Prescriptive Authority for Nurse Practitioners - page 2

by lazer31285 33,807 Views | 36 Comments

The passage of the Affordable Care Act (ACA) will provide many more Americans access to health care. The ACA will reduce the cost of receiving health care, while also enabling uninsured Americans access to insurance and more... Read More


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    I appreciate the OP sharing this article on allnurses.

    Having said that, I would like to encourage readers to put the article in perspective. While only a minority of states have independent prescribing for NP's (17 per the NCSBN website at: https://www.ncsbn.org/2567.htm), NP's who practice outside of those states are not completely helpless in initiating drug therapy. All 50 states allow NP's to prescribe within protocols that include various levels of physician involvement. In most states, a collaborative agreement allows NP's to initiate drugs and monitor patient response during the course of the treatment without having to consult the collaborating physician each time. There are states where rules are more strict. Florida is probably by far one of the more restrictive states and this seems to be where the OP resides.

    Controlled substance prescribing is another story. While the DEA, a federal agency, provides DEA licenses to NP's and PA's. Two states in the union do not allow NP's to prescribe controlled substances. It comes to no surprise that Florida is one of them (Alabama being the other). In Florida, both PA's and NP's can not prescribe controlled substances (Source: http://www.deadiversion.usdoj.gov/dr...p_by_state.pdf).

    We've definitely had a long rocky course as far as achieving a goal of uniformity in terms of NP training, core competencies, and scope of practice but for a profession that only arose since the 1960's, I think we've come a long way.
    NRSKarenRN, CrufflerJJ, elkpark, and 1 other like this.
  2. 0
    Interesting that per the CDC, Florida has the highest per-capita sales for prescription pain killers - all prescribed by doctors, right? Hmm, maybe there's a lot of money to be made in writing these prescriptions, and that is more the issue here? CDC - State Rates - Unintentional Poisoning Policy Impact Brief - Home and Recreational Safety - Injury Center
  3. 0
    I had wondered the same thing. I thought maybe this person meant clonidine (catapres), however that is a cardiac med not a psych med. Still makes you wonder.
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    deleted
    Last edit by harmonizer on Jan 6, '13
  5. 0
    Quote from lazer31285

    The Association of American Medical Colleges estimates a shortage of 46,000 primary care physicians by the year 2025 (Rouston, 2010). Nurse Practitioners can easily step into the role of primary care.

    There are currently 150,000 nurse practitioners in the United States, and 5,500 practitioners graduate every year (Rouston, 2010).

    Nurse practitioners are more cost-effective than physicians, while continuing to provide the same quality of care. Time and time again, patient satisfaction and respect for nurse practitioners is extraordinary. The appropriate action for state legislatures is to remove prescriptive restrictions permitting nurse practitioners to provide the care they were trained to provide.
    So because of the Affordable Care Act we will have a shortage of primary care physicians estimated at roughly 46,000. The idea is to increase the Nurse Practitioners scope of practice to better handle the massive shortage. The prescriptive authority of the Nurse Practitioner would be the primary focus as. We reorganize and reallocate the 150,000 plus 5,500 graduates yearly to better fill the need.



    It is a brilliant idea to reallocate the NPs to an area with a deficit in man power. Makes absolutely perfect sense to do so.

    However, there is an alternative route. Rather than change the scope of practice in several states in the US, society can just reallocate Physicians Assistants to fill the 46,000 expected deficit. According to the Bureau of Labor ans Statistics there are currently 83,600 PAs from the last census. There are also more graduating every year.

    From a practical stand point I do not see the need to advance the scope of practice for NPs when the alternative will work just as well without any extra work. There is no legal issues about practicing nursing vs practicing medicine. PAs work form the same medical model as MDs so prescription are easily carried out. You pay them significantly less than an MD so they are very cost effective.

    My question is why go through the state to state battle to enhance the NPs scope of practice when there is a viable alternative that also fills the 46,000 deficit?

