There have been some recent developments in granting full practice authority to nurse practitioners in some states. Considering that, you may ask whether nurse practitioners are able to prescribe medications.
As a general rule, the answer is yes and no, depending on the state. But, there might also be specific criteria that must be met.
It remains a contentious issue whether nurse practitioners are capable of prescribing medications autonomously. However, the nurse practitioner profession continues to make progress regarding the prescription of medication.
Many people wonder what medications a nurse practitioner can prescribe. The ability of nurse practitioners to prescribe medications, and what exactly they can prescribe, varies drastically by state.
Our discussion in this article will cover how nurse practitioners are able to prescribe medication and all the little details associated with such a responsibility.
Prescriptive Authority for Nurse Practitioners
Full prescriptive authority for nurse practitioners, as defined by the American Association of Nurse Practitioners (AANP), is the authority to prescribe medication without supervision, per a state’s nursing board.
Nurse practitioners with full prescriptive authority can independently order durable medical equipment (DME), services, and controlled substances.
A state that allows full practice authority for nurse practitioners allows them to prescribe and manage a wide range of medications and services without the direction or oversight of a doctor.
In accordance with their state boards of nursing licensure authority, nurse practitioners with full practice authority can diagnose, interpret tests, evaluate, and prescribe medications and treatments.
“All 50 states and the District of Columbia grant nurse practitioners prescriptive authority,” according to the American Association of Nurse Practitioners. It is important to note, however, that not every state grants nurse practitioners full practice authority, which restricts nurse practitioners’ prescribing practices.
Who Grants and Regulates Nurse Practitioner Prescriptive Authority?
In accordance with the nurse practitioner role, education, and certification, prescriptive authority is granted and regulated by state boards of nursing. Because there is no national regulation for prescriptive authority, each state defines it differently.
Prescriptive authority for nurse practitioners falls into three categories.
1. Full Practice Authority
Full practice authority allows nurse practitioners to write prescriptions independently and legally.
2. Reduced Practice Authority
A nurse practitioner with a reduced practice authority may write prescriptions, but each state has specific guidelines for how this can be accomplished. Some states require a doctor to be present, while others require a collaborative agreement with a doctor.
In all states with reduced practice authority, nurse practitioners must be supervised by a doctor to some extent.
3. Restrictive Practice Authority
In states with restrictive practice authority, nurse practitioners must be supervised by a doctor for the duration of their careers. Nurse practitioners cannot perform all functions of healthcare on their own, including prescribing medications.
Advantages and Disadvantages of Prescriptive Authority for Nurse Practitioners
Nursing practitioners working to their fullest potential is beneficial for society in many ways. There are differences of opinion regarding the pros and cons of full practice authority, depending on who you ask.
There has historically been resistance from some physicians regarding nurse practitioners receiving full prescriptive authority. Some doctors claim nurse practitioners cause healthcare costs to rise by ordering too many tests and referring patients too quickly.
According to them, allowing nurse practitioners to practice independently will not improve access to healthcare.
There is disagreement among nurse practitioners, some physicians, and many government agencies. The advantages and disadvantages of granting full prescriptive authority to nurse practitioners are outlined here.
Advantages of Full Practice Authority
There are many advantages to nurse practitioners having full practice authority.
- Affordability: Nurse practitioners are less expensive to hire than physicians.
- The patient has a greater choice of providers: Depending on their diagnosis and personal preferences, patients may favor a nurse practitioner over a physician, or vice versa. When a nurse practitioner is able to treat patients fully, patients have more choices when it comes to their health care.
- It is easier for care to be delivered: It costs time to wait for a physician to sign off on orders or oversee a nurse practitioner. Consequently, patients have to wait longer for treatment and providers have to spend more time on provider tasks. The flexibility of autonomous nurse practitioners increases patient care opportunities throughout the day.
- The Baby Boomer generation is aging: There is a rapid increase in the number of people over 65, according to the U.S. Census Bureau. Now that baby boomers are senior citizens, nurse practitioners are more valuable than ever since healthcare needs are increasing.
- The job outlook for nurse practitioners is excellent: Nurse practitioners continue to be in high demand around the country. There is even more value in the job market for nurse practitioners who have full practice authority and are able to prescribe medication.
- Nurse practitioners provide improved access to care: The nurse practitioner fills gaps in rural and underserved areas where there are physician shortages, contrary to what some physician sources might claim.
- According to the Rural Health Clinic Act of 1977, 50% of services in funded rural health clinics must be provided by nurse practitioners, clinical nurse specialists, and physician assistants. As a result of this act, nurse practitioners were to be reimbursed for their services.
