Changing practice to using pre-filled syringes for flushing IV cannulas.

In the UK, the Medicines and Healthcare products Regulatory Agency classifies 'pre-filled syringes' for flushing Intravenous (IV) cannulas and IV access devices as 'borderline' devices and offers some advice on how control measures can help mitigate risks. The Medicines Act (1968) and Medical Device Regulations try to address the legal position of these devices and allow each employer to identify those groups of staff allowed to use them. In turn, this may help address anomalies around the need to prescribe and document their use. This article describes how one large university health board in Wales implemented a change in products and practice and explores the issues around adopting and using CE-marked pre-filled, sterile syringes of 0.9% sodium chloride in place of manually drawing up an IV flush (the CE mark indicates devices that conforms with European legal requirements). Whether the use of individual components or a single pre-filled device can lead to a streamlined and cost-effective way to manage the flushing of IV cannula and vascular access devices was explored. Additional risk factors were identified, and the legal status clarified in line with current guidelines and regulations. As 0.9% sodium chloride in ampoules and vials is classified as a prescription-only medicine, the administration needs control via formal prescription or a patient group direction. Adopting and using these pre-filled syringes as CE-marked medical devices requires careful consideration and sign-off from each employing authority, before implementing them for flushing IV cannulas and IV access devices.

APRNs' controlled substance prescribing and readiness following Florida legislative changes.

ABSTRACT: Two years after the Florida legislature expanded APRN prescribing to include schedule II-IV drugs in 2017, we studied APRN utilization of this prescriptive authority. Study results reveal that Florida APRNs are meeting the educational requirements to prescribe and apply the use of these drugs in practice, improving patient access to care.

The Effect of Supervision Waivers on Practice: A Survey of Massachusetts Nurse Practitioners During the COVID-19 Pandemic.

BACKGROUND: While optimal utilization of the nurse practitioner (NP) workforce is an increasingly popular proposal to alleviate the growing primary care shortage, federal, state, and organizational scope of practice policies inhibit NPs from practicing to the full extent of their license and training. In March of 2020, NP state-specific supervisory requirements were temporarily waived to meet the demands of the coronavirus disease 2019 (COVID-19) pandemic in Massachusetts. OBJECTIVE: The objective of this study was to examine the impact of temporarily waived state practice restrictions on NP perception of care delivery during the initial surge of the COVID-19 pandemic in Massachusetts. RESEARCH DESIGN: Mixed methods descriptive analysis of a web-based survey of Massachusetts NPs (N=391), conducted in May and June 2020. RESULTS: The vast majority (75%) of NPs believed the temporary removal of practice restriction did not perceptibly improve clinical work. Psychiatric mental health NPs were significantly more likely than other NP specialties to believe the waiver improved clinical work (odds ratio=6.68, P=0.001). NPs that experienced an increase in working hours during the pandemic surge were also more likely to report a positive effect of the waiver (odds ratio=2.56, P=0.000). CONCLUSIONS: Temporary removal of state-level practice barriers alone is not sufficient to achieve immediate full scope of practice for NPs. The successful implementation of modernized scope of practice laws may require a collective effort to revise organizational and payer policies accordingly.

[New nursing competencies since 2004 : scope and limits]. / Les nouvelles compétences infirmières depuis 2004: étendue et limites.

Since 2004, procedures which can be carried out by nurses have no longer been subjet to a single global decree and now feature in different legislative and/or regulatory articles. Since 2006, several laws and decrees have expanded the scope of nursing practice, but the lists of authorised procedures for a large part of the profession have not been updated, except for theatre nurses and nurse anaesthetists. The obsolescence of these regulatory lists is out of step with the technical evolution of care, the organisation of the health system and patients' needs.

[Regulated practices of fire and rescue service nurses]. / Les pratiques protocolées des infirmiers sapeurs-pompiers.

Nurses in the fire and rescue service have been providing emergency care to people for more than twenty years. Their practice is regulated by national emergency nursing care protocols drawn up by the relevant learned societies. Numerous training programmes and more recently, the possible use of telemedicine, help to ensure the quality of the emergency care provided to patients or victims.

[Nurse anaesthetist, autonomous and expanded practice]. / Infirmier anesthésiste, un exercice autonome et élargi.

