Prescriptive Authority Response – Week 4 Response Solutions

Prescriptive Authority Response

Post 1

In the state of South Carolina (SC), nurse practitioners are able to write prescriptions, but they must obtain authority from the state board of nursing and have a supervising physician with an agreement. This considers SC to be a restrictive practice state and is one of 12 states in the country (Peterson, 2017)

After obtaining a South Carolina (SC) nurse practitioner license, a prescriptive authority application may be completed. Evidence of at least 45 contact hours of education in pharmacotherapeutics and at least 15 of those hours should be in controlled substances to pursue a DEA license (SCBON, 2022). The graduate level pharmacology course is sufficient for new graduates. Authorization for prescriptive authority is valid for two years unless terminated by the state board of nursing.

Prescriptive authority is limited to drugs and medical devices that are used to treat medical conditions within their specialty field. Nurse practitioners are able to prescribe Schedules III through V controlled substances as long as they are listed in the practice agreement. They may also prescribe Schedule II non-narcotics, but they must not exceed a thirty-day supply.

Schedule II narcotics can be prescribed, but they must not exceed a five-day supply and a refill prescription may not be given unless the physician has a written agreement stating otherwise. The nurse practitioner can however write them for patients who are in hospice, on palliative care or those living in long-term care facilities, but these have to be written in 30-day increments (SCBON, 2022).

Post 2

The discussion board this week is similar in regards to what I had posted the week before about nurse practitioners being able to prescribe medications. The nurse practitioner must have a certificate of fitness and there are many regulations that have to be followed for the NP to be able to prescribe narcotics. A nurse practitioner must have a certificate of Fitness, issued by the state board of nursing, which allows nurse practitioners to prescribe medications (Tennessee Secretary of State: Division of Publications, 2019).

The nurse must provide the state with the name of the physician who is overseeing their prescribing of medications and if this information changes, then the nurse practitioner must notify the board within thirty days (Tennessee Secretary of State: Division of Publications, 2019). For the nurse to receive a certificate of fitness, they must have a nursing license, have a master\’s degree or higher, a national certification in their specialty, and graduation from an accredited program (

Tennessee Secretary of State: Division of Publications, 2019). A nurse practitioner may prescribe schedule II-V drugs but must consult with the supervising physician first and maintain a certificate of fitness from the board of nursing (The National Conference of State Legislators, 2022). There is not currently any medical use for schedule I narcotics and for this reason, they are not able to be prescribed by any provider. Schedule I narcotics are drugs that have a high possibility for abuse which include LSD, ectasy, heroin, marijuana, and a couple other drugs (United States Drug Enforcement Association, 2022).

The board of nursing is the statutory body that allows nurse practitioners to prescribe drugs within the state, but the Drug Enforcement Agency is what monitors and controls the type of drugs that can be prescribed according on how they are categorized. Within the state of Tennessee, Nurse practitioners are not able to prescribe narcotics for family members and prescriptions may be called in for family members only in emergency situations (ThriveAP, 2016).

The nurse practitioner must do a complete history and physical and examination of the patient before prescribing any medications (ThriveAP, 2016). It is required the nurse practitioner collaborates with the supervising physician when prescribing any narcotics. It is very important to document the need for all medications and the examination that can support these diagnoses and reasons for medications prescribed. 

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Prescriptive Authority Response

Response to Peers

Response 1

Thank you, Summer, for an informative and engaging discussion. The state board o nursing is responsible for regulating NP prescriptive authority. I have read about prescriptive authority in the state of South Carolina (SC). Nurse practitioners are still limited from providing or ordering prescriptions because they must acquire the authority of the state board of nursing and have an agreement with supervising physicians (Gadbois et al., 2015).

To apply for prescriptive authority, nurses must also table evidence of completing forty-five education contact hours in pharmacotherapeutics acceptable to the body within two years prior to application. At least a third of the forty-five hours, fifteen, should be spent in controlled substances to apply for a DEA license. I agree that South Carolina is among the 12 states that lack full-practice authority for the state’s nurse practitioners. The steps to acquire prescriptive authority are:

1. Register for the state’s medical license.
2. Sign a collaborative practice agreement.
3. Register for prescriptive authority.

References

Gadbois, E. A., Miller, E. A., Tyler, D., & Intrator, O. (2015). Trends in state regulation of nurse practitioners and physician assistants, 2001 to 2010. Medical care research and review: MCRR, 72(2), 200–219. https://doi.org/10.1177/1077558714563763

Response 2

Hello, Nicole. Your discussion is educative and insightful. Individual states regulate NP practice authority. Practice authority is perceived as a barrier to nursing practice, and more states are embracing the idea of allowing nurse practitioners full practice authority. According to the American Association of Nurse Practitioners (AANP), full practice authority allows NPs to evaluate patients, diagnose, order, interpret diagnostic tests, and initiate and manage treatments, including medication prescription (Peterson, 2017). The state body of nursing provides exclusive licensure authority.

Other states have either reduced practice or restricted practice. In Tennessee, NPs can only prescribe medications under physician supervision. The NPs must present the physician name and contact information and the NP’s name and contact information when prescribing medicine. However, supervision does not necessitate the constant and continuous presence of the physician. Tennessee remains among the states with a high level of restrictions for NPs. A collaborative practice agreement with a physician is a must.

Reference

Peterson, M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

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