Читать книгу The Advanced Practice Registered Nurse as a Prescriber - Группа авторов - Страница 10

A legislature must pass a bill to enable any changes in the scope of practice for ARPNs. The law typically cannot be implemented until the Board of Nursing adopts rules that specify the intent of the law. Scope of practice changes can take months to years to finalize. The history of APRN prescribing in Washington State begins with a 1977 law that authorized APRNs to prescribe legend drugs (medications requiring a prescription). However, dispensing medications and prescribing controlled substances were prohibited. The Board of Nursing then wrote rules that authorized APRNs to prescribe Schedule V drugs in 1982 and dispensing was added in 1983. It was not until 2000, after more than a decade of lobbying, that APRNs in Washington State obtained Schedule II–IV prescriptive authority.

This long‐sought authority came with a price. For the first time since APRN practice was authorized by the legislature in 1973, physician involvement in APRN practice was mandated. APRNs who wanted II–IV prescriptive authority were required to obtain a Joint Practice Agreement (JPA) with a physician. Slowly over the next four years many APRNs began obtaining Schedule II–IV prescriptive authority. However, until the JPA was removed, over one‐third of APRNs chose not to obtain II–IV prescriptive authority. This contradicted the expectation of APRN leaders in the state that nearly all APRNs would want the legal ability to prescribe controlled substances even if it was only utilized occasionally. We conducted research in Washington State to understand this unexpected phenomenon (Kaplan & Brown, 2004, 2007, 2009; Kaplan et al., 2006, 2010).

The findings of our research serve as a basis of understanding how APRNs may or may not transition to full prescriptive authority and practice when provided the opportunity. It also offers lessons learned about the need to prepare APRNs for a major transition in scope of practice. Change may cause concern for some who have adapted to the status quo, even if prescribing barriers limited their ability to practice. Many of these findings are discussed in Chapter 3. They will enhance your understanding about APRN prescribing practice, the consequences of limiting APRN practice, and the poorly understood experience of transition to a new scope of practice. It is not surprising, however, that APRNs respond to new practice authority with the natural ambivalence that accompanies most change processes.