OUTLINE 9/28/15. Common Certification Exam Questions. What New NPs Need to Know: Beginning Your NP Practice in Texas

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1 What New NPs Need to Know: Beginning Your NP Practice in Texas Monica Aleman DNP, MSN-FNP, APRN Rachelle Campbell, RN, MS, FNP-C Texas Nurse Practitioner Conference Dallas, Texas 2015 OUTLINE O Certification O Licensure O Prescriptive Authority Board of Nursing O Prescriptive Authority: DEA and Texas Control substances O Credentialing O National Provider Number (NPI) O Negotiating Nurse Practitioner Contract O Landing that first job O Independent practice O Salary Common Certification Exam Questions O Which certification exam am I eligible to sit for? O What are the costs of each ANCC and AANP certification exams? O When can I apply to sit for the ANCC or AANP board certification exam? 1

2 Getting started O 3-6 months before anticipated graduation begin the process of selecting which organization you want to apply to take the national NP certification exam O AANP-American Association of Nurse Practitioners Certification Program AANPCP ( O ANCC-American Nurses Credentialing Center ( ANCC Certifications O NP certifications: Acute Care, Adult NP, Adult Gero Acute Care NP, Adult Gero Primary care NP, Adult Psychiatric Mental Health NP, FNP, Gero NP, PNP, Psychiatric Mental Heatlh NP, School NP O CNS certifications: O Adult Health CNS O Adult Gero CNS O Adult Psychiatric Mental Health CNS O Child/Adol Psychiatric Mental Health CNS O Gero CNS O Home Health CNS O Pediatric CNS O Public Community Health CNS AANPCP Certification O Adult Nurse Practitioner (retired Dec. 2016) O Family Nurse Practitioner O Adult Gerontology Primary Care NP 2

3 2015 Costs for NP Certification Exam O ANCC costs for initial certification exam: O Nonmember 395 O ANA member 270 O AANP member 340 O AANP student member 290 O AANP costs for initial certification exam: O AANP nonmembers 315 O AANP members 240 Steps for Certification Exam O First apply to sit for the board exam O Applying begins the process towards certification O Once you apply to sit for the exam, the certifying body (ANCC or AANPCP) will review your application and notify you if you are pending or lacking any documentation O When application is complete and all documentation has been received and approved, you will be given permission to sit (test) for the exam O Once you receive permission to test, you can schedule your exam testing date and time AANPCP Eligibility Requirements O Successful completion of all didactic NP program coursework and all faculty-supervised clinical practice hours required for the NP program. O Successful completion of graduate level courses in advanced physical assessment, advanced pharmacology, and advanced pathophysiology. O a current active RN license in a state/territory of the United States or respective province of Canada O a transcript showing academic work-to-date, or a final official transcript showing your degree awarded (conferred) 3

4 Required Documentation O Clinical Hours O Didactic hours O Course numbers O Course titles O Dates O Preceptors Graduation O Once you have graduated and completed all of your clinical and didactic work, your school will send the certifying body notice that your degree was conferred O If the remainder of your application was completed, submitted, reviewed and cleared then you will be given permission or authorization to schedule your board certification exam For Exam: Preparation is Key O Options include: O Purchase study books O Board certification exam review course O Consider the costs associated with each option and if time and travel expenses can be factored into your budget 4

5 NP Certification Exam Review O Review books O Live or recorded board review courses available, such as APEA Adult and Family NP review courses (Amalie Hollier), Fitzgerald Health Education Associates NP Certification Exam Review (Margaret Fitzgerald), and Barkley Review O If purchasing a review course, recommend you schedule the course at least 3 months prior to graduation Tips to scheduling your exam O Schedule the exam within a month of graduation O Schedule study time daily in the weeks leading up to the exam O Stop studying hours before the exam Your results O You passed!!! Now begin the process of applying to your state board of nursing for your APRN license (if aanpcp, now use credential NP-C) O You did not pass-give yourself a few days to reflect on the results and then begin a new plan of study 5

