Comparison of Prescriptive Authority in Wyoming and Texas

Prescriptive authority is the concept that involves advanced nurse practice in which the practitioner can prescribe medication and therapy in clinical medicine. Full prescriptive authority is exercised by advanced nurse practitioners who work in Wyoming after meeting some recommended qualifications. However, full prescriptive authority faces some challenges and is not without opposition both inside the United States of America and on the international level. Autonomy, more accessible healthcare and realization of career aspirations are some of the arguments for full prescriptive authority and are enjoyed in states where this is practiced such as in Wyoming. Clearly outlined policies, plenty of direction and supervision are some of the pros of restricted prescriptive authority practiced in states such as Texas. The purpose of this work is to compare and contrast the regulations on prescriptive authority in the state of Texas and Wyoming and determine the state that is most suitable for a prosperous career in advanced nurse practice.

The authority of advanced practice nurses to offer medicine, equipment, or therapy prescriptions to a patient is referred to as prescriptive authority. In America, for an advanced practice nurse to have full prescriptive authority depends on several factors the chief of which is the prescriptive authority regulations of the state in which he or she wants to work in. Some states have restricted prescriptive authority which means that nurses cannot prescribe treatment and medication without the oversight of a physician (Mitchell & Spitz, 2015). In other states, nurses have moderated authority which means that they are allowed to carry out some prescriptions while are restricted in those that are deemed too complicated for advanced practice nurses to carry out (McGee, 2009). In the State of Texas, regulations dictate fully restricted prescriptive authority while in the State of Wyoming advanced nurse practitioners have full practice authority which means that they have full prescriptive authority.

One of the reasons the State of Wyoming has adopted the policy of full prescriptive authority is so that access to primary health care is increased for the majority of residents of the State. In this state, the only requirement is a compulsory 30 hours of training in pharmacology and drug therapy clinical management. An alternative prerequisite is phamacotherapeutic training of the same duration. Physician involvement is not required for nurse practitioner prescriptive authority in Wyoming. Also, Nurse Practitioners have the authority to prescribe schedule III-V controlled substances (Ambrose & Tarlier, 2013). Prescriptive authority allows nurse practitioners to prescribe legend drugs and controlled substances though registration for a DEA number is required.

Prescriptive authority has been a controversial topic in healthcare circles. Those against the issue assert that advanced nurse practitioners are not fully qualified with all the necessary knowledge to prescribe therapeutic and medical interventions appropriately. On the other side, due to the need to meet healthcare serviced demands, nurses are in some ways already prescribing medication albeit outside legal oversight. Therefore the crux of the issue is not whether nurses should prescribe but to what extent. Therefore, with the right system in which nurses gain credentials to prescribe medication and therapies under a regulated system and ultimately achieve the full potential of their practice.

There are benefits of practicing in the State of Wyoming as well as some risks associated with the full prescriptive authority. The benefits include the autonomy, and flexibility that a practitioner may have which would enable the practitioner to offer individualized primary healthcare services as opposed to physician practitioners who use a more generalized template. The higher number of advanced nurse practitioners compared with physicians also is an added advantage as healthcare services can reach more people including those whose access to health care is adversely affected by their low social-economic status. On the risks side, the most significant risk is the responsibility for making medical decisions that are often complex and can result in complications whenever insufficient experience, knowledge or guidance can lead to problems for the patient, the practitioner and their hospital (Gardenier, Thomas & O’Rourke, 2016). All in all, the greatest advantage of working in Wyoming as an advanced nurse practitioner is the available opportunities to make a difference in healthcare by realizing career aspirations and helping more people regain their health in the best way that fits them.

Practicing in the state of Texas under restricted prescriptive authority has its advantages and drawbacks. The major advantage is that with the authority to prescribe medication and therapies being the responsibility of the physician, the advanced nurse practitioner can provide supportive services that maximize the comfort of the patients (Tran, 2020). Having nurses’ authority to prescribe restricted helps in preventing situations where the advanced nursing practice may experience failure due to insufficient supportive infrastructure (Rapsilber, 2015). The disadvantage to having restricted prescriptive authority in place in Texas could be contributing to some practitioners becoming complacent and updating their knowledge only to remain competent instead of striving to meet their fullest potential (Barton, Hannum, Lindsey & Towle, 2021). Practicing in Texas is the safer option if an advanced nurse practitioner is not able to keep up with the quickly shifting landscape that is the healthcare legislation, where many healthcare workers find themselves in a constant dilemma over how to do their job.

The state of Texas fully restricts prescriptive authority while in the state of Wyoming full prescriptive authority is exercised. The advanced nurse practitioners in Wyoming is free to exercise their knowledge fully and can practice without oversight from a physician which enables them to reach more people who might otherwise have significant difficulty in accessing physicians who are fewer in number and thus more expensive. With an appropriate regulation system in place combined with proper support in terms of resources, access to knowledge and sufficient training/ career advancement opportunities full prescriptive authority is the best option for advanced nursing practice. The most significant barrier to the realization of this prospect is the complications that arise from rapidly changing legislation in the healthcare industry which becomes less of a problem if the burden is transferred to physicians. Practicing in the State of Texas is advantageous in that nurses enjoy the guidance of physicians in all matters but face the danger of stagnating career-wise due to the lack of motivation to explore the various full practice opportunity. As for me, practicing in Wyoming is the final goal but for now, I am content to gain knowledge, skills and experience in Texas under the guidance of physicians to feel more confident to eventually establish my own practice.

 

 

 

 

 

 

 

 

References

Ambrose, M., & Tarlier, D. (2013). Nurse Practitioners and Controlled Substances Prescriptive Authority: Improving Access to Care. Nursing Leadership, 26(1), 58-69. doi:10.12927/cjnl.2013.23303

Barton, M. J., Hannum, B. C., Lindsey, M., & Towle, T. (2021). The Path Toward Full Practice Authority: One State’s Strategy. The Journal for Nurse Practitioners, 17(2), 147-152. doi:10.1016/j.nurpra.2020.09.011

Gardenier, D., Thomas, S. L., & O’Rourke, N. C. (2016). Will Full Practice Authority Mean Higher Malpractice Premiums for Nurse Practitioners? The Journal for Nurse Practitioners, 12(2), 78-79. doi:10.1016/j.nurpra.2015.11.013

McGee, P. (2009). Advanced practice in nursing and the allied health professions. Chichester, U.K.: Wiley-Blackwell.

Mitchell, K. A., & Spitz, A. (2015). Use of Advanced Practice Providers as Part of the Urologic Healthcare Team. Current Urology Reports, 16(9). doi:10.1007/s11934-015-0535-5

Rapsilber, L. (2015). Connecticuts Journey to Full Practice Authority. The Journal for Nurse Practitioners, 11(2), 272-273. doi:10.1016/j.nurpra.2014.10.033

Tran, A. Q. (2020). Full practice authority for nurse practitioners: is it right for Texas? (Doctoral dissertation).