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Autonomous Advanced Practice Registered Nurse Discussion Paper

Autonomous Advanced Practice Registered Nurse Discussion Paper

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Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Please include information to the following questions.

  1. Identify whether your NPA requires the APRN to have a collaborative agreement with a physician? Discuss your thoughts and provide support for or against having a collaborative agreement. Autonomous Advanced Practice Registered Nurse Discussion Paper

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In the stated of Florida advanced nurse practitioners are required to have general supervision by a physician. The APRN may only “perform medical acts of diagnosis, treatment and operation in accordance with a protocol between themselves and the medical physician” (Florida Administration Code & Florida Administration Register, 2017). There will be a collaboration agreement that describes the duties of the ARNP including therapies that may be initiated, treatments, drug therapies that may be prescribed for initiation, monitoring and alterations. This collaboration agreement is to be reviewed annual by both parties. I do agree with collaboration agreement because it allows for the ARNP to have some autonomy in patient care with support to a physician.

 

  1. Does your NPA require the APRN to have a prescriptive agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement and explain why/why not.

Florida law allows the ARPN to prescribe, dispense and administer drugs, and controlled substances defined with section 893.08. Section 893.08-includes Schedule II,III,IV, and drugs (The 2023 Florida Statues (including special session C), 2023).  I believe that the NPA should not require nurses to have an agreement to prescribe. APRN are certified by the state board of Florida to have practicing rights which include medication prescribing. To obtain APRN licensure they must have graduated from a masters or doctoral level program. Autonomous Advanced Practice Registered Nurse Discussion Paper

  1. Discuss whether your NPA allows the APRN to prescribe all classes of medications.  Discuss whether or not you believe the APRN should be allowed to prescribe all classes of medications with literature support for your discussion.

In the state of Florida APRN can prescribe medications from scheduled classes II, III, and IV. Schedule II medications prescribed by APRN are limited to a seven-day supply limited to psychotropics medications for children under the age of 18 (Important Legislative Update regarding HB 423, 2016). The ARNP is required to completed at least three hours of continuing education on safe and effective prescribing controlled substances.

 

  1. Discuss your State or residence and federal laws that apply to the authority to prescribe schedule II controlled substances, including your state of residence laws regarding the treatment of chronic pain, and governing the manner of issuance of a prescription.

In the state of Florida APRN can prescribe schedule II drugs. Schedule II drugs are defined as “ drugs that have a valid medical use but have a high potential for abuse, both psychological and physiologic” (book).  In 2016 House Bill 423 was passed allowing APRN’s in Florida to prescribe schedule II drugs (Practitioners And Prescriptive Authority – StatPearls – NCBI Bookshelf (nih.gov). With this bill APRNs can only write a schedule II prescription for 7 days and must complete continued education on prescribing controlled substances.

  1. Choose one disease process that may require pain medication management with a Schedule II medication.  Describe whether a collaborative process is required by your state board of nursing & how that process can be managed effectively. Autonomous Advanced Practice Registered Nurse Discussion Paper

Due Date

Florida Nurse Practitioners

  1. Identify whether your NPA requires the APRN to have a collaborative agreement with a physician? Discuss your thoughts and provide support for or against having a collaborative agreement.

Florida State has a restricted practice environment that restricts the ability of APRNs to engage in some elements of professional practice. This requires that APRNs enter into a collaborative agreement with a physician, detailing the elements of practice they would engage in and aspects of the supervision (American Association of Nurse Practitioners, 2023). The state licensure and practice laws require that an APRN be under the supervision of a medical doctor (MD) or doctor of medicine (DO). The APRN are supervised, and the arrangement is outlined in nursing. While the supervising MD or DO may not be available in person, the law requires the individual to be available on the phone for consultations, and cannot supervise more than four offices in addition to the primary practice location. In 2000, the State Board of Nursing introduced a caveat allowing APRNs who have completed 3,000 hours of supervised practice in the last five years to apply for an unrestricted license. The caveat allows APRNs who have met the set conditions to get a new designation as Autonomous Advanced Practice Registered Nurses, enabling them to enjoy full practice authority (Florida Board of Nursing, 2023). Autonomous Advanced Practice Registered Nurse Discussion Paper

APRNs should not be supervised and should instead be allowed to enjoy unrestricted, full practice authority. These reforms would help improve access to healthcare services, lower cost of care and boost productivity. An important point is that APRN have advanced education and knowledge, enabling them to provide quality care in different settings (Kleinpell, Myers & Schorn, 2023).

  1. Does your NPA require the APRN to have a prescriptive agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement and explain why/why not.

