Discussion On Prescriptive Authority For The APRN
1. Review the requirements of North Carolina for prescribing privileges and compare them with another state of your choice.
2. Are there similarities and differences with a focus on client safety concerns or initiatives.
3. Are there variations in prescriptive authority among APRN’s? Provide specific examples.
4. In response to the state of California, what are the variations in North Carolina state compared to California?
5. Provide scholarly literature related to safety concerns that may have been associated with prescribing privileges of an APRN.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Your Nurse Practitioner approval includes prescriptive authority for legend drugs and Controlled Substance Schedules II – V consistent with your scope of practice as determined by your educational preparation and national certification.
https://www.ncbi.nlm.nih.gov/books/NBK574557/ State laws to determine NPs’ prescriptive authority differ considerably. Some states allow the full practice of NPs where they may prescribe medications with a level of autonomy comparable to physicians. On the other hand, many states have restrictions on NP prescriptive authority and require physician supervision. The American Association of Nurse Practitioners categorizes state practices into three divisions: restricted, reduced, and complete practice authority. Twenty-two states are classified as full practice where NPs have similar prescriptive authority to physicians. In sixteen states, NPs have reduced authority and work alongside physicians in joint practice agreements. States with reduced prescriptive authority have varying limitations on medications that NPs have the authority to prescribe to patients. NPs are categorized as restricted in the remaining twelve states and require physician supervision or delegation when prescribing controlled substances. Overall, NPs have a broader scope of practice and fewer limitations on prescriptive authority than PAs, particularly in states that allow full practice.
NPs have the prescriptive authority to prescribe controlled substances in all fifty states. However, NPs cannot prescribe Schedule II medications in Georgia, Oklahoma, South Carolina, and West Virginia.  Furthermore, state legislation in Arkansas and Missouri restricts NPs to prescribing only hydrocodone combination medications listed under Schedule II. Notably, surveys have shown that many NPs have used strategies to prescribe controlled substances which were not strictly legal. These strategies included using pre-signed prescription pads, having a physician sign the prescription without consulting them, and prescribing scheduled medications without physician involvement. 
Notably, the passage of legislation allowing for the greater prescriptive authority does not equate to uptake by advanced practice providers. For example, in 2001, Washington state passed laws to allow NPs to prescribe Schedule II-IV medications under a joint practice agreement with a physician. However, NPs were required to apply to the DEA to obtain the increased prescriptive authority. Surprisingly, only 60% of NPs submitted applications to prescribe Schedule II-IV drugs following the new law’s implementation.  Reasons for the low uptake of expanded prescriptive authority included concerns about knowledge, questions regarding discipline by regulatory agencies, and concerns about working with patients with drug-seeking behaviors.
Some physician groups have expressed concern relating to the increasing prescriptive authority by advanced practice providers. The current literature is mixed of differences in provider care concerning physician and advanced practice providers. Certain studies have highlighted higher average opioid prescriptions written by NPs and PAs compared to physicians.   However, other studies have shown that the overall prescribing patterns of advanced practice providers are comparable to those of physicians.  One study found that PAs were slightly more likely to prescribe controlled substances to patients than physicians or NPs.  Moreover, researcher bias may be contributing to the often opposing conclusions demonstrated in the literature.
Regardless of the specific prescribing patterns of different provider types, all providers must focus on patient-centered care. The growing PA and NP professions are essential to alleviate the burden of a physician shortage, especially in primary care settings.  In addition, the employment of advanced practice providers is a cost-effective means of supplying comparable health services to the public.  The Affordable Care Act has resulted in increased workload and patient demands for primary care, further necessitating the full utilization of advanced practice providers. Expanding the prescriptive authority of PAs and NPs is one mechanism to alleviate the increased healthcare needs of the public.
The state-by-state legislation on advanced practice provider prescriptive authority is continuously changing and expanding. Given the current trends, it is likely that advanced practice providers will continue to have increasing prescriptive authority over time. Therefore, creating a dialogue between physician groups and advanced practice provider organizations can improve understanding of the attitudes towards increasing autonomy. Such discussions have shown that both physicians and NPs have similar beliefs surrounding increasing prescriptive authority.  Both physicians and NPs were concerned for patient safety, and both agreed that most NPs understand when it is necessary to refer patients to a specialist. Interprofessional communication between different provider groups can enhance team performance while reducing polarizing beliefs.