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Role of Advanced Practice Nursing
According to the Florida Board of Nursing, advanced registered nurse practitioners (ARNPs) can prescribe patients with controlled substances that are listed in the schedule II, III and IV which are well described in s. 893.03 Florida Statutes. Before doing so, they are to participate in three-hour training sessions which would help them implement the right strategies (Florida Board of Nursing, 2016). For APRNs to provide the right prescriptions to their patients they are necessitate to analyze and describe patient’s health problems. They are also required to fill their patients with enough knowledge regarding the drugs side effects and how they are supposed to take them (Pigman et al., 2016). As well-known medical practitioners should ensure that after a patient receives a drug, its use is well achieved. As stated by the state requirements an APRN should also do the same to make sure that the drug given achieves the goal it it supposed to achieve (Kooienga and Wilkinson, 2017).
There are numerous barriers that inhibit APRN practitioners from carrying out their prescriptions roles as required. First, there are various programs that may be directed towards the deliverance of health care services that are of high quality. But the problem comes in when the leaders of these programs fail to equip APRNs with advanced skills for dealing with them. Lack of enough knowledge and negative perceptions towards the same may inhibit them from performing their prescription roles. Secondly, state license restrictions may limit APRNs from fully participating in their practices as required because most boards only allow they to take part in one nursing practice role depending on the concerted agreement (Reynolds et al., 2021).
When prescribing medication to patients ARNPs have a great role and responsibility. Their role depends on state laws which are associated with the prescriptive authority provided to them (Florida Board of Nursing, 2016). After and before prescribing APRNs have the role of ensuring that all the drugs are taken at the right time and that the patients know of their side effects. To be on the safer side all APRNs must be responsible while prescribing drugs as this is in all of the patients benefit.
To add on that every practitioner who needs to prescribe medication must be registered by the United States drug enforcement administration. They should also have an experience of two years in terms of the drugs they purchase, distribute, administer and dispense (Florida Board of Nursing, 2016).
Reynolds, A. M., Reynolds, C. J., & Craig-Rodriguez, A. (2021). APRNs' controlled substance prescribing and readiness following Florida legislative changes. The Nurse Practitioner, 46(6), 48-55.
Pigman, Campbell, and others. (2016). HB 423 – Access to Health Care Services. Retrieved from https://www.flsenate.gov/Committees/BillSummaries/2016/html/1424
Florida Board of Nursing. (2016, April). Important Legislative Update Regarding HB 423. Retrieved from https://floridasnursing.gov/new-legislation-impacting-your-profession/
Kooienga, S., & Wilkinson, J. (2017, January). RN prescribing: an expanded role for nursing. In Nursing forum (Vol. 52, No. 1, pp. 3-11).
Role of advanced practice nursing in safe prescribing.
Advanced practice registered nurses (APRNs) have become an essential part of the health care community because of the growing demand for primary care. They are registered nurses who have prescriptive authority and advanced training in the prevention, diagnosis, and treatment of illnesses (OLU, Alison & Oldman, 2022). In the state of Florida, the statuses mandate these advanced professionals to be in line with the supervisory standards when prescribing controlled substances. This entails the professions having training about self-prescribing and any effective implementation based on similar strategies. The APRNs do the evaluation and definition of the issues facing the patients in order to give prescriptions that are free of errors. They should also provide the needed knowledge to the patients concerning any warnings and how the prescribed medicines should be taken. In addition, they do regular monitoring of the patients they correctly benefit from the provided prescriptions.
Prescribing barriers for APRNs.
Even though APRNs are authorized to prescribe, there are a number of barriers limiting their autonomy. Some of these barriers are:
1. Policy restrictions on APRN practice
In some cases, state licensure hinders these professionals from engaging entirely based on their academic qualifications. As a result, their engagement in one of the NP roles can only be based on collaborative agreements.
1. APRN-physician relations
These professionals, in many cases, lack full autonomy from physicians. In the state of Florida, the conditions they work under are controlled, and they are required to work with the physicians to describe.
1. The barrier of payer policies
Certain payer policies dissuade APRNs from participating in health care delivery activities at their full capacity, despite their training and licensure (Schirle, Norful, Rudner & Poghosyan, 2018). In some cases, scope-of-practice policies limit practitioners' duties to certain roles. For example, a majority of private payers require APRNs to work under a physician in order to be compensated, which results in an extremely restricted scope of practice for APRNs.
