Nurse Practitioner Practice Agreement, Certification, and Licensure in Pennsylvania
In Pennsylvania (PA), advanced practice registered nurses are referred to as certified registered nurse practitioners (CRNPs) (Buppert, 2021). In PA, CRNPs operate under a reduced practice arrangement. State laws governing practice and licensure mandate that they establish a collaborative agreement with a physician who holds a current PA license. This agreement allows them to provide patient care and prescribe medications (American Association of Nurse Practitioners, 2019). The collaborative agreement must detail the physician’s availability to the CRNP, whether directly or through phone communication, include an emergency services plan, and specify the regular review of the CRNP’s patient charts by the physician (Buppert, 2021).
To attain CRNP certification in PA, students must graduate from an accredited master’s or post-master’s nurse practitioner program approved by the Board. They must also meet the minimum clinical hour requirement of 500 hours (Pennsylvania Department of State, 2021). CRNP students must subsequently pass a nationally recognized certification exam in their specialized field (Pennsylvania Department of State, 2021). Additionally, applicants must complete a minimum of 45 hours of advanced pharmacology coursework within five years before seeking prescriptive authority (Buppert, 2021). To secure licensure, candidates must pay a $100 licensing fee for in-state institutions or a $140 fee for out-of-state education. They must also submit a $50 application fee for prescriptive authority (Pennsylvania Department of State, 2021). Furthermore, applicants are required to complete three hours of child abuse recognition and reporting continuing education for initial licensure (Pennsylvania Department of State, 2021). Established CRNPs must fulfill 30 hours of continuing education every two years, including a minimum of 16 hours of pharmacology and two hours of child abuse education. They are also obligated to pay a biennial renewal fee of $81 along with a $41 biennial prescriptive authority renewal fee (Pennsylvania Department of State, 2021). The primary resource for CRNPs regarding nurse licensure in Pennsylvania is the Pennsylvania Department of State website, which provides comprehensive information and resources related to the requirements of the PA State Board of Nursing Pennsylvania Nursing Certification and Licensure.
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Nurse Practitioner Scope of Practice in PA
In collaboration with a licensed physician in the Commonwealth of Pennsylvania, CRNPs are authorized to perform comprehensive patient assessments and establish medical diagnoses. They can order and conduct diagnostic tests, initiate patient referrals to other licensed healthcare professionals, create and implement treatment plans, and administer pharmaceutical treatments if granted prescriptive authority. CRNPs are also responsible for completing admission and discharge summaries (Buppert, 2021). Furthermore, they have the authority to order blood products, dietary plans, home health and hospice care, and durable medical equipment for patients. CRNPs can refer patients for physical, occupational, respiratory, and dietary therapies as well. In addition, the scope of practice for CRNPs in PA includes conducting disability assessments, conducting initial methadone treatment assessments, issuing homebound schooling certifications, and issuing verbal orders in accordance with a healthcare facility’s policies. While CRNPs in PA have a wide-ranging scope of practice, it is important to note that they are constrained by the necessity of a collaborative agreement with a physician to execute their scope of practice Pennsylvania Nursing Certification and Licensure.
Obtaining a Drug Enforcement Agency License and PA Regulations
To be authorized to prescribe and dispense controlled substances, CRNPs must register with the United States Department of Justice Drug Enforcement Administration (DEA) as mid-level practitioners and secure a DEA number (Pennsylvania State Board of Nursing, 2019). In Pennsylvania, a separate state registration for prescribing controlled substances is not required (Pennsylvania State Board of Nursing, 2019). CRNPs in PA are permitted to prescribe a Schedule II controlled substance for up to a 30-day supply and a Schedule III or IV controlled substance for up to a 90-day supply, as stipulated in their collaborative agreement (Buppert, 2021). Notably, CRNPs are not authorized to prescribe or dispense gold compounds, heavy metal antagonists, radioactive agents, oxytocics, and Schedule I controlled substances (Buppert, 2021).
Maryland Registered Nurse Certification and Licensure
Legislative and Advocacy Activities
The Pennsylvania Coalition of Nurse Practitioners (PCNP) is a state organization dedicated to safeguarding and advocating for CRNPs’ practice in PA (Pennsylvania Coalition of Nurse Practitioners [PCNP], n.d.). PCNP is currently engaged in advocating for PA to become a full-practice authority state for CRNPs (PCNP, n.d.). Senate Bill 25 and House Bill 100 have successfully passed in the Senate and are currently undergoing assessment in the House (PCNP, n.d.). These bills propose granting CRNPs full practice authority after completing 3,600 hours and three years in a collaborative agreement (PCNP, n.d.). Advocating for full-practice authority legislation for CRNPs has the potential to address the primary care provider shortage in PA, extend services to underserved healthcare areas in the state, and reduce healthcare costs for patients (PCNP n.d.) Pennsylvania Nursing Certification and Licensure.
Restrictions and Barriers Impacting Nurse Practitioner Independent Practice in PA
The nurse practitioner workforce is the fastest-growing primary care provider workforce in the United States, with the potential to lower healthcare costs and enhance patient access to quality healthcare services in Pennsylvania (Poghosyan, 2018). However, reduced practice constraints in PA have been associated with less efficient and costlier patient care (Ortiz et al., 2018). These restrictions hinder patient access to healthcare, particularly in medically underserved urban and rural areas of the state, affecting the three million PA residents covered by Medicaid insurance (PCNP, n.d.). Furthermore, with the increased demand for healthcare services due to COVID-19, restricted practice authority limits the PA healthcare system’s ability to respond effectively to patient needs (Moore et al., 2020). It surprised me to discover that 22% of PA’s population, approximately 2.5 million residents, reside in designated medically underserved areas (PCNP, n.d.). Research by the PCNP also highlights that patients covered by Medicare and Medicaid experience 50% more unnecessary hospitalizations in a restricted practice state like PA compared to states with full practice authority (PNCP, n.d.). While CRNPs in PA possess the authority to deliver quality care to patients, healthcare policy reform is imperative to grant CRNPs full practice authority and, in turn, expand access to affordable, high-quality care across the entire state of PA (Poghosyan, 2018).
References
American Association of Nurse Practitioners. (2019). State practice environment.
https://www.aanp.org/advocacy/state/state-practice-environment
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett.
Moore, C., Kabbe, A., Gibson, T.S., & Letvak, S. (2020). The pursuit of nurse practitioner practice legislation: a case study. Policy, Politics, & Nursing Practice, 21(4), 222-232. https://doi.org/10.1177/1527154420957259
Ortiz, J., Hofler, R., Bushy, A., Lin, Y.L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. Healthcare, 6(2), 65. https://doi.org/10.3390/healthcare602065
Pennsylvania Coalition of Nurse Practitioners (PCNP). (n.d.). Full practice authority for nurse Pennsylvania Nursing Certification and Licensure practitioners expands care for PA. https://careforpa.com/improving-care
Pennsylvania Department of State. (2021). Certified registered nurse practitioner Pennsylvania licensure requirements. Commonwealth of Pennsylvania. https://dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Pages/Certified-Registered-Nurse-Practitioner-Licensure-Requirements-Snapshot.aspx
Pennsylvania State Board of Nursing. (2019, July). Instructions for certified registered nurse practitioner (CRNP) prescriptive authority application. https://dos.pa.gov/ProfessionalLicensing/BoardsCommisions/Nursing/Documents/Applications%20and%20Forms/Prescriptive-Authority-Application.pdf
Poghosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioner workforce and practice. Nursing Economics, 36(1), 43-45 Pennsylvania Nursing Certification and Licensure.
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