Abstract
Advanced practice nurses have several responsibilities, tasks, and obligations during either their education or practice. In this paper, the analysis of the requirements for APN prescriptive practice will be developed to identify the main regulatory bodies for nursing practice in New Jersey. The discussion of basic and continuing education, a collaboration between a nurse and a physician, and the role of chart reviews and formularies will prove the significance of nurse attention and dedication. Medications are differentiated in terms of their abuse potentials and effects on patients. Some drugs can be refilled and disposed of easily, and some drugs have to be refilled under the doctor’s control. Nurses should have specific degrees and participate in master’s-level programs to obtain approval from the Board of Nursing for prescribing, treating, and cooperating with patients. Prescriptive authority is a complex aspect of nursing practice, and the example of NJ APNs will help to clarify its essence through the prism of certification, education, and communication.
Introduction
Advanced practice nurses (APNs) expand healthcare services and offer multiple interventions, relying on their knowledge bases, post-graduate education experience, decision-making skills, and high-quality clinical competencies. Prescriptive authority is one of the abilities of nurses to prescribe and control drugs and devices. However, in each American state, certain standards and requirements are imposed, and it is important to learn laws and consider the guidelines. In this paper, the analysis of APN prescriptive practice in New Jersey will be developed, including its major requirements, regulatory bodies, and schedules.
Regulatory Bodies
In New Jersey, APNs have prescriptive authority, but certain specifications should be mentioned. For example, before prescribing medication, attention has to be paid to a joint protocol with a licensed collaborative physician (New Jersey Board of Nursing, 2020). States laws are considered to understand all the aspects of prescriptive authority, including education, certification, and skills, so this author is a legislated privilege. The Board of Nursing is the regulatory body that has authority over APN practice, establishes licensure requirements, and signed the Nurse Practice Act (American Association of Nurses Practitioners, n.d.). There is the New Jersey Administrative Code (N.J.A.C.) that addresses programs, licensure, and certification of APNs.
APN Requirements
An APN prescribes medications and orders treatments, focusing on such details as his or her, patient’s, and physician’s full name, telephone number, and address, as well as drug name, route, quantity, and refill. APNs should graduate from a master’s-level program (as registered professional nurses) and complete a 3-credit course in Pharmacology as basic education (New Jersey Board of Nursing, 2020). Continuing education certification implies 30 contact hours obtained within five years before prescription authority. Physician collaboration includes a working process during which respective practices are promoted between a nurse and a physician in a written or oral form. Therefore, physician oversight is critical for nursing practice and the enhancement of safety and high-quality prescriptive practice. However, independent prescribing by an APN does not require direct collaboration with a physician (Parker & Hill, 2017). APNs could prescribe drugs with high abuse potential and physical dependence (2 and 2N), with limited quantities of narcotic drugs (3 and 3N), and with less abuse potential (schedules 4 and 5) (“Mid-level practitioners authorization by state,” 2020). These chart review requirements and formularies in New Jersey are developed within the Code of Federal Regulations.
CDC Guidelines
Today, there are many guidelines and recommendations on how to improve the way of how opioids and other controlled dangerous substances (CDS) are prescribed. The Centers for Disease Control and Prevention (2019) underlines the importance of ensuring safe patient access to chronic non-cancer pain treatment by reducing drug overdose or misuse. More than 11% of adults experience chronic pain, and millions of American patients receive opioid treatment (The Centers for Disease Control and Prevention, 2019). The basic requirements to prescribe CDS are the duration of pain for more than three months and patients who are older than 18 years (Dowell, Haegerich, & Cho, 2016). First, it is necessary to establish treatment goals, discuss the risks, and select a therapy (The Centers for Disease Control and Prevention, 2019). Then, an opioid, with its short-and long-lasting outcomes, dosages, and treatment duration, is discussed. Finally, the assessment of harms and risks is recommended by analyzing the results of urine drug tests.
Specific APN Regulations
Being responsible for safe and quality care, APNs should clearly understand their duties and responsibilities when they decide to prescribe medication. The New Jersey Board of Nursing (2020) admits that each CDS prescription has to be written on a separate N.J. prescription blank. Other specific rules include the attention to the medical history of a patient to understand the nature and frequency of pain. A physical examination has to be conducted to observe physiological and psychological functions. The development of a treatment plan is also obligatory because it allows defining which drugs are used.
The patient has to be educated about possible misuse or overdose conditions to predict additional problems and changes. Pain contracts are signed between a doctor and a patient to explain all precautions, restrictions, and recommendations in a written form. In addition, an APN should remember that not all substances could be refilled. For example, schedule 2 (2n) has to be re-written every time, and no refill is possible. Schedule 3 (3n) and 4 drugs can be refilled several times during six months, and the drugs from schedule 5 are frequently refilled by a nurse. Finally, the appropriate medication disposal cannot be ignored to avoid related complications and threats to human health. If an APN does not have direct access to medication for its disposal, the patient should be educated about how to remove it safely (remove it from original packages, seal it in a bag, and throw it away).
APN Prescribing Requirements on Safety and Quality
The concepts of safety and quality are frequently discussed in APN practice. Even if a nurse obtains the necessary education and certification, it does not mean that all dangerous aspects of health care are removed. The evaluation of recent regulations in prescription practices shows that much depends on how well an APN shares knowledge and experience with patients. It does not take much time to prescribe a drug and follow all the necessary standards. However, the outcomes of this activity have to be taken into consideration. If a patient is poorly educated, a negative result can be observed. If medications are refilled not as per the standards and schedules they belong to, poor health consequences may be observed. If a drug is wrongly disposed of after being used, new threats can be created either for a patient or for the environment.
In general, APN prescribing requirements vary in American states, imposing nursing following strict regulations and laws. The N. J. Board of Nursing is a leading regulatory body in the state under analysis that approves certifications and licensure for APNs and their intention to prescribe drugs for chronic non-cancer pain. The implications of rules depend on how well nurses understand their duties and cooperate with doctors, patients, and their families. In the majority of cases, basic and continuing education plays a crucial role in the promotion of human health that has to be improved using medications. Safety and quality are the major rules for APN in their prescriptive practice, and following state regulations is the key to success.
References
American Association of Nurse Practitioners. (n.d.). New Jersey: Information and resources of New Jersey NPs. Web.
The Centers for Disease Control and Prevention. (2019). CDC guideline for prescribing opioids for chronic pain. Web.
Dowell, D., Haegerich, T. M., & Chou, R. CDC guideline for prescribing opioids for chronic pain – United States, 2016. Morbidity and Mortality Weekly Report, 65(1), 1-49. Web.
The New Jersey Board of Nursing. (2020). New Jersey Administrative Code: Title 13: Law and public safety: Chapter 37. Web.
Mid-level practitioners authorization by state. (2020). Web.
Parker, J. M., & Hill, M. N. (2017). A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong special administrative region (SAR), China. International Journal of Nursing Sciences, 4(2), 196-204. Web.