NP Scope Of Practice

Which of the following is most accurate about nurse practitioner’s scope of practice?

A. The organization that grants NP certification dictates a profession scope of practice.

B. The employer is able to require the NP to provide services that are beyond what regulatory bodies outline.

C. The law of the state where the NP practices provides regulatory guidance on scope of practice.

D. Federal law advises on NP scope of practice.
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Transcript

Voiceover: Welcome to NP certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question, so you can better understand how to arrive at the correct test answer. 

So, if you're ready, let's jump right in. 

Margaret Fitzgerald: Which of the following is most accurate about nurse practitioner scope of practice?  

A: The organization that grants NP certification dictates a profession scope of practice. 

B: With supervision, the employer is able to require the NP to provide services that are beyond what regulatory bodies outline.  

C: The law of the state where the NP practices provides regulatory guidance on scope of practice. 

D: Federal law advises on NP scope of practice.  

Where do we start? Let's first take a look at what kind of a question this is. Given in this question we're not in the exam room, this is a professional issues question. While the NP boards don't contain many of these questions, there are a few crucial items that often crop up. 

And this is one. In addition, this is part of your knowledge base that you should come to your professional practice with as an NP, so you're best able to negotiate the regulatory part of being an APRN. NP scope of practice describes the who, what, where, when, why, and how of NP practice defining what the NP can legally do once certified and licensed  

Scope of practice, often abbreviated SOP, is influenced by professional licensure and state laws. Some state laws are more limiting than others on describing what an NP scope of practice is. While other states grant NPs full practice authority, or FPA. What is full practice authority? It is the authorization of the nurse practitioner to evaluate, diagnose, or order and interpret diagnostic tests; initiate and manage treatments, including prescribing medications under the auspices of the State Board of Nursing. 

While practice acts vary, the requirements for an NP to sit for NP certification are: professional qualifying exam are consistent across the USA, the District of Columbia, and the U.S. territories. So, with that in mind, let's take a look at the options. Which of the following is most accurate about NP scope of practice? A: The organization that grants NP certification dictates the profession’s scope of practice. 

This is incorrect. The purpose of NP level certification is to assess entry-level NP knowledge and practice competencies required to provide safe and quality healthcare. The NP certification is required in nearly every state and the nation that has this as a requirement for NP licensure to practice as an NP or nurse practitioner. And the handful of states that don't require certification for NP licensure, employers will require this important vetting of entry level NP competency. 

And I'm often asked that, ‘Well, if the state doesn't require you to get certified to get a license, why not just skip certification?’ And my come back to that is all right, you're sitting on the other side of the table getting ready to hire an NP. You are in that rare state that doesn't require NP certification to get a license, but you have two candidates who at least on paper, or shall I say the computer screen, look fairly equivalent. 

One is certified and therefore has demonstrated passing an exam that vet you to see if you will be a safe, competent, entry level NP clinician and the other has not. Which one are you going to hire? I know as somebody who has had a higher fire capability for almost my entire career as an RN and an NP, I am definitely going for the person who is certified. Option B: With supervision, the employer is able to require the NP to provide services that are beyond what regulatory bodies outline.  

This is incorrect. Employers cannot require the NP to practice beyond the state's scope of practice. Providing supervision does not negate that. On the other hand, an employer can limit an NP scope of practice as it is outlined by state regulation. One of the most common examples of this is seeing that a nurse practitioner has to have a physician supervisor while practicing in a full practice authority state where regulation does not require this. Option C: The law of the state where the NP practices provides regulatory guidance on scope of practice.  

This is the correct answer. NP scope of practice is largely dictated by state regulations, whereas RN practice acts are relatively similar state to state. The NP practice acts are quite different from one another. Scope of practice acts, however, are written broadly, and if a person is looking for something in their state's practice act that says you can prescribe a certain drug or do a certain procedure, you're unlikely to find that in the document. 

The reason, as these are broadly written allow for intelligent interpretation, adding skills and knowledge in evolution over time. I'm going to give you a quick example from my own practice. When I was in NP school, which was a while ago, there were no progestin implants. Okay. They simply didn't exist. So I never learned how to insert a progestin implant because it didn't exist. 

I added that to my skill set because I've been vetted to do it. There's a whole process to get approved to do this. What we have to make sure we do is recognize practice is really dynamic. And so, scope of practice laws cannot be written so distinctly as to need to go back and be updated. Every time we turn around, when there is a new procedure to do or a new medication to prescribe. Option D: Federal law advises on NP scope of practice. 

This is interesting. The federal law has virtually no oversight on NP practice, with the exception of controlled substances. So, the DEA does comment and dictate practice for select controlled substances. Obviously, that's not the correct answer. Key takeaway: knowledge of NP regulation, including scope practice, is key to your professional development and NP board success. Your state organization and our national organization are great resources for this information. 

Voiceover: Thank you for listening to NP certification Q&A presented by Fitzgerald Health Education Associates. Please rate, review, and subscribe to this podcast, and for more NP resources, visit FHEA.com