NURS 6050 Week 5 Board Rulemaking Post Example

Week 5 Discussion: Initial Post

The Law Passed; the Rule Decides: Who Can Mentor a Nurse Practitioner Through the Transition to Full Practice

The state in this post is a composite. Last session its legislature passed a full practice authority law for nurse practitioners, with one condition: a new nurse practitioner must complete a transition-to-practice period before practicing without a formal agreement. The statute set the requirement and a number of hours and delegated the details, including who may serve as a mentor during the transition, to the Board of Nursing. That delegation is the point of this post. The legislature made the policy; the board now writes the rule that decides how it works in practice, and the rule can shape the law's effect as much as the statute did.

Rulemaking follows a process set by the state's administrative procedure act, and each stage is a point where the public can act (Milstead & Short, 2019). First, the board publishes notice of the proposed rule in the state register, with its text and a summary of its purpose and cost. Second, a written comment period opens, usually for at least 30 days, during which anyone may submit comments. Third, the board holds a public hearing where comments can be delivered in person. Fourth, the board reviews the comments, may revise the rule, and votes to adopt it at a public meeting. Fifth, in this state, a legislative rules review committee examines the adopted rule to confirm that it stays within the authority the statute delegated. A board cannot expand scope beyond what the statute allows, and a rule does not pass by a floor vote; it passes by board adoption after notice and comment.

The clause at issue in the proposed rule counts only hours spent in collaboration with a physician toward the transition period. Experienced nurse practitioners who have practiced independently for years in other full practice states, or who practiced under the old law, would not qualify as mentors. I think the clause should be revised. The statute's purpose is to ensure that a new nurse practitioner gains supervised experience; it does not say that only a physician can provide it, and nurse practitioners with years of practice in the same role are well placed to mentor. In rural counties, where physicians are scarce, the physician-only clause could make the transition period hard to complete, which would slow the arrival of new clinicians where the law was meant to help most. The landmark Future of Nursing report urged states to remove scope-of-practice barriers that keep advanced practice nurses from using all of their education and training (Institute of Medicine, 2011), and a mentor rule that excludes the profession's own experienced clinicians rebuilds one of those barriers inside a law written to remove them.

The APRN Consensus Model supports this argument by calling for consistent regulation of advanced practice nurses across states based on education, certification, and licensure, with independent practice as the goal (APRN Joint Dialogue Group, 2008). A rule that treats nurse practitioner mentorship as inadequate runs counter to that aim. My comment would be submitted in writing during the comment period, by the deadline printed in the register notice, in the format the notice specifies, and signed by me as a registered nurse and graduate student, with a copy sent to the state nurse practitioner association so they can coordinate with other commenters.

Reply to Daniel

Daniel, your issue, requiring school nurses in every public school, is important, and your post treated the Department of Education as the body that would decide it. I wonder whether that decision actually sits with the legislature, since it involves funding and a mandate on districts, and the department would only write rules for how a statute is carried out. If your state has already passed a law, the rulemaking stage would be your entry point; if not, the bill stage comes first. Do you know whether a bill has been filed?

Reply to Nicole

Nicole, you identified the proposed rule on nurse-to-patient ratios in your state's hospitals, and you noted the comment period closes next month. That is a real opening. One suggestion: comments that cite a specific section of the rule and propose replacement language tend to carry more weight than general support. Is there one section you would focus on?

References

APRN Joint Dialogue Group. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. National Council of State Boards of Nursing. https://www.ncsbn.org/public-files/Consensus_Model_for_APRN_Regulation_July_2008.pdf

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. The National Academies Press. https://doi.org/10.17226/12956

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.