OLU, Alison, & Oldman. (2022). The Role of the Advanced Nurse Practitioner. Retrieved 10 January 2022, from https://www.independentnurse.co.uk/blogs-article/the-role-of-the-advanced-nurse-practitioner/213167/
Schirle, L., Norful, A., Rudner, N., & Poghosyan, L. (2018). Organizational facilitators and barriers to optimal APRN practice: An integrative review. Health Care Management Review, 45(4), 311-320. doi: 10.1097/hmr.0000000000000229
Role of APRNs In Safe Prescribing
Advanced Practice Registered Nurses (APRN) play an integral part in the healthcare system by prescribing safe medicines to the patient population and by offering various other healthcare services to the public. Prescribing the right medicine at the right dosage is a complex and an essential concept in healthcare system as it helps in improving the health of the patients by alleviating their pain conditions (Cardiff et al., 2018). It also helps in avoiding unnecessary medical expenses and poor health outcomes in a community. The APRNs are equipped with special education and training to prescribe the right medicines to the patient population for enhancing the overall health outcomes. They guide the healthcare facilities in offering the right prescription to the patients by keeping both the nurses and the patients safe from healthcare adversaries. However, each state in the US differs in providing licensure to the APRNs in terms of safe prescription (Tilley et al., 2019).
According to the 893 Section 03 Florida Statutes of standards and schedules, the APRNs are authorized to prescribe the patients with controlled drugs and substances under the supervisory standards and by abiding to the ethical guidelines. These registered nurse practitioners are equipped with the adequate skills, knowledge, and training to prevent, diagnose, order tests, and treat patients from various infections and diseases. Their position in the nursing community offers them with the legal rights to prescribe the most appropriate medicines and treat the patients in a safe and effective manner (Woo et al., 2017). Additionally, the APRNs are also involved in monitoring the health of the patients frequently after the administration of the prescribed drugs. In general, APRNs offer safe, effective, high quality and patient-centered care through the right prescription of medicines to the patient. As a primary healthcare service provider, autonomy is regarded as the central concept of APRNs. Even though the APRNs possess the authority to prescribe medicines, there are certain cases, where they experience barriers in prescribing medicines for the patients. These barriers limit the registered nurses from being independent in prescribing the patients with the right medications. Failing to prescribe timely medicines in primary care settings causes the APRNs a lack in delivering high quality care services and also delays the process of receiving timely treatment to the patients while waiting for confirmation and agreement from the physician who is in collaborative working terms with the APRN. These kinds of barriers impose a huge burden upon the people especially among those living in rural areas and those belonging to the underserved population in a community. These prescribing barriers are also involved in increasing the medical costs which makes the patients and the tax payers difficult to pay the expenditure.
One of the most important barriers that are widely observed is the state licensure restrictions. As per this barrier, the registered nurses are restricted to serve the community independently, besides their educational qualifications and other professional eligibilities. In Florida, the APRNs are allowed to work under controlled conditions through a collaborative association with a physician for prescribing the medicines. Another barrier that the APRNs face in prescribing medicines is their poor skills and lack of adequate training. This prevents them from offering high quality services to the public. Hence, it is essential that the APRNs should be well-equipped and trained in order to perform their role well and to provide safe and effective prescription of medicines to the patients. Third important prescribing barrier noted among APRNs includes certain healthcare policies that inhibit the registered nurses to actively engage in their professional functions and responsibilities to the full potential. Unfavorable working conditions, dissatisfaction in job, and certain practice policies causes the APRNs to perform their role effectively which in turn results in poor patient outcomes. Hence, in order to enhance the health conditions of the people in a healthcare system, it is essential that these barriers for prescribing medicines by the APRNs be removed (Bates and Martin-Misener, 2021).
