Week 1: Discussion- Foundation of the Role of the Nurse Practitioner as Prescriber Legal and Professional Issues in Prescribing

Week 1: Discussion- Foundation of the Role of the Nurse Practitioner as Prescriber Legal and Professional Issues in Prescribing • Describe NP practice in your state. • Tell the class what your state laws are related to nurse practitioner prescribing. • Include how many continuing education hours are required for your state. • Describe the importance of knowing the specific laws in your state pertaining to Nurse Practitioners prescribing medications. Good afternoon Class and Professor Paalberg, Nurse practitioners are considered restricted in the State of Florida. They are able to make diagnoses, prescribe medications, and order labs and necessary diagnostics all under the supervision of a practicing physician. Nurse practitioners are seen in multiple settings including primary care clinics, hospitals, and specialty clinics across the country. They are capable of independent diagnosis and prescribing other states, but it ultimately depends on the legislature as well as the progressiveness of the state. Nurse practitioners must hold a registered nursing license and apply for a program. The program must be accredited not only in their state, but should be accredited nationally in case he/she were to move into another state. they must also complete a master's degree in order to practice. When working in a group setting with other medical doctors, nurses and other ancillary staff. A nurse practitioner “must enter into a supervisory protocol with at least one physician within the physician group practice," according to the Florida S (2018). This has benefits and consequences. This maybe be extremely beneficial to a new graduate NP that is starting off in her career. Having a safety net can be reassuring especially when diagnosing more challenging patients in their practice. While later on this may also be a limiting factor, since nurse practitioners were created to practice independently of a doctor due to shortages and unwillingness to practice in a rural parts of the country. Nurse Practitioners may even find this restrictive and somewhat what limiting of their capabilities and may even consider changing their careers. Nurse practitioners in the state of Florida according to the Florida Senate (2018) are capable of: (a) Monitor and alter drug therapies. (b) Initiate appropriate therapies for certain conditions. (c) Perform additional functions as may be determined by rule in accordance with s. 464.003(2). (d) Order diagnostic tests and physical and occupational therapy. (4) In addition to the general functions specified in subsection (3), an advanced registered nurse practitioner may perform the following acts within his or her specialty: 1. Manage selected medical problems. 2. Order physical and occupational therapy. 3. Initiate, monitor, or alter therapies for certain uncomplicated acute illnesses. 4. Monitor and manage patients with stable chronic diseases. 5. Establish behavioral problems and diagnosis and make treatment recommendations. Nurse Practitioners in the State of Florida are required to complete 24 hours of continuing education during each renewal period. Two of those hours must be related to prevention of medical errors and two (2) hours in Laws and Rules in Nursing (, 2018). Every third renewal requires an additional 2 hour course on domestic violence and abuse, for a total of 26 hours. Nurse practitioners are given the right to prescribe controlled substances, under the approval/supervision of a physician and their predetermined protocols. Starting July 1, 2018, Florida recently updated this statute due to the ongoing narcotic crisis; requiring NP’s to complete a specified board-approved continuing education course to prescribe controlled substances. This course also requires health care practitioners to check the prescription drug monitoring program (PDMP) database prior to prescribing or dispensing a controlled substance (New Legislation Impacting Your Profession, 2018). It is ultimately the responsibility of the Nurse practitioner to be up to date with the laws and regulatory changes within his/her state. Np’s are considered sole, independent practitioners in some states, and no matter where you are, you should practice with that thought in mind. Prescribing medications is a huge responsibility considering the issues we are having in this country today. Nurses Practitioners are demonstrating that they are up to the challenge of becoming a strong alternative practitioner for their patients. This gives patients more choices when seeking out a PCP for a routine visit, or even a great ER Acute Care NP in a major hospital. I hope Florida decides to move away from restricting NP’s in the future, but in the mean time we can see that they are playing a huge role in many facilities around the state. Thanks Class! References The Florida Senate. (n.d.). Retrieved July 9, 2018, from How many continuing education hours are required for licensure renewal? (n.d.). Retrieved July 9, 2018, from New Legislation Impacting Your Profession. (n.d.). Retrieved July 9, 2018, from Peer Response Hey Lana and Class, Thanks for that great response! I can sympathize with you regarding the step backwards for nurse practitioners. I'm shocked that a facility would limit the practice of an NP that way! I worked for a healthcare system that used NP's as overworked extensions of the physicians which i thought was disturbing. For example, the NP would see the patient do a full head to toe assessment, diagnose, order labs and medications and then report all of the info to the doctor who would sign off on it. This practice would intern allow the doctor to see more patients if he so wished and charge as though he were seeing them himself. I agree with you, that NP's need a stronger presence in politics as well. Historically, change in nursing is a long and agonizing process, usually with delays, and setbacks. As nurse practitioners who follow evidence based practices that are proven to be more accurate, the latest in research and who push to improve the medical system. I believe we should have a stronger presence with both legislature and the American physician board who seem to hold the power. I believe that there is a new crisis on the rise Lana, there will be a lack of nurses willing to stay at the bedside. Nurses are finding that patient care is no longer about the patient, it's about EMR systems, protecting against lawsuits, and ensuring that readmission rates are low while keeping satisfaction scores above a certain percentage. Patient care environments are now more like hotel lobbies and nurses as waiters/waitresses which is not what we went to school for. Nurses find meaning when they are able to practice and care for their patients in a way that aligns with their own professional identity and the values of the nursing professional culture (Baumann et al., 2001). (Links to an external site.)Links to an external