The Florida legislation as presented by the board of nursing allows APRN to prescribe, dispense, and administer medication. However, it does not allow them to prescribe controlled substances, even with physician supervision. The restriction extends to use of prescription forms pre-signed by an MD or DO, or even from using the physician’s DEA number on a prescription. Still, the regulation includes an element allowing APRNs to prescribe controlled substances pursuant to the individual’s education, training, experience and protocol although the restriction remains in place for Schedule II controlled substances (Toney-Butler & Martin, 2023). Autonomous Advanced Practice Registered Nurse Discussion Paper

The state board of nursing should not require APRN to have a prescribing agreement. In fact, APRN should prescribe medication with a level of autonomy comparable to physicians. APRNs have at least an MSN level of education and advanced certifications that denote specialized experience. In addition, they have undergone additional years of clinical experience. The education and experience implies that they learnt to diagnose patient conditions, assess symptoms and recommend appropriate prescriptions. Their education program includes learning more about pathology and drug interactions, as well as safe use of medication, assessing patient risk factors and making informed decisions about medication and dosages. As such, they should be allowed to practice more independently and autonomously, including prescribing medication (Tracy, O’Grady & Phillips, 2022).

  1. Discuss whether your NPA allows the APRN to prescribe all classes of medications.  Discuss whether or not you believe the APRN should be allowed to prescribe all classes of medications with literature support for your discussion. Autonomous Advanced Practice Registered Nurse Discussion Paper

The Florida board of nursing does not permit APRN to prescribe controlled substances, except for PMHNP who may be permitted to prescribe schedule classes II, III and IV, although this is restricted to a seven-day supply for patients less than 18 years of age (Toney-Butler & Martin, 2023). Controlled substances have proven medicinal qualities and additive properties, thereby requiring that they be carefully regulated. Although APRNs have undergone advanced training, the nature of controlled substances requires strict monitoring. As such, APRN should only be allowed to prescribe controlled substances after undergoing additional pharmacology training that explores the unique nature of controlled substances. This training would equip APRNs to responsibly prescribe controlled substances (Tracy, O’Grady & Phillips, 2022). Autonomous Advanced Practice Registered Nurse Discussion Paper

  1. Discuss your State or residence and federal laws that apply to the authority to prescribe schedule II controlled substances, including your state of residence laws regarding the treatment of chronic pain, and governing the manner of issuance of a prescription.

APRN in Florida can prescribe schedule II controlled substances under supervision, but the prescription must be limited to a seven-day supply. This restriction does not apply to PMHNP, who can prescribe psychiatric medication not limited to a seven-day supply even for patients younger than 18 years of age. The authority to prescribe controlled substances is dictated by the APRN education, training and experience, as well as the specific terms in the collaborative agreement (Florida Association of Nurse Anesthesiology, 2023).

  1. Choose one disease process that may require pain medication management with a Schedule II medication.  Describe whether a collaborative process is required by your state board of nursing & how that process can be managed effectively. Autonomous Advanced Practice Registered Nurse Discussion Paper

Schedule II medication, particularly opioids, are typically prescribed for relieving cancer pain as they are highly effective. This includes morphine, fentanyl, methadone, hydromorphone, oxycodone and codeine (Smith, 2020). Florida state board of nursing does not permit APRN to prescribe schedule II medication. While APRN can recommend that physicians prescribe schedule II medication, they (APRNs) cannot write the prescription (Florida Association of Nurse Anesthesiology, 2023).

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References

American Association of Nurse Practitioners (2023). State Practice Environment. https://www.aanp.org/advocacy/state/state-practice-environment

Florida Association of Nurse Anesthesiology (2023). Florida HB 423 – ARNP/PA Controlled Substance Prescribing. https://www.fana.org/florida-hb-423-arnppa-controlled-substance-prescribing

Florida Board of Nursing (2023). Autonomous Advanced Practice Registered Nurse. https://floridasnursing.gov/licensing/autonomous-advanced-practice-registered-nurse/

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19. Journal of nursing regulation14(1), 13–20. https://doi.org/10.1016/S2155-8256(23)00064-9

Smith, B. T. (2020). Pharmacology for Nurses (2nd ed.). Jones & Bartlett Learning, LLC.

Toney-Butler, T. J., & Martin, R. L. (2023). Florida Nurse Practice Act Laws and Rules. StatPearls Publishing.

Tracy, M. F., O’Grady, E. T., & Phillips, S. J. (2022). Hamric & Hanson’s Advanced Practice Nursing. Elsevier Health Sciences. Autonomous Advanced Practice Registered Nurse Discussion Paper

1. Identify whether Florida NPA requires the APRN to have a collaborative agreement with a physician? Discuss your thoughts and provide support for or against having a collaborative agreement.
2. Does Florida require the APRN to have a prescriptive agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement and explain why/why not.
3. Discuss whether Florida allows the APRN to prescribe all classes of medications. Discuss whether or not you believe the APRN should be allowed to prescribe all classes of medications with literature support for your discussion.
4. Discuss Florida’s and federal laws that apply to the authority to prescribe schedule II controlled substances, including your state of residence laws regarding the treatment of chronic pain, and governing the manner of issuance of a prescription.
5. Choose one disease process that may require pain medication management with a Schedule II medication. Describe whether a collaborative process is required by Florida board of nursing & how that process can be managed effectively. Autonomous Advanced Practice Registered Nurse Discussion Paper

 

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