Prescriptive Privileges of the Advanced Practice Registered Nurse (APRN) Essay

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Using peer-reviewed journal articles or evidence-based practice websites locate policy or regulatory position statements or campaigns that support changes in APRN prescribing practices at the state or national level.

In a paper not to exceed six double-spaced pages, excluding title and reference pages, analyze these statements by assessing their alignment with the American Association of Nurse Practitioners (AANP)’s Nurse Practitioner Prescriptive Privilege statement (see AANP Position Statement & Papers). Use the Assignment 1 Rubric below to guide you in completing this assignment.

According to the APRN Consensus Model, there are four roles of the advanced practice registered nurse. Each of these roles gives the particular APRN a specific population focus that they can take care of. The four roles are certified nurse practitioner (CNP), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), and certified nurse midwife or CNM (Sabo et al., 2018). After certification, typically every APRN chooses the state in which they are going to practice. Ideally, every APRN is trained and educated to provide the best primary health care services to their population focus. They are all competent regardless of the specific APRN role. Prescriptive Privileges of the Advanced Practice Registered Nurse (APRN) Essay.  However, the scope of practice that they get in different states is different. As much as APRN practice is regulated by state boards of nursing and the nursing practice Act in the state, legislation in the 50 states and the District of Columbia differs three-fold with regard to both practice and prescriptive authority. The best states to practice in and that will give the APRN autonomous practice status are those that give full practice authority (FPA) to the ARNs. This means that the ARN in these states is allowed by licensure to practice to the fullest extent of their knowledge, training, and experience without supervision or restrictions (AANP, 2021). This FPA is usually accompanied by full prescriptive authority, meaning that the APRN does not have to consult a practising and supervising physician before prescribing medications. The prescriptive authority in a FPA state usually includes the prescription of scheduled or controlled substances. This paper outlines some of the position statements, advocacy, and support for APRN prescriptive privilege in all the states of the United States of America. Prescriptive Privileges of the Advanced Practice Registered Nurse (APRN) Essay.

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The Current Position

The scope of practice in all the states in the US at the present moment reflects one of three positions. These are full practice authority (FPA), reduced practice, or restricted practice. Autonomy for the APRN in each of these three scenarios decreases in the order in which they have been presented above. The best practice environment for the APRN to practice in is that in which there is FPA. In this practice environment, the APRN is given the authority to treat all illnesses and injuries in their population focus as well as prescribe without formal oversight by a physician. This is completely autonomous practice. In a reduced practice environment, the APRN’s ability to carry out at least one element of their practice is reduced and curtailed. In this scenario, the APRN is required to enter into a written collaborative agreement with a practising physician in the state. This physician will oversight them and regulate their treatments and prescriptions throughout their career. In restricted practice states, the ability of the APRN to engage in at least one aspect of their practice is also limited by legislation. The APRN is also required to enter into a career-long written collaborative agreement with a practising physician in that state. This physician will supervise, delegate, and manage the APRN in all the duties that she will perform. This includes examining patients, ordering investigations and tests, and writing prescriptions (AANP, 2021). Prescriptive Privileges of the Advanced Practice Registered Nurse (APRN) Essay. From the analysis above, it is clear that the only scope of practice environment favorable to full APRN prescriptive privileges is that of full practice authority. Currently, 28 states give legal full practice authority to APRNs. The rest are either reduced or restricted practice jurisdictions.

Why Having Full Prescriptive Privileges is Important for the APRN

In a landmark report by the Institute of Medicine (IOM), it was recommended that the future of nursing would require APRNs who are given the authority to practice to the fullest extent of their education, knowledge, skills, and experience. The same report encouraged nurses to go for higher postgraduate education to increase their knowledge and competence. Nurses were to become part and parcel of healthcare delivery and management, a situation that cannot be realized if they are restricted in practice (Hopper, 2016; ANA, n.d.). For this reason, it is important that APRNs be allowed practice autonomy so that they can effectively deliver services to their population foci that require urgent primary health care. Several studies have demonstrated that in the rural areas and within marginalized communities, access to basic primary health care services is limited. This is because most physicians prefer to practice in large metropolitan areas but also charge expensively. APRNs were meant to be the solution to this. This is because they have a nursing background and therefore would offer more personalized compassionate care, they charge reasonable for their services (cost-effectiveness), and most importantly provide healthcare services that are comparable to that given by the physicians. Prescriptive Privileges of the Advanced Practice Registered Nurse (APRN) Essay. Preventing APRNs from performing these duties will result in a deterioration of access to quality healthcare as a social determinant of health. This is especially true for vulnerable and poor communities (Duncan & Sheppard, 2015). ARNs must therefore be granted full practice autonomy as well as full prescriptive authority and privileges.

