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Post 1
Each state will have its own regulations on the scope of practice for nurse practitioners. In Alabama, a collaborative practice agreement is required, and this states that the collaborating physician must be present for at least 10% of the nurse practitioner's hours that are scheduled. They also must visit each collaborative practice site at least quarterly. Additionally, the collaborating physician must provide direction, and oversight must be available to the nurse practitioner by radio, telephone, or other forms of telecommunications. They also require a written standard protocol to identify the scope of practice (American Medical Association, 2019). Comparatively, in Arizona, the physician involvement for a nurse practitioner is not needed, and nurse practitioners must refer a patient to a physician or another health provider if the referral will protect the health and welfare of the patient. The scope of practice includes assessing clients, analyzing data, applying principles of health, managing health, diagnosing, performing diagnostic tests, and prescribing medications. In a state such as Arkansas, there is also no collaborative practice agreement required for an APRN however, the RNP's must practice with protocols developed through their practicing physicians (AMA, 2019). These protocols must address the established procedures, the desree to which collaboration is needed, and the acts of assessment diagnosis, treatment, and evaluation (Feyeresein & Goodrick, 2021).
The benefits of having a collaborative agreement outline what the nurses are allowed to do as far as their scope of practice. The drawbacks of this would be that their practice may be limited in certain states even though their education fulfills practice needs (Feyeresein & Goodrick, 2021). Performing telehealth in a state other than licensing depends on the state's laws. For example, a health care provider that is not licensed in Arizona may provide telehealth services to a person in Arizona, providing they comply with certain conditions. This includes registering with the regulatory board, registering with the controlled substance prescription monitoring program, paying registration fees, and holding an unrestricted practice license in another state (Frey & Chiu, 2021).
The compact nursing license refers to nursing licensure, which is an agreement between states that allows nurses to have one compact state nursing license that will give them the ability to practice in other states. This was originally developed in 2000, and in 2015 it had grown to 25 states. Currently, it is enacted in 39 jurisdictions. It does require state and federal fingerprint criminal background check (Kappel, 2018).
Reimbursement will also vary; however, Medicare will reimburse the nurse practitioner care at 100% if the visit is billed as an incident rather than under the own NPI number, and this will be attributed to the physician (Feyeresein & Goodrick, 2021).
In many area, there is also an 85% reimbursement policy that is supported by a rationale that physicians have higher student loans and pay the overhead for their practice costs. It is also based on the fact that they have higher malpractice premiums and care for more complex patients (Feyeresein & Goodrick, 2021).
During the COVID-19 pendemic, there was the introduction of waiver 1135 for telehealth, and it has been shown that telehealth is a positive strategy to enhance healthcare (Frey & Chiu, 2021).
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