need help comparing states

IGiveTheShots · Oct 25, 2008

Im currently enrolled at DePaul MENP in Chicago. I believe our prereqs are only two semesters of bio, one sem chem, and one sem organic (but i would check on that. i do know that there aren't very many of them). My program is a "generalist nursing" MS (which means we don't specialize, but only recieve an MS) which transitions into an NP after you graduate if you wish to pursue that route. If you aren't sure what you want to do, this is the best program I've found. I came in thinking I would like to do psych or women's health, now I'm dead set on peds after consulting with people and taking classes. Let me know if you have any questions about the program.

PMHNP10 · Oct 27, 2008

I am interested in transitioning from my clergical job to advanced practice nursing (I suppose CNS or NP).
I'm looking into direct entry Masters programs so I can reach the finish line in the quickest possible way since I am supporting a family.
The Q - We're considering numerous states, mostly in the northeast and midwest. I'm not fixed on a certain degree, but psychiatry is my preliminary interest. Once we move, moving again would be difficult, so I want to make sure I don't close any doors on myself with this move. In terms of autonomy and prescriptive rights, I hear that different states have different rules. MI, MD, CA, amd WI are highest on our list. Are there any lists out there of which states allow autonomy and prescriptive rights to masters level nurses? Any suggestions that might help us narrow our choices?
Also, any suggestions of programs that don't have long lists of science prereq's? Thank you!

when you mention autonomy and prescriptive rights, you can look up The Pearson Report. Every year, Linda Pearson lists each state and who regulates the practice (i.e., nursing or nursing and medicine); if you have trouble finding it (which you shouldn't) I might still have links to the 2007 and 2008 report on my compurer; I can post them; it also lists autonomy and priscriptive privileges and a bunch of other cool stuff; it'll tell you, for example that in the state of AL, the medical board will "staunchly" oppose any attempts by nursing to expand scope of practice. so as a rule of thumb, if the board of medicine has any say with regards to your scope of practice, I'd venture to guess that you can bet you won't be anywhere close to an independent practitioner

here's the problem, though; and I don't mean this to discourage you because advanced practice absolutely can be very rewarding if you are in it for the right reasons--APRNs are only as independent as the money they can collect from insurance companies; problem being that they do not get compensated the same as physicians (and "incident-to" or shared billing are not the answer); and yes, I believe research has shown that APRNs deliver quality services at least equal to, if not better than physicians; so why not equal pay for equal work? if an APRN wants to bill Medicare directly under their own provider number, they will get reimbursed 85% of what a doctor will get reimbursed for doing the exact same thing; Medicaid varies from state to state (between 70-100% of physician rates); and as for commercial policies (HMOs, PPOs) good luck getting empaneled, and in some cases, continuing as a covered provider

unfortunately, medicine has such a deathgrip on insurance (and the financial backing to maintain that deathgrip) that changing APRN reimbursement is likely not going to happen any time soon

PMHNP10 · Oct 27, 2008

oh, 1 other thing; in 2006 (I think) the National Council for the State Boards of Nursing (NCSBN) released a vision statement; in short, they want all state nursing boards to change their rules regarding advanced practice nurses to make them independent practitioners (not including the reimbursement issue I mentioned above) by like 2016, but in the same statement, they also say that CNS's will no longer be considered APRNs; I'm not saying this will or won't happen, but I'm thinking if the NCSBN wants it to happen, the individual states are pretty much going to be taken to task; or maybe it's a bunch of lip service; we'll see

Advanced Practice Columnist / Guide · Oct 28, 2008

The Pearson Report is available here: http://www.webnp.net/ajnp08.html

To the OP:

Since you mentioned Michigan, I can give you my take on how APN's particularly NP's are accepted here. The Michigan Public Health Code which contains the laws governing nursing practice in the state does not provide any information defining what the scope of advanced practice nursing is. That can be a blessing because no specific laws can also mean no specific requirement for physician supervision. Since prescription writing is not a traditional function of nurses, it is not included in the scope of nursing practice as stated in our law. However, the law on the practice of medicine states that physicians can delegate the authority to write prescriptions to a qualified nurse.

So in short, there is no requirement for physician supervision or collaboration of NP's in the state but prescriptive authority is a delegated role and requires the involvement of a physician. The rest of PsychRN03's post gives you an idea of other barriers to independent NP practice. Although state practice acts determine independence as a provider, other factors such as insurance reimbursement can push NP's miles back from being truly independent.

NP opportunities are quite favorable in the state as I see it. However, I do not know any Psych NP's personally apart from the Psych NP students I met while in school who are probably in clinical practice now. There are Psych NP programs in the state at the University of Michigan Ann Arbor, University of Michigan Flint, and Wayne State University. Unfortunately, none of these programs are offered as a direct entry option. Students are admitted in a traditional manner as practicing RN's with a BSN. That said, I don't know how prospective employers in the state view a new NP with no bedside nursing experience.

apinteleyid · Nov 23, 2008

I very much appreciate your responses.

Good luck to you!