NR565 Week 2 Study Guide (Page
Chapter 1: The Role of the Nurse
Practitioner as Prescriber
Roles and Responsibilities of APRN Prescribers
APRN prescriber is responsible for the final decision on which drug to use and how
to use it. Degree of autonomy in this role and the breadth of drugs that can be
prescribed vary from state to state based on the nurse practice act of that state.
Nurse practitioner prescriptive authority is regulated by the State Board of Nursing
for each state.
Advanced Knowledge
o Additional knowledge, critical thinking, and assumption of a higher
level of legal responsibility are required to assume the prescriber role
o Knowledge of medicine, pharmacology, and nursing intertwine in the NP
role
o As a prescriber, it becomes the role and responsibility of the NP to
determine the diagnosis for which the drug will be ordered, prescribe
the appropriate drug, monitor the expected outcome of the drug, and
incorporate a holistic assessment of the impact of disease and therapy
on patient lives
Benefits of an APRN as Prescriber
o Alternative treatment options are also part of the armamentarium that
can be used to treat a given disorder and may interact with the
pharmacotherapeutic intervention
o APRN look at the big picture and consider alternative treatment options
and lifestyle changes
o Patients are looked at in a holistic approach and include the patient in
decision making regarding their care.
o NP practice may thrive under healthcare reform because of the
demonstrated ability of nurse practitioners to control costs and
improve patient outcomes
pg. 1
, NR565 Week 2 Study Guide (Page
Clinical Judgment in Prescribing
Prescribing drug results from:
o Clinical judgment based on a thorough assessment of the patient and
the patient's environment
o Determination of medical and nursing diagnoses
o A review of potential alternative therapies, and specific knowledge
about the drug chosen and the disease process it is designed to treat
o NPs factoring in the cost to the patient of the medication prescribed
Is there a clear indication for drug therapy?
o In the age of health-care reform and increased awareness of the
limitations of drugs, whether a medication is the best option for
treatment has become an important question.
What drugs are effective in treating this disorder?
o Several drugs may be effective in treating a condition, so which
one is best for a particular patient?
Even if only the most effective class of drug is considered, few
classes of drugs include only one drug
o How does one determine “best”; what are the criteria? Are there
nationally recognized guidelines that can be used?
The Agency for Health Care Quality (AHCQ), the National
Institutes of Health (NIH), and many specialty organizations
publish disease-specific treatment guidelines that include both
pharmacological and nonpharmacological therapies
Consult nationally recognized guidelines for disease management
What is the goal of therapy with this drug?
o What is the best drug to achieve treatment goals?
pg. 2
, NR565 Week 2 Study Guide (Page
Various goals are possible in the choosing of therapy
Under what conditions is it determined that a drug is not meeting the
goal and a different therapy or drug should be tried?
o At the onset of therapy, the provider and patient should have a
clear understanding of what outcome or goal is expected of the
medication prescribed
o Follow-up and monitoring times are established to see how well
treatment with the drug is meeting the goal
Are there unnecessary duplications with other drugs that the patient is
already taking?
o The patient’s medication history should be reviewed at each
encounter to detect duplications or medications that may be
discontinued
Would an OTC drug can be just as useful as a prescription drug?
o Increasing numbers of drugs are being moved from prescription to over-
the-counter (OTC) status
What about cost?
o Who will pay for this drug? Can the patient afford it? Will the cost
of the medication affect adherence to the treatment regimen?
Cost is an issue for several reasons
Many insurance policies do not cover the cost of drugs or
only provide partial coverage, so the patient must pay
“out of pocket”
The newer the drug, the more likely the cost is too
high based on the drug manufacturer’s need to
reclaim research and development costs while the
corporation still holds the patent on that drug
Newest is not always best, and condition of cost is a major
factor in choosing between newer drugs and ones that have
been around long enough to be available in generic form
Many insurance plans have larger copays for name-brand
drugs than for generic medications
Multiple national retail pharmacies have developed $4
prescription formularies
pg. 3
, NR565 Week 2 Study Guide (Page
Awareness of what is on the local discount formulary
may save the patient hundreds of dollars in
prescription costs and may increase compliance
Factors likely to lead to poor adherence include a drug
that is expensive in relation to a patient's finances, a
drug that must be taken daily as part of a complex
regimen, and a drug that is not covered by insurance.
Where is the information to answer these questions?
o Wide array of professional literature that ranges from the well-reputed
journals to literature from specialty and professional organizations, the
multitude of computerized drug databases
Collaboration with Other Providers
Collaborate with physicians, pharmacists, podiatrists, mental health specialists,
therapists, and other providers, including APRNs who are not NPs, physician
assistants (PAs), and other nurses.
Physicians
o Early in the development of the NP role, physicians were the
teachers in the NP programs and accepted NPs as physician-
extenders
Pharmacists
o Profession of pharmacy requires graduate-level preparation for all
pharmacists with the granting of a practice doctorate, the Doctor of
Pharmacy (PharmD)
o A PharmD can assist by offering expertise on the clinical
management of patients, including available dosage forms,
potential adverse reactions, and drug interactions
Other APRNs
pg. 4
Chapter 1: The Role of the Nurse
Practitioner as Prescriber
Roles and Responsibilities of APRN Prescribers
APRN prescriber is responsible for the final decision on which drug to use and how
to use it. Degree of autonomy in this role and the breadth of drugs that can be
prescribed vary from state to state based on the nurse practice act of that state.
