Posted: September 7th, 2023

The Relationship Between Nurse Practitioner Practice Authority

Expectations

Length: A minimum of 180 words, not including references or attachments
Citations: At least two high-level scholarly references in APA from within the last 5 years
To get a controlled substance certificate in Pennsylvania, APRNs must fulfill the following requirements.

RN license in Pennsylvania: The APRN is required to possess a current, valid RN license from the Pennsylvania State Board of Nursing.
MSN or higher degree: The APRN is required to hold a master’s or higher degree in nursing with a focus in one of the six recognized roles, including Nurse Practitioner, Clinical Nurse Specialist, Nurse-Midwife, Nurse Anesthetist, Certified Registered Nurse Anesthetist, and Psychiatric/Mental Health Nurse Practitioner.
National certification: APRNs must obtain national certification from an accredited body, such as the American Nurses Credentialing Center (ANCC) or the American Association of Nurse Practitioners (AANP).
Nurse practitioners must get a DEA number to prescribe controlled substances. A DEA number (DEA Registration Number) is an identifier assigned to a health care provider (such as a physician, physician Helpant, nurse practitioner, optometrist, podiatrist, dentist, or veterinarian) by the United States Drug Enforcement Administration allowing them to write prescriptions for controlled substances.
According to the Pennsylvania State Board of Nursing, to prescribe and dispense medication, you must complete 45 contact hours of advanced pharmacology before you can apply for prescriptive authority. All NP preparatory programs must also include advanced clinical experience of up to 500 hours for each population focus. CRNPs with prescriptive or dispensing authority are required 30 hours related to specialty every two years, 16 of which must be in advanced pharmacology.
Scope of practice for CRNP in the state of Pennsylvania:

In Pennsylvania, nurse practitioners (NPs) may diagnose medical conditions, develop and implement treatment plans, order and perform diagnostic tests, and deliver other health care services pursuant to a written collaborative agreement with a licensed physician. The collaborative agreement must address the availability of the physician to the NP through direct communication or telecommunication, a plan for emergency services, and the physician’s regular review of the charts and records of patients under the NP’s care. NPs are recognized as primary care providers in Pennsylvania (Plemmons, et al. 2023).

In Pennsylvania, according to code § 21.284b. Prescribing, administering, and dispensing controlled substances. A CRNP authorized to prescribe or dispense, or both, controlled substances shall register with the Drug Enforcement Administration. A CRNP may prescribe drugs, devices, and Schedule II-V controlled substances as outlined in a written collaboration agreement with a physician. Pennsylvania NPs with proper training or appropriate experience can receive a federal waiver to dispense buprenorphine-containing products as long as the supervising physician is certified, trained, or permitted to treat and manage patients with opioid use disorder.

Process of Obtaining a DEA Number:

In Pennsylvania and other states, APRNs must get a Drug Enforcement Administration (DEA) number in order to prescribe restricted drugs. A government organization called the DEA is in charge of policing the production, distribution, and prescription of banned narcotics. Filling out a DEA application form, submitting the appropriate personal and professional information, and paying the requisite fees are all steps in the process of getting a DEA number. The APRN is given a special identification number by the DEA after receiving approval, which enables them to lawfully prescribe banned medications.

CEU Requirements for APRN Certification Renewal:

CRNPs with prescriptive or dispensing authority are required 30 hours related to specialty every two years, 16 of which must be in advanced pharmacology, including 2 hours of approved child abuse recognition and reporting training, and a minimum of 2 hours must be in pain management, identification of addiction, or the practices of prescribing or dispensing opioids.

Information that is required on prescription pads when prescribing controlled substances:

The name of the prescriber, the name of the patient, full directions for the use of its contents, and the name, address, telephone number, and DEA number of the pharmacy must be present on the prescription pad. Prescriptions for controlled substances must show the DEA number of the prescriber. Prescriptions for Schedule II controlled substances must be written with ink, indelible pencil, typewriter, word processor, computer printer or by electronic means and shall be manually signed by the prescriber, except that prescriptions written by electronic means shall be electronically signed by the prescriber. Prescriptions for Schedule II controlled substances may not be filled more than six months from the date of the prescription. Prescriptions for Schedule II controlled substances may not be refilled. A controlled substance in Schedule III, IV, or V may not be filled or refilled more than five times in the 6-month period from the date of the prescription.

