A patient needs a refill of a medication, but the doctor’s schedule is booked for weeks. What is the patient to do? In some states, the patient can make an earlier appointment with a nurse practitioner who has the authority to write prescriptions. However, each state has different rules governing what services that nurse practitioners provide, including whether they can prescribe medications without physician supervision.
Regardless of where they practice, nurse practitioners provide essential primary care services, including conducting patient checkups, diagnosing and monitoring conditions, and recommending treatments. Some professional groups and politicians are advocating for expansion of prescriptive authority for nurse practitioners to improve healthcare efficiencies and patient outcomes. Nurses can prepare to advance their careers as nurse practitioners by pursuing a program such as Norwich University’s online Master of Science in Nursing.
Why Prescriptive Authority Matters
Prescriptive authority gives nurse practitioners more power to impact the quality of health care delivery. With full prescriptive authority, nurse practitioners can prescribe medications without a lengthy process requiring physician approval. Patients receive ready access to necessary medical treatments, at reduced costs. This is especially true in rural areas where primary care providers are often in short supply and there may not be a physician present to supervise prescription processes.
About 25% of primary care clinicians in rural areas are nurse practitioners, according to Health Affairs. That number increased from about 18% in 2008, with nurse practitioners having a stronger presence in states that allow greater autonomy. This means that states with more relaxed scope-of-practice laws may find it easier to mitigate shortages of primary care physicians.
Increased authority also helps nurse practitioners to establish stronger relationships with patients and improve patient satisfaction rates. Preventive care programs positioned to reduce hospitalizations for chronically-ill patients can be more effective when nurse practitioners can conduct regular checkups and manage patients’ adherence to medication regimens.
Demand for primary care services will grow as the U.S. population ages, feeding the need for nurse practitioners with full medical practice authority. The number of residents 65 and older is expected to grow from 52 million to 95 million between 2018 and 2060, according to the U.S. Census Bureau, increasing more rapidly than the overall population.
Growing demand for mental healthcare is another pressing issue supporting prescriptive authority for nurse practitioners. Due to the growing opioid crisis in the U.S., the federal government has set up a Controlled Substances Act waiver program to allow nurse practitioners to prescribe buprenorphine addiction treatments. However, some state laws limit nurse practitioners’ authority to issue this potentially lifesaving medication.
Prescriptive Authority in the U.S.
Each state has its own laws governing the conditions under which nurse practitioners can write prescriptions. Nationwide, all health care professionals prescribing controlled substances must apply for a registered Drug Enforcement Administration (DEA) number. While nurse practitioners have some degree of prescriptive privileges in all states, including controlled substances, many states restrict these capabilities with physician oversight or transition period rules.
Full Independent Prescriptive Authority
About 20 states and Washington, DC allow nurse practitioners to prescribe medications without any physician oversight. This operating model gives full independent prescriptive authority. Most states that allow prescribing freedoms also grant nurse practitioners full independent prescriptive authority including Idaho, Oregon, New Hampshire, and Arizona. However, other states, including Nevada and Minnesota, allow some prescribing privileges but require physician oversight for certain tasks.
Transition to Independent Prescribing
A handful of other states grant prescriptive authority for nurse practitioners after a transition period. Under this model, nurse practitioners must operate under a doctor’s supervision for a specified number of hours or years before gaining full prescriptive authority. Examples include Colorado’s 1,000-hour mandatory prescribing mentorship period and West Virginia’s three-year transition-to-practice period.
Physician Relationship Required
About 30 states require nurse practitioners to have a relationship with a physician who supervises prescribing capabilities. In California, nurse practitioners can prescribe drugs in their area of practice, but must involve the supervising physician when prescribing Schedule II or Schedule III controlled substances. In Florida, on the other hand, all drugs must be prescribed under physician supervision and permissions must be outlined in a written protocol.
The Future of Prescriptive Authority
More states are pursuing increased prescriptive authority for nurse practitioners as government officials recognize the growing demand for primary care services and the essential role that nurse practitioners can fill in health care settings. As the shortage of physicians in the U.S. is predicted to become more widespread, the need for nurse practitioners will only intensify. The U.S. could see a shortage of between 54,100 and 139,000 physicians by 2033, according to the Association of American Medical Colleges.
Recent bills looking to expand the role of nurse practitioners include Florida’s HB 607, which was approved by the state House of Representatives in 2020 and sent to the Senate. HB 607 would authorize autonomous practice for advanced practice nurse practitioners and physician assistants, allowing them to perform specified acts, such as prescribing medication, without physician supervision after a transition period.
Pursue a Master of Science in Nursing
Nurse practitioners provide critical primary care services in different settings and scope depending on state regulations. They offer holistic care by focusing on promoting healthy lifestyles, preventing disease, and guiding patient treatments. These services help to improve patient outcomes and lower health care costs.
Norwich University’s online Master of Science in Nursing program helps nurses develop advanced skills in a variety of nursing specialties. The program features concentrations in Healthcare Systems Leadership, Nursing Education, and Nurse Practitioner. Three track options are available in the Nurse Practitioner concentration: Family Nurse Practitioner, Adult Gerontology Acute Care Nurse Practitioner, and Psychiatric Mental Health Nurse Practitioner.
Learn more about how Norwich University’s online Master of Science in Nursing program can help you pursue your professional goals.
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NP Fact Sheet, American Association of Nurse Practitioners
State Practice Environment, American Association of Nurse Practitioners
New AAMC Report Confirms Growing Physician Shortage, Association of American Medical Colleges
America’s Aging Population Is Leading to a Doctor Shortage Crisis, CNBC
House Passes Top Priorities of Jose Oliva, Florida Politics
Rural and Nonrural Primary Care Physician Practices Increasingly Rely on Nurse Practitioners, Health Affairs
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Nurse Practitioners’ Primary Care Role for Rural Areas Hobbled by Practice Restrictions, HealthLeaders
Fact Sheet: Aging in the United States, Population Reference Bureau
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Nurse Practitioners Overview, Scope of Practice Policy
Expanded Role for Nurses in Florida Gets House Support, The Daytona Beach News-Journal
By 2030, All Baby Boomers Will Be Age 65 or Older, U.S. Census Bureau
Demographic Turning Points for the United States: Population Projections for 2020 to 2060, U.S. Census Bureau