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Chapter 2

Chapter 2. Historical Review of Prescriptive Authority: The Role of Nurses (NPs, CNMs, CRNAs, and CNSs) and Physician Assistants. Prescriptive Authority of Nurses. Changes in Roles of Nurses Overview of CNS role; evolution of NP role Initial physician support

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Chapter 2

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  1. Chapter 2 Historical Review of Prescriptive Authority: The Role of Nurses (NPs, CNMs, CRNAs, and CNSs) and Physician Assistants

  2. Prescriptive Authority of Nurses • Changes in Roles of Nurses • Overview of CNS role; evolution of NP role • Initial physician support • Evolution of educational programs • Certificate to master’s degree programs • Research supporting role development and quality of care of advanced practice nurses

  3. Prescriptive Authority of Nurses • Legal Foundation of Prescriptive Authority for APNs • Role of the federal government • State control of prescriptive privileges

  4. Prescriptive Authority of Nurses • Overview of the Prescribing Activity of Advanced Practice Nurses • Clinical nurse specialists • Definition and scope of practice • Educational preparation and certification • Status of prescriptive authority

  5. Prescriptive Authority of Nurses • Overview of the Prescribing Activity of Advanced Practice Nurses (cont’d) • Certified registered nurse anesthetists • Definition and scope of practice • Educational preparation and certification • Status of prescriptive authority

  6. Prescriptive Authority of Nurses • Overview of the Prescribing Activity of Advanced Practice Nurses (cont’d) • Certified registered nurse anesthetists • Definition and scope of practice • Educational preparation and certification • Status of prescriptive authority • Benefits of prescriptive authority • Disadvantages of seeking prescriptive authority

  7. Prescriptive Authority of Nurses • Overview of the Prescribing Activity of Advanced Practice Nurses (cont’d) • Certified nurse-midwives • Definition and scope of practice • Educational preparation and certification • Status of prescriptive authority

  8. Prescriptive Authority of Nurses • Overview of the Prescribing Activity of Advanced Practice Nurses (cont’d) • Nurse practitioners • Definition and scope of practice • Education and certification • Moves to standardized curricular content • FNP pharmacology curriculum recommendations • Credentialing • Status of prescriptive authority

  9. Prescribing of Controlled Substances • DEA Regulations • Provider registration • 1991: Providers must have “plenary” authority to prescribe controlled substances • Barrier to practice • Legal dilemma • 1993: Definition and Registration of Mid-Level Practitioners (MLPs) (21 CFR Parts 1301 and 1304 or 58 FR 31171) • Inappropriate use of DEA numbers and barriers to practice

  10. Dispensing Privileges • Federal Law • Addresses labeling and packaging requirements of medications • Does not exclude specific providers from dispensing medication • NPs in all states may dispense pharmaceutical samples • States may impose site restrictions and/or medication restrictions

  11. Dispensing Privileges • Ongoing Prescriptive Authority Issues • Across-state-line prescribing • Central pharmacies (mail order)

  12. Research on Prescriptive Practices of APNs • First Studies • State of California study: 1981 • Guide future legislative initiatives surrounding prescriptive authority for NPs and other “midlevel providers” • Results • Additional studies • Consistency of results

  13. Barriers to Practice for Nurses in the Diagnosing and Prescribing Role • Regulatory Irregularity Among States • Increased Antagonism from Organized Medical Groups Competing with APNs for Patients • Growing Number of NP Graduates without Prior Nursing Experience

  14. Barriers to Practice for Nurses in the Diagnosing and Prescribing Role • Inequity in Data Collection on Physician Prescribing Patterns Among Pharmaceutical Companies • Difficulty in Obtaining Prescribing Data from PDMA

  15. Prescriptive Authority and the Physician Assistant • Overview of PA Role • Qualifications • Education • Certification • Legal Foundation of Prescriptive Authority • History among states

  16. Prescriptive Authority and the Physician Assistant • Research on Prescriptive Practices of PAs • Cipher and colleagues: National Ambulatory Medical Care Survey from 1997 through 2003 • Found that prescribing patterns among PAs, NPs, and primary care physicians were similar • Legislative Progress • Barriers to practice that once existed now have largely been resolved

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