Scope of Practice of Nurse Practitioners in the State Of Maryland
Although the state of Maryland provides full practice authority to nurse practitioners, all nurse practitioners are required to practice under the collaborative relationship of a physician for at least 18 months. After practicing under a collaborative relationship with a physician for a full 18 months, nurses are then allowed to practice fully with no supervision in Maryland (Kaplan, 2020).
Prescribing Authority
In the state of Maryland, nurse practitioners are authorized to sign medical orders, including life-sustaining treatment forms. Nurse practitioners in Maryland also have prescriptive authority, which involves having the ability to independently dispense and prescribe health devices, including schedule II and V controlled substances (Kaplan, 2020).

Limitations of Practice
After receiving full practice authority, which includes working under the supervision of a physician for at least 18 months, nurse practitioners do not have any practice limitations in the state of Maryland. In this regard, nurse practitioners in Maryland are recognized in the state policy as primary care providers. In this regard, nurse practitioners can serve in different areas in the state of Maryland, including geriatric, pediatric, adult, and obstetric gynecologists (Kaplan, 2020).
Process for Obtaining Licensure
In Maryland, the process for obtaining a license as a nurse practitioner includes having a registered nurse license. Nurse practitioners with a registered nursing license can therefore apply for the advanced practice registered nurse license. Nurse practitioners who hold registered nurse licenses from other States are required to apply for a new license in the state of Maryland (Kaplan, 2020). The application for an RN license in Maryland will therefore involve submitting an application and paying the required fees while providing supporting documents. The two major routes that nurse practitioners can take to receive a registered nurse license in Maryland include registered nurse by endorsement and registered nurse by examination. Nurses who come from a board approved institutions and apply for a registered nurse must have an associate degree and provide proof of completing such programs (Dillon & Gary, 2021). After presenting transcripts, all applicants for registered nurse licenses are also required to take the National Council licensure examination for registered nurses (NCLEX-RN) exam. Nurse practitioners who already have a license to practice in other states can also receive a registered nurse license in Maryland through endorsement. The nurses need to have passed the NCLEX-RN exam. Eventually, the license of such nurses will be verified, and they will be given a Maryland license (Kaplan, 2020).
The second step in obtaining licensure as a nurse practitioner in Maryland includes having advanced training, which includes a master’s degree (Poghosyan et al., 2021). Nurse practitioners also need to have post-graduate education, including national certification based on their specialization. The certifying agencies that are approved in the state of Maryland include the American nurses credentialing center (ANCC) and the American Academy of Nurse Practitioners (AANP). The application fee for getting a license as a nurse practitioner in Maryland is $50, with an additional $25 for every population of focus that a nurse practitioner would want to add to their license (Plemmons et al., 2022).

Certification and Education Requirements for Licensure
The education and certification requirements for licensure as an APRN in Maryland include proof of APRN education submitted with original transcripts from the awarding institution. National certification is also an important requirement in the application process to be a nurse practitioner in Maryland. Registered nurses are also required to have a copy of the verification of the board for each population of focus they intend to work with (Kaplan, 2020).
Advantages of Independent Practice of APNs In Maryland
Independent practice of advanced practice nurses has contributed to numerous benefits in the state of Maryland, including cost-effectiveness in care delivery. Nurse practitioners are able to provide healthcare services that cost less compared to physicians but are of the same quality (Carthon et al., 2022). Nurse practitioners, therefore, contribute significantly too significant cost savings for healthcare institutions. In the state of Maryland, nurse practitioners who have full practice authority also contribute to filling the gap of care in underserved and rural areas (Carthon et al., 2022). Physician shortages were also a common occurrence in Maryland. However, nurse practitioners play a significant role in plugging the gap related to the delivery of health care services. Nurse practitioners also play an important role in making the delivery of patient care more effective (Plemmons et al., 2022). In this regard, patients benefit significantly by accessing qualified healthcare practitioners who can be able to meet their healthcare needs. Nurse practitioners also play a significant role in providing healthcare services to the aging population, which includes individuals above 65 years of age who are likely to struggle with chronic conditions (Plemmons et al., 2022). The elderly population is, therefore, able to get effective care from nurse practitioners, which would have been impossible to receive from physicians who are busy and overworked.
Impact of Access to Nurse Practitioners on Health Care Disparities
Improved access to nurse practitioners contributes significantly to addressing the issue of health care disparities in a given region. This is because nurse practitioners are able to serve in low-income and underserved areas and ensure equal access to healthcare services among different social classes in a community (Dillon & Gary, 2021).

References
Carthon, M. B., Brom, H., Nikpour, J., Todd, B., Aiken, L., & Poghosyan, L. (2022). Supportive Practice Environments Are Associated With Higher Quality Ratings Among Nurse Practitioners Working in Underserved Areas. Journal of Nursing Regulation, 13(1), 5–12. https://doi.org/10.1016/s2155-8256(22)00028-x
Dillon, D., & Gary, F. (2021). Full Practice Authority for Nurse Practitioners. Nursing Administration Quarterly, 41(1), 86–93. https://doi.org/10.1097/naq.0000000000000210
Kaplan, L. (2020). Marylandʼs Nurse Practitioner Full Practice Authority Act of 2015. The Nurse Practitioner, 40(5), 8. https://doi.org/10.1097/01.npr.0000461956.53786.5b
Plemmons, A., Shakya, S., Cato, K., Sadarangani, T., Poghosyan, L., & Timmons, E. (2022). Exploring the relationship between nurse practitioner full practice authority, nurse practitioner workforce diversity, and disparate primary care access. Policy, Politics, & Nursing Practice, 24(1), 152715442211380. https://doi.org/10.1177/15271544221138047
Poghosyan, L., Pulcini, J., Chan, G. K., Dunphy, L., Martsolf, G. R., Greco, K., Todd, B. A., Brown, S. C., Fitzgerald, M., McMenamin, A. L., & Solari-Twadell, P. A. (2021). State Responses to COVID-19: Potential Benefits of Continuing Full Practice Authority for Primary Care Nurse Practitioners. Nursing Outlook, 70(1). https://doi.org/10.1016/j.outlook.2021.07.012