II. State of New Jersey APN’s requirements.
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III. CDC guidelines and Federal Regulations on CDC prescription
IV. Implications to prescriptive APNs care.
This paper provides APN’s (Advanced Practice Nursing) overview in the USA, particularly in the state of New Jersey. It is based upon presented documents to the New Jersey Board of Nursing and medicine and by the CDC guidelines. Implications reasons about APN’s prescriptive purpose are also provided.
Recently, APNs (advanced practice nurses) with an education level of post-baccalaureate graduate is becoming more and more recognized around the world. There are many roles that APNs play in states and are identified according to topics given by the CNN (China Nursing Network) such as APN scope of practice; capacity requirements; role legitimacy; educational preparation, limited rights and domains of activities for referral and prescription; performance evaluation system; accreditation system; and professional promotion ladder.
Each state in America has distinct requirements and regulations for APN prescriptive practice; I chose the state of New Jersey as my place of practice as an APN (Chesney & Duderstadt, 2017). The regulatory bodies in this state that governs APN practice are New Jersey Board of Nursing (Chesney & Duderstadt, 2017). The state of New Jersey has the following requirements:
A. A licensed nurse practitioner holding a prescriptive authority license and is categorized in the certified nurse-midwife may prescribe comparably with a consulting physician’s electronic or written practice agreement or may prescribe without any inclusion requirement Schedule VI controlled substance.
B. According to the New Jersey Administrative Code, physician is not to serve more than six prescriptive authority nurse practitioners as the patient care team physician at any one time.
C. The agreement of practice should contain the following:
I. A comprehensible statement of the patient attention team physician’s name that has joined the practice correspondence or the victim care team doctors signature that the nurse practitioner practices with.
II. Categories of devices and drugs authorization within the requirements of New Jersey Administrative Code.
III. A description of the nurse practitioner’s prescriptive authority within the nurse practitioner’s scope allowed by the practice and law.
D. If there are any changes in the scope of practice, authorization to prescribe or patient care team physician, the nurse practitioner should revise and maintain the practice agreement.
E. Only within the electronic or written scope practice agreement and with a patient care team physician will a prescriptive authority nurse practitioner be allowed to prescribe.
The guidelines of the CDC for Opioids prescription for chronic pain is to reduce the associated risk of long-term opioid therapy, for example, opioid overdose and use disorder, enhance the productivity and safety of pain cure and enhance communication between patients and givers about the advantages and dangers of chronic pain’s opioid therapy. The following are CDC guidelines for opioids prescription:
A. If there is an anticipation of expected benefits for both function and pain to outweigh the patient’s risk, the APNs should consider opioid therapy combined with non-opioid pharmacologic therapy and non-pharmacologic therapy.
B. Periodically during and before starting opioid therapy, APNs should discuss opioid therapy’s realistic benefits and known risk with the patient, and APN and patient responsibilities for managing therapy.
C. Before commencing opioid therapy, all patients’ treatment goals including realistic goals for function and pain should be established by APNs and they should consider how to discontinue opioid therapy if the risk outweighs the benefits.
D. Lowest effective dosage should be prescribed by APNs. They should first carefully reassess patients’ risks and benefits evidence when considering increasing dosage.
The following are some of the specific federal regulations on CDC prescription:
A. the rule for refilling, for example, Schedule V CSs, is not developed by the federal law. The authorized refills’ numbers rely on the prescriber or pharmacist’s professional judgment.
B.Prescriptions must be written, for example, Schedule II CSs which has some exemptions. The prescription must be signed on and dated as of the day when issued, must include the practitioner’s registration number, address and the name, and must include the patient’s address and full name, directions of drug use, quantity, strength, dosage form and drug name (Osborne, 2017). The prescription must also be written with typewriter, indelible pencil or ink and the practitioner must manually sign it.
C. Partial quantities prescriptions fill should be administered to patients in an LTCF (long-term care facility) or with a terminal illness.
There is a bill HB 421 that allows APNs to give the same care level, independent completely from collaborations of physician as obstetricians, pediatricians, family physicians, pain management physicians, anesthesiologists or other specialists with no equivalent requirements for training and education standards that physicians are needed to complete by the law (Valentine, 2016). This bill is not a good public policy for quality care access improvement. This bill will also grant APNs full prescriptive authority including drugs like opioids which are the in the Schedule II drugs’ category. Furthermore, this bill will allow APNs to independently provide severe/chronic disease management, obstetrical care, and anesthesia services with no physician collaboration. The best of patient’s concerns will not be fully addressed; especially those who require specialty care or suffer from multiple medical conditions (Valentine, 2016). In addition to, the introduction of independent APN’s practice will not aid in solving the health professional shortages issue in underserved areas. Instead, studies show that nurses and physicians continue to work in states where the independent nursing practice is developed.
Valentine, N. M. (2016). Advancing Advanced Practice Nurses in Illinois: Challenges in the Land of the American Medical Association.
Chesney, M. L., & Duderstadt, K. G. (2017). States’ Progress Toward Nurse Practitioner Full Practice Authority: Contemporary Challenges and Strategies. Journal of Pediatric Health Care, 31(6), 724-728.
Centers for Disease Control and Prevention. (2016). Guideline for prescribing opioids for chronic pain. Journal of pain & palliative care pharmacotherapy, 30(2), 138-140.
Osborne, K. (2017). Regulation of Controlled Substance Prescribing: An Overview for Certified Nurse‐Midwives and Certified Midwives. Journal of Midwifery & Women’s Health.