The Advanced Practice Registered Nurse as a Prescriber. Группа авторов
Kai and Lee, for their understanding of the time I spent working on this project and advocating for advanced practice registered nurses. And to all the advanced practice registered nurses who have worked tirelessly to achieve full practice authority globally.
Louise Kaplan
To my husband, Eric Leberg, whose loving support and household management has sustained our family. To the patients, students, and colleagues who fueled my enthusiasm for a lifelong dedication to the advanced practice nursing role. And to my father, E. Moss Brown, who inspired me to believe that change is always possible and education is transformative.
Marie Annette Brown
Contributors
Editors Louise Kaplan, PhD, ARNP, FNP‐BC, FAANP, FAAN Associate Professor Washington State University Vancouver, WA
Marie Annette Brown, PhD, ARNP, FNP‐BC, FAANP, FAAN Professor Emeritus University of Washington Seattle, WA
Contributors Carolyn Dolan, JD, MSN, FNP‐BC, PPCNP‐BC Professor University of South Alabama Mobile, AL
Pamela Stitzlein Davies, MS, ARNP, AGNP, RN‐BC, FAANP Nurse Practitioner Adjunct Faculty, School of Health Sciences, Seattle Pacific University Affiliate Instructor, School of Nursing, University of Washington Seattle, WA
Tracy Klein, PhD, FNP, FAANP, FRE, FAAN Associate Professor Washington State University Vancouver, WA
Donna L. Poole, MSN, ARNP, PMHCNS‐BC Nurse Practitioner Peninsula Community Health Services Poulsbo, WA
Preface
The purpose of this book is to provide advanced practice registered nurses (APRNs) with the information necessary to be fully informed, rational, and ethical prescribers. The genesis of this book was our teaching, practice, and research. Throughout our professional lives as nurse practitioners, we have experienced the demands, difficulties, and satisfaction inherent in accomplishing this goal.
In 2001, Washington State APRNs obtained prescriptive authority for Scheduled II–IV controlled substances. Our research revealed that when controlled substance prescribing was initially optional, many APRNs did not apply for this hard‐won prescriptive authority. Some were reluctant to prescribe controlled substances. The slower‐than‐expected transition prompted our desire to develop a more in‐depth understanding of how APRNs adopt the role of a prescriber. Likewise, our colleagues, the chapter authors, were inspired to share their prescribing wisdom gleaned from experience to mentor students and colleagues. They dedicated countless hours to the time‐consuming and often difficult challenge of writing in addition to their ongoing professional demands.
We intend for this book to assist students who are adopting the role of APRN prescriber. We also intend to assist practicing APRNs who confront challenges as they transition to the full scope of the prescriber role. Most APRNs need to deepen their knowledge base as they fully implement new or expanded roles, particularly that of fully autonomous prescriber. Ultimately, this information will assist our colleagues across the nation and the world as they work to advance the profession to better serve patients. As APRNs enhance their prescribing expertise, they will enrich their professional opportunities to contribute to greater access and more patient‐centered care. This expertise is also a basis on which we can create changes necessary to improve the quality of healthcare delivered to Americans.
Over the decades, multiple studies and national statements have supported the need for APRNs to practice to the full extent of their education and expertise. The major recommendation is that legal and regulatory barriers to APRN practice should be eliminated. We thank the APRNs who have worked tirelessly to do just that.
We acknowledge policymakers as well as local, state, and national nursing organizations that have been instrumental in advancing the profession of nursing. They honored the dream of advanced practice nursing pioneers who championed their creative innovation that is part of our professional heritage. We dedicate this book to the APRNs who continue the work needed to eliminate the barriers to full practice authority for all APRNs. We will not rest until we meet that goal!
Louise Kaplan and Marie Annette Brown
1 What Do APRN Prescribers Need to Understand?
Louise Kaplan and Marie Annette Brown
Today’s healthcare transformations herald unprecedented opportunities for advanced practice registered nurses (APRNs) to provide and model patient‐centered, evidence‐based healthcare. As APRNs across the country increasingly secure full practice authority, they must seize the opportunity to become pacesetters for ethical, rational, and responsible prescribing. The vast majority of APRNs (nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists) work with prescription medications on a daily basis. Many are unable to imagine a practice that does not include the ability to prescribe, provide, and/or manage medications for at least some of their patients. A goal of most APRNs, however, is utilization of a wide range of therapeutic modalities in the process of patient‐centered care. This may include, but is not focused solely, on medications. Health promotion and disease prevention continue to be a hallmark of APRN practice.
At the same time, as the demand for prescriptive medications increases, prescriptive authority becomes an even more vital component of APRN practice. The number of prescriptions dispensed in 2018 was 5.8 billion, an increase of 2.7% from the prior year. During the same one‐year period, opioid prescription use decreased by 17.1% (The IQVIA Institute, 2019). In order to appropriately meet the prescribing needs of patients, APRNs must have unencumbered, full prescriptive authority and practice.
Practice in today’s complex, fast‐paced healthcare delivery system in which there is a constant barrage of information can be overwhelming. Selection and monitoring of medication appropriate for patients is only one aspect of the complex process of prescribing. This book serves as an easily accessible reference to guide practicing APRNs through these challenges and supplements pharmacotherapeutic knowledge about specific medications. APRN students can also benefit from the content of this book. Standards for APRN programs specify a pharmacotherapeutic course as well as analysis of the APRN role (National Organization of Nurse Practitioner Faculties [NONPF], 2016). Educators must focus on teaching the essential knowledge about pharmacokinetics, pharmacodynamics, and evidence‐based drug treatment recommendations. Consequently, an in‐depth discussion of the APRN’s role as a prescriber is not usually found in the curriculum. The information included in this book has been compiled by experts to facilitate this discussion. The authors have used their clinical and professional experience to synthesize and organize key ideas on a wide variety of subjects. These include:
What it means to be a prescriber
The many facets of the prescriber role
The legal, regulatory, and ethical responsibilities of APRNs who prescribe medications
Who is a prescriber globally
Managing difficult patient situations
Strategies for assessing and addressing special considerations with controlled substances
Authorizing medical marijuana
THE JOURNEY OF APRN PRESCRIPTIVE AUTHORITY
For decades, APRNs have invested innumerable hours in lobbying and regulatory work to advance APRN practice. They have solidified the APRN role, strengthened the foundation for APRN education, and expanded the knowledge base for expert