The State of Advanced Practice Registered Nursing in Alabama

Scope of practice for advanced practice registered nurses (APRNs) varies according to U.S. jurisdiction licensure requirements. Nineteen U.S. jurisdictions currently allow independent practice in all four APRN roles: certified nurse midwife (CNM), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). Twenty-six U.S. jurisdictions allow full practice authority for CNPs. APRNs practicing in the remaining U.S. jurisdictions have varying practice restrictions, which are dictated by their state licensure laws. Alabama's scope and standards of practice restrict all APRN roles. During the initial months of the COVID-19 pandemic, Alabama was one of many U.S. jurisdictions that implemented emergency waivers, thereby expanding the scope of APRN practice and granting increased autonomy to APRNs while caring for more complex patients. Once the pandemic threat lessened, many U.S. jurisdictions, including Alabama, returned to pre-pandemic restrictive scope of practice regulations. Through empirical evidence, we conducted a review of APRN practice before, during, and after the pandemic. The literature included anecdotal reports of safe delivery of healthcare provided by APRNs working under the emergency waivers. The literature revealed that APRNs are prepared to practice to the full extent of their scope of practice and provide high-quality healthcare services to improve access to care. Alabama and other U.S. jurisdictions where APRN practice is restricted should advocate for legislative changes supporting APRN full practice authority commensurate with their educational training and certification. © 2023 National Council of State Boards of Nursing

Sensory quality and shelf-life of locally produced British butters compared to large-scale, industrially produced butters

Purpose The purpose of this pilot-scale study was to compare the quality of traditionally manufactured butters from local, small British producers with the quality of butters that are produced industrially. Design/methodology/approach Butter samples were obtained after supervised site inspections of three traditional-butter manufacturers and one large-scale butter producer. The samples were subject to initial microbiological, chemical and sensory testing, followed by a refrigerated shelf-life study over 24 weeks. Findings Traditional butters matched or exceeded the sensory quality of industrial butters, but spoilage microorganisms tended to grow faster on traditional butters. This seemed to be related to poorer water droplet dispersion in the manufacture of some of the traditionally made butters. Visible mould appeared on two of the traditional butters after eight weeks, but this occurred well after the nominal "best before" date. Originality/value Prolonged lockdowns due to the current coronavirus disease (COVID-19) pandemic pose a threat to the food supply chain, and food produced by local manufacturers may become increasingly important. However, are foods produced by local small-scale manufacturers of a quality comparable to that produced using large-scale production facilities? To the best of the authors' knowledge, there is no comparative study of the quality and shelf-life of traditionally-produced and industrially-produced butters. The current work presents such a comparison together with an outline of how the process of traditional butter-making differs from commercial production in Britain.