Advance Nursing Practice Act in Maryland
APRN Prescriptive Authority
Regulatory position statements that support changes in APRN prescribing practices at the state or national level
Association of Nurses in AIDS Care (ANAC) Position Statement
The prescribing practices of APRNs are regulated at the state level. Some states permit autonomous prescribing by APRNs. Other states require some form of oversight either through a collaborative agreement with or supervision by a physician. ANAC supports APRNs to practice at the top of their expertise, education, credentials, accreditation, and licensure. According to ANAC (2014), in states with restricted prescriptive and practice authority for APRNs, state legislatures and state boards of nursing (BONs) are supposed to expand the prescriptive and practice authority of APRNs in line with evidence and national trends.Advance Nursing Practice Act in Maryland
According to ANAC (2014), APRNs should be fully authorized to prescribe and practice without the requirement for a supervisory or collaborative agreement with a physician. ANAC (2014) asserts that APRNs have the responsibility of recognizing the limits of their training and experience and are able to recognize when it is suitable to consult with or refer patients to a clinician with specialized or advanced training. Additionally, utilizing a collaborative practice model, APRNs can lead health care providers’ interprofessional teams.
The National Association of Pediatric Nurse Practitioner (NAPNAP) Position Statement
NAPNAP supports all NPs be granted full authority to prescribe along with dispensing privileges based on their licensure, certification, education, and training. NAPNAP (2016) asserts that the prescription of medications is fundamental to the practice of NPs. The capability of NPs to autonomously prescribe, without any restriction promotes the care provided to patients through enhancing greater efficiency and continuity of care, enhancing accountability and safety, and augmenting cost-effectiveness. NPs are comprehensively educated in advanced pharmacology, physiology as well as management, and prevention of pediatric disease. Numerous studies have shown that nurse practitioners provide cost-effective and safe health care, entailing prescription of medications. NAPNAP advocates for:Advance Nursing Practice Act in Maryland
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- NPs to be granted full authority to prescribe as suitable based on their education, certification, and training.
- NPs be authorized to prescribe adjunct medical/health services, DME and supplies, and all medical devices.
- Displaying of the NP’s name on prescription pads as well as dispensed medication bottles.
- All NPs be allowed to autonomously receive and dispense medication samples.
- Language Nurse Practice acts (NPAs) of all states to specifically and clearly include prescriptive authority in the scope of practice of a NP as suitable based on the NP’s education, certification, and training.
- All nurse practitioners getting scheduled drug licenses, drug enforcement agency number, and National provider identifier number.
National Association of Clinical Nurse Specialist (NACNS) Position Statement
NACNS supports clinical nurse specialists (CNSs) to be granted independent ordering and prescribing privileges as outlined in the regulations and rules put forward by the APRN Model Act and Rules. This would permit the state BONs to provide ordering and prescribing authority via the APRN license. According to the NACNS (2020) clinic, nurse specialists are advanced practice nurses who specialize in offering or indirect and direct care o vulnerable and complex populations in a wide rate of settings. So as to offer safe and comprehensive patient care, clinical nurse specialists must perform the assessment, diagnosis, and development of personalized care plans. The care plans include acts of prescribing, ordering, and dispensing pharmacological agents and durable medical equipment (DME), and also supportive, rehabilitation, and consultative services. NACNS support ordering and prescribing privileges to the state for CNSs as a scheme of providing care to particular populations.
American Psychiatric Nurses Association (APNA) Position Statement
APNA takes the position that all APRNs be permitted to practice at the top of their training and education. The majority of Psychiatric mental health APRNs provide care to individuals with opioid use disorder (OUD) and these APRNs are educationally prepared to offer psychotherapy and also prescribe medications. Nevertheless, the level of prescriptive authority of the APRN varies depending on the NPA of each state (APNA, 2020).Advance Nursing Practice Act in Maryland
According to APNA(2020), the 2018 SUPPORT Act and the 2016 Comprehensive Addictions, Recovery Act (CARA) increases access to medications approved by FDA for treating individuals with opiate addiction, entailing buprenorphine or buprenorphine/naloxone (BUP) by permitting physicians assistants and nurse practitioners to prescribe BUP for OUDs indefinitely and CNSs, (CRNAs) and CNM) to prescribe buprenorphine through October 2023. The legislation requires APRNs who are authorized to prescribe to complete twenty-four hours of education for them to be able to make an application for a DEA waiver to prescribe buprenorphine. With the continuing opioid crisis in the United States, APNA supports the continued authority of APRNs to prescribe buprenorphine/naloxone and buprenorphine in treating patients with OUD.