6 NP Recertification O AANPCP-5 years O ANCC-5 years Steps to APRN Licensure O Once your are certified in your specialty, you are considered certified but you are not licensed to practice O You may not practice until you apply for and receive your APRN license from your state board of nursing Texas APRN License APRN Role & Population Focus O Nurse Practitioner O Certified Nurse Midwife O Certified Registered Nurse Anesthetists O Clinical Nurse Specialists APRN License Number O Regardless of the role and population, approved applicants will receive one APRN License Number, for example, AP

7 Texas APRN application O APRN license: $ O APRN license with Rx authority: $ O Must already have a current active Texas RN license O Must have completed APRN accredited program O Must have nat l certification in role and population focus congruent with educational preparation O Completion of minimum of 500 hours of practice in APRN role within the last 24 calendar months or completion of program in last 24 months O Completion of minimum of 20 hours of CE in advanced role & population focus within last 24 mo. Texas RN License O If your RN license is about to expire, renew it which will cost around $100 O If you are moving to a new state, you will need to become licensed as a registered nurse in the state where you plan to practice (unless you are licensed in a compact state and moving to another compact state) Nurse Licensure Compact O Agreement between states that allows a nurse to obtain an RN license in the nurse's primary state of residence and allows the nurse to practice as an RN in any other Compact state without obtaining an RN license in that state O If you hold a current valid Compact RN lic, you are not req to obtain a TX RN license before applying for APRN licensure in Texas 7

8 APRN license in other states O Similar to how you have obtained a license to work as a registered nurse in your state, once you graduate from your NP program and receive certification, you must obtain a state advanced practice nursing (APN or APRN) license in the state you plan to practice Prescriptive Authority in Texas O Prescriptive authority-optional authority for those who qualify and wish to write prescriptions O Prescriptive authority agreements in Texas: APRNs and PAs are req. to have delegated authority agreements to provide medical aspects of patient care, i.e., protocol or other written authorization Required Elements of a Prescriptive Authority Agreement O Name, address, and all professional license numbers of all parties to the agreement O State the nature of the practice, practice location or practice settings O Identify the types of categories or drugs or devices that may be prescribed OR the types or categories of drugs or devices that may not be prescribed O Provide a general plan for addressing consultations and referrals O Provide a plan for addressing patient emergencies O State the general process for communication and sharing information related to the care and treatment of patients O Describe a quality assurance and improvement plan and how it will be implemented. The plan must include plans for chart reviews and periodic face to face meetings. 8

9 Prescriptive Authority O TMB Rule physicians may delegate ordering and prescribing nonprescription drugs, prescription drugs and medical devices (dangerous drugs) and DME to an APRN O Must be delegated by a physician to APRN through a written document (PAA or facility based protocols must have CSR # s from DEA and DPS) O Schedules III through V controlled substances can be rx d O What is a Dangerous Drug? A bit about controlled substances. O Currently, an APRN who writes a prescription for a controlled substance in TX must have a state controlled substances registration (CSR) issued by the Texas Department of Public Safety (DPS) and a federal Drug Enforcement Agency (DEA) number O There are five steps each APRN must complete before signing a prescription for a controlled substance Steps to prescribing controlled substances 1. Must be licensed to practice as APRN in TX 2. Delegating physician must agree to delegate authority to rx controlled substances & affirm agreement in the prescriptive authority agreement (PAA) or facility based protocol 3. APRN must register with TX DPS. All CSR applications must be completed and submitted with a fee *all CSRs will expire on Aug. 31,

10 Step 4 Obtaining a DEA number in Texas O APRNs with full licensure and prescriptive authority must submit an application for a controlled substances registration to the TX DPS O After the controlled substance permit has been issued, the APRN may apply for a DEA registration number O Application fee: $ for 3 years Step 5 Writing the RX for Controlled Substances O APRN s name and professional credentials (i.e. RN, FNP) O APRN's BON prescriptive authority number O APRN's practice address and phone number where the prescription was issued O Delegating physician's name and professional credentials O Delegating physician's business address and phone number (if different than APRN's) O APRN's and delegating physician's and APRN's DEA number if prescription is for a CS Controlled Substances Registration O Must have TX APRN license to apply for CSR O Complete application form for CSR ( Forms/NAR pdf) O SB 195 eliminates the requirement for APRNs to have CSR in Texas effective Sep. 1, 2016 O All new registrations will continue to be accepted and processed but all will expire Aug. 31,