site. We seem to be losing that identity as we progress in this futuristic manner. Patients are arriving to hospitals and facilities with unrealistic expectations. On many occasions I have personally taken the time to explain, address, and even correct patients regarding care and how it should be expected within the medical setting. I believe that there is also a new wave of nurses, a newer and stronger generation that is capable of overcoming these limitations and who will fight for our independence. It’s us by the way! Reference A. Baumann, L. O'Brien-Pallas, M. Armstrong-Stassen, J. Blythe, R. Bourbonnais, S. Cameron. (2001) Commitment and Care: The Benefits of a Healthy Workplace for Nurses, their Patients and the System. A Policy Synthesis Canadian Health Services Research Foundation, Ontario (2001) Response to professor Vanessa, Do nurse practitioners have to complete any special training or courses prior to gain authority to prescribe controlled substances in Florida? Are there any limitations on what controlled substances a nurse practitioner can prescribe in Florida? Caitlin Good afternoon Professor and Class, Thanks for the question professor, the answer is no…and yes. Nurse Practitioners have the right to prescribe medications including controlled substances. Although, this right becomes more limited depending on the state and their defined legislatures. Florida, is a great example of this in this case; according to the Florida Board of Nursing, under the new law, an ARNP’s and PA’s prescribing privileges for controlled substances listed in Schedule II are limited to a seven-day supply and do not include the prescribing of psychotropic medications for children under 18 years of age, unless prescribed by an ARNP who is a Psychiatric Nurse (2018). This is in fact a new law that was passed recently last year. It seems somewhat silly, and I can see this law as having a good intention, but also restrictive and discouraging. Patients with quickly determine who can prescribe them what they need and will seek out those physcians. It also removes one of our basic rights as nurse practitioners; to prescribe. Currently the Florida Board of Nursing is working on establishing a committee to recommend a negative formulary of controlled substances that ARNPs may or may not prescribe for specific uses, or in specific quantities. As I mentioned before, the State of Florida now requires all nurse practitioners and physicians to take a course on narcotic safety and to verify medication dispensing information on an online database. Reference Florida Board of Nursing. (2016, April 15). Important Legislative Update regarding HB 423. Retrieved July 12, 2018, from Peer Heidi Pfeiler Heidi Pfeiler YesterdayJul 13 at 8:15am Manage Discussion Entry Dr. Paarlberg and class, Thank you for your response to my discussion post. According to the Florida Board of Nursing (2018), currently in order to become a nurse practitioner (NP) in the state of Florida, you must hold a master's degree or post masters degree certification, an active registered nurse license in the state of Florida, proof of a passing score on the national certification exam, and proof of malpractice insurance or an exemption. A NP must renew their license every 2 years and complete 24 hours of continuing education prior to renewal, 26 hours every third renewal to include two hours of domestic violence. I have mixed feeling about working as a NP in a restricted state. At the beginning of my journey to become a NP, I thought it was great that upon graduation I will be able to work with a collaborating physician to ask questions and get guidance from. I still feel this is great for a newly graduating NP, but I feel that this restriction should be held for a certain amount of years until the NP gets experienced. After a set amount of years, I feel a NP should be able to work independently. Florida could greatly benefit from allowing NPs to work independently with such a shortage of primary care physicians. According to Kuo, Loresto, Rounds, and Goodwin (2013), states with the least restrictive regulations of NP practice had a 2.5-fold greater likelihood of patients’ receiving their primary care from NPs than did the most restrictive states, relaxing state restrictions on NP practice should increase the use of NPs as primary care providers, which in turn would reduce the current national shortage of primary care providers. Since my move to Florida, I consider my primary care provider to be a nurse practitioner since she is the only person I have seen in the office since becoming a patient. She obviously works under a physician, due to working in a restrictive state, but with her knowledge and expertise, I do not feel it is necessary. I have never doubted her decisions in my care and feel confident that she would do great working independently. After being seen by NP's for years, along with my kids care being provided by NPs, this has definitely made me take a look from a different angle on restrictive practice and feel it is unnecessary after a set amount of years. Reference Florida Board of Nursing. (2018). Advanced registered nurse practitioner. Retrieved from Kuo, Y., Loresto, F. L., Rounds, L. R., & Goodwin, J. S. (2013). States with the least restrictive regulations experienced the largest increase In patients seen by nurse practitioners. Health Affairs, 32(7), . doi:10.1377/hlthaff.2013.0072 Heidi, I can really relate to your unease. I also find that nurse practitioners being so restricted in Florida, will result in a few things. They will leave the state and practice somewhere less restrictive. This will continue to affect the shortage of primary care physicians we already have. Secondly, it will make nurses considering grad school change concentrations, maybe to be CRNA’s or midwives rather than NP’s due to the severe restrictions imposed on them. Thirdly, it will create more antagonism between the professions doctor vs nurse will continue to be the “it” topic. I think there needs to be a shift community wide that educates our patients as to who we are, what we are, and how we treat differently (our nurse patient approach vs. physician approach). According to Norful A. et al. (2018), some physicians view nurse practitioners as having an inferior role in primary care. This viewpoint inhibits nurse practitioners from working to their full potential and can create mistrust or resentment. This implies that more education needs to be pushed in the direct of the physicians as well as the patients. Why is our presence considered a threat? This there a way to eliminate with type of thinking? We are considered a team, that demands mutual respect on all side in order to accomplish the greatest good of treating the patient. Reference Norful A., de Jacq K., Poghosyan L., Carlino R. Nurse Practitioner-Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain. Annals Of Family Medicine [serial online]. n.d.;16(3):250-256. Available from: Science Citation Index, Ipswich, MA. Accessed July 14, 2018.