Paper Sample on Advanced Practice Nurse Prescribing Rights in Iowa

In the United States, nursing practices vary between states. Several bodies across America have been fighting for full practice authority (FPA) to meet the increasing demand for qualified nurses. The Iowa board of nursing regulates nursing practice by enacting a code specific for the state found in chapter 152 of the state law. In Iowa, there are provisions for requirements, scope, and standards of practice for Advanced Practice Registered Nurses (APRN), Registered Nurses, and Licensed Practical Nurses. There are some variations, specific to the state, but the provisions align with those of the American Association of Nurse Practitioners (AANP). Over the years, there have been several changes in APRN prescribing practices. This paper focuses on those changes that occurred in the state of Iowa and assesses their alignment with AANP's provisions.

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Prescribing is among the duties of APRNs nationwide. They can prescribe controlled drugs, services, medical devices, and other supplies, which allows the provision of quality, cost-effective, and timely care. In its position statement, AANP gives state boards the sole authority to regulate this practice while abiding by the education, certification, and role of APRNs. The Association offers these prescriptive privileges to all nursing practitioners in all states and DC. However, it is up to the nursing regulation boards to dictate how to implement them.

The state of Iowa gives APRNs full authority to practice independently within their area of speciality without physician supervision. They do not have to enter into a contract with doctors about prescription as it happens in other states. In this regard, nursing practitioners have the privilege to admit, diagnose as well as prescribe medications, including controlled substances autonomously. This practice requires the possession of a current active license and adherence to state laws as required by AANP. Besides, APRNs need to register with the Iowa Pharmacy Board and the Drug Enforcement Administration (DEA) to prescribe controlled substances. This provision ensures responsible prescription and use of potentially addictive drugs that could cause harm to users and the public. It is per the principles and ethics of nursing, as it helps practitioners avoid causing damage.

In 2019, the Centers for Disease Control and Prevention (CDC) enacted legislation requiring APRNs to undergo continuing education (CE) about opioid prescriptions. The Iowa board of nursing acted per this law and implemented policies to ensure compliance. Any nursing practitioner who prescribes opioids during the renewal cycle has to undergo CE for at least two contact hours. The rationale is to refresh one's knowledge about the guidelines for opioid prescriptions for chronic pain provided by the CDC. Besides, the learning includes risk factors for abuse, the recommended length of medication and dosage limit, as well as non-pharmacologic and non-opioid therapy options. These changes have allowed nurses to limit the unnecessary prescription of these potentially addictive drugs, putting them at the forefront of combating the growing pandemic.

It is mandatory for APRNs who prescribe opioids seeking license renewal every three years to complete this continuous education. Since 2019, the Iowa board of nursing has made it a requirement to abide by these provisions and provide documented evidence of the opioid CE hours to keep prescribing in the state. This policy aligns with AANP's prescriptive position statement that prescribing APRNs have to abide by nursing education and certification requirements. It ensures that the practitioners keep up to date with emerging trends in the field and changes in CDC's regulations about the prescription of controlled substances.

In 2009, Iowa implemented a Prescription Monitoring Program (PMP) and allowed PRNs to participate. It established a database for prescribers, including nursing practitioners, and pharmacists to record information about all dispensed controlled drugs. From that time, APRNs had to document requests for all prescriptions they made to create history reports for individual patients. The data is disposed of after four years of entry to creating room for new listings. The growing crisis of opioid abuse inspired this change. With this database, it is possible to track prescription habits, as healthcare professionals can access a summary of their patients' use of controlled drugs. This practice helps in determining the most appropriate therapy options for the best quality of care. Prescribers can identify potential misuse, abuse, or diversion of these substances by their clients while facilitating the most effective and appropriate clinical use.

The introduction of the PMP database is in line with AANP's prescriptive privileges for nurses. The Association's only requirement is that prescription practice abide to roles, education, and certification of nursing practitioners. According to Ranapurwala et al. (2019), nurses have a responsibility to protect life and avoid causing any harm to patients. This duty includes preventing addiction resulting from abuse, misuse, or eversion of controlled medical substances. They should be at the forefront of fighting against the opioid crisis that is ravaging young and older people in the US. As part of this responsibility, APRNs must avoid aiding malicious use of drugs that can cause addiction and other adverse effects. Requiring nurses to adhere by PMP has helped prevent irresponsible prescription and aversion of drugs, which has aided in the control of the growing opioid catastrophe. According to a survey by Ranapurwala et al. (2019), opioid pain reliever prescriptions reduced significantly following the implementation of PMP. It has promoted evidence-based practice and accountability as per the requirements of competent nursing practice.

In 2018, the state of Iowa passed a law requiring the transmission of all prescriptions to the pharmacy to be electronic by January 1, 2020. This provision requires all prescribers, including nursing practitioners, to adopt an e-prescription system of all drugs, both controlled and non-controlled. It aimed to get rid of excess paperwork that is prone to errors and alterations and replacing them with advanced software that removes these shortcomings. According to Porterfield et al. (2014), e-prescriptions saves on time and cost and eliminates mistakes that may occur from handwritten notes.

Currently, most facilities in the state have not successfully transitioned from the old manual to the old electronic system. The Iowa Board of Pharmacy (2019) reported 67.6% of prescribers in Iowa who have complied with the requirement. While AANP does not directly say anything about the use of technology while prescribing, such changes improve the quality of care, which is in line with nursing practice. E-prescription is going to streamline clinical practice, thus removing loopholes for potential diversion. As a result, misuse and abuse of medical substances will reduce, leading to fewer cases of addiction, overdose, and death. The change also improves patient satisfaction and compliance.

Conclusion

Iowa is among the states where APRNs can practice independently in America. Its regulations and policies allow these practitioners to act as primary care providers without having to collaborate with physicians. Over the years, systematic changes have accorded APRNs in this state the privilege to prescribe medications, including controlled substances autonomously, medical devices, and services. This practice has allowed the provision of quality, cost-effective and timely care for Iowans. The Iowa board of nursing recently made it compulsory for all APRNs who prescribe opioids to undertake continuing education provided by CDC about the practice after every three years to renew their licenses. This policy aligns with AANP's prescriptive position statement that APRNs have to abide by nursing education and certification requirements. In 2009, Iowa implemented a Prescription Monitoring Program (PMP) where all prescribers, including nursing practitioners, have to record information about all dispensed controlled drugs in a database. The most recent change has been the requirement to transmit all prescriptions electronically to streamline clinical practice and eliminate loopholes for diversion. As a result, the abuse and misuse of opioids in Iowa have been declining.

References

Iowa Board of Nursing. (n.d.). Iowa Prescription Monitoring Program (PMP). Retrieved from https://nursing.iowa.gov/practice/arnp-role-scope/iowa-prescription-monitoring-program-pmp

Porterfield, A., Engelbert, K., & Coustasse, A. (2014). Electronic prescribing: improving the efficiency and accuracy of prescribing in the ambulatory care setting. Perspectives in Health Information Management, 1. (Spring).

Ranapurwala, S. I., Carnahan, R. M., Brown, G., Hinman, J., & Casteel, C. (2019). Impact of Iowa's prescription monitoring program on opioid pain reliever prescribing patterns: An interrupted Time-Series Study 2003–2014. Pain Medicine, 20(2), 290-300.

The Iowa Board of Pharmacy. (2019). News. Retrieved from https://nabp.pharmacy/wp-content/uploads/2016/06/Iowa-Newsletter-September-2019.pdf