Alignment of the position statements with the American Association of Nurse Practitioners (AANP)’s Nurse Practitioner Prescriptive Privilege statement
The aforementioned position statements align with AANP’s Nurse Practitioner Prescriptive Privilege statement. The AANP identifies that the practice and of a NP entails prescribing. Prescribing devices, modalities, medications and treatments is a central constituent of the NP practice, and AANP advocates that NPs have unrestricted authority to prescribe in their practice scope. According to AANP (2020), prescribing is not a discrete activity differentiated from or outside of the practice of a NP. The AANP position is that the prescriptive authority of the NP be only regulated by state BONs and in accordance with the education, certification, and role of the NP The endorsement of NPs to prescribe controlled and legend drugs, devices, DME along with other supplies and equipment is fundamental to delivering superior quality, cost-effective and well-timed care
The AANP also supports and endorses the execution of integrated, multidisciplinary team-based approaches to the delivery of coordinated health care that is centered on the needs of the patients and offer NP to be leaders of the multidisciplinary team. Team-based care involves the provision of health care services to families, individuals or/and their communities by a minimum of two health care providers who work in collaboration with patients along with their caregivers to the level preferred by every patient to achieve mutual goals across and within settings to accomplish coordinated superior quality care. AANP is in opposition to regulations and laws that make it unlawful for clinicians to practice to the full level of their training or that necessitates regulation or licensure as a portion of a team to practice. AANP (2020) asserts that these regulations and laws unnecessarily impede the accountability of the licensed individual and make the health care workforce less efficient and flexible in fulfilling the health care needs of diverse patients.
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Poghosyan and Liu (2016) emphasize that teamwork is effective in enhancing access to and quality of primary care. Nevertheless, limiting the independence of particular members of the care team might be challenging it. In members of a health care team should be allowed to be autonomous while acknowledging they differently contribute to the team because they have different levels of expertise. Leadership can play a crucial role in supporting teamwork through the engagement of members in collaborative efforts to meet the needs of both the patients and the providers.Advance Nursing Practice Act in Maryland
References
American Association of Nurse Practitioners, AANP. (2020). AANP’s Positions and Papers. https://www.aanp.org/advocacy/advocacy-resource/position-statements
American Psychiatric Nurses Association, APNA. (2020). Position Statement: APRNS Prescribing Buprenorphine & Buprenorphine/Naloxone & the Continuing Opioid Crisis. https://www.apna.org/m/pages.cfm?pageID=5295
Association of Nurses in AIDS Care, ANAC. (2014). Position Statement: Advanced Practice Registered Nurses Full Practice Authority. Journal of the Association of Nurses in AIDS Care, 25(5), 465-467.
National Association of Clinical Nurse Specialists, NACNS. (2020). National Association of Clinical Nurse Specialist’s Position Statement on Prescriptive Privileges for the Clinical Nurse Specialist. https://nacns.org/advocacy-policy/position-statements/national-association-of-clinical-nurse-specialists-position-statement-on-prescriptive-privilege-for-the-clinical-nurse-specialist/
National Association of Pediatric Nurse Practitioner, NAPNAP. (2016). Position Statement on Nurse Practitioner Prescriptive Privileges. Journal of Pediatric Health Care, 30 (3), A15-A16. https://doi.org/10.1016/j.pedhc.2016.01.007
Poghosyan, L., & Liu, J. (2016). Nurse Practitioner Autonomy and Relationship with Leadership Affect Teamwork in Primary Care Practices: A Cross-Sectional Survey. Journal of General Internal Medicine, 31(7), 771-777. doi: 10.1007/s11606-016-3652-z
Advance Nursing Practice Act in Maryland