Nursing professionals are guided not only by their professional code of conduct but also by state laws regulating states in which they practice. In most cases in the United States nurses' practice under different categories including under full practice, reduced practice or under restricted practice. In the United States nurses under full practice is allowed by state practice and licensure law to evaluate, diagnosis, interpret diagnosis results as well as initiate and manage patient treatment ( American Association of Nurse Practitioners, 2016) . Their mandate includes prescribing medication to patients as well as controlling substances under exclusive licensure of the state board of nursing practice. Nurses working under the reduced practice model are allowed by State laws to only engage in at least one specific element of the NP practice. State laws hence limit nurses under this model to engage in more than one element and require them to collaborate with health care providers to offer patient care. State law on nursing practice and licensure requires nurses working under the restricted practice model to carry out their practice under the supervision of a health care provider to practice. Such nurses are not allowed to engage in any element of nursing practice without supervision.
Despite efforts to allow nurses across the United States to practice under full license, States such as Florida have lagged. They still do not allow nursing practitioners to practice under the full scope of their licenses. Arizona and Florida both require nurses to have a minimum of a graduate degree, a nursing license and a national certification ("State Practice Environment", 2020) . Therefore, certain legislative barriers prevent nurses in these states to practice to the full licensure of their licenses. In Florida, for example, pediatric cardiology does not have advanced practice hence limiting nurses who would want to practice. There is need for proper legislation and policy formulation from health care policymakers and legislators to come up with workable practice requirements for nurses in these states to meet the end goal of better health care for all.
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Advance practise registered nurses is tasked with different roles in the health care system depending on their area of specialization. Certified nurse-midwives are RN specialists in the field of childbirth. Their roles usually involve women reproductive health care, childbirth and infant care. Certified registered nurse anesthetists (CRNA) are RN who specialist in administering anesthesia to patients undergoing surgery as well as other medical procedures. Clinical Nurse Specialists (CNS) are a group of RN who provide clinical expertise in their areas of specialization the medical field ( American Association of Nurse Practitioners, 2016) . Clinical nurses also work closely with communities they serve to offer services and implement government policies within these communities. Nurse practitioners are an advanced group of nurses who offer comprehensive care to patients. They usually specialize in one area and become experts in the same. An example is a psychiatric nurse practitioner who works alongside psychiatry experts to offer nursing services to patients.
Like other professions, networking is a key element of the nursing career. Even though most nurses choose to specialize in certain areas, the dynamics around patient needs and the changing health care system especially with advancements in technology and development of new fields, nurses have the opportunities of working alongside each other to enhance patient experience and advance their careers. An example is the fact that an intern or a nurse under restricted practice can work closely with a health care provider under supervision to learn and increase their experience which then enables them to attain other practising licenses.
Moral distress is common among NP under all categories. The code of ethics governing nurses in America stipulates different rules that should be followed in the practice. An example of an ethical dilemma that NPs face is that of protecting the patient's privacy, especially in cases where the patient's family is involved or where a patient has to receive care from another profession. As an NP it is important to maintain a close relationship with the patient especially under the current centred model adopted by different health care providers ( Sullivan, Kiovsky, Mason, Hill & Dukes, 2015) . Such a relationship between the patient and the nurse allows effective communication between the parties involved. I would seek the consent of the patient in cases where I have to disclose personal patient information for the benefit of the patient.
APRN's have wider scope in the profession as compared to RN. They have undergone more training and have specialized in one of the four key areas as stipulated by the law ( Sullivan, Kiovsky, Mason, Hill & Dukes, 2015) . Professionalism, however, applies to both of them and only varies in terms of the code of conduct, the ethical issues they interact with daily and how they are expected to react to them. APRNs are more likely to face more specific ethical issues relating to their specific areas of work as opposed to RNs who may face ethical issues in a broader scope.
Advance practise nursing roles have evolved over the years. The developments can be attributed to developments in the health care system driven by the government aim of providing better and affordable health care services to all citizens. At the same time, the needs of patients have advanced over the years. Issues such as inflation and the impact of economic depression on the people have also played a major role in shaping the roles of the Advance practice nurses. An example is the fact that most people now prefer to have the elderly and chronically ill patients taken care of by nurses in established facilities as opposed to doing so in their homes ( Sullivan, Kiovsky, Mason, Hill & Dukes, 2015) . State laws have also impacted the scope of work that advance practice nurses can engage in hence shaping the nature of their work.
References
American Association of Nurse Practitioners (AANP). State practice
environment. 2016 Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment .
State Practice Environment. (2020). Retrieved 8 June 2020, from
https://www.aanp.org/advocacy/state/state-practice-environment
Sullivan M, Kiovsky R D, Mason D J, Hill C D, Dukes C (2015). Interprofessional collaboration and education: Working together to ensure excellence in health care. American Journal of Nursing .
