Before we permit a new driver to get behind the wheel of a car, we must familiarize her with the laws governing driving. But the laws don't tell the whole story. For example, what is a driver to do when entering an unprotected intersection? What governs the driver's movement into the intersection? How does the driver take into account the conditions of weather, vehicle, and road? What is the driver's level of knowledge and experience? The new driver needs guidance or rules to manage the inherent risks.

As stated by the National Council of State Boards of Nursing (NCSBN): The practice of nursing requires specialized knowledge, skill, and independent decision making. Nursing careers take widely divergent paths - practice focus varies by setting, by type of client, by different disease, therapeutic approach of level of rehabilitation. Because nursing care poses a risk of harm to the public if practiced by professionals who are unprepared or incompetent, the state, through its police powers is required to protect its citizens from harm. That protection is in the form of reasonable laws to regulate nursing. State legislatures delegate many enforcements activities to state administrative agencies. In the case of the nursing profession, that delegation is to boards of nursing. The charge from the state to the board of nursing is to protect the public. (" (NCSBN)," 2017)

The NCSBN states that, all states and territories have enacted a Nurse Practice Act (NPA). Each state's NPA is enacted by the state's legislature. The NPA itself is insufficient to provide the necessary guidance for the nursing profession, therefore, each NPA establishes a board of nursing (BON) that has the authority to develop administrative rules or regulations to clarify or make the law more specific. Rules and regulations undergo a process of public review before enactment. Once enacted, rules and regulations have the full force and effect of law. (" (NCSBN)," 2017)

State Practiced

I have licenses to practice in both New York and Connecticut states, but currently, am practicing in New York State only. According to the National Council of State Boards of Nursing, although the specificity of NPAs varies among states, all NPAs include, authority, power and composition of a board of nursing, education program standards, standards and scope of nursing practice, types of titles and licenses, requirements for licensure and grounds for disciplinary action, other violations and possible remedies.

Role of the RN based on New York State NPA

According to New York State Education Law §6902, RNs diagnose and treat human responses to actual or potential health problems through such services as case finding, health teaching, health counseling and providing care supportive to or restorative of life and well-being. RNs also execute medical regimens prescribed by a licensed physician, dentist, nurse practitioner, physician assistant, specialist assistant, midwife or podiatrist in accordance with New York State Education Department regulations. A nursing regimen must be consistent with any existing medical regimen. RNs may practice independently, in collaboration with other health care practitioners, or under the supervision of a physician, nurse practitioner, midwife, dentist, podiatrist clinical nurse specialist or another RN. An RN typically provides the following types of services (assuming that the RN is personally competent to do so):

Performs physical exams and patient assessments to identify and address health problems and unmet patient care needs.

Develops comprehensive nursing care plans and performs nursing interventions (i.e., bereavement counseling, ostomy care).

Performs medical treatments (i.e., medication administration, wound care) as prescribed or by a physician, dentist, nurse practitioner,

physician assistant, specialist assistant, midwife or podiatrist.

Provides health teaching and emotional support to help patients and their families adjust to or manage serious or chronic illnesses or injuries.

Supervises care delivered by other health care personnel, such as licensed practical nurses and home health aides.

Works with physicians, and other health care practitioners to ensure that patients receive appropriate, timely, well-coordinated care.

Conducts health screenings to detect and address signs of early disease or risk factors for disease and then provide health teaching or make referrals, as appropriate. ("NYSED," 2010)

Role of the MSN Prepared Nurse based on New York State NPA

Master's prepared nurses enter the workforce with the skills and competencies to assume an advanced nursing role in a specialty area, put theory and research into practice with individuals, families and communities, develop, implement and assess nursing strategies to assure quality of care, utilize leadership skills for positive change in policies at the local, regional and national level, and adapt professionally to the constantly changing healthcare environment and contribute to the advancement of the profession. The two master's prepared nursing, identified by the New York Nursing Profession are the Nurse practitioners (NPs) and clinical Nurse Specialists (CNSs).

Nurse Practitioners (NPs). New York State certifies NPs to practice in one or more of the following specialty areas: Adult Health; Family Health; Gerontology; Neonatology; Obstetrics; Oncology; Pediatrics, Perinatology; Psychiatry; School Health; Women's Health; Holistic Care; and Palliative care.

Clinical Nurse Specialists (CNSs). New York State certifies CNSs to practice in one or more of the following specialty areas: Adult Health; Pediatrics; Psychiatric/Mental Health; and Oncology. In New York, midwifery is not considered a nursing profession. Midwifery is a separately licensed profession.

In New York State, a clinical nurse specialist is a registered professional nurse who has completed advanced education (usually a master's or doctorate degree) in a nursing clinical practice specialty and is certified by the New York State Education Department (SED) as a "Clinical Nurse Specialist" or "CNS" ("NYSED," 2010).

Clinical nurse specialists provide expert, highly skilled nursing services to benefit patients with complex health care needs. In addition to providing, coordinating and supervising care, CNSs evaluate the quality and effectiveness of patient care. They provide clinical consultation to other health care personnel. CNSs may be involved in health care management, health systems improvement, clinical research and health care policy development. Also, in New York State, a nurse practitioner is a registered professional nurse who has completed advanced nursing education (usually a master's or doctorate degree) in a nurse practitioner specialty area and is certified by the New York State Education Department ("SED") as a "Nurse Practitioner" or "NP". SED certifies nurse practitioners to practice in the following specialty practice areas: Adult Health; Family Health; Gerontology; Neonatology; Obstetrics; Oncology; Pediatrics, Perinatology; Psychiatry; School Health; Women's Health; Holistic Care; and Palliative Care. Nurse Practitioners manage the medical and nursing care to their patients. According to New York State Education Law §6902, a nurse practitioner diagnoses illnesses and physical conditions and performs therapeutic and corrective measures within a specialty area of practice in which the nurse practitioner is certified by SED. ("NYSED," 2010)

Differences Between the Role of the RN and the Role of MSN prepared Nurses in NY State

Both Nurse Practitioners (NPs) and Registered Nurses (RNs) work closely with patients to monitor their health and provide care for acute and chronic illnesses. However, the work environments and responsibilities bestowed upon these different types of nurses can be quite different. The differences between the roles of the RN and the role of the MSN prepared nurses are for example; with Nurse Practitioners (NPs) they prescribe medications and monitor side effects and drug interactions, take, analyze, and interpret patient health histories in order to provide correct diagnoses, create individualized treatment plans, diagnose and treat acute illnesses, monitor and managing chronic illnesses and work with patients to create and maintain a healthy lifestyle. Whilst the role of the RN are patient monitoring, recording and maintaining patient records, ordering and interpreting diagnostic tests, consulting and supervising other members of a patient's healthcare team, communicating with patients and families about care plans, health education, and disease prevention and assisting physicians with patient examinations and treatments.

The New York State Nurse Practice Act identifies the role of Nurse Practitioner and Clinical Nurse Specialist. (CNSs). I believe my aspiration of MSN with a specialization in IPC will fall under the role of CNS. In conclusion, "the practice of nursing is a right granted by a state to protect those who need nursing care. The guidelines of the NPA and it rules provide safe parameters within which to work and protect patients from unprofessional and unsafe nursing practice" (Russell, 2012, p. 40). As a nurses, it's imperative we make sure we know our state's Nurse Practice Act, rules and regulations and work within the guidelines to protect our patients from unprofessional and unsafe nursing practice.