KBN`s position and interpretation of applicable laws and regulations was that Kentucky`s APRN independently operate an advanced nursing practice. Legal advice on APRNs as independent practitioners can be found in the document library. Here`s a summary: Some drugs like Adderall, oxycodone, testosterone, ambien, and cough syrup with codeine still require a cooperation agreement. Of the state`s 5,410 nurses, 1,948 have an agreement to prescribe these more restrictive drugs, according to the Kentucky Board of Nursing. APRN are required to prescribe a cooperation agreement with a doctor. At the national level, however, stakeholders doubt that this approach is really an innovative compromise. “Making it easier for someone to carry out an unnecessary burden to meet the requirements does not negate the fact that it is a burden,” said Tay Kopanos, AANP vice president for state government affairs. She said the cooperation agreement for controlled drugs, which the government considers more dangerous and addictive, is a major obstacle. Currently, 19 states require NPs to have a full collaboration agreement throughout their careers, and another 12 require supervision or team management with a physician, with these nurses prescribing through physicians, according to the American Association of Nurse Practitioners (AANP). Formalized cooperation agreements with forms signed by the NP and the physician can be very different. Kentucky, for example, has never required doctors to review the prescribing habits of NPs or meet with them regularly, but some states do.

“I called a dozen doctors,” Pittman said, recalling their frantic feuds after the deals ended. Both times, she left empty-handed and had to close her practice for four days, losing about $12,000. “It was eating away at my budget and many patients complained about not being able to be seen, not being able to get their refills,” said Pittman, who under the new law no longer needs to be associated with a cooperating doctor to prescribe most of the drugs. For nearly two decades, state nurses have only been able to prescribe drugs such as antibiotics and blood pressure medications if they have a cooperation agreement in place with a doctor who can charge a fee for it. But when the doctor withdrew from the agreement, the nurses were forced to find other doctors or limit their practices by not prescribing. Most practices can`t survive simply by performing diagnostic tests and physical exams, according to Beth Partin, vice president of the Kentucky Coalition of Nurse Practitioners & Nurse Midwives. Nothing in the regulation prevents APRN from opening its own practice. However, all [nurses] are responsible for making decisions based on the person`s nursing preparation and experience and must practice nursing with appropriate skill and safety. See KRS 314.021. Nursing practice should comply with Kentucky`s nursing laws, established standards of practice and evidence-based.

Sheila Schuster, a lobbyist for the Coalition for Nurses and Midwives, said the replacement of the career requirement with the four-year cooperation agreement “is an important step forward in reaffirming independent practice.” Kopanos and other proponents point to a 2006 Colorado law that requires a newly graduated NP to ask a doctor to sign all prescriptions for the first 1,800 hours of practice. Next, they must complete 1,800 hours of overtime as part of a formal mentoring agreement with a physician who needs to review their prescribing habits. This setting would have made a big difference for Brenda Pittman, a nurse at Mt. Sterling, Ky. One doctor withdrew from an agreement with her in June 2013, while another did so last March. In both cases, the doctor`s offices were purchased by large hospital systems that did not allow them to continue the agreements. The act establishes a six-member committee to create a list of physicians who are willing to enter into these agreements. If the nurse does not find anyone on the list within 30 days, the committee must provide a physician. After four years, NPs no longer need an agreement to prescribe most medications. “The concern is that you don`t know what you don`t know,” said Robert McLean, an internist in New Haven, Connecticut, where a 2014 state law requires nurses to spend 2,000 hours in a collaboration agreement with a doctor before practicing independently. “There are a lot of nurses who provide good services, but if you pass a law that allows them to be independent, even if they are not experienced, how many patients will receive less than ideal care?” AprN Prescriptive Authority Collaborative Prescriptive Agreements (CAPA).

In addition, physician ownership and involvement is required for licensed pain management facilities. A pain management facility is one where more than 50% of patients receive pain treatment that involves the use of controlled substances, and pain management is advertised by the facility or is the primary practice component of the facility. See KRS 218A.175. On the next page, you will learn more about other points related to the prescription of controlled substances APRN prescription of controlled substances. . Joanne Spetz, a professor of health policy studies at the University of California, San Francisco, who specializes in staffing issues, says the success of Kentucky`s law will depend on the new committee`s ability to establish the necessary level of cooperation. . The required forms must be submitted by uploading them to the KBN APRN portal. “Your main task will be to ensure that a sufficient number of doctors are available to work together as NPs develop their knowledge of prescribing and gain the trust of the provider community,” she said.

It is possible that the panel “does not have sufficient resources to do this work effectively” or “is hampered by other policy issues,” she added. The remaining 19 states and the District of Columbia allow nurses to practice independently of a doctor. Of these, five states, in addition to Connecticut — Minnesota, Vermont, Nevada, Maine, and Colorado — require NPs to spend some time in an agreement with a doctor before receiving independent prescribing rights. . “Kentucky will face a significant influx of Medicaid recipients [under the Health Care Act], and right now there aren`t enough doctors to walk around,” said Dr. Nancy Swikert, vice president of the Kentucky Medical Association Alliance Foundation. “We hope that rural doctors will be able to find NPs and hope that NPs will find doctors to help them. We hope this is a win-win situation. » APRNs should familiarize themselves with four required CAPA forms: All KBN documents and forms can now be found in our document library… The new law, passed earlier this year, offers much more flexibility to experienced NPs and creates a framework that helps those who don`t have four years of cooperation find a doctor willing to oversee their work.

. The law that makes this possible was passed after five years of legislative debate. Nurses in other states are fighting for more authority in treating patients at a time when there is growing concern about the impact of federal health care law. As more and more Americans buy insurance, there may be a shortage of primary care doctors, especially in states like Kentucky, which have many rural areas. From 15. In July, Kentucky nurses who completed a four-year collaboration with a doctor are allowed to prescribe routine medications without medical intervention, a significant change that could help improve consumer access to care. “Hope and promise. did not happen. So when I see other state legislators making similar compromises. it`s hard to .

expect a different outcome,” Kopanos said. This move also established the Nurse Physician Advisory Working Group for Colorado Healthcare, Kopanos said. While it doesn`t have the same mandate as the Kentucky Committee, she and others had hoped the law would help NPs transition into practice, but so far it`s been a disappointment. . This khn story also clashed with it. It can be republished for free. (Details) Kentucky`s action offers a possible compromise for states trying to define the roles of nurses while allaying doctors` concerns. However, some experts doubt that this approach is a model for others. State Senator Paul Hornback, a Republican who was the bill`s main sponsor, said the four-year rule seemed appropriate because it somewhat mimicked the concept of a medical residence. “I didn`t think it was fair for an IP to get straight out of school and open his own practice,” he said. The real problem, he added, was finding doctors willing to work together. You must designate us as the original publisher with a hyperlink to our website khn.org.

If possible, please enter the original author(s) and “Kaiser Health News” in the signature. Please keep the hyperlinks in the story. Nurses with at least a college education have long argued that in primary care, pediatric care and women`s health, they are qualified to treat chronic diseases and provide preventive services without medical supervision. On the other hand, there are those who say that these health professionals do not have the practical experience or academic training to provide the same quality of care as doctors who go through years of training and specialized training. We encourage organizations to republish our content for free. Here`s what we`re asking:. It is important to note that not everything on khn.org is available for a reissue. If a story is labeled “All Rights Reserved,” we can`t grant permission to republish that item…