Prescription for a Solution?

Nurses in many states can prescribe drugs. Different states have different rules, and I’m not sure what they all are, but they involve different clinical specialties and different levels of independence.

I imagine the first person to suggest that nurses be able to prescribe drugs was probably nearly burned at the stake – or at least pronounced heretics, especially by physicians. After all, if nurses can write prescriptions, who needs a doctor?

Of course, it’s not as simple as that, and neither is the previous political in-fighting that has apparently occurred between various nurse-factions. A front-page story in March/April/May issue of The Nursing Voice, a publication of the California chapter of the American Nurses’ Association, makes a call for all advance practice RNs to band together to push for legislation that allows all of them to prescribe drugs without working under the authority of a physician.

There are four types of advance practice RNs: nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists. In California, they have different degrees of authority in prescribing.

The nurse anesthetist is the only one who can prescribe independently (while working in the OR and once the physician has ordered anesthesia).

Nurse practitioners and nurse midwives have “furnishing” authority – that is, they work in a dependent role supervised by a physician.

The clinical nurse specialists can’t prescribe at all.

According to the article, there have been rivalries among these four groups. But now there is a call from one of the clinical nurse specialists group (whose members can’t prescribe) to all advanced practice nurses to help push for a bill that allows all advance practice nurses the authority to prescribe without physician supervision. The group says that everyone should have a hand in crafting legislation language because the end result will be more cost-effective health care.

More nurses who can prescribe also will help meet the needs of the underserved “within the hospital and the community.”

Nurses who are allowed prescribing privileges would have to meet stringent educational criteria and guidelines.

Should all advance practice nurses have the authority to prescribe medications independently?

Are some specialties more qualified than others?

Should there even be a debate at this point about whether nurses should be allowed to prescribe at all?

What do you think?