Advanced Practice Nurses and Prescriptive Authority

Introduction

The "Nurse Practitioner" is a relatively new American medical role. First conceived in the 1960s as a restricted diagnostic/nursing hybrid, the discipline has developed within a patchwork of varying state and federal regulations and legislation. The modern Nurse Practitioner is at once empowered and hampered by state and federal authorities across several vital areas. Fortunately, the sheer number of American Nurse Practitioners gives them the political clout to significantly influence their roles toward eventual autonomy and financial equity.

Historical Development of Prescriptive Authority

Though non-physicians have filled medical care gaps created by a lack of physicians for hundreds of years, the formal category of "Nurse Practitioner" is relatively young. During the 1960s, Dr. Henry Silver and a nurse educator named Loretta Ford created an educational program to prepare nurses for responding to the lack of physicians in rural areas of Colorado. Taught at the Master's level, this program required a nursing license and patient care experience for admission, and was innovative in that it combined traditional nursing care with the ability to diagnose. The first Nurse Practitioners began practicing in the late 1960s. Though the nursing profession was initially skeptical of this "physician extender" that seemed to militate against its patient-care focus, as the profession became more defined and as educational programs developed and spread across the country, nursing eventually welcomed this new role.

While Nurse Practitioners enjoyed some autonomy and greater privileges in their roles, the issue of prescriptive authority proved to be a separate battle that took years and even decades to win. By the mid-1970s, state legislatures began considering the possibility of granting prescriptive authority to Nurse Practitioners. Some states eventually granted prescriptive authority through their regulatory bodies, while others did so through their legislative bodies. By 2006, all 50 states and the District of Columbia had granted at least some degree of prescriptive rights to Nurse Practitioners (Buppert, 2012, p. 7).

As of the year 2000, approximately 95,000 Nurse Practitioners practiced in every state and the District of Columbia, with varying requirements and authority granted by each state. According to the National Center for Health Workforce Analysis, the 95,000 Nurse Practitioners working in 2000 represented an increase of more than 240% in the number of American Nurse Practitioners since 1992. By 2011, the number of Nurse Practitioners in the United States exceeded 135,000 (Crane, 2011), and the American Academy of Nurse Practitioners estimates that 656 million prescriptions per year are written by Nurse Practitioners (Brown, 2010, p. x). Today, Nurse Practitioners fill numerous roles in nearly every health care setting, fulfilling the nursing profession's primary focus on the patient's total well-being while exercising the authority to prescribe medication and to order, perform, and interpret some laboratory tests. A recent multidisciplinary health care study found that "Nurse Practitioners demonstrate a high level both of collaboration and high levels of autonomy" (Klein, 2011, p. 80). Nurse Practitioners are able to practice autonomously in many states, though a number are supervised by physicians in some capacity (National Center for Health Workforce Analysis, 2010, pp. 7–9).

The Family Nurse Practitioner specialty is more flexible than areas specializing in neonatal or acute care. Consequently, Family Nurse Practitioners can practice in a number of health care specialties, including family medicine, urgent care, internal medicine, pediatrics, women's health, cardiology, gastroenterology, and urology. While the Family Nurse Practitioner is limited in acute care or neonatal complications, this specialty is often chosen precisely because it allows practice across many areas (Advanced Practice Recruiters, 2012). Most closely resembling the general practitioner of earlier medicine, Family Nurse Practitioners are in ever greater demand due to the shortage of family practice physicians — particularly in rural and inner-city areas — the increasing number of Baby Boomer patients, and the demands created by uninsured patients accessing the health care system through government programs (Advanced Practice Recruiters, 2012). Family Nurse Practitioners are normally found in clinics providing family medicine to patients of any age and are capable of providing care across patients' lifetimes. Depending on their geographic and clinical areas, they may concentrate on any age group, typically from toddlers through older adults. Their prescriptive authority is governed by state legislation, and all 50 states currently allow Family Nurse Practitioners to prescribe medications (Advanced Practice Recruiters, 2012).