This was the beginning of the trend for nurse practitioners to fill shortages of providers in these areas. The provider shortage continues to grow today, resulting in a greater need for nurse practitioners with prescriptive authority. - Providing full prescriptive authority to nurse practitioners in shortage areas will allow patients to receive complete care where before there was limited or no care available.
- Opioid crisis: Opioids are still a major problem in the United States. In rural and underserved areas, nurse practitioners who are able to autonomously care for and prescribe medication to addicts can make a huge difference in the treatment of substance abuse.
Disadvantages of Full Practice Authority
There are fewer disadvantages associated with granting prescriptive authority to nurse practitioners.
- In the opinion of some doctors, nurse practitioners are not doctors and should not be treated the same as doctors. Their argument is that nurse practitioners are underqualified and undertrained to provide patients with quality care.
States Where Nurse Practitioners Have Full Prescriptive Authority
Only nurse practitioners with full prescriptive authority can prescribe medications without the supervision of a physician.
Nurse practitioners are allowed to practice with full prescriptive authority by virtue of having full practice authority (FPA).
It may seem that progress is slow, but we have come a long way since 1994, when only five states granted full practice authority to nurse practitioners. There was a pioneering spirit among the states of New Mexico, Oregon, Montana, Iowa, and Alaska that paved the way for future nurse practitioners to practice without supervision.
There are currently 25 states that have full practice authority. These states include: Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New York, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washing, and Wyoming.
States Where Nurse Practitioners Have Partial Prescriptive Authority
For nurse practitioners, partial prescriptive authority is also referred to as reduced practice authority.
There are currently 14 states that have reduced practice authority. These states include: Alabama, Arkansas, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Jersey, Ohio, Pennsylvania, Utah, West Virginia, and Wisconsin.
States Where Nurse Practitioners Have No Prescriptive Authority
There are only a few states with prohibitive restrictions on nurse practitioners. In these states, NPs have no independent prescriptive authority, which is called restrictive practice.
According to California Senate bill 890, nurse practitioners will be allowed to practice independently by 2023 once they meet certain requirements.
Only 11 states remain under restricted practice, indicating progress in this category. These states include: California (until 2023), Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia.
Nurse Practitioners and Medications to Be Filled Out-Of-State
Depending on the state where the nurse practitioner is practicing, nurse practitioners can prescribe medications that can be filled out-of-state.
Additionally, the criteria vary depending on the state in which the medication is prescribed. Washington state, for example, allows nurse practitioners to prescribe medications out of state with no restrictions. It may not be allowed in other states with reduced or restricted practice for nurse practitioners.
Likewise, individual state regulations for the pharmacist filling the prescription and the type of medication, such as controlled substances, all influence whether a nurse practitioner can prescribe medications to be filled out-of-state.
In each state, the board of medicine designates a specific scope of practice for nurse practitioners. There are three general categories of whether NPs can prescribe out-of-state.
- A prescribing nurse practitioner must follow the written guidelines for nurse practitioners in the state in which they are prescribing the medication.
- A prescribing nurse practitioner must follow the written guidelines within the state in which the nurse practitioner is licensed.
- Nurse practitioners are not permitted to prescribe medications out-of-state.
Before writing prescriptions out-of-state, nurse practitioners should verify their own individual state’s criteria, along with the state where they will be prescribing.
10 Most Common Medications That Nurse Practitioners Prescribe
NPs can prescribe a variety of medications depending on their specialty and the age of their patients. Nurse practitioners generally prescribe certain medications more frequently than other medications.
Here are the top ten most commonly prescribed medications by nurse practitioners:
- Analgesics
- Antibiotics
- Anti-hypertensives
- Bronchodilators
- Cardiovascular drugs
- Cholesterol medication
- Contraceptives
- Diabetes medications
- NSAIDS
- Thyroid medication
Conclusion
Obtaining full prescriptive authority for nurse practitioners has been a long and challenging process. Nurse practitioners are not seeking to become doctors.
With a focus on integrative health and patient-centered care, we pride ourselves on our individualized skills. Our training and education has prepared us to prescribe medications safely and effectively.
To legally work within the scope of practice for your state, nurse practitioners must know what medications they are allowed to prescribe. Currently, nurse practitioners have a wide variety and sometimes complex criteria for prescribing, as we have discussed in this article.
Written by Joanne Potter
Joanne, BSN and RN, is a writer that specializes in health and wellness. She has fifteen years of experience as a Registered Nurse in the NICU (Neonatal Intensive Care Unit).
Her years working at the bedside and extensive neonatal knowledge enable her to write with a deep understanding of what patients and families want from their communities. Visit her LinkedIn page.
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