills and expertize without physician's order which is against the regulations. If the patient's blood sugar is 20mg/dl and the sugar level do not rise to expected level even after sugar substitutes, then the nurse takes a decision to change the intravenous fluid to dextrose from plain normal saline. If required she also starts to infuse 25% dextrose which is considered to be concentrated electrolyte, one of the high alert medication that should not be infused without doctors order or prescription. In this emergency, this act of the nurse is ethical as she makes her best effort to save the life of the patient and moreover it is a evidence based practice to use intravenous dextrose during severe hypoglycemia.

The other issue that has been seen is that inspite of implementing the APRN scope of practice standards, some state still prefer individual state licensure for practice. The implemention of APRN scope of serivce has been beneficial that has helped nurses to comply with their work practice effectively.