Healthcare Policy

Problem Identification

Healthcare policies in the United States include the creation and implementation of law and regulations in order to help in the management of the federal and state healthcare system. According to the National Conference of State legislatures (n.d), every year, the 50 state legislatures create and implement health policies, which often oversee the operations of public and private hospitals for the collective good of the community and medical staff. The decisions usually range from an appropriation of budgets, insurance coverage, medical staff license requirements, management of personal health, and immunizations among others. Essentially, in the United States, the controlled substances act is the federal drug policy that oversees the regulation of manufacturing and distribution of controlled substances to the public. The Act classifies drugs into five schedules depending on their potential for abuse, medical benefits, and their status within the international treaties. Schedule I controlled are drugs with a high risk of abuse and mostly not accepted for medical use in the United States (“Controlled Substances Act,” n.d). Schedule II also have a high potential for abuse and may lead to severe psychological and physical dependence. Nonetheless, schedule II to VI are often prescribed to patients and have fewer restrictions on supply. Unfortunately, as a way of managing controlled substance use, patients are supposed to have an appointment with an authorized prescriber to get new prescriptions or refills. In clinics with a high demand of patients requiring controlled substances and a limited number of prescribers, it becomes hard to handle as many patients as is necessary. In response, the State of Florida proposed a bill of law that sought to address the advocacy by the nursing community to improve the health of Florida society by allowing more healthcare personnel to prescribe and administer controlled substances.

Florida HB 423 – ARNP/PA Controlled Substance Prescribing

On April 14, 2016, the HB423 was passed into law allowing Physician Assistants and Advanced Registered Nurse Practitioners to prescribe controlled substances listed in Schedule II, III and IV as defined by the s. 893.03 Florida Statutes (“Florida HB 423 – ARNP/PA Controlled Substance Prescribing,” n.d). Under the new law, the ARNP and PA’s have been granted privileges for prescribing controlled substances but limited to prescribing for children under the age of 18 years unless the ARNP is a psychiatric nurse. The bill is also clear on that, only allopathic physicians licensed under chapter 458 or osteopathic PAs licensed under chapter 459 of Florida statutes have the authority to dispense drugs or prescribe controlled substances.

Legislators involved in the Making of the Policy

The creation and implementation of the bill into law was formulated by a committee comprising of 7 members selected from various professionals (“Florida HB 423 – ARNP/PA Controlled Substance Prescribing,” n.d). Among them were three ARNP’s who was appointed by the Board of Nursing, three MDs or Dos who were recommended by the Board of medicine and a doctor recommended by the Pharmacy Board. The committee was to sit and come up with a formula of controlled substances that ARNP’s are allowed to prescribe or may prescribe for limited quantities or specific uses.

Role of APRN in Assisting with the Policy

Administration of drugs is not only a part of a nurses’ job but also constitutes of most of their work. Within the hospital settings, Pirinen, Kauhanen, &  Danielsson-Ojala (2015) note that one patient may require multiple scheduled or unscheduled drug doses per day. In the case of unscheduled treatments, these are not planned and if the nurse is not authorized to administer drugs discontinuities in work may occur. Thus, nurses play a significant role in promoting drug prescription and administration in the absence of physicians or prescribers. Unfortunately, while nurses have been authorized to prescribe and administer other forms of medication; controlled substances have sparked many debates with some states in the United States prohibiting the ARPNs from prescribing. Nonetheless, in the 2016 legislative session, Florida passed a bill that granted advanced registered nurse practitioners and physician assistants the mandate to prescribe controlled substances subject to approval by the supervising practitioner. By large, this brings a significant change in the professional authority in accordance with what other States in the United States allow. For the ARNPs, this means that they are allowed to give prescriptions, dispense, and administer controlled drugs under the supervisory arrangement of the practitioner in charge.

Policy Influence on Clinical Practice and Promotion of Best Outcomes

In the United States, there is a shortage of primary caregivers, with the impact being exacerbated by the Affordable Care Act that increased access to health care without increasing the number of providers. Essentially, nurses and physician assistants have the ability to alleviate the primary care shortage that is facing the United States if only their scope of practice is not limited by the state regulation. Such limitations have been in existence in respect to physician assistants and nurse practitioners involvement in treatment, diagnosis, prescriptive authority, and controlled substances (Gadbois, Miller, & Tyler, 2015). By allowing the ARNPs to prescribe controlled substances, they fill the gap between service needs and care capacity that will, in turn, alleviate the primary care crisis and ensure a cost-efficient means of supplying much-needed care provided by more highly trained physicians.

Using the Policy in Coordinated and Comprehensive Care

Within the healthcare settings, interprofessional teams are groups of individuals with different healthcare disciplines working together towards achieving a common goal in order to meet the needs of a patient population (Hardin, Kilian & Hardin, 2017). When such teams work together, they divide the work based on their scope of practice, share information, and coordinate processes and interventions to provide quality services to patients. Challenges in interprofessional teams, which include disorganized patient records, an improper organization of work, and lack of resources are some of the problems contributing to patient’s medical problems. In this context, a collaboration between inter-professional teams can be achieved through sharing of tasks, where one party is not overburdened with dug prescription and other responsibilities such as patient drugs recording. The other way to enhance inter-professional collaboration is by sharing pharmaceutical knowledge and developing tools for comprehensive and quality care.

Conclusion

For a long time, the issue of controlled substances and the professionals authorized to prescribe and administer these drugs has sparked a lot of interest with a majority of the States allowing Nurse Practitioners and Physician Assistants to prescribe and administer controlled substances. In Florida the law, which came into effect in January 2017 allowed ARNPs and PAs to prescribe and administer controlled substances. By far, the policy is expected to improve the quality of care in treating the local population, especially in rural areas. In fact, it is a significant step in removing obstacles in the delivery of healthcare.

References

“Florida HB 423 – ARNP/PA Controlled Substance Prescribing.” (n.d). Florida Association of Nurse Anesthetists. Retrieved from: http://fana.org/florida-hb-423-arnppa-controlled-substance-prescribing/

Controlled Substances Act. (n.d). FDA. Retrieved from: https://www.fda.gov/ohrms/dockets/ac/03/briefing/3978B1_07_A-FDA-Tab%206.pdf

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, 72(2), pp. 200-219.

Hardin, L., Kilian, A., Hardin, L., Kilian, A., & Spykerman, K. (2017). Competing health care systems and complex patients: An inter-professional collaboration to improve outcomes and reduce health care costs. Journal of Interprofessional Education and Practice, 7(),pp. 5-10.

National Conference of State legislatures. (n.d). Health. Retrieved from: http://www.ncsl.org/research/health.aspx

Pirinen, H., Kauhanen, L., Danielsson-Ojala, R., Lilius, J., Tuominen, I., Díaz, R. N., & Salanterä, S. (2015). Registered Nurses’ Experiences with the Medication Administration Process. Advances in Nursing, 2015(1), pp. 1-10.