After close to two decades, the Florida Nurses Association and other professional nursing groups around the Sunshine State continue to work toward seeing the privilege for advanced registered nurse practitioners to prescribe controlled substances finally come to fruition. Some say this step, as well as better collaboration with physicians, would help extend healthcare access to more of the 20 million Floridians — an issue that continues to make headlines across the state.
Patient, yet persistentMavra Kear, RN
In a state that faces challenges including a growing drug abuse problem and the shortage of primary care physicians, Floridas nurses have been working to implement changes in practice and access to healthcare. They have proposed bills or strategies during several consecutive legislative sessions on such topics as prescribing controlled substances. “That is the change we have been trying to make for the past 19 years,” said FNA Executive Director Willa Fuller, RN, BSN.
The change Fuller referred to is in Florida statute 893.02, the drug control statute that defines practitioners, according to Fuller. “ARNPs would need to be added as ‘approved practitioners who can prescribe controlled substances,” she said.
The FNA will not have a bill on the topic considered during the legislative session that runs through May 3, but plans to work toward collaborative practice solutions to make healthcare more accessible to state residents, according to FNA President Mavra Kear, ARNP, BC, PhD.
Leading change requires collaborationDenise Elswick, RN
Florida is one of only two states (the other is Alabama) that do not allow ARNPs to prescribe controlled substances, Schedule II drugs such as hydrocodone and Ritalin, as classified by the Federal Drug Administration. “We even had to legislate to get our names as the prescriber written on the bottle,” Denise Elswick, ARNP, BC, MSN, treasurer, Florida Nurse Practitioner Network, said. “This is one more area where NPs have been invisible. Physicians who employ NPs usually just sign the script without ever seeing the patient, so they must trust our judgment.”
But there is light at the end of the tunnel, according to Elswick, who explained that Florida lacked a prescription tracking system until recently. “Florida is at last working on the drug issue,” she said. “In the past, Florida didnt adequately track prescriptions being filled at different pharmacies.”
According to Fuller, the FNA has generated two Senate studies concluding ARNPs should be able to prescribe drugs, in addition to the many research studies that address the quality of care by ARNPs. “Its an injustice to misrepresent our qualifications and our contributions to the healthcare arena,” she said. “In this way, physicians truly are biting the hand that feeds them.”
The goal: full partnership
Prescribing controlled substances is just one area that needs to be addressed in Florida, Elswick said. In 2010, the Institute of Medicine released, “The Future of Nursing: Leading Change and Advancing Health” report with key recommendations, such as: “Nurses should be full partners, with physicians and other health professionals, in redesigning healthcare in the United States.” The IOM report also noted that “restrictions on scope of practice, policy and reimbursement-related limitations, and professional tensions have undermined the nursing professions ability to provide and improve both general and advanced care.”
“The IOM, AANP, Robert Wood Johnson Foundation, [Florida] Office of Program Policy Analysis and Government Accountability, Florida State Senate Interim Report of 2008 and others all indicate that NPs should be allowed to practice at their full level of education and training,” Elswick said.
The Florida Action Coalition, led by the Florida Center for Nursing and Blue Cross Blue Shield Foundation of Florida, is working on multifaceted strategies to advance IOM recommendations. “Florida actively participated in the initiatives generated by the IOM report and formed the FL-AC,” Kear said. “There has been some physician participation on the FL-AC.”
Florida Surgeon General John Armstrong, MD, convened a collaborative practice workgroup in December 2012 that included leadership from organized nursing, organized medicine and physician assistants. “Dr. Armstrong stated his goal is for the group to shape a patient-centered model of care that improves efficiencies of care delivery and collaboration among all healthcare professionals,” Kear said.
According to the AANP, more than 80% of NPs nationwide are trained to provide primary care services. “The nursing community as a whole supports enabling ARNPs to practice to the full extent of their education, training and experience as recommended in the IOM 2010 report,” Kear said.