Nurse anaesthetists have had the right to perform certain procedures for more than twenty years. A 2017 decree further expanded their scope of practice both within and outside the theatre. In parallel, their practice continues to adapt to medical developments, in collaboration with the anaesthesiologist. They are also starting to perform more clinical practices with the patient, such as hypnosis, which need to be better integrated into the often dense operating schedules.

33rd Annual APRN Legislative Update: Unprecedented changes to APRN practice authority in unprecedented times.

ABSTRACT: In a year unlike any other in recent history, healthcare workers, including advanced practice registered nurses (APRNs), faced challenges and triumphs as the frontline in the battle against COVID-19. This 33rd Annual Legislative Update covers the scope of practice changes and legislative decisions that most impacted APRNs across the US in 2020.

COVID 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority.

The coronavirus disease 2019 (COVID-19) pandemic ushered in a new era for advanced practice registered nurses, as emergency regulatory and policy changes expanded the nurse practitioner (NP) scope of practice. The legislative changes enabled NPs to bolster the national pandemic response by working to the full extent of their education and training. The changes are only temporary, and many have contemplated the permanent impact of COVID-19 when healthcare transitions to a postpandemic normal. NPs now have a unique opportunity to educate others about the merit of their role and advocate for permanent legislative changes. In this creative controversy manuscript, we build a case that national NP full practice authority increases access to care and is vital for a sustainable and resilient healthcare system that can react to future pandemic crises.

Barriers and enablers for midwives to use the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines for midwives.

BACKGROUND: In 2010, the Nursing and Midwifery Board of Australia introduced a new registration standard: Endorsement for scheduled medicines for midwives. The endorsement enables midwives to provide women with Medicare-rebatable care, prescribe relevant medications, and order relevant Medicare-rebatable diagnostics. Translating endorsement education into clinical midwifery practice has been slow, indicating the presence of barriers affecting midwives' ability to use this standard, despite it increasing their scope for service provision. AIM: To discover the mechanisms affecting midwives' ability to work to full scope of practice after completing a programme of study leading to endorsement. METHODS: An observational (non-experimental) design was used. Midwives who had completed an education programme leading to endorsement were invited to complete a survey. Descriptive statistics were used to analyse the quantitative questions and content analysis was conducted on the qualitative data. FINDINGS: Results indicated that barriers - such as the limitations of Medicare provisions for endorsed midwives and a general lack of support for the role - restrict endorsed midwives' ability to provide quality maternity services. Having some form of support for the role may act as an enabler, in addition to midwives having personal determination and confidence in their ability to use the endorsement. Recommendations to strengthen the endorsed midwife's role include facilitating endorsement use in the public sector, relaxing Medicare Benefit Schedule and Pharmaceutical Benefit Scheme restrictions, raising awareness of the role and scope, and improving midwives' pre-endorsement preparation. CONCLUSION: This study highlights the need for an all-of-system approach to support and develop the endorsed midwife's role.

Seventeen states enacted executive orders expanding advanced practice nurses' scopes of practice during the first 21 days of the COVID-19 pandemic.

CONTEXT: Rural hospitals in the USA are often served by advanced practice nurses, due to the difficulty for such facilities to recruit physicians. In order to facilitate a full range of services for patients, some states permit advanced practice nurses to practice with full independence. However, many states limit their scopes of practice, resulting in the potential for limited healthcare access in underserved areas. The COVID-19 pandemic temporarily upended these arrangements for several states, as 17 governors quickly passed waivers and suspensions of physician oversight restrictions. ISSUES: Physician resistance is a primary hurdle for states that limit advanced practice nurse scopes of practice. Longstanding restrictions were removed, however, in a short period of time. The pandemic demonstrated that even governors with strong political disagreements agreed on one way that healthcare access could potentially be improved. LESSONS LEARNED: Despite longstanding concerns over patient safety when advanced practice nurses practice with full autonomy, governors quickly removed practice restrictions when faced with a crisis situation. Implied in such behavior are that policymakers were aware of advanced practice nurses' capabilities prior to the pandemic, but chose not to implement full practice authority, and that governors appeared to disagree as to whether to temporarily waive specific restrictions or suspend restrictions entirely, consistent with their political affiliation. We propose more research into understanding whether or not such changes should become permanent.