Bates, A. E., & Martin-Misener, R. (2021). Facilitators and barriers to nurse practitioners prescribing methadone for opioid use disorder in Nova Scotia: A qualitative study. Canadian Journal of Nursing Research, 084456212199622. https://doi.org/10.1177/0844562121996222
Cardiff, L. M., Lum, E. P. M., Mitchell, C., Nissen, L. M., Patounas, M. P., & McBride, L.-J. (2018). Teaching the principles of safe prescribing to a mixed profession postgraduate cohort: Program development. Journal of Multidisciplinary Healthcare, 11, 635–644. https://doi.org/10.2147/jmdh.s169424
Tilley, E., Hamilton-Jones, M., & McNabb, A. (2019). Nurse practitioners’ safe prescribing of controlled substances and the impact on Nursing Education in Ontario. Journal of Nursing Regulation, 9(4), 42–47. https://doi.org/10.1016/s2155-8256(19)30015-8
Woo, B. F., Lee, J. X., & Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: A systematic review. Human Resources for Health, 15(1). https://doi.org/10.1186/s12960-017-0237-9
Role of Advanced Practice Nurse in Safe Prescribing
APRNs derive their prescriptive authority from legal provisions contained in the laws of the State of Florida. Chapter 893 Section 03 of the 2018 Florida Statute defines the supervisory and prescription standards that APRNs must adhere to before prescribing medication (Toney-Butler & Martin, 2018). However, APRNs must attend 3-hour training sessions. These sessions provide practitioners with vital skills in the safe prescription of medication. In addition, APRNs acquire competence to effectively implement the associated Statute's provisions. The Statute expects APRNs to evaluate and define the unique health issues affecting patients before prescribing any medication. It also requires APRNs to educate patients about the associated contraindications of administered or recommended prescriptions. Moreover, its provisions encourage APRNs to regularly monitor patients to ensure that they benefit from the intended benefits of prescribed medications. Additional provisions of the Statute emphasize the centrality of APRNs in the prescription of medicines (Florida Board of Nursing, 2016). Accordingly, the Statute expands the scope of APRNs in the safe prescription of medication by requiring these practitioners to adhere to similar standards as physicians. The expansion of the role of the nurse results in an alteration of the scope of practices traditionally delegated only to doctors, as is the case of the prescription of drugs. The defense of the representative entities of nursing, refers to a defense of the profession's own autonomy and should not be construed as a threat to other categories. The responsibility for the final decision on which drug to use and how to use it is the hands of APRN prescriber (Moser & Robinson, 2016).
Prescribing Barriers for APRNs
Several barriers diminish the ability of APRNs to safely and effectively prescribe medication. The first primary barrier is stringent state licensure regulations, which prohibit APRNs from prescribing medication based on their educational qualifications (Hain & Fleck, 2014). State regulations only allow APRNs to prescribe within the scope of their nursing practitioner (NP) roles and training. A second barrier is the level of education of an APRN. Presently inadequacies of nursing training programs reduce the ability of APRNs to provide advanced healthcare services (Hain & Fleck, 2014). Adverse perceptions of their nursing role, poor working conditions, and knowledge deficiencies further exacerbate this barrier resulting in a diminished ability of practitioners to prescribe safely. Finally, health insurance provider policies often dissuade APRNs from accomplishing their role in writing prescriptions in clinical settings (Hain & Fleck, 2014). For example, a variety of practice policies limits practitioners to nursing positions based on training, knowledge, experience, and licensure statutes. Subsequently, the interaction of these barriers and individual nursing perceptions complicates the APRNs' ability to deliver effective healthcare services during practice.
Florida Board of Nursing (2016). Important legislative update regarding HB 423. Retrieved from https://floridasnursing.gov/new-legislation-impacting-your-profession/
Hain, D., & Fleck, L. (2014). Barriers to NP practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2). doi:10.3912/ojin. vol19no02man02
Moser, T., & Robinson, M.V. (2016). Pharmacotherapeutics for Advance Practice Nurse Prescribers. (4th ed.). Philadelphia: F. A. Davis Company.
Toney-Butler, T. J., & Martin, R. L. (2021). Florida Nurse Practice Act Laws and Rules. Treasure Island, FL: Stat Pearls Publishi
Role of Advanced Practice Nursing in Safe Prescribing
An advanced practice nurse plays a critical role in the country's health sector. Nurses deliver a universal viewpoint and personal touch to health care by combining clinical competence in diagnosing and treating health issues, emphasizing disease prevention and health management.