    This is an honest question and not being sarcastic.
    Last edit by kalevra on Jan 7, '13 : Reason: addition
  6. 0
    Quote from kalevra
    So because of the Affordable Care Act we will have a shortage of primary care physicians estimated at roughly 46,000. The idea is to increase the Nurse Practitioners scope of practice to better handle the massive shortage. The prescriptive authority of the Nurse Practitioner would be the primary focus as. We reorganize and reallocate the 150,000 plus 5,500 graduates yearly to better fill the need.



    It is a brilliant idea to reallocate the NPs to an area with a deficit in man power. Makes absolutely perfect sense to do so.

    However, there is an alternative route. Rather than change the scope of practice in several states in the US, society can just reallocate Physicians Assistants to fill the 46,000 expected deficit. According to the Bureau of Labor ans Statistics there are currently 83,600 PAs from the last census. There are also more graduating every year.

    From a practical stand point I do not see the need to advance the scope of practice for NPs when the alternative will work just as well without any extra work. There is no legal issues about practicing nursing vs practicing medicine. PAs work form the same medical model as MDs so prescription are easily carried out. You pay them significantly less than an MD so they are very cost effective.

    My question is why go through the state to state battle to enhance the NPs scope of practice when there is a viable alternative that also fills the 46,000 deficit?

    This is an honest question and not being sarcastic.
    This is exactly why I stated on my previous post about putting the article in perspective. NP's and PA's ARE practicing primary care now in all the 50 states. Scope of practice restrictions aside, federal law allows for NP's and PA's to see their own panel of patients and be reimbursed as long as provisions for collaboration or supervision is in place in states that require them. The article is about prescriptive authority. Both professions prescribe medications in all 50 states except for controlled substances in some states. The OP is in Florida where both PA's and NP's are not allowed to write prescriptions for any controlled substance. Does that make sense at all for PA's and NP's to be able to write any other medication that has just as many deleterious effect on a patient and not be able to write for controlled substances? You decide.
  7. 0
    Specifically, when do they begin to practice medicine and not nursing? Lets say the NPs and PAs get what they asked for. They get prescriptive authority as requested in all 50 states. Now at what point would the NPs be practicing medicine and not nursing. I am interested in how that would be handled on a court room debate level.

    I still see the PAs with an edge over the NPs regarding their practice. Only is reason being is that as nurses you can get sued for practicing medicine. Where as PAs are are built on the medical model so there is less resistance there.
  8. 2
    Quote from kalevra
    Specifically, when do they begin to practice medicine and not nursing?
    As long as NPs and other advanced practice nurses are practicing within their scope of practice established by the state in which they're practicing, they are practicing nursing, not medicine.
    myelin and Psychcns like this.
  9. 0
    My understanding is that medicine got control of everything related to health care a long time ago in every state and made it illegal for any other professions to practice anything related to medicine or surgery. All non MD's have had to have laws enacted so they can have a profession--and the support of MD's are needed to pass any health care legislation!!
  10. 0
    Quote from kalevra

    So because of the Affordable Care Act we will have a shortage of primary care physicians estimated at roughly 46,000. The idea is to increase the Nurse Practitioners scope of practice to better handle the massive shortage. The prescriptive authority of the Nurse Practitioner would be the primary focus as. We reorganize and reallocate the 150,000 plus 5,500 graduates yearly to better fill the need.

    It is a brilliant idea to reallocate the NPs to an area with a deficit in man power. Makes absolutely perfect sense to do so.

    However, there is an alternative route. Rather than change the scope of practice in several states in the US, society can just reallocate Physicians Assistants to fill the 46,000 expected deficit. According to the Bureau of Labor ans Statistics there are currently 83,600 PAs from the last census. There are also more graduating every year.

    From a practical stand point I do not see the need to advance the scope of practice for NPs when the alternative will work just as well without any extra work. There is no legal issues about practicing nursing vs practicing medicine. PAs work form the same medical model as MDs so prescription are easily carried out. You pay them significantly less than an MD so they are very cost effective.

    My question is why go through the state to state battle to enhance the NPs scope of practice when there is a viable alternative that also fills the 46,000 deficit?

    This is an honest question and not being sarcastic.
    PAs require a MD supervisor and are not individually licensed, so how does moving them address the shortage of PCPs in rural areas if a MD must move with them, and there is an increasing deficit of PCP physicians.


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