Clarification on prescriptive authority

  1. it's amazing how much misinformation is perpetuated by "would-be crna's" and other misinformed persons. i was told by more than one person (in another forum) to avoid west virginia's camc program since you are unable to obtain prescriptive authority with the doctoral degree that is awarded upon graduation. out of concern i contacted the head of the program to see what she had to say on the matter and found the answer very enlightening. (long story short: ask programs directly about any concerns you have about their validity or how their program is run. relying on third party information is liable to get you into trouble). i was given permission to post the response so any commentary on the subject is greatly appreciated.

    this is a fairly complicated question, so bear with me.

    prescriptive authority is a licensure issue, so each state regulates this. most nurse anesthesia practice does not require prescriptive authority. prescriptions are written for third parties to dispense medication. most nurse anesthetists obtain their own drugs and administer them directly. since no third party is involved, there is no "prescription".

    crnas in certain situations could use prescriptive authority. if a crna wrote a patient prescription for a preoperative medication, that would require prescriptive authority. i have heard of controversy in some states regarding crnas requesting meds to be given in pacu. asking the pacu nurse to give the med could require prescriptive authority. of course, the easier solution is for the crna to give the med themselves.

    the concern you raise seems to come up with fair regularity here in wv. our wv state law requires advanced practice status to obtain prescriptive authority. our state is the only one of the 50 that requires a masters in nursing to obtain advance practice status. so nurse anesthesia graduates of non-nursing programs are not able to obtain prescriptive authority here in wv. however, 450 crnas are hard at work every day in every county of wv. only a handful of these crnas have a msn, and that fact does not impeed their ability to work in the least. while some state require advanced practice status to work as a crna, that is not a requirement in wv.

    it really saddens me every time i hear that a potential student (like your friend) has ruled out our program based on misunderstandings of these issues. half of the nurse anesthesia programs in this country grant non-nursing degrees. if these graduates were having trouble finding employment, these non-nursing programs would not continue to exist. camc has graduates working in every one of the 50 states. we have graduates from 2000 and 2005 who went to work in washington state. i have never heard about any of our graduates having any limitations upon them about where they choose to work. in states other than wv, our graduates qualify for advanced practice status, just like any other graduate from a non-nursing program. if prescriptive authority is in fact required for nurse anesthesia practice in some states, then graduates of non-nursing programs are eligible for it.

    the confusion occurs when people mix up requirements from one state (where many crnas can't get it, but nobody needs it) with the requirements in other states (where crnas may need it, but can all easily get it). crnas are in great demand. it would not be in any state's best interest to pass legislation or regulation that would limit their pool of potential workers. half of our programs are in non-nursing. why would any state want to limit themselves to attracting only half of the graduates in any given year? it wouldn't make sense.

    if you need further information about this, or any practice issue, contact the state nurse anesthetist organization in the state you plan to practice. they will be able to tell you exactly what the requirements are for that state.

    i hope this helps. if there is anything else i can help with regarding your application, please let me know. good luck to you!

    cassy taylor crna, dnp, dmp, cne 
instructor, camc school of nurse anesthesia 
associate faculty, lewis college of business 
marshall university
    (i asked permission to post this response to applicable forums and dr taylor sent the following response).
    i am glad it was helpful. i think it would be ok to re-post my information. as i re-read it, i would add a clarification that when i gave the example of writing a prescription for a preop med, that i was referring to one that would be taken to a pharmacy to be filled, for the patient to take at home the evening before or the morning of their procedure. not a very common occurence in the typical practice, but may come up in some crnas situations. i hope the rest is clear enough.
    obviously, i am most knowledgable about the practice environment of wv. if your post generates any discussion about situations in other states, that does not fit with the description i have given you, i would be most interested in learning of it, so feel free to get back to me if that occurs.
    cassy taylor crna, dnp, dmp, cne
    instructor, camc school of nurse anesthesia
    associate faculty, lewis college of business
    marshall university

    Last edit by sirI on Feb 11, '10
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