Prescriptive Authority

In the United States, health care accessibility, quality, and affordability continue to be ongoing topics of discussion that effect many Americans on a regular basis. The need for affordable, quality healthcare continues to grow, not only due to a growing elderly population, but also as a result of the Affordable Care Act which has allowed millions of previously uninsured Americans access to health insurance and therefor better access to healthcare services (Patient Protection and Affordable Care Act, 2010). According to the Institute of Medicine (IOM) the projected demand increased for healthcare have led to a call for expansion of primary care services by policy makers (Institute of Medicine, 2010; National Governors Association, 2012). Since Advanced Practice Nurses or Nurse Practitioners (APNs or NPs will be used interchangeably for the purpose of this paper) are one of the fastest growing groups of healthcare providers, and continue to practice and provide care in a range of settings including primary care, it is important to investigate and address any potential barriers to practice. This author believes that allowing APNs to write prescriptions for commonly used controlled substances will help improve timeliness and flexibility in health care delivery; studies have shown that there is a positive impact on high

First, the state licensure regulates NP practice and it has been a big issue since NPs are not able to practice to the fullest extent despite of their education and training. NPs practice is regulated by state licensure and only about one-third of the nation has adopted full practice authority licensure and practice laws for NPs (Hain & Fleck, 2014). The American Association of Nurse Practitioners (AANP) reports that, under a full practice authority model, NPs are still required to meet

been restricted on what they can and can’t do including signing certain documents and orders they can prescribe. With the Affordable Care Act the demand for primary care providers is growing (Gadbois, Miller, Tyler, & Intrator, 2015). This means that the need for APRNs is rising and the need change is approaching. In the primary care setting, there is a variety of medical staff working including medical assistance, LPNs, and RNs. This can become more for the APRN when delegating medication administration. When the APRN cannot delegate medication administration the quality of patient care is sacrificed and is not productive in providing care to the patients.

State law is made up of two different forms: statues and regulations (Buppert, 2015). Under the established rules and regulations, an ARNP can: (a) monitor and alter drug therapies; (b) initiate therapies for certain diagnosis’; (c) perform additional functions as may be determined by rule; (d) and order diagnostic tests and appropriate therapies (The Florida Legislature, 2016). A practitioner licensed under chapters 458, 459 or 466, must maintain supervision for directing certain course and medical treatment (The Florida Legislature, 2016). Within the context of advanced nursing practice and the Florida Statues chapter 464.003(2), an ARNP may diagnosis, treat, alter medication regimes, diagnose, prescribe and operate, which are approved by a joint committee composed of three members appointed by the Board of Nursing, three members appointed by the Board of Medicine and the State Surgeon General or his/her designee (The Florida Legislature, 2016). On the other hand, the federal government regulates nurse practitioner practice through statutes passed by Congress and regulations (Buppert, 2015). According to Buppert (2015), federal law can override state law, and when federal and state law conflict with one another, federal law usually triumphs. Due to these state and federal statutes and regulations, this can impose a huge threat and impact to NP practice since the BON and the Nurse Practice Act usually help

The APRN Consensus Model was released in July of 2008 to define advanced practice registered nurse, identify the titles to be used by APRNs, and define specialty area of practice. The Consensus Model also describes population foci, suggests a process for recognition of new APRN roles, and recommends requirements for implementation (American Nurses Association [ANA], 2010). The APRN regulatory model helps uniform scope of practice of APRN across the United States, which benefit individual APRN, enhance patient outcomes, and improve the quality of care. Consensus Model consists of Licensure, Accreditation, Certification, and Education. The Education criteria in LACE Consensus Model relate to all APRN programs regardless of master’s or doctoral

Bahadori and Fitzpatrick conducted a study regarding the actual level of autonomy of the APRNs in primary care settings. They compared clinical outcomes for patients assigned to either APRNs or physicians and found there was no significant differences in reported health status between patients treated by NPs or by the physicians. Also Bahadori and Fitzpatrick (2009) stated within their report although the APRNs had more restrictions regarding their professional authority and struggle with maximal autonomy they recommend APRNs have more autonomy and decision-making authority to allow them to work as competent professionals, and improve patient care outcomes.

