Case Study – School Nurse: Middle School Student with ADHD,

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. Michigan- Certification and Licensure Plan In Michigan, the Michigan Board of Nursing, which is part of the Department of licensure and Regulatory Affairs (LARA), manages NP certification and licensure. To become a certified NP, one must have a valid Michigan RN license and national certification from an approved certifying body (MICNP, 2024). The certification application is submitted online via the Michigan Professional Licensure User System (MiPLUS), which is available at MiPLUS (MICNP, 2024). LARA Licensing Information (MICNP, 2024) provides further information and a presentation on the process. Scope of Practice The Occupational Regulation Sections of the Michigan Public Health Code Act 368 of 1978 establish the scope of practice for nurse practitioners in Michigan. In Michigan, NPs can undertake a variety of tasks, including conducting full physical examinations, managing acute and chronic illnesses, and prescribing drugs. While NPs can practice independently, some actions, including as prescription-controlled medications, require a physician's approval. Practice Agreements In Michigan, NPs must obtain a practice agreement with a physician before prescribing restricted medications. This agreement describes the collaboration practices between the NP and the physician (MICNP, 2024). Prescriptions for prohibited medications must include the names and DEA registration numbers of both the NP and the delegating physician. Drug Enforcement Agency (DEA) License To prescribe restricted substances, NPs must hold a DEA license. This entails filing an application with the DEA and producing documentation of certification and state licensure (MICNP, 2024). The application can be submitted online via the DEA Diversion Control Division website. Controlled Substance Prescriptive Authority Michigan law enables NPs to prescribe restricted medications from schedules 2 through 5, as long as they are accompanied by physician delegation (Public Health Code, 1978). Such prescriptions must include the NP and physician's DEA registration numbers. Legislative and Advocacy Activities The Michigan Council of Nurse Practitioners (MICNP) actively participates in legislative and lobbying activities to support NP practice. This involves promoting NP rights, campaigning for policy changes, and improving NP recognition and utilization in the healthcare system (MICNP, 2024). MICNP Resources (MICNP, 2024) provides information on their advocacy initiatives. Regulations, Barriers, and What surprised me In Michigan, laws for NPs include certain limitations that affect their ability to operate independently as well as certification, scope of practice, and prescriptive authority. NPs in Michigan must be certified by a national certifying organization and hold a valid RN license (MICNP, 2024). Certification entails completing educational and examination criteria tailored to the NP's specialty. i. Scope of Practice. Under Michigan law, NPs can practice autonomously within the scope of their education and qualification. This involves conducting physical examinations, diagnosing and treating ailments (Public Health Code, 1978). However, for specific actions, such as prescribing controlled medications, NPs need a practice agreement with a physician, which necessitates delegation (MICNP, 2024). ii. Prescriptive Authority. NPs may prescribe prohibited medications in schedules 2-5, but must include both their and the delegating physician's DEA registration numbers on prescriptions (Public Health Code, 1978). This regulation requirement ensures compliance while adding an extra degree of bureaucracy. Regarding barriers to independent practice, one key barier is the need for a practice agreement with a physician before prescribing banned substances. This agreement may limit an NP's capacity to practice thoroughly freely and may impair their ability to manage patient care effectively. Also, the requirement for both NP and physician DEA numbers on prescriptions complicates the procedure and increases administrative burden. Regarding surprising findings, what shocked me was that Michigan's regulations require both the NP's and the physician's names and DEA registration numbers on controlled substance prescriptions, despite the fact that the NP practices independently in other areas. This dual necessity appears to contradict the otherwise autonomous practice paradigm, emphasizing the difficult balance of autonomy and regulatory control. Conclusion In Michigan, nurse practitioners can practice autonomously, but certain rules, particularly those governing prescriptive authority, provide considerable impediments. The requirement for a physician's practice agreement, as well as the inclusion of both the NP's and physician's DEA registration numbers on controlled substance prescriptions, imposes an administrative barrier that limits full autonomy. This unexpected dual mandate shows the ongoing difficulty of reconciling independent practice with regulatory control in the state. References Michigan Council of Nurse Practitioners. (2024). Standards of practice. https://micnp.org/page/resources# PUBLIC HEALTH CODE (EXCERPT) Act 368 of 1978 PART 172 NURSING http://www.legislature.mi.gov/(S(tgeuoc552vfk0heepvz34j55))/documents/mcl/pdf/mcl- 368-1978-15-172.pdf

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