Prescribing is a core component of life as a nurse practitioner. While we advocate for lifestyle change and encourage alternate therapies, sometimes medication is the answer for our patients. Prescribing as a nurse practitioner can be a complex matter. Laws related to NPs and prescribing vary state to state. Some require a collaborative agreement with a physician, while others allow for independence. Even in states where nurse practitioners enjoy a greater scope of practice, state and federal guidelines still apply. What do nurse practitioners need to know when it comes to prescribing?
To cover the ins and outs of NP prescribing, I’ve gathered ThriveAP’s most popular posts into a single resource. Here’s the 411.
Scheduled Medications / Controlled Substances
Let’s get started with the basics and take a look at controlled substances and what nurse practitioners need to know about these types of medications.
Many states are implementing controlled substance prescribing CME requirements. But, the online continuing education market still seems to be lagging when it comes to offering such courses. My search for affordable controlled substance related CME led me to these five resources.
The Center for Disease Control and the Federal Drug Administration both recently released new guidelines, from the CDC, and new regulations, from the FDA, aimed at addressing the rising concern about the nationwide opioid epidemic. Not coincidentally, these guidelines and regulations were announced within a week of one another. This signals a strong message from the federal government to both state governments and health care providers: if you won’t fix this problem, we will.
Working in the emergency department I treat patients for fractures, extensive lacerations, and abscesses, many of which warrant a script for controlled medications. But, prescribing these meds everyday makes me a bit nervous. I know I am unaware of all the potential legal implications that go along with controlled substance prescribing. So, I consulted healthcare attorney Alex Fisher for advice. Here’s what she had to say.
Can Nurse Practitioners Prescribe Out-of-State?
Practicing within an hour of a state border, a handful of my even patients reside across state lines. Scope of practice regulations, however, vary from state to state making it difficult for nurse practitioners to know where they stand when it comes to practicing and prescribing in different locations. Is it allowable for NPs to prescribe out of state?
While prescribing controlled substances is a common part of nurse practitioner practice, it must be done with caution. NPs that don’t back up the prescriptions they write with timely, accurate documentation can get themselves into a sticky situation with their employer, regulatory board, or the DEA. What needs to be included in your documentation when you prescribe controlled substances as a nurse practitioner?
We’ve all gotten that text – the one where a family member lets you know their child is inconsolable, most certainly suffering from an ear infection. Or, maybe a friend lets you know they have spent the night sleeping on the bathroom floor, gut twisting with food poisoning. As nurse practitioners, the temptation to help out a friend or family member in these situations by calling in a prescription is strong. Surely prescribing an innocent antibiotic or antiemetic for an acquaintance isn’t an issue, right?
Writing Prescriptions / DEA
When it comes to prescribing as a nurse practitioner the list of rules and regulations is a long one. Not only must NPs prescribe in accordance with federal law, they must prescribe within state guidelines as well. The legal implications surrounding nurse practitioners and prescribing are many, but let’s look at a few of the most common questions and concerns NPs ask about prescribing.
Graduating from a nurse practitioner program and passing the national certification exam doesn’t automatically grant you the ability to sign prescriptions. Yes, these things are likely required by laws in your state, but in order to write prescriptions for many medications (controlled substances) you must obtain approval at the federal level by applying for a DEA number. Here’s the process of getting a DEA number as a nurse practitioner.
I received an interesting question from a reader- do you need a DEA number in order to prescribe medication? My immediate reaction to this question was that yes, a DEA number is most certainly required in order to prescribe medication. However, upon reviewing the intricacies of prescribing law, I stood corrected.
Most often, when I read research articles, I find them interesting, but not directly applicable to my practice. Or, the article presents an interesting perspective, however the research is young and not widely tested. Recently, however, a journal article was recommended to me that proved to be practical and directly applicable to my work as a nurse practitioner. The article? Principles of Conservative Prescribing published in the Archives of Internal Medicine.
The integration of pharmacogenetics into the everyday clinical setting is a relatively new development, and one that nurse practitioners can increasingly expect to encounter in their practices. Here’s a brief background of this new approach to prescribing.
For me, presentations given by speakers for pharmaceutical companies have offered a chance to network with other providers as well as expand my clinical knowledge. Presenters are always engaging speakers, and full of information related to their fields of expertise. I have always wondered how nurse practitioners could get involved in these professional opportunities. In this post, one of my very best friends and former NP program classmates, Jennie, fills me in.
What questions do you have about prescribing as a nurse practitioner?