A Statewide Survey of Clinical Nurse Specialist Practice: Opportunities and Challenges.

Clinical nurse specialists are the second largest advanced practice nursing role in the United States and remain underused in many states. Expanding access to care to improve patient outcomes is a national priority, which prompted this state clinical nurse specialist association to identify practice barriers, identify opportunities for practice expansion, differentiate registered nurse from clinical nurse specialist practice, and describe differences in those who have practiced in other states. This study was composed of a 15-question online survey, including demographic information, collected over a 4-week period in 2016. Sixty-one respondents (7% of eligible clinical nurse specialists in the state) completed the survey. Regulations limiting the scope of practice in the state were identified by 75% of participants as a practice barrier. Work environment, educational factors, and organizational support contributed to limitations in practice as delineated in the Consensus Model for Advanced Practice Registered Nurses. Participants support increasing public awareness of clinical nurse specialists as advanced practice nurses. Survey results confirm the need for a multifaceted approach in removing clinical nurse specialist practice barriers and improving access to their care by aligning state law and regulation with the National Council of State Boards of Nurses' Model Nurse Practice Act.

Effect of state regulatory environments on advanced psychiatric nursing practice.

The first key message in the landmark Future of Nursing report is that "Nurses should practice to the full extent of their education and training" (Institute of Medicine, 2011). Although there has been significant progress across states to remove or diminish barriers to the exercise of full scope of practice by advanced practice registered nurses (APRN), state regulations continue to unnecessarily restrict APRN practice in most of the United States. This article integrates data from studies that examine how state and local regulation affects psychiatric mental health APRN practice with the literature on how state scope of practice regulation affects the size and distribution of the broader APRN workforce, access to care, health care costs and prices, and innovation in health care service delivery. Common themes include confusion about regulatory requirements and mixed experiences of mandated physician supervision.

The Pursuit of Nurse Practitioner Practice Legislation: A Case Study.

Across the United States, nursing practice acts (NPAs) have been revised to include provisions that promote full practice authority (FPA) for nurse practitioners (NPs). Such revisions provide a mechanism to better utilize the full scope of NP services to address growing demands for access to health care. Modernized NPAs that facilitate FPA for NPs are imperative, especially now with the unprecedented health care crisis that the world now faces: Coronavirus Disease 2019. This is the first known study to use an embedded single-case study design, guided by the Kingdon policy stream model, to provide a detailed account of how stakeholders for NP FPA determine the appropriate time to pursue legislative changes to NP scope of practice regulations. Qualitative data analysis revealed four themes which comprised the components considered by stakeholders during their decision-making processes related to NP FPA: participants, problem, policy development, and politics. Themes were further collapsed within concepts from the Kingdon model to form the case description. Study findings can be used to increase the competency among NP FPA stakeholders in determining the timing of legislative pursuits for regulatory change.

How State Scope-of-Practice Policies Impact NP Care.

Three projects examine the effect of NP practice acts on access to health care.

The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016.

BACKGROUND: Nursing resources can have a protective effect on patient outcomes, but nurses and nursing scope of practice have not been studied in relation to injury outcomes. The purpose of this study was to examine whether scope of practice and ease of practice laws for nurse practitioners and registered nurses are associated with suicide and homicide rates in the United States. METHODS: This state-level analysis used data from 2012 to 2016. The outcome variables were age-adjusted suicide and homicide rates. The predictor variables were NP scope of practice by state (limited, partial, or full) and RN ease of practice (state RN licensure compact membership status). Covariates were state sociodemographic, healthcare, and firearm/firearm policy context variables that have a known relationship with the outcomes. RESULTS: Full scope of practice for NPs was associated with lower rates of suicide and homicide, with stronger associations for suicide. Likewise, greater ease of practice for RNs was associated with lower suicide and homicide rates. CONCLUSIONS: Findings suggest that nurses are an important component of the healthcare ecosystem as it relates to injury outcomes. Laws supporting full nursing practice may have a protective effect on population health in the area of injuries and future studies should explore this relationship further.

Preparing for the liberty protection safeguards.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the revised framework for authorising the deprivation of liberty of a person who lacks capacity.