Certification and Licensure Plan: South Carolina
Advanced nurse practitioners must adhere to the regulations of the nursing board, which specifically requires them to establish a collaborative practice agreement. This agreement is mandatory in twenty U.S. states currently and states that APRNs are required to have the supervision of a physician while working (Bell et al., 2018, pp. 5). The state that will be examined today is South Carolina, which currently mandates a practice agreement for all APRNs with a collaborating physician who is “readily available for consultation” (pp. 6). The chosen physician must live within a forty-five-mile range from where the APRN practices and is only allowed to collaborate with a maximum of three APRNs at a time (pp.6).
According to the South Carolina Legislature (2017), the practice agreement must lay out the foundation of the APRN’s standards of practice. This would include details about prescribing medications, patient safety, policies and procedures, and an on-call agreement with the physician must also be established. Each of these things must be approved by the collaborative physician of the APRN’s choice (pp. 4).
To become a licensed APRN in the state of S.C., the person must first obtain a nursing license. They must then complete an accredited APRN program and successfully pass boards to begin what is known as the “Orientation” process or practice. There are several things the APRN must apply for which include an application for an APRN license by Endorsement. The applicant must provide their certifications, and transcripts from the master’s program attended, pay any fees to the board, and they must declare a specialty. After completing the endorsement application, the APRN must apply for prescriptive authority within the state of S.C. by completing the online application and paying any additional fees. Also noted before obtaining prescriptive authority the applicant must have a minimum of “twenty contact hours in pharmacotherapeutics within two years before application” (SCLLR, 2022, pp. 5) with 15 of those hours consisting of controlled substances (pp.5).
After the applicant has been employed and completed the contact hours necessary to gain prescriptive authority, they must also establish a practice agreement with a physician. The SCLLR (2022) reports that prescriptive authority is given before applying for a DEA license. It is optional to obtain a DEA licensure. If desired, the APRN can apply for the “Controlled Substance Registry through SC DHEC” (SCLLR, 2022, pp. 6). The website to obtain all of the information needed for licensure is on the website https://llr.sc.gov/nurse/
Links to an external site., which is the S.C. Board of Nursing website.
Prescription monitoring programs or PMPs are “databases that track controlled substance prescribing and dispensing across patients and prescribers, are a primary policy strategy to reduce OA supply and prescribing that may increase overdose risk.” (Allen et al., 2022, pp. 4088). The state of South Carolina does have a PMP called The South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS) and administered by SCDHEC according to the U.S. Department of Justice (2018, pp. 1).
According to the South Carolina Legislature (2017, pp. 9), South Carolina does allow APRNs who have obtained prescriptive authority specifically for controlled substances to prescribe them. The APRNs are authorized to prescribe Schedule II – Schedule V and this must be included in the practice agreement with the collaborating physician. Some stipulations are described by the SC Legislature that only allow the prescription to be written for no more than five days and if a refill is needed the physician’s consent must be obtained first.
As a future APRN, I have considered the regulations placed on collaborating physicians may impact practice. Discussed earlier was the limit on the number of APRNs a physician could supervise in S.C. Also, the 45-mile range a collaborating physician must be from their APRN was considered. These two things may make it very difficult to initially find a collaborating physician to initiate a practice agreement with. This may prolongate the process of obtaining prescriptive authority and even finding a job. What surprised me while doing research is how easy it is to access information about becoming licensed in S.C., all of the steps were outlined on the SC Board of nursing’s website. This should make it easier to obtain my licensure when I am ready.
References
Allen, B., Jent, V. A., & Cerdá, M. (2022). Cycles of Chronic Opioid Therapy Following Mandatory Prescription Drug Monitoring Program Legislation: A Retrospective Cohort Study. Journal of General Internal Medicine, 37(16), 4088–4094. https://doi.org/10.1007/s11606-022-07551-z
Bell, N., Hughes, R., & Fede, A. L.-D. (2018). Collaborative Practice Agreements and Their Geographic Impact on Where Nurse Practitioners Can Practice. Journal of Nursing Regulation, 9(3), 5–14. https://doi.org/10.1016/S2155-8256(18)30149-2
Links to an external site.
South Carolina Board of Nursing. SCLLR. (2022). https://llr.sc.gov/nurse/Online/APRNRX.aspx
South Carolina Legislature. Code of laws – Title 40 – Chapter 33 – Nurses. (2017). https://www.scstatehouse.gov/code/t40c033.php
U.S. Department of Justice. (2018). Prescription Drug Monitoring Program: South Carolina State Profile. Prescription Drug Monitoring Program: South Carolina State Profile | Office of Justice Programs. https://www.ojp.gov/ncjrs/virtual-library/abstracts/prescription-drug-monitoring-program-south-carolina-state
Certification and Licensure Plan
Now that you are in the final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass the national PMHNP certification exam. Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.
Although a movement called the APRN Consensus Model is attempting to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish an independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.
Another important area to consider and plan for is prescriptive authority. The appropriate board, which may be the medical board, state board of pharmacy, or nursing board, grants prescriptive authority under state law for the appropriate state licensure. The federal government grants the authority to write for a controlled substance, and the Drug Enforcement Administration (DEA) verifies this action through by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.
In this Discussion, you will locate and review the practice agreements in the state in which you plan to practice, identify potential collaboration requirements in your state, and understand the certification and licensing process that you will need to follow.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review practice agreements in your state.
Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.
Research the following:
How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?
What is the application process for certification in your state?
What is your state’s board of nursing website?
How does your state define the scope of practice of a nurse practitioner?
What is included in your state practice agreement?
How do you get a DEA license?
Does your state have a prescription monitoring program (PMP)?
How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
By Day 3 of Week 1
Post a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.
Read a selection of your colleagues’ responses.
Certification and Licensure Plan
I recently moved to the State of Tennessee (TN) from Florida, so researching for this discussion post greatly benefits me as I must explore my certification and licensure plan. The state of TN has Restricted practice; this means that APRNs with a “certificate of fitness” must have a supervising physician. Supervising physicians must have a current and valid TN license, share the same field as the APRN, be always available for consultation/and must have a substitute physician readily available. In addition, the supervising physician must personally review medical data and sign on any patient within 30 days, review at least 20% of charts every 30 days, and visit the APRN’s clinical site every 30 days.
To get certified and licensed as an APRN in TN, an RN must possess a valid and unrestricted license and complete a master’s degree or higher in a nursing specialty. APRN application instructions include obtaining a national certification and requesting certifying body such as ANCC to send verification to nursing.health@tn.gov; holding a TN RN or multi-state RN license; requesting an official electronic transcript indicating conferred advanced nursing degree to nursing.health@tn.gov; applying at https://lars.tn.gov/datamart/mainMenu.do, upload RN license and Proof of citizenship documents in PDF format; complete mandatory practitioner profile questionnaire (Tennessee State Government, 2023). The review of the application can take up to 6 weeks. The TN State Board of Nursing website is https://www.tn.gov/health/health-professionals/hcf-main/licensure/licensure-applications.html
Links to an external site..
The APRN Scope of Practice Policy in TN requires a physician relationship for practice and prescriptive authority. A written protocol must be jointly developed between the supervising physician and APRN and is reviewed and updated every other year. NPs may also prescribe Schedules II- V controlled substances once a certificate of fitness from the TN BON is received and physician supervision is in place; an NP can only prescribe these medications after consulting with the physician (NCSL, 2023). The state of TN also has a Prescription Drug Monitoring Program that automatically submits dispensed records to the state to track warnings and errors for correction and resubmission.
A DEA License can be obtained online at the U>S Department of Justice website. Requesting a physical copy of the order form can be obtained by calling the DEA headquarters or DEA registration field office and can be mailed within ten working days. A completed requisition of DEA form 222A needs to be submitted (AANP, 2023).
In conclusion, TN is a local state for APRNs, and coming from FL, where transitioning to independent practice and prescribing period can happen after completing specific criteria; this can be disappointing. However, as PMHNPs very soon, we have an ethical duty to abide by the state’s rules and regulations in our practice.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days in one or more of the ways listed below.
Share an insight from having viewed your colleagues’ posts.
Suggest additional actions or perspectives.
Share insights after comparing state processes, roles, and limitations.
Suggest a way to advocate for the profession.
Share resources with those who are in your state.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