Considerations for Prescribing Controlled Substances via Telemedicine:

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. APRNs should maintain the following steps when using telemedicine to prescribe non-controlled substances. APRNs should assess the patient, including the patient’s current health status and past medical history; obtain informed consent clearly explaining the nature of the telemedicine consultation, potential risks and benefits, and how prescriptions will be sent; APRNs should have the license to telemedicine practice as per state law; ensure electronic prescription transmission; and maintain follow-up and documentation (Faget, et al. 2023). Under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 and the Drug Enforcement Administration’s (DEA) implementing regulations, after a patient and a practitioner have had an in-person medical Assessment, that practitioner may use telehealth to prescribe that patient any prescription for a controlled medication that the practitioner deems medically necessary. The Ryan Haight Act and DEA’s implementing regulations do not apply to other forms of telemedicine, telehealth, or telepsychiatry that are not otherwise addressed in the Controlled Substances Act. This proposed rule applies only in limited circumstances when the prescribing practitioner wishes to prescribe controlled medications via the practice of telemedicine and has not otherwise conducted an in-person medical Assessment prior to the issuance of the prescription.

When do APRNs need more than one DEA number?

If APRNs have multiple clinics/offices in one state and have supplies of controlled substances to administer or dispense at those multiple locations, then they need a separate DEA registration for each location. If they practice in multiple states, then they need a DEA registration for each state where they want to practice.

The Relationship Between Nurse Practitioner Practice Authority, Workforce Diversity, and Access to Primary Care
Introduction:
As the demand for primary care providers increases in the United States, nurse practitioners (NPs) have played an expanding role in meeting this need. However, restrictions on NP scope of practice and lack of full practice authority in some states may limit their ability to provide comprehensive primary care. Additionally, the diversity of the NP workforce does not always match the racial/ethnic diversity of the populations they serve. This study aims to explore the relationship between NP practice authority, workforce diversity, and access to primary care.
Methods:

A comparative analysis was conducted of NP practice regulations, workforce demographics, and patient population characteristics in all 50 U.S. states. Data on NP scope of practice requirements and level of authority in each state was obtained from the American Association of Nurse Practitioners. Workforce data including racial/ethnic breakdowns of NPs in each state was collected from the National Sample Survey of Registered Nurses. U.S. Census data provided population demographics for comparison.
Results:
Preliminary results suggest states with full practice authority for NPs have a more racially/ethnically diverse NP workforce that more closely matches the population. These states also report higher rates of primary care provided by NPs, especially in underserved rural and urban areas with physician shortages. States with reduced practice authority report NP workforces that are less diverse and provide a smaller percentage of primary care services.
Discussion:

By removing restrictions that limit their ability to practice independently, full practice authority may help attract a more diverse pool of NPs into primary care roles. This could help address issues of healthcare access and reduce disparities, as NPs of diverse backgrounds are more likely to practice in underserved communities that match their own races/ethnicities. However, further research is still needed to fully understand this relationship and the long term impacts on patient outcomes.
Conclusion:

This study provides initial evidence that greater NP practice authority may positively influence workforce diversity and primary care access. As healthcare demands continue rising, states should consider policies supporting full NP practice to maximize their potential contributions to the workforce. However, more robust research is still needed.

References

Faget, K. Y., & Boubker, J. (2023). Legal considerations. In Emerging Practices in Telehealth (pp. 77-96). Academic Press. https://doi.org/10.1016/B978-0-443-15980-0.00012-0

https://www.federalregister.gov/documents/2023/03/01/2023-04248/telemedicine-prescribing-of-controlled-substances-when-the-practitioner-and-the-patient-have-not-had

Plemmons, A., Shakya, S., Cato, K., Sadarangani, T., Poghosyan, L., & Timmons, E. (2023). Exploring the relationship between nurse practitioner full practice authority, nurse practitioner workforce diversity, and disparate primary care access. Policy, Politics, & Nursing Practice, 24(1), 26-35.https://doi.org/10.1177/15271544221138047

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Tags: The Relationship Between Nurse Practitioner Practice Authority, Workforce Diversity