11 IMPORTANT TO KNOW O Prescription drug monitoring is transitioning out of DPS O All active/current CSRs were automatically renewed on Aug. 20 th, 2015 O New/Original CSRs will continue to be processed and will expire on Aug. 31, 2016 O Effective Sep. 1, 2016 the regulation of the state s prescription drug monitoring program regulation will be through the Texas State Board of Pharmacy (BOP) Who can RX Schedule II drugs under physician delegation? O APRNs or PAs can rx schedule II drugs: O in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who: O has been admitted to the hospital for an intended length of stay of 24 hours or greater; or O is receiving services in the emergency department of the hospital; or O as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider. Credentialing O The process by which hospitals and health care organizations ensure that providers have been educated, trained, certified and licensed to perform certain medical and health care acts O Practitioner will complete an application to submit for credentialing O Keep copies of your application (either hard copy or electronic copy) O Credentialing can take several weeks or months 11

12 Hospital Privileges O TX Hospitals not req to credential & privilege APRNS but most do O APRNs must meet req of Health & Safety Code Hospital Privileges for APNs and PAs NPI Numbers O NPI must be used on claim forms by all health care providers who meet the definition of a covered entity O Apply for your NPI number through the National Plan and Provider Enumeration website ( O A word to the wise.. nationalprovidentstand/apply.html Landing the best, first job O Apply to 4-5 NP opportunities O Research the organization O Write a cover letter O Dress for the job you want O Pay attention to the culture O Know your worth O Send a thank you letter after the interview 12

13 Negotiating your contract O Consider pay, benefits, professional development, malpractice insurance, delineation of responsibilities, hours per week, patients per day, bonuses, etc. Independent Practice O Timeline O Expectations O Considerations O Values Selecting Mentors O Colleagues O Experts 13

14 PhD and DNP PhD O Terminal degree in nursing O Major focus: Research O Prepare nurses at the highest level of nursing science to conduct research to advance the science of nursing DNP O Terminal degree in nursing O Major focus: Practice O Prepare nurse leaders at the highest level of nursing practice to improve patient outcomes and translate research into practice Can I use the title Doctor O If you have received a terminal degree, such as a PhD or DNP, you may use the title Dr. as a credential but also indicate the profession being practiced O Correct: Dr. Monica Alleman DNP, FNP, APRN O INCORRECT: Dr. Monica Alleman APRN Associations in Texas O Texas Nurses Association O Texas Organization of Nurse Executives O Texas Association of Nurse Anesthetists O Texas Emergency Nurses Association O Advanced Practice Nurses of the Permian Basin O Denton Area Nursing Advanced Practice Nurses O East Texas Nurse Practitioner Association O Galveston Coalition of Advanced Practice Nurses O Houston Area Nurse Practitioners O North Texas Nurse Practitioners O San Antonio Nurses in Advanced Practice O Southeast Texas Nurse Practitioners O CTCNM Consortium of Texas Certified Midwives O The Greater Texas Chapter of NAPNAP National Association of Pediatric Nurse Practitioners O Texas School Nurses Organization O Laredo APN Association O Fort Work RNP (FWRNP) Association 14

15 NP salary O AANP 2015 national NP Compensation Survey: NPs in the Southwest 95, 868 O Advance for NPs & Pas 2011 National Salary Survey: Texas 107, 526 O 2011 base salary for NPs in Texas: 94, 868 ( Conclusion O You are exactly where you need to be, you have learned exactly what you needed to learn and you will do exactly what you were meant to do 15

16 Questions?? O Dr. Monica Alleman DNP, APRN, FNP-BC O O

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