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APRN Prescriptive Authority for Two New England States: A ComparisonResearch Paper

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APRN PRESCRIPTIVE AUTHORITY: NH VS Massachusetts

APRN Prescriptive Authority

APRN Prescriptive Authority: New Hampshire vs. Massachusetts

APRN Prescriptive Authority: New Hampshire vs. Massachusetts

Massachusetts is the 44th largest state in the United States with 7,838 square miles of land (Netstate.com, 2014). By comparison, New Hampshire (NH) is the 45th largest state with 8,969 square miles of land. These statistics reveal NH is the larger of the two states in terms of land mass, yet in 2014 had less than one fifth the population of neighboring Massachusetts (U.S. Census Bureau, 2014). Accordingly, NH residents are more likely to live in a rural setting and receive healthcare services from advanced practice registered nurses (APRNs) (Buerhaus, DesRoches, Dittus, & Donelan, 2014). Physicians, on the other hand, are more likely to practice in suburban areas. Given the logistical constraints associated with providing primary, acute, and long-term care in rural settings, it may come as no surprise that APRNs practicing in NH have plenary authority to prescribe medications (New Hampshire Board of Nursing, 2013a). In other words, board-certified APRNs practicing in NH have the same prescriptive authority as licensed physicians. This stands in stark contrast to a number of other states who require physician oversight of prescriptive authority, in addition to limiting the classes of drugs that can be prescribed by APRNs (Gadbois, Miller, Tyler, & Intrator, 2014). All that is needed to prescribe FDA-approved drugs in NH is a valid individual or group registration number from the U.S. Drug Enforcement Agency (DEA) (New Hampshire Board of Nursing, 2013b).

The administration of prescriptive authority for APRNs in Massachusetts, however, is much more complex. There are five recognized APRN specialties in Massachusetts: clinical nurse practitioner (CNP), clinical nurse midwife (CNM), clinical nurse anesthetist (CRNA), psychiatric mental health clinical nurse specialist (PCNS), and clinical nurse specialist (CNS) (Mass.gov, 2015a). Board certification for each specialty is obtained from the respective national certifying organization and prescriptive authority is granted by the Department of Public Health Drug Control Program (DCP) (Mass.gov, 2015b). The Department of Public Health, after determining an APRN has met the requirements for prescriptive authority in that specialty, will confer a Massachusetts Controlled Substance Registration (MCSR) number to the APRN. The APRN can then request an individual or group registration number from the DEA. CNMs have plenary prescriptive authority in the State of Massachusetts, while CNSs have none (Department of Public Health, 2014). The remaining APRN specialties, CNP, CRNA, and PCNS, require an ongoing prescriptive agreement with a supervising physician.

The supervising physician must hold an unrestricted full license in Massachusetts, completed training in an accredited school in the United States or Canada, be board-certified, and practicing in a specialty area similar to the one practiced by the supervised APRN (Board of Registration in Nursing, 2014). Physicians supervising PCNSs, however, must have completed training in psychiatry at an accredited institution of higher learning. If the supervising physician has hospital admitting privileges for the specialty area, board certification is not required for CNPs and CRNAs. The supervising physician must also have valid controlled-substance registrations through the Massachusetts Department of Public Health and DEA.

The written agreement between the Massachusetts APRN and supervising physician must define the nature and scope of the APRN's prescriptive authority and be renewed every two years (Board of Registration in Nursing, 2014). The agreement should also describe how supervision can be delegated to another physician, along with any limitations in the duration and scope of the delegation. The agreement should state the circumstances which trigger a physician consultation or referral, define the mechanism and duration for monitoring prescribing practices, and require review of Schedule II drug administration within 96 hours. Even though medical marijuana is still categorized as a Schedule I drug by the DEA (Silverman, 2015), CNPs are authorized by the State of Massachusetts to prescribe this drug under appropriate physician supervision (Board of Registration in Nursing, 2014). The prescriptive agreement between the APRN and supervising physician is a public document and must be provided to anyone requesting a copy (Mass.gov, 2015b). If the APRN needs prescriptive authority in multiple settings, but a supervising physician is not available who practices in all settings, then a supervising agreement must be created with a physician for each additional setting. Other restrictions include physician oversight of APRN patient diagnosis and treatment in Massachusetts (Gadbois, Miller, Tyler, & Intrator, 2014).

APRNs requesting prescriptive authority in Massachusetts are only required to have a general Master in Science… [END OF PREVIEW]

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