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Advanced registered nurse practitioners (ARNPs) have to consider a broad range of factors when prescribing medicines. For instance, professionals in this area have to consider federal and state laws that regulate their practices. The focus on controlled substances is particularly important because registered nurses have a responsibility to prevent fraud and diversion (Klein, 2016). ARNPs have the authority to prescribe Schedule II, Schedule III, and Schedule IV drugs if they pass certification (Florida Board of Nursing, 2016). It is imperative to prevent tampering to prevent abuse and negative health effects when prescribing such substances. Similarly, nurses have to identify behavioral red flags and demonstrate outstanding communication skills when dealing with scammers (Klein, 2016).
Advanced practice nurses have to deal with a set of barriers that limit their ability to prescribe medicines. First of all, ARNPs have to consider such factors as state licensure and regulations. The situation has improved over the years, and such organizations as the American Association of Nurse Practitioners (AANP) seek to improve the prescriptive authority of nurse practitioners. Nevertheless, nurse practitioners have to deal with such issues as supervision and delegation. It is also noted that physician professional organizations believe that it is necessary to limit the scope of nursing practice because of such factors as the overall quality and safety of care (Hain & Fleck, 2014). Available research indicates that most of the concerns voiced by the opponents of unrestricted prescriptive authority are unreasonable. It is also suggested that payer policies affect the ability of registered nurses to prescribe medicines because of low reimbursement rates (Hain & Fleck, 2014). The situation is challenging because both public and private payers often prevent nurse practitioners from practicing independently. It may be beneficial to cooperate with policymakers to address the problem and eliminate the barriers that have an adverse effect on advanced practice nurse prescribers.
Florida Board of Nursing. (2016). Important legislative update regarding HB 423. Retrieved from https://floridasnursing.gov/new-legislation-impacting-your-profession/
Hain, D., & Fleck, L. M. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2). DOI: 10.3912/OJIN.Vol19No02Man02
Klein, T. (2016). Legal and professional issues in prescribing. In T. M. Woo, & M. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.) (37-50). Philadelphia, PA: F. A. Davis Company.
Advanced Practice Nurses (APRNs) as health professionals, are tasked with the responsibility to care for and safeguard the health and safety of patients. One duty of care owed by APRNs is on ethical and legal prescribing of medication. APRNs are expected to adhere to strict standards of prescribing, which serve the needs of the patient, minimize medical errors as well as maintain high levels of professionalism and accountability (Mitchell & Oliphant, 2016). In 2007, the World health Organization (WHO), outlined 7 guidelines which were meant to serve as a universal regulatory framework for ethical prescribing for all health practitioners, including APRNs. They are as follows: (1)Evaluate and define the patient’s problem; (2) Determine the therapeutic objective of the drug therapy; (3) Select an appropriate medication; (4) Provide patients with information, warnings and instructions; (5) Monitor the patient regularly; (6) Consider drug costs when prescribing and (7) Use appropriate tools, such as prescribing software and electronic drug references, to reduce prescription errors.
While the role of APRNs has been extended to include drug prescription, the independence to do so is not absolute. The primary barrier to APRN prescribing involves state practice and licensure (Hain & Fleck, 2014). Only 22 states so far have given full independence to APRNS to prescribe to patients. In the majority of states, including Florida, APRNs can only prescribe with the supervision or collaboration of a qualified physician. Another major barrier lies in the lack of physician cooperation and goodwill. The American Medical Association for instance, is yet to accept and support APRNs as capable of handling independent practice (Hain & Fleck, 2014). Thirdly, APRNs grapple with a physician-biased insurance system that discriminates against nurse practice. Several payer policies and reimbursement models in various states fail to recognize nurse practitioners as primary care providers, thereby affecting the extent of APRN practice including prescription (Altman et al.,2016).
Altman, S. H., Butler, A. S., Shern, L., & National Academies of Sciences, Engineering, and Medicine. (2016). Removing Barriers to Practice and Care. In Assessing Progress on the Institute of Medicine Report the Future of Nursing. National Academies Press (US).
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).
Mitchell, A., & Oliphant, C. M. (2016). Responsibility for Ethical Prescribing. The Journal for Nurse Practitioners, 12(3), A20.
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