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Evolution of Prescriptive Authority for Advanced Practice Nurses and Physician Assistants

Explore the historical review and current state of prescriptive authority for NPs, CNMs, CRNAs, CNSs, and PAs, including legal foundations, educational paths, benefits, and challenges.

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Evolution of Prescriptive Authority for Advanced Practice Nurses and Physician Assistants

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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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