Ensuring the safety of prescriptive practice, especially regarding Controlled Dangerous Substances (CDS), remains one of the essential priorities of authorities and medical institutions. By introducing these improvements, they aim to increase transparency and enhance public’s access to effective treatment. The author of this paper lives in New Jersey; for that reason, prescriptive practice requirements in this state will be assessed. The paper will review the regulatory bodies responsible for the policies, discuss the requirements for advanced practice nurse (APN) authorities and federal guidelines, finishing up by examining the implications on safety and quality of APN practice.
Background Information
The term advanced practice nurse includes nurse practitioners, nurse anesthetists, and clinical nurse specialists, and there are currently around 6,800 APNs in New Jersey (Drake & Torre, n.d.). On the contrary, nurse midwives have different licensing authority and are not considered as APNs (Drake & Torre, n.d.). The only institution that certifies APNs is the New Jersey Board of Nursing (BON) (New Jersey Division of Consumer Affairs, 2020a). The main activity of this regulatory body is ensuring the accreditation process and proper certification of nursing practitioners. However, it is the Division of Consumer Affairs that oversees nursing practitioners as a whole (New Jersey Division of Consumer Affairs, 2020). Getting APN certification, thus, requires advanced educational background.
Requirements
While there are different possible options, the minimum of a Master’s degree in nursing is required to get a license. It can be MA, MN, or Doctorate in Nursing Practice, sometimes even a Ph.D., depending on the content of the educational program (Drake & Torre, n.d.). The core curriculum should include health promotion and disease prevention, health assessment, physiology, pharmacology, organization of health care delivery and more, besides, professional clinical experience must be successfully completed. To request an application to be certified as APN, an individual must already be a registered nurse (RN), submit Original Official Transcripts and the proof of passing the highest level national APN examination (New Jersey Division of Consumer Affairs, 2020). Aside from that, each applicant is expected to pass the highest-level practice examination in their specialization area.
Prescribing Authority
In New Jersey, APNs are held accountable for collaborating with other specialists, and they need to function using a joint protocol. In terms of continuous education, the current initiatives imply that nursing education programs get limited funding, but restrictive cooperation requirements are minimized. The charts and formularies are to be reviewed together with a physician (New Jersey Division of Consumer Affairs, 2020). A protocol must contain the nature of the practice, patient population, categories of medications prescribed, record-keeping plan, and requirements for recording refills. However, this level of authority implies risks addressed by federal regulatory bodies, such as the Drug Enforcement Administration (DEA) or Centers for Disease Control and Prevention (CDC).
Chronic Non-Caner Pain Management
When conducting a diagnosis of pain syndromes of non-cancerous origin, the fundamental differences between acute and chronic pain are taken into account. CDC’s guidelines aim at establishing the framework for prescription of CDS. Opioids generally are not advised as the first-choice option for chronic pain, rather they are perceived as a course of action undertaken in case treatment goals and benefits cannot be achieved by nonopioid therapy (Centers for Disease Control and Prevention [CDC], n.d.). For the same purposes, it is advised to prescribe immediate-release opioids of the lowest effective dosage (CDC, n.d.). Besides, the patient’s condition should be carefully monitored during the first weeks of opioid medication, and clinicians should also evaluate risk factors and include risk mitigating strategies in the course of treatment (CDC, n.d.). As CDC tries to nullify the possibilities of illicit use of prescribed drugs, clinicians are advised to use urine testing and, in general, minimize the prescription of opioid medication (CDC, n.d.). Federal guidelines, nonetheless, are complemented by state regulations.
Registration and Prescription
In New Jersey, there are specific state requirements, following CDS registration and prescription. Firstly, there is an application fee for CDS registration, depending on the status of the individual (New Jersey Division of Consumer Affairs, 2020b). Secondly, health practitioners are expected to check designated Schedules on CDS and, by all means, obtain New Jersey state registration (New Jersey Division of Consumer Affairs, 2020b). APNs in New Jersey are entitled to prescribe substances from Schedules II, III, IV, and V (“Mid-level practitioners authorization by state,” n.d.). These include both substances with high abuse potential, such as opium, morphine or codeine, and others with lower abuse potential (“Mid-level practitioners authorization by state,” n.d.). The CDS requirements do not include general recommendations on patient management procedures, but there are specific aspects of prescribing, scheduling, dispensing, dosing and refilling a specific drug. Preparation of dosages is possible in cases where the dosage regimen of a drug involves changing the regimen or method of use. In each particular case, nurses should provide patient education, manage pain medication agreements, track pill count, and disposal.
Concluding Points
The final goal of federal and state regulations is, undoubtedly, the increase of transparency and safety in nursing practice. This goal sometimes results in restrictions that harm the integrity of the treatment processes. Some studies highlight gender-related issues regarding the lack of full practice authority for nurses – it is proven that states with conservative agendas are more likely to deny nursing practitioners the full extent of their licenses (Lugo, 2016). Moreover, as medical boards of the states have most of the resources under their control, it is challenging to push legislation on loosening some of the existing restrictions (Lugo, 2016). Therefore, as the issue remains highly politicized, it seems impossible to discuss the implications of the existing limitations on the safety or quality of APN practice.
References
- Centers for Disease Control and Prevention. (2018). CDC guideline for prescribing opioids for chronic pain. Web.
- Drake, S., & Torre, C. (n.d.). New Jersey advanced practice nurses. Web.
- Lugo, N. R. (2016). Full practice authority for advanced practice registered nurses is a gender issue. The Online Journal of Issues in Nursing, 21(2), doi: 10.3912/OJIN.Vol21No02PPT54
- Mid-level practitioners authorization by state. (2020). Web.
- New Jersey Division of Consumer Affairs. (2020). New Jersey Board of Nursing. Web.
- New Jersey Division of Consumer Affairs. (2020a). New Jersey Board of Nursing. Web.
- New Jersey Division of Consumer Affairs. (2020b). New Jersey Drug Control Unit. Web.