Advocacy and Position Statements on Nurse Practitioner Prescriptive Privileges

One of the professional nursing organizations that have a position statement and advocacy stance on the issue of prescriptive privileges for APRNs is the National Association of Pediatric Nurse Practitioners or NAPNAP. Its holds that nurse practitioners should be granted full prescriptive authority and dispensing privileges in congruence with their education, training, competence, skills, certification, and licensure (NAPNAP, 2016). In particular, this position statement and advocacy stance states that:

• Nurse practitioners (NPs) should not be subjected to reduced or restricted practice but be given autonomy of practice in the form of full practice authority.
• NPs should be allowed to prescribe – in addition to medications – all other medical devices, adjunct medical or health services, and medical equipment and supplies.
• A provision for e-prescribing should be made for APRNs just as it is for physicians with e-prescribing and computerized provider order entry or CPOE (Alotaibi & Federico, 2017).
• The names of the prescribing NPs should be displayed prominently on all dispensed medications and prescription pads, electronic or otherwise. Prescriptive Privileges of the Advanced Practice Registered Nurse (APRN) Essay.
• NPs should be allowed to independently (without physician intervention) receive and freely distribute drug samples from drug companies.
• There should be similar and identical language in state nurse practice Acts that recognize the ability of APRNs to practice autonomously to the fullest extent of their education, training, certification, and licensure.
• All NPs be given not only the Drug Enforcement Agency or DEA number, but also a National Provider Identifier or NPI number (NAPNAP, 2016).

The other professional nursing organization that has a position stamen on the matter of prescriptive authority and privileges for APRNs is the American Association of Nurse Practitioners or AANP. In its position statement, it recognizes that prescribing is part and parcel of the scope of practice of a nurse practitioner. The AANP clarifies that prescribing is not a distinct or different act that is separated from normal NP practice (AANP, 2020). To provide safe, effective, efficient, timely, equitable, and patient-centered care, the AANP advocates that:

• The NP to be given the ability to prescribe not only controlled medications, but also medical devices, durable medical equipment, healthcare services, equipment and supplies.
• Only state boards of nursing regulate NP practice in conformity with the APRN role, training, education, and certification (AANP, 2020). Prescriptive Privileges of the Advanced Practice Registered Nurse (APRN) Essay.

Conclusion

With the current numbers of nurses who have completed postgraduate education to the highest possible level, there is no reason why APRNs should be denied an autonomous practice environment. This is because there is no justification for this denial on the basis of competence or knowledge. APRNs have been found to be just as competent as physicians if not better when it comes to treating patients with various illnesses and injuries. It is time therefore that all APRNs got full prescriptive authority and privileges in all states as a matter of course.

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References

Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631

American Association of Nurse Practitioners [AANP] (January 1, 2021). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

American Association of Nurse Practitioners [AANP] (2020). Position statement: Nurse practitioner prescriptive authority. https://storage.aanp.org/www/documents/advocacy/position-papers/NP-Prescriptive-Authority.pdf. Prescriptive Privileges of the Advanced Practice Registered Nurse (APRN) Essay.

American Nurses Association [ANA] (n.d.). IOM future of nursing report. https://www.nursingworld.org/practice-policy/iom-future-of-nursing-report/

Duncan, C.G. & Sheppard, K.G. (2015). Barriers to nurse practitioner full practice authority (FPA): State of the science. International Journal of Nursing Student Scholarship, 2. https://journalhosting.ucalgary.ca/index.php/ijnss/article/view/56778

Hooper, V.D. (2016). The Institute of Medicine report on the future of nursing: Where are we 5 years later? Journal of PeriAnesthesia Nursing, 31(5), 367-369. http://dx.doi.org/10.1016/j.jopan.2016.08.013

National Association of Pediatric Nurse Practitioners [NAPNAP] (2016). Position statement on nurse practitioner prescriptive privileges. Journal of Pediatric Health Care, 30(3), A15-A16. https://doi.org/10.1016/j.pedhc.2016.01.007

Sabo, J.A., Chesney, M., Tracy, M.F., & Sendelbach, S. (2017). APRN consensus model implementation: The Minnesota experience. Journal of Nursing Regulation, 8(2), 10-16. https://doi.org/10.1016/S2155-8256(17)30093-5. Prescriptive Privileges of the Advanced Practice Registered Nurse (APRN) Essay.