State Regulations for APRN Prescribers in Nevada

The State of Nevada is among one of the most eminent jurisdictions with robust regulations informing the scope of practice for advanced practice registered nurses (APRN). State licensing and practice laws in Nevada are informed by a framework which allows nurse practitioners to review patients, make an informed diagnosis, order and deduce diagnostic tests in addition to prescribing appropriate medications and controlled substances. This is made possible by the presence of the Nevada State Board of Nursing (NSBON); the result of a model endorsed by the National Academy of Medicine (National Academies of Sciences and Medicine et al., 2016).

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Agencies overseeing Advanced Practice Registered Nurses Prescribing in Nevada

The Nevada State Board of Pharmacy (NSBOPh) and the Nevada State Board of Nursing (NSBON) are leading agencies tasked with overseeing and regulating APRN prescribing in Nevada. They work jointly to guarantee safe and appropriate nursing practice within the state of Nevada through structured regulation. The NSBOPh and NSBON are solely responsible for granting prescriptive authority, through a dual application process, to APRNs within the state of Nevada. They are also responsible for licensing eligible candidates aiming to progress in the nursing practice as APRNs. NSBOPh and NSBON develop and approve rules and regulations which are then implemented within the state to guarantee adherence to the highest standards of practice.  The mandate of the aforementioned agencies also includes exercising a degree of control over the practice as a strategy aimed at ensuring stakeholders remain aware of undertakings  within the health sector. This involves evaluating education credentials to certify applicant’s eligibility to become APRNs in addition to managing the renewal of licenses for practitioners (Scope of Practice Policy, 2020).

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The NSBON plays a central role in reviewing applications by nurse practitioners transitioning to independent service providers within the healthcare sector as a seemly approach to improving access. It also participates in conducting timely and comprehensive statistical assessments of the APRN population within the state of Nevada. It is through this process that the board determines the exact number of applicants to become APRNs and provide much needed health services to the general population.  The NSBON also conducts frequent evaluations of the cost of care within the state of Nevada as a novel framework towards the ultimate standardization of health services in the United States.

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Educational requirements for prescribing as an Advanced Practice Registered Nurses in Nevada

In order to prescribe as an APRN in Nevada, one should be a holder of a master’s degree (or higher), having successfully completed an academic program in advanced health assessment diagnosis. This information will be obtained from applicant’s official transcript as soon as they complete the APRN program. The presence of the said educational requirements is important in making sure applicants are uniquely qualified to prescribe as APRNs within the state and with cutting-edge skills essentials when plagued with emerging challenges. Applicants must also prove completion of an advanced pathophysiology academic program and Pharmacotherapeutics. This particularly fundamental to the practice since specialized skills are at the core of an APRNs scope of practice as they endeavor to either serve as nurse midwives, nurse anesthetists, or clinical nurse practitioners. The APRN program typically prepares applicants within the state as they aspire to join the ranks of other qualified medical practitioners while playing their duty within a specific capacity. Applicants are also expected to have 2000 hours of service in the profession which is equivalent to 2 years of full practice. Those who fail to meet this requirement must obtain a supervising practitioner agreement prior to an evaluation of their academic credentials. Individuals who fail to satisfy the above requirements will be required to enroll in refresher courses for capacity building and making certain they hone specialized skills.

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Clinical nurse specialists will be required to have completed at least two high-level nursing courses in any area of advanced physical assessment and physiology. Nursing practitioners working towards certificate recognition will be required to enroll in a related program which will then be accredited and recognized by the board. Earning certification after completing appropriate programs will then be followed by certification by acclaimed bodies. The state of Nevada currently recognizes the National Board of Certification & Recertification of Nurse Anesthetists (NBCRNA) American Nurses Credentialing Center (ANCC), Pediatric Nurse Certification Board (PNCB), American Academy of Nurse Practitioners (AANP), National Certification Corporation (NCC), and American Midwifery Certification Board (AMCB) as eligible certification bodies.   

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Nurse practitioners are required to complete an Application for Advanced Practitioners of Nursing Prescribing Privileges and a fee which will then be presented to the NSBOPh.  Additionally, one can also apply for temporary approval of practice in the event results for national certification are still pending. Successful applicants will be expected to develop a collaborative agreement with procedures outlining current collaborative relationship with the physician as outlined in the Record of Practice and Guidelines Protocols.

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Comparison of regulations in the state of Nevada and Illinois

Although regulations have been standardized across the United States and in jurisdictions such as Nevada, key differences can be identified when compared to the state of Illinois where I intend to practices. One of the main differences in the regulations is in the licensing. Despite the fact that Nevada has emerged as a paragon of regulation with a relatively simple procedure, Illinois references a highly sophisticated system. Its complexity lies in the requirement that nurses should possess appropriate skills and competencies before being licensed eventually (Stokowski, 2018). The state of Illinois also requires applicants to have 700 hours compared to Nevada’s 2000 hours of service in order to be certified.  Another fundamental difference between both states is the manner in which they approach nurse practitioners. Illinois only recently began offering refresher courses; a practice which is commonplace in Nevada targeting nurses requiring accrediting and registration. The NSBON plays an important role during this process by creating a robust system for monitoring progress among nurses while guaranteeing adherence to high standards within the practice.  In Illinois, the state board of nursing relies on a strict code of conduct nurse practitioners which offers them a sense of direction in the practice. Contrary to the practice in Nevada, the board in Illinois has the power to revoke the license of any nurse practitioner who fails to live up to set expectations or in the event that they contravene the code of conduct.

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Outline of the actions required to prescribe in Nevada

Prescribing in the state of Nevada is a methodical process requiring nurses and other medical staff to remain well within the precincts of set rules and regulations. The following is an outline of actions required to prescribe in Nevada:

  1. A patient is first required to consult a certified medical practitioner.
  2.  The medical practitioner then conducts an in-depth evaluation of the symptoms manifesting and any other complaints voiced by the patient.
  3. The patient then undergoes a series of extensive medical tests to determine health condition behind recorded symptoms.
  4. Test results should then guide the medical practitioner in making an informed determination of the condition and accompanying medication.
  5. The medical practitioner should then inquire about adverse drug interactions to guide their choice of the most appropriate medication to administer.
  6. The medical practitioner then makes an informed decision and prescribes suitable medication together with recommended dosages.

Controlled Substances regulations in Nevada and the process for obtaining DEA registration

Controlled substance regulation is a major feature of state control in Nevada. The implementation of control substance regulations is part of a grand scheme by the federal government to regulate the use and distribution of substances such as opioids (Rosenthal & Burchum, 2021). In Nevada, this process involves prescribing, cataloguing, record keeping, security, inventory, and apposite contingency measures of breach. Nurse practitioners are also guided on proper handling and disposal of controlled substances approved for use (Nevada.gov. 2020). Certified APRNs within the state are primarily tasked with prescribing to prevent medical errors and abuse.  DEA certification is paramount for APRNs. Applicants in the state of Nevada are required to submit a complete application form to the agency for approval. Registration forms will be obtained from the DEA website before being submitted physically. Applicants should expect to pay a non-refundable processing fee to the state of Nevada.  Mandatory course training will also be offered to improve applicant’s knowledge of state law and the distribution of controlled substances.

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