In 2008, the National Council of State Boards of Nursing (NCSBN) in conjunction with the Advanced Practice Nursing Consensus Work Group released the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. The purpose of this consensus model was to standardize regulation of APRN roles. One of the recommendations in this consensus model was the transition of APRNs to independent practice (full prescriptive authority). The governing bodies also gave timelines for completion and incorporation of their recommendations into practice. Although many recommendations were made, no specifics were provided on how individual states and organizations should meet these requirements. Many states and organizations have therefore been left with the burden of figuring out how to implement these recommendations. As we know, change is not easy, and in order for change to produce the desired results, it has to be implemented in a way that addresses all stakeholder concerns. As the VA transition to APRN independent practice, no specific guidelines exist that will guide this transition. Thus, the purpose of this study is to use focus groups to understand the barriers and facilitators in implementing APRN full prescriptive authority in VA facilities and to develop a policy to address the same.
Research Questions
- What are the barriers and facilitators of NP achieving their full prescriptive authority?
- How has implementation of NP prescriptive authority been done?
- Specifically for Psychiatric Mental Health NPs, how does full prescriptive authority affect them considering a significant number of medications they prescribe are still controlled substances?
Methods
This is a systematic review of literature. All articles related to the three research questions and written between 2014 and 2017 will be of interest. Using the PRISMA method and checklist, a systematic review will be written to help evaluate the existing knowledge on the subject and identify a need for a new study. Research databases used include CINAHL, PubMed, Psych Infor and Google Scholar. Key words include APRN full prescriptive authority, barriers and facilitators, and psychiatric mental health NP. Search words include non-medical prescribing, nurse practitioner full prescriptive authority, implementation of non-medical prescribing, APRN barriers to prescription, implementation of APRN prescribing, and Psychiatric NP prescriptive authority. The initial literature search yielded 30 articles. After careful consideration, 18 articles that met the inclusion criteria for the study were chosen. These were examined for significance and relevance to topic.
Results
There is a large amount of literature on the feelings of patients related to care provided by NPs. Some literature exists about the barriers and facilitators of NP achieving their full potential. Most of these research articles are done using qualitative methods. There is a lack of concrete descriptions regarding how the implementation of NP prescriptive authority has been done, but there are studies describing the feelings and questions of other members of multidisciplinary teams. No articles were found talking directly about Psychiatric Mental Health NPs. This indicates a need for more research to be carried out on this subject.
Conclusion
- we need more regulation related to implementation
- need policy and procedure across board
- need recommendations related to educational requirements for full practice authority
- need a collaborative model that includes all stakeholders such as APRN, administrators, physicians, and staff nurses to address the implementation of full prescriptive
Implications for Practice
This information will be used as a basis to propose a research study related to understanding barriers and facilitators of APRN full prescriptive authority that is interdisciplinary in nature and takes into account stakeholder concerns and will eventually lead to a policy/procedure recommendation on how this can be achieved in various practice settings.
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters