Regulating Nursing Practice: Definition, Objectives, and Procedure

Introduction

Regulating nursing practice is an essential objective exemplified by multiple entities within the healthcare industry. This includes putting in place policies and guidelines in terms of licensing the professionals, determining supervision guidelines, and defining the scope of each category of nurses. The overall objective of such regulations is based on two premises, including the improvement of healthcare as a whole and making it more accessible, efficacious, and ethical for patients. While nursing regulations correlate with the position itself and the individuals within the field, the entities responsible for policy implementation and organizational aspects have the interest of the general public as well as those they either regulate or advocate for.

Boards of Nursing vs. Nurse Associations

Diverse associations, boards, and other bodies are put in place to create favorable, regulated, and helpful conditions for nurses. While certain entities have the objective of implementing regulatory guidelines, others have the role of advocacy and promotions. This can be highlighted in the difference between Boards of Nursing and Professional Nurse Associations. Boards of Nurses (BONs) are governing entities that have the objective of facilitating public safety through regulatory measures such as overseeing licensing to ensure the high expertise of the nurses (California Board of Registered Nursing, 2022). For example, the increasing popularity of technology use in healthcare is partially regulated by BONs (Petersen et al., 2015). Thus, the entity is responsible for the practical implementation of guidelines and policies.

American Nurses Associations (ANAs) have the role of being the voices for the nurses in terms of professional advancements, protecting rights, and suggesting systematic changes to address the difficulties of their members. The primary goal is advocacy, not only for the nurses but also for the patients who are to receive high-quality patient-centered care (ANA, 2022). As a result, nursing associations and boards are preoccupied with improving the healthcare industry through nursing practice, both for the practitioners and the patients seeking assistance. However, while the associations are advocates and can suggest new policies and regulations, the boards practically apply them and implement them on state and federal levels.

California Board of Registered Nursing

Each state has a BON specializing in the regulations and policies put in place in that particular state. Thus, the board of nursing for the state of California is to ensure that the scope of practice specifically implemented in this state is followed. The board is entitled to oversee and manage the standards that are to be followed in nursing programs before the individual becomes a licensed registered nurse. The state of California board consists of nine members (four public members and five professionals). The five licensees are to consist of two nurses, an advanced practice nurse, an administrator, and an educator (California Board of Registered Nursing, 2022). One can become a member either by being appointed by the Governor (seven out of the nine members) or by the Legislature. The board of nursing oversees how nurses are being licensed, registered, and regulated. Thus, the members are to be fully aware of the nuances correlating with the position.

General Nursing Scope of Practice

Each state implies that different nursing positions correlate with various scopes of practices, hence, the professional’s roles and responsibilities in providing care. A California state regulation related to general nurse scope of practice highlights the regulations for registered nurses (RNs). RNs can be independent practitioners with an extended scope of practice, including the administration of medications, skin tests, and certain objectives shared with physicians, such as medication refilling (Nursing Explorer, 2022). The scope of practice is relatively complex due to the extended program length required for the licensing and the responsibilities correlating with the position. Thus, the roles of nurse practitioners are well-defined, and the objectives are highly regulated and require different licensing depending on the exact position. While Certified Nursing Assistants (CNAs) assist patients with bed baths, feeding, and toileting activities, RNs can administer certain medications, monitor vital signs, and facilitate care plans based on each individual’s personal needs. The regulation implies the nurse’s role to be primary in terms of safe and patient-centered care.

The Role of Scope Practice Regulation

The fact that RNs in the state of California can be independent practitioners encourages certain autonomy and higher responsibility, highlighting the importance of the role. This is also beneficial in terms of timely care delivery, the improved cost compared to the same objective solely being performed by physicians and better access to healthcare for a larger demographic. Needless to say, such a high level of independence creates competition and encourages RNs to utilize the full scope of their skills. This gives patients an opportunity to receive higher quality healthcare while encouraging a cost reduction due to the increase in practicing RNs without the supervision of physicians. While not all practice implies independence, the opportunity itself is beneficial for the nurse practitioners as well as for the broader goal of improving the health of the general population through healthcare practices.

APRN State Regulation

California state is also highly regulated when it comes to licensing and standardizing practices for Advanced Practice Registered Nurses (APRNs). In California, APRNs are still accompanied by doctors when it comes to certain procedures and tasks. The state is the only western one in which physicians’ oversight is needed for APRNs, which mitigates the opportunity to act independently and be autonomous in regard to certain decisions (California Health Care Foundation, 2018). Thus, the nurse’s role becomes less crucial not because of the objectives that are being fulfilled but because a doctor is to monitor certain processes when it comes to healthcare provision. This is a negative implication on multiple levels, starting with care delivery.

An urgent situation may not be resolved due to the need for feedback or assistance from a physician, which is a limitation for APRNs who have to address the circumstances in a timely manner. Moreover, the need for physician sight is costly because of the extra time and resources needed to make sure two professionals work hand-in-hand at all times. Last but not least, it minimizes the accessibility of healthcare for patients in need of urgent interventions and is negative in terms of autonomy (Bosse et al., 2017). The regulation has not been addressed within the past five years, yet multiple other states have switched to a more autonomous approach, a method which may be applied in the state of California in the following years.

Conclusion

It is certain that nursing boards and associations are different entities with contrasting tasks, yet the objectives are similar. While only the board has the power to implement regulations, associations are effective in advocacy work and promotional campaigns. The state of California, like every other US state, is regulated through the state’s board of nursing, which implements policies and licenses professionals. The board, however, is to address certain aspects, such as California’s need for physician oversight of APRNs when the practice is not autonomous. Protecting the rights of nurses and ensuring effective regulatory and practical measures in terms of licensing, scopes, and supervision is not only beneficial for the professionals but also for the health of the general population. Both boards and associations are able to contribute to prolific and safe environments for those they aim to regulate, which is why it is essential to consider the needs of nurses to improve patient-centered care and minimize risks.

References

ANA. (2022). Advocacy. Nursing World. Web.

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761–765.

California Board of Registered Nursing. (2022). Welcome to the Board of Registered Nursing.

California Health Care Foundation. (2018). California’s nurse practitioners: How scope of practice laws impact care. CHCF. Web.

NursingExplorer. (2022). Nursing licensure & scope of practice in California.

Petersen, C., Adams, S. A., & DeMuro, P. R. (2015). mhealth: Don’t forget all the stakeholders in the business case. Medicine 2.0, 4(2).