Professional Issues: NP Practice

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.
Robert has recently graduated from his nurse practitioner program. During a job interview for an organization that has clinical sites in multiple states, he's asked questions about NP practice issues. Which of the following is accurate?
A. Once I’m certified, I'm also licensed to practice as an NP.
B. Once I'm certified as an NP and licensed to practice in one state, I'm able to practice in all states.
C. From state to state, the NP practice acts are largely standardized.
Or is it option
D. NPs must obtain state level prescriptive authority as well as federal DEA registration number in order to prescribe controlled substances.
And the correct answer here is D. Where do you start? As always, determine what kind of question this is. In this question, it's mentioned that Robert is being asked about NP practice issues during a job interview. Now that might simply strike terror in your heart, but this can happen. And it is not uncommon for a job candidate to be asked such questions in part to evaluate how well informed the future NP employee is about professional issues, including licensure and certification. Therefore, this is a professional issues question and these topics can crop up now and again on the NP board.
Let's take a look at the background information here. As you know well, the NP assumes the role of assessor, diagnostician, prescriber, and evaluator of response to care and now will be practicing one of the four APRN roles with the other three being the CNS, the CNM and the CRNA. A standardized course of education is needed to qualify for the NP boards and then NPs need to take and pass an additional qualifying exam beyond the NCLEX needed to practice at the RN role. The NP certification of course, is that qualifying exam and this is a highly regulated, highly vetted exam, regardless of the area of focus. The person who passes NP boards has demonstrated possession of the knowledge base and its application needed to practice as a safe entry level NP and the area of focus of the NP study, such as family and I'm a family NP, adult-gero primary care, adult or pediatric acute care, psych mental health and the like. Given the additional responsibility of the NP role, the requirements to practice, of course, then are more complex than that of the RN role.
Let's take a look at the question and the test options provider. Robert has recently graduated from his NP program. During a job interview for an organization that has clinical sites in multiple states, he's asked questions about NP practice issues. Which of the following is accurate? A, once I'm nationally certified, I'm also licensed to practice as a nurse practitioner. I suspect you all knew this one is incorrect. Certification is certainly an important part of NP licensure, but it's only one part. You must be familiar with what is required in each state when you apply for an APRN slash NP license.
B, once I’m certified as an NP and licensed to practice in one state, I'll be able to practice in every state. Also, of course, incorrect. As mentioned, you must meet the legal requirements for each state where you plan to practice. In particular, NP’s prescriptive authority is regulated at the state level and some states have very specific requirements to obtain this. There are a variety of RNs who do have access to compact licensure which has been long touted at the RN level from a viewpoint of treating RN license like, shall we say, your driver's license, that I have a driver's license in Massachusetts, which is where I reside, but I can drive a car in any one of the 50 U.S. states and the District of Columbia. But whereas RNs, have some access to compact licensure that allows the RN to get licensed in one state, but practice in many but not all states, APRN Licensure Compact is not yet developed. There is talk about doing it, but we aren't very far in that process yet.
C, from state to state, NP practice acts are largely standardized. Again, incorrect. Do we have a word that means more than incorrect? I'll just be a Bostonian here and I'll say that's wicked incorrect. NP practice acts differ significantly. More than half of the states and the District of Columbia have full practice authority. I practice in a state with full practice authority. What is full practice authority? According to the AANP, it's the authorization of NPs to evaluate, diagnose, order, and interpret diagnostic tests and initiate and manage treatments, including prescribing medications under the exclusive licensure authority of the State Board of Nursing. And in states with full practice authority, often abbreviated FPA, physician collaboration or supervision is not required for an NP to practice. Obviously, nearly half of the states then do not grant NPs will practice authority and require varying degrees of physician involvement in regulation of practice. By the way, because words count, what we have to be doing is using the term full practice authority because that's what it is, not independent practice. And if you're saying, oh, potatoes, potatoes, what difference does it make? Words do count. It does make a difference because when you think about it, do any of us practice independently? No, none of us. Yet in my practice, I know how to diagnose somebody with gallbladder disease. I don't know how to take out a gallbladder. That's fine with me. But I could do everything in the workup up to, but not removing the gallbladder. The surgeon also doesn't know how to take care of people with hypertension, dyslipidemia, diabetes, hypothyroidism, the mental health challenges, etc., etc. etc. The things that I'm actually quite good at and so I can't do with the surgeon does, but the surgeon can't do what I do. So, I find it works out where mutually dependent on one another.
Option D of course then has to be the correct answer because we eliminated A, B and C and must obtain state level prescriptive authority as well as federal DEA registration number in order to prescribe controlled substances. NPs are able to prescribe controlled substances in all 50 states and the District of Columbia. The NP must be licensed in the state to practice, then obtain state level prescriptive authority, then apply for the federal DEA number in order to prescribe controlled substances. Now, I know you're probably thinking to yourself, well, I'm not sure I want that responsibility. I'm not sure that I want to prescribe controlled substances, and maybe it's easier to say to a patient, while I can't prescribe an opioid for pain or something like that, and I really would encourage you not to think along those lines, but rather to think: NPs have worked for decades to get the state a practice that we have now, and we still have a fairly long way to go to make practice equitable state to state and to make patient access to NP care equitable state to state. So, get your DEA number. You never know when you might need to prescribe a controlled substance.
What's the key takeaway here? Entering into NP practice can be daunting, but also thrilling. As you're truly in a new role in your health care provider career, your state NP association, as well as our national organization, American Association of Nurse Practitioners, AANP, provide great information on how to proceed.
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.