The Advance Practice Nurse as Prescriber
Background
As healthcare consumers, we have come to expect similar outcomes from a visit to our primary care provider. The provider gathers information by obtaining our history, hearing our chief complaint, and completing a physical examination and diagnostic tests. The provider formulates a diagnosis and devises a treatment plan with this information. This plan could include further diagnostic studies, referral to a specialist and, in many cases, medication prescriptions.
Though writing a prescription is considered a common practice, it has become somewhat controversial in recent years. As the disparity between the supply of primary care providers and the demand for primary care services increases, alternative provider roles have evolved. These new roles challenge the traditional model of care.
Individual State Laws About Nurses’s Prescriptive Authority
Individual state laws regulate prescriptive authority. This includes licensure, certification, and continuing education on all providers’ safe prescribing practices. Hence, patients will find some variation as to which providers may prescribe various classifications of medications.
Physician Assistants (PAs) are among the roles that have evolved, with prescriptive authority being expanded nationwide. Though this is a new role, PA prescriptive authority has not been associated with much controversy. This is primarily because PAs practice shoulder-to-shoulder with their physician supervisors, and their prescribing practices are considered collaborative.
Advanced Practice Nurse (APRN) prescriptive authority has been somewhat more controversial. This is primarily because in many states, APRNs, practicing to the top of their scope, may function autonomously of their physician colleagues.
Why Would My State Restrict My APRN From Prescribing Medications
As stated above, individual state legislatures regulate the scope of nursing practice. The vehicle for regulation of practice is the Nurse Practice Act, Which serves as the state’s regulatory standard for nurses. Boards of Nursing in each state are ultimately responsible for licensure and regulation of practice based on the Nurse Practice Act.
Bills introduce changes in prescriptive authority for APRNs to amend Nurse Practice Acts. Bills and their ultimate conversion to law are subject to the political process. Lobbyists, PACs and other entities influence legislators’ votes. Hence, in some states, physician groups may oppose APRN prescriptive authority. Powerful lobbying and the state’s political climate determine the outcome of votes in support of, or in opposition to, these changes.
Consumers are encouraged to know their respective state’s laws governing APRN prescriptive authority. This is particularly true in underserved areas of the country, where primary care providers are scarce. In these areas, it is essential that all providers are able to function at the full scope of their training and education to meet the community’s healthcare needs.
What is the Status of APRN Prescriptive Authority in My State
So, can a nurse practitioner prescribe? The American Association of Nurse Practitioners identifies three categories of state practices about prescriptive authority:
- Restricted Prescriptive Authority
- Reduced Prescriptive Authority
- Full or Complete Prescriptive Authority
Restricted Prescriptive Authority requires physician supervision or delegation when prescribing controlled substances.
- California
- Georgia
- Michigan
- Missouri
- North Carolina
- Oklahoma
- South Carolina
- Tennessee
- Texas
- Virginia
- Florida
- Alabama
- Arkansas
- Illinois
- Indiana
- Kentucky
- Louisiana
- Mississippi
- New Jersey
- Ohio
- Pennsylvania
- Puerto Rico
- S. Virgin Islands
- West Virginia
- Wisconsin
- Alaska
- Arizona
- Colorado
- Connecticut
- Delaware
- Guam
- Hawaii
- Idaho
- Iowa
- Kansas
- Maine
- Maryland
- Massachusetts
- Minnesota
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Mexico
- New York
- North Dakota
- North Mariana Islands
- Oregon
- Rhode Island
- South Dakota
- Utah
- Vermont
- Washington
- Washington, D.C.
- Wyoming
Can My APN Prescribe Controlled Medications Like Narcotics
There are five categories (Schedules) of controlled substances as established by the US Drug Enforcement Agency (DEA). The Schedules are based on the drug’s potential to create dependence, abuse and safety. Narcotics (Schedule II) drugs are one of these categories.
APRNs in many states have prescriptive authority for controlled substances, but the extent of this authority, including the ability to prescribe Schedule II drugs, varies by state. However, as is true with prescriptive authority for APRNs in general, some states have legislated restrictions on Schedule II drug prescriptions by non-physician providers.
Some states significantly restrict Schedule II prescriptive authority for APRNs, including limiting the types of drugs that can be prescribed, restricting the duration of prescriptions, or requiring collaboration with a physician. Some states allow for full prescriptive authority.
Is Allowing APRNs to Prescribe Controlled Substances a Safe Practice
APRNs with the authority to prescribe Schedule II drugs must meet the same DEA conditions as their physician colleagues. This includes ongoing monitoring of prescribing practices and mandatory continuing education related to drug-seeking behaviors and the safety of prescribing controlled substances.
Conclusions
Increased demand for primary care providers paired with an inadequate supply of these providers has caused academic institutions, legislative bodies, regulatory bodies and licensure boards to identify alternative approaches to alleviate this disparity. Academic programs have been established to educate a new group of providers with the knowledge and skills to fill this gap and provide for the health of communities.
APRNs are well-positioned to meet this societal need. These providers are experienced registered nurses who have successfully met the rigorous requirements of academic training programs and regulatory bodies. They possess the knowledge and skill to assess, diagnose, and treat patients who present to them for care.
My Opinion on Prescriptive Authority in Nursing
Prescriptive authority is just one component of an APRN’s scope of practice. However, absent prescriptive authority, the APRN’s ability to provide comprehensive treatment and quality patient care is challenged.
Legislative bodies across the nation govern the scope of practice, including prescriptive authority. Hence, the political climate in each state dictates whether APRNs can practice at the top or at a lesser level. Prescriptive authority is one of the more controversial issues that continues to be dealt with as alternative care models are developed.
See Also
How to Deal With Rude Patients
Does Medicaid Cover Prescriptions
How to Educate Patients About Medications
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