Nurse practitioner prescriptive authority is regulated by the State Board of Nursing
for each state.
Advanced Knowledge
o Additional knowledge, critical thinking, and assumption of a higher
level of legal responsibility are required to assume the prescriber role
o Knowledge of medicine, pharmacology, and nursing intertwine in the NP
role
o As a prescriber, it becomes the role and responsibility of the NP to
determine the diagnosis for which the drug will be ordered, prescribe
the appropriate drug, monitor the expected outcome of the drug, and
incorporate a holistic assessment of the impact of disease and therapy
on patient lives
Benefits of an APRN as Prescriber
o Alternative treatment options are also part of the armamentarium that
can be used to treat a given disorder and may interact with the
pharmacotherapeutic intervention
o APRN look at the big picture and consider alternative treatment options
and lifestyle changes
o Patients are looked at in a holistic approach and include the patient in
decision making regarding their care.
o NP practice may thrive under healthcare reform because of the
demonstrated ability of nurse practitioners to control costs and
improve patient outcomes
pg. 1
, NR565 Week 2 Study Guide (Page
Clinical Judgment in Prescribing
Prescribing drug results from:
o Clinical judgment based on a thorough assessment of the patient and
the patient's environment
o Determination of medical and nursing diagnoses
o A review of potential alternative therapies, and specific knowledge
about the drug chosen and the disease process it is designed to treat
o NPs factoring in the cost to the patient of the medication prescribed
Is there a clear indication for drug therapy?
o In the age of health-care reform and increased awareness of the
limitations of drugs, whether a medication is the best option for
treatment has become an important question.
What drugs are effective in treating this disorder?
o Several drugs may be effective in treating a condition, so which
one is best for a particular patient?
Even if only the most effective class of drug is considered, few
classes of drugs include only one drug
o How does one determine “best”; what are the criteria? Are there
nationally recognized guidelines that can be used?
The Agency for Health Care Quality (AHCQ), the National
Institutes of Health (NIH), and many specialty organizations
publish disease-specific treatment guidelines that include both
pharmacological and nonpharmacological therapies
Consult nationally recognized guidelines for disease management
What is the goal of therapy with this drug?
o What is the best drug to achieve treatment goals?
pg. 2
, NR565 Week 2 Study Guide (Page
Various goals are possible in the choosing of therapy
Under what conditions is it determined that a drug is not meeting the
goal and a different therapy or drug should be tried?
o At the onset of therapy, the provider and patient should have a
clear understanding of what outcome or goal is expected of the
medication prescribed
o Follow-up and monitoring times are established to see how well
treatment with the drug is meeting the goal
Are there unnecessary duplications with other drugs that the patient is
already taking?
o The patient’s medication history should be reviewed at each
encounter to detect duplications or medications that may be
discontinued
Would an OTC drug can be just as useful as a prescription drug?
o Increasing numbers of drugs are being moved from prescription to over-
the-counter (OTC) status
What about cost?
o Who will pay for this drug? Can the patient afford it? Will the cost
of the medication affect adherence to the treatment regimen?
Cost is an issue for several reasons
Many insurance policies do not cover the cost of drugs or
only provide partial coverage, so the patient must pay
“out of pocket”
The newer the drug, the more likely the cost is too
high based on the drug manufacturer’s need to
reclaim research and development costs while the
corporation still holds the patent on that drug
Newest is not always best, and condition of cost is a major
factor in choosing between newer drugs and ones that have
been around long enough to be available in generic form
Many insurance plans have larger copays for name-brand
drugs than for generic medications
Multiple national retail pharmacies have developed $4
prescription formularies
pg. 3
, NR565 Week 2 Study Guide (Page
Awareness of what is on the local discount formulary
may save the patient hundreds of dollars in
prescription costs and may increase compliance
Factors likely to lead to poor adherence include a drug
that is expensive in relation to a patient's finances, a
drug that must be taken daily as part of a complex
regimen, and a drug that is not covered by insurance.
Where is the information to answer these questions?
o Wide array of professional literature that ranges from the well-reputed
journals to literature from specialty and professional organizations, the
multitude of computerized drug databases
Collaboration with Other Providers
Collaborate with physicians, pharmacists, podiatrists, mental health specialists,
therapists, and other providers, including APRNs who are not NPs, physician
assistants (PAs), and other nurses.
Physicians
o Early in the development of the NP role, physicians were the
teachers in the NP programs and accepted NPs as physician-
extenders
Pharmacists
o Profession of pharmacy requires graduate-level preparation for all
pharmacists with the granting of a practice doctorate, the Doctor of
Pharmacy (PharmD)
o A PharmD can assist by offering expertise on the clinical
management of patients, including available dosage forms,
potential adverse reactions, and drug interactions
Other APRNs
pg. 4
