About the APRN Practice and Information

With advanced practice registered nurses (APRN), there is a constant need to clarify the scope of practice (SOP). It was discussed briefly at the bottom of the About a PMHNP-BC page. It simply talked about safe practices because overall, there are still many different variations. Normally the SOP falls into 6 categories:

1. It’s defined by statute
2. Clearly defined by regulations
3. Vaguely defined by statue
4. Simply not defined
5. SOP is defined by state laws prohibiting the practice without a medical license
6. Determined by a physician, who may delegate to an NP by law

Therefore, some of the states SOP’s for APRN’s are not good or have an elegantly defined one such as Oregon’s description for a certified registered nurse practitioner (CRNP):

• (1) Purpose of Scope of Practice: (a) To establish acceptable levels of safe practice for the nurse practitioner. (b) To serve as a guide for the Board to evaluate nurse practitioner practice. (c) To distinguish the scope of practice of the nurse practitioner from that of the registered nurse.
• (2) The role of the nurse practitioner will continue to expand in response to societal demand and new knowledge gained through research, education, and experience.
• (3) The nurse practitioner provides holistic health care to individuals, families, and groups across the life span in a variety of settings, including hospitals, long-term care facilities, and community-based settings. (4) Within his or her specialty, the nurse practitioner is responsible for managing health problems encountered by the client and is accountable for health outcomes. This process includes: (a) Assessment; (b) Diagnosis; (c) Development of a plan; (d) Intervention; (e) Evaluation.
• (5) The nurse practitioner is independently responsible and accountable for the continuous and comprehensive management of a broad range of health care, which may include: (a) Promotion and maintenance of health; (b) Prevention of illness and disability; (c) Assessment of clients, synthesis and analysis of data and application of nursing principles and therapeutic modalities; (d) Management of health care during acute and chronic phases of illness; (e) Admission of his/her clients to hospitals and/or health services including but not limited to home health, hospice, long term care and drug and alcohol treatment; (f) Counseling; (g) Consultation and/or collaboration with other health care providers and community resources; (h) Referral to other health care providers and community resources; (i) Management and coordination of care; (j) Use of research skills; (k) Diagnosis of health/illness status; (l) Prescribing, dispensing, and administration of therapeutic devices and measures, including legend drugs and controlled substances as provided in Division 56 of the Oregon Nurse Practice Act, consistent with the definition of the practitioner’s specialty category and scope of practice. (6) The nurse practitioner’s scope of practice includes teaching the theory and practice of advanced practice nursing.
• (7) The nurse practitioner is responsible for recognizing limits of knowledge and experience, and for resolving situations beyond his/her nurse practitioner expertise by consulting with or referring clients to other health care providers.
• (8) The nurse practitioner will only provide health care services within the nurse practitioner’s scope of practice for which he/she is educationally prepared and for which competency has been established and maintained. Educational preparation includes academic coursework, workshops, or seminars, provided both theory and clinical experience are included.
• (9) The scope of practice as previously defined is incorporated into the following specialty categories and further delineates the population served:

Psychiatric/Mental Health Nurse Practitioner (PMHNP): The Psychiatric/Mental Health Nurse Practitioner independently provides health care to clients with mental and emotional needs and/or disorders. The Psychiatric/Mental Health Nurse Practitioner scope may be further differentiated by the care of populations from newborn to young adulthood, adolescent to adult, or across the lifespan.

–Oregon Website (they detailed all the other domains of APRNs)
-Also, check out your specific state

States Allowing Full Practice

Another issue for APRN’s is a collaborative practice, the following states allow NO physician involvement for practice: Alaska, Arizona, Colorado, Connecticut***, Washington DC, Hawaii, Idaho, Kentucky, Maryland, Main**, Minnesota, Montana, North Dakota, Nebraska, New Hampshire, New Mexico, Nevada, Oregon, Rhode Island, Utah**, Vermont**, Washington, Wyoming, West Virginia
**After 2 years of practice or if operating a pain clinic
***After 3 years of practice
They are additional states that have recently changed their status, -check out the AANP Map

Before heading to another state, double-check to make sure state laws haven’t changed because more states are trying to implement more independent practices to handle the demands of health care. Most states have a collaborative agreement with doctors or other requirements to prescribe or perform procedures. The National Council of State Boards of Nursing (NCSBN) handles how titles are used, the SOP, and how acts become laws and has a great section for APRNs. Make sure your program is accredited!

Another issue that is affecting PMHNP practice is how The Nurse Licensure Compact allows portability to only 25 states for RN’s but not for APRNs. However, in 2015 the NCSBN approved an APRN Compact model but it has yet to be widely accepted. The map is consistently being updated and hopefully would encourage more acceptance. Read how the NP’s practice authority varies state by state.