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Advanced Practice Registered Nurses (APRNs) are crucial in healthcare delivery, offering specialized care and services to patients across various settings. However, according to Bosse et al. (2017), the scope of practice and regulatory frameworks governing APRNs vary significantly from state to state. This comparison examines the regulations for APRNs in Missouri and California, two states with differing approaches to APRN practice. As Neff et al. (2018) highlighted, by exploring these regulations, we can gain insight into the level of autonomy and authority APRNs possess in each state and understand how these regulations impact patient care.
In Missouri, APRNs operate under restricted practice regulations. They must have a collaborative practice agreement with a physician (Missouri Division of Professional Registration, n.d.). This agreement outlines the scope of practice, prescribing authority, and protocols for collaboration. Additionally, Missouri requires a written protocol for prescriptive authority, which includes a list of drugs and devices that APRNs can prescribe. The APRN’s collaborating physician must approve the protocol.
Conversely, California grants NPs full practice authority, allowing them to practice independently with standardized procedures approved by supervising physicians. They can independently assess, diagnose, interpret diagnostic tests, initiate treatment plans, and prescribe medication. However, they must have a standardized procedure approved by a supervising physician for prescribing medication.
For instance, an NP in Missouri would follow protocols outlined in their collaborative agreement when prescribing antibiotics for a bacterial infection. At the same time, their counterpart in California could independently diagnose and treat the disease according to their standardized procedure agreement. These differences in regulatory frameworks underscore variations in APRN autonomy and prescriptive authority between states (Short, 2022), highlighting the importance of understanding and adhering to state-specific regulations to ensure safe and effective patient care.
In conclusion, the regulations governing APRNs in Missouri and California exemplify the diverse approaches states take in defining the scope of APRN practice. In contrast, Missouri requires collaborative agreements and written protocols, and California grants NPs full practice authority with standardized procedures. Understanding these differences is crucial for APRNs to navigate their practice environments effectively and provide optimal care to patients. As the landscape of healthcare continues to evolve, policymakers must consider the role of APRNs in meeting the growing demand for accessible and quality healthcare services, ensuring that regulatory frameworks support APRNs in delivering safe and effective care to their communities.
References
Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary careLinks to an external site.. Nursing Outlook, 65(6), 761–765.
Missouri Division of Professional Registration. (n.d.). Advanced practice. https://pr.mo.gov/nursing-advanced-practice-apps.aspLinks to an external site.
Neff, D. F., Yoon, S. H., Steiner, R. L., Bumbach, M. D., Everhart, D., & Harman J. S. (2018). The impact of nurse practitioner regulations on population access to careLinks to an external site.. Nursing Outlook, 66(4), 379–385.
Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ”
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