This paper explores the perception of clinical practitioners to the change in policy related to the advanced practice registered nurse (APRN) full practice authority. The author conducts a one-on-one, open-ended interview of 5 nurse practitioners and 5 physicians licensed to practice in Maryland on their perceptions of the recent passage of the Advanced Practice Registered Nurse Full Practice Authority. A literature review was conducted in a policy report by the professional nursing organization, and discussion within the peer-reviewed article supported an overview, regulatory differences among 50 states, including the District of Columbia. Their policy implication for enhancing APRNs role nationally. The author discusses a critical component

In 2008, the coalition of members from the Alliance for Advanced Practice Credentialing and the National Council of State Boards of Nursing (NCSBN) created the Consensus Model for Advanced Practicing Registered Nurses (APRN’s). This model creates a framework for APRN’s in licensing, accreditation, certification, and education in the United States (Alleman & Houle, 2013). The establishment of this Consensus Model has developed a bases for the ARNP’s comprehensive knowledge base, ability for clinical reasoning, cultural, and ethical competencies, establishing a model of practice for ARNPs in which to follow. These concepts will be further discussed in this paper.

According to the Pearson Report, there is a total of 147,295 Nurse Practitioners throughout the United States (Pearson, 2009). However, for NPs in some states the battle continues over some forms of prescriptive authority or physician involvement in NP prescribing, such as the state of Pennsylvania. State regulatory approaches to NP prescribing range from no authorization for prescribing (in Georgia, 2006 legislation passed which recognized NPs as prescribers, but the rules have not been approved at the time of this writing) to unencumbered prescriptive authority (Arizona, DC, Montana, Oregon, Washington, and Wyoming) (Lugo, O’Grady, Hodnicki & Hanson, 2007).

Since the inception of the Nurse Practitioner (NP) role in the 1960s, NPs have thrived in the delivery of primary healthcare and nurse case management. Despite patient satisfaction with NPs ' style of care, nurses have been critical of NPs, while physicians have been threatened by NP encroachment on MD practice. Balancing assessment, diagnosis, and treatment with caring defines NPs ' success as primary care providers. Understand the role and Scope of Practice of NPs is sometimes difficult for some to understand. The purpose of this paper is to define the role and history of NP, compare and contrast licensure versus certifications, understand NP Scope Of Practice and Standards of Care, discuss how the State Practice Acts regulate FNP practice, discuss credentialing and privileging, and differentiate between legislative and regulatory processes.

Some groups, including the American Medical Association, have stated that advanced practice nurses should not have full authority because their training is shorter than physicians (Hain & Fleck, 2014). The concern raised is that an APRN is not trained well enough to safely diagnose and treat a patient without supervision. Many studies have been completed to test this argument. One such study by the Cochran review concluded that in primary care settings APRNs had high patient satisfaction scores and overall improved patient outcomes (Hain & Fleck,

Whether the changes are related to evidenced-based practice or laws related to practice, the nursing field is constantly evolving. Although APRNs are heading in a great direction, there are still many limitations to their practice. As shown in Barton Associates’ (2015) law guide, there is a trend in the chart that shows more restrictions placed on NPs the farther southeast one works. Considering I live in South Carolina, I witness these restrictions first hand. However, to our advantage, South Carolina has a lot of influence from the military community considering it’s high population of military personnel. “The Department of Veterans Affairs (VA) is proposing to amend its medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment” (Department of Veterans Affairs, 2016). Therefore, APRNs will be able to practice independently within the VA system, regardless of the state’s rules and regulations. I am looking forward to the changes this will bring within the next few years. I believe this will help motivate states to relieve some, if not all, of the restrictions placed on APRNs as they see more efficient use of healthcare resources in the VA system in every

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

The role of Advanced Practice Nursing (APN) has changed dramatically in recent years. Currently, the Unite States (U.S.) health care is focusing on delivering a cost -effective health care to all patients. In the last decades, there were many efforts to control health care over spending in the U.S. One of such efforts is to focus on applying proven principles of evidence-based practice and cost-effectiveness to find the least expensive way to produce a specific clinical service of acceptable quality (Bauer, 2010). The vast changes in health care system, such as cost, need for high productivity, limitation on reimbursement, and the inadequacy on access have made APNs to think in a way where they most fit to provide independent care for

Nneka, I absolutely agree with you that an independent prescriptive authority gives the APN the right to prescribe without any limitations, such as medical devices, health and medical services, durable medical goods, prescription and controlled drugs some of the state that issue independent prescriptive authority includes Alaska, Arizona, Idaho etc. In the state of GA, where I currently practice as a Registered Nurse, Georgia’s APRN practice laws are some of most restrictive in the nation and their APRN practice regulations do not align with national trends. Georgia Secretary of State websites state that NPs need a Nurse Protocol Agreement to be granted prescriptive authority which is a written document mutually agreed upon and signed by an