An advanced practice nurse can prescribe medications for patients based on the current legislation. For example, Florida State passed the law in April 2016 authorizing nurse practitioners to prescribe controlled substances. The law now allows an Advanced Registered Nurse Practitioner who is also a psychiatric nurse to prescribe certain controlled substances (Reynolds et al., 2021)
Nurse practitioners, however, face prescribing obstacles. For example, state license governs nurse practitioners practice and serves as a roadblock to nurses practicing to the full extent of their training. It means that the practitioners licensing and practice laws differ by state, despite a full practice authority- a collection of state practices and licensing rules that permit nurse practitioners to prescribe medications. Still, the issue is that most of the country has not adopted the full practice authority. They result in little practice and licensing, implying that nurses can perform at least one aspect of their training under supervision (Germack, 2021).
Furthermore, some physicians, such as the American Medical Association, consider nurse practitioners incapable of providing excellent, safe care, as compared to them, since they have more extensive training than nurse practitioners (Germack, 2021).
Payer policies are another major barrier. Nurses believe that it substantially impacts their capacity to explore their potentials. The degree of nurses to practice independently may be limited in their scope of practice if restricted.
According to the American Association of Nurse Practitioners, a prescription is a part of a nurse scope of practice. Therefore prescribing is neither a separate act from nurse practitioners practice.
Germack, H. D. (2021). States Should Remove Barriers to Advanced Practice Registered Nurse Prescriptive Authority to Increase Access to Treatment for Opioid Use Disorder. Policy, Politics, & Nursing Practice, 22(2), 85-92.
Reynolds, A. M., Reynolds, C. J., & Craig-Rodriguez, A. (2021). APRNs' controlled substance prescribing and readiness following Florida legislative changes. The Nurse Practitioner, 46(6), 48-55.
Advanced Registered Nurse Practitioners (ARNPs) are involved in the safe prescribing of control substances listed in Schedule II, III, or IV as defined in section 893.03 of Florida Statutes. APRNs provide patients with relevant information concerning medications, such as warnings of side effects and instructions on how to take medications. The APRNs also provide efficient monitoring of patients on the regular basis to observe the recovery progress and detect the presence of any side effects associated with the use of drugs (Floridasnursing.gov, n.d.). To improve safety in prescribing, APRNs use appropriate tools such as prescribing software and electronic drug references that help in reducing prescription errors (Floridasnursing.gov, n.d.). These strategies have been useful in providing safe prescriptions to patients.
One of the prescribing barriers for APRNs is inadequate to state practice and licensure. Some APRNs may not have a full practice, limiting them from prescribing medications (Hain & Fleck, 2014). In Florida, only licensed practitioners are allowed to prescribe medication and a few of them limit the prescription posing risks to the on-demand prescription services. Another barrier involves physician-related issues. Variations in education and training make some physicians exposed to rigorous training while others have less training, preventing them from providing quality and safe practices and prescriptions. Specifically, nurse practitioners have struggled for several years to move to full practice authority from restrictive practice in Florida because of the inadequate training and education (Hain & Fleck, 2014). With the increasing demand for primary care, there is a need for education and more training to allow APRNs to develop quality and safe care skills and knowledge. Also, payer policy is threatened (Schirle et al., 2020). The payer policies have significantly impacted APRNs' ability to practice to the fullest of their training and licensure by limiting what they can do, especially those who do not conform to the requirements of the policies (Hain & Fleck, 2014). Payer policies are among the state practice regulations and licensure. Thus, the restrictive scope of practice leads to stricter payer policies that limit APRNs from working independently (Hain & Fleck, 2014). In this case, the limits are applicable to those who should give prescriptions.
Florida Board of Nursing (2016). Important Legislative Update regarding HB 423. Florida Board of Nursing. https://floridasnursing.gov/new-legislation-impacting-your-profession/
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. The Online Journal of Issues in Nursing, 19(2). https://doi.org/10.3912/OJIN.Vol19No02Man02
Schirle, L., Norful, A. A., Rudner, N., & Poghosyan, L. (2020). Organizational facilitators and barriers to optimal APRN practice: An integrative review. Health Care Management Review, 45(4), 311-320. https://www.nppostgradtraining.com/wp-content/uploads/2020/08/Organizational_facilitators_and_barriers_to.99685.pdf
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