Alaska license and prescriptive authority

[nomadcrna, DNP, CRNA, NP]

I feel the need to tell this story. I am still shaking my head and really would like this out in the open.

I'll start with the background. I am already licensed in Alaska as an advanced practice nurse. I have been a CRNA for 19 years. I already have prescriptive authority in Alaska (as well as multiple other states).

So anyway, I went back to school for my Doctor of Nurse Anesthesia Practice (DNAP) in 2008. I'm finishing this spring, thank god. About halfway through it I thought I'd start an FNP program. So I completed it this past June. I can't tell you how much I enjoyed it. It was truly fantastic. I really love primary care.

So I started adding the FNP to my current APRN licenses in the various states which include Montana, Idaho, Washington, Oregon, Wyoming, Texas and Alaska. No problems in any states(except Alaska) with prescriptive authority, as I already had it in all but Texas and Oregon.

Alaska on the other hand, wanted me to re-apply for legend drugs and controlled drugs. There rational was FNP practice was different from CRNA practice. Hmm, ok, I can see that for legend drugs. Even though I prescribe and manage acutely, for every disease process, in all age groups in the perioperative period. I can see their point on the legend drugs. But the controlled drugs? I'm supposed to be the pain expert. I treat both acute and chronic pain conditions every day. Their rational for making me re-apply for controlled substances? I may prescribe Ritalin to a child. OMG.

So I have no choice, I send in the applications again and pay the fees. The board then tells me I need to get 15 ceus of pharmacology. Because obviously FNP pharmacology is different from CRNA pharmacology. HUH?

Lets see:

1. I just completed an FNP program(and passed boards) which of course had the required pharmacology.

2. I had taken within the past 1.5 years, 12 CREDIT HOURS(2 semesters) of pharmacotheraputics in my DNAP program. But since I was in a DNAP program, the pharmacology must be different, right? See the course descriptions below.

HSC 7601. The Interrelationships of Pathophysiology, Biochemistry and Pharmacology I 6 hours

This class will cover the treatment of disease and the drugs. It will integrate the pathophysiology of various disease states and underlying biochemical mediators, with available drug treatments. This will include drug discovery, drug action at synaptic and neuroeffector junction sites, CNS drugs, drug abuse, drugs of inflammation, renal and cardiovascular function. [Fall]

HSC 7602. The Interrelationships of Pathophysiology, Biochemistry and Pharmacology II 6 hours

This class will cover the treatment of diseases with drugs. It will integrate the pathophysiology of various disease states and underlying biochemical mediators with available drug treatments. This will include discussions on GI function, chemotherapeutics of microbial disease, neoplastic diseases,immunomodulators, blood and blood forming organs, hormones and antagonists, pharmacogentics, and toxicology. [spring]

3. I had 12 CREDIT HOURS of pharmacotheraputics in my Masters - CRNA program.

4. I'm already an advanced nurse practitioner with prescriptive authority.

So I contact the head of the Alaska Nurses Association. Here is her response.

I certainly sympathize with you and also congratulate you on your FNP. I can see the Boards point however. If you are going to practice as an FNP, the pharmacology requirements are for drugs that are prescribed for the family practice patient. It seems they are giving you an out with completion of prescribers letter or with medscape. Prescribers letter is only $87.00 per year if you are a member of AANP and medscape is free. You could easily knock out 15 hours in an evening or two and submit those. It would be a lot faster and easier than trying to change the board or a lawsuit. Sometimes it is easier to just do what they ask!

Am I in an alternate universe? I get so tired of fighting for our practice rights as advanced practice nurses. It really disheartens me when I have to fight other nurses.

Thanks for listening,

[zenman]

I feel your pain. I was considering a position in Alaska but when I found out how long it took to get a license I said forget it. You know how long it took New Mexico to give me an APN license? EIGHT DAYS and they called me to tell me they had issued me one! Unbelievable!!

And now I'm leaving Texas, the state of my birth because I just finished a post-master's program but TX requires 400 clinical hours within the last 2 years and I only needed 320 hrs for my program. It's ironic that UT Austin, for example, requires 49 credit hours while I have 65 credit hours from my 2 programs. In addition, I have a total of 701 clinical hours while UT Austin requires 540. On my way out the door, I sent a letter to my senator telling him goodby!

[nomadcrna, DNP, CRNA, NP]

That is just so ridiculous. Nurses truly are their own worst enemy. First off, why are non-nurse practitioners making decisions about advanced practice, no offense intended. :)

Secondly, why do nurses seem to fight to hold other nurses back.

They can't seem to understand that you have clinical hours in two programs. LOL

Thats almost as bad as the Alaska board telling me that pharmacology is different for FNP vs CRNA. I just have to shake my head and wonder at the ignorance in charge.

Did you contract the Texas advanced practice nurses association? I know they are very proactive and helpful. They look out for their members. Unlike my experience with the Alaska advanced practice association.

[zenman]

No, I actually didn't think about them. Thanks, I'll contact them just to register my displeasure.