Access to primary care in the United States has been a significant issue for years, with the primary care physician (PCP) shortage leaving many Americans without adequate healthcare. According to projections by the Association of American Medical Colleges (AAMC), 83 million people in the US are affected by this problem.

Unfortunately, the situation is not expected to improve anytime soon, with projections indicating that the shortage will worsen by 2030. Nurse practitioners (NPs) have been suggested as a potential solution to address the issue. However, only 22 US States grant nurse practitioners full practice authority, allowing them to prescribe medications without physician supervision.

In this article, we will explore how nurse practitioners could be vital to resolving the primary care shortage. We will examine what NPs can do, particularly in prescribing medication, and how this varies throughout the country.

Key Takeaways

  • Nurse Practitioners (NPs) have varying levels of authority to prescribe medications depending on the state or country in which they practice. Different laws regulate this authority to an extent that can impact their practice.
  • In some states, NPs have full practice authority, allowing them to prescribe medications independently. However, in other states, they may need a collaborative agreement with a physician or additional certifications.
  • When it comes to prescribing controlled substances like narcotics or ADHD medications, NPs may require a DEA number, and they must comply with specific regulations, including additional educational requirements or restrictions.
  • NPs can prescribe a wide range of medications, from antibiotics and antihypertensives to more specialized drugs like antidepressants, pain management medications, and even birth control, which highlights their role in providing comprehensive patient care.
  • NPs are essential in increasing healthcare accessibility, particularly for underserved populations or areas, by providing essential services, including prescribing medications.
  • To ensure safe and effective patient care, NPs must stay informed about the latest healthcare practices, including medication prescribing guidelines and laws, through ongoing education and compliance with state and federal regulations.

What Is a Nurse Practitioner?

A nurse practitioner standing outside her office

Nurse practitioners (NPs) are advanced practice registered nurses (APRNs) who have completed a master’s or doctoral degree program and have advanced clinical training beyond their initial professional registered nurse preparation. This training includes classroom education and clinical experience, covering key areas such as advanced pathophysiology, pharmacology, and physical assessment.

Unlike registered nurses (RNs), who primarily provide general care and support under the direction of physicians and NPs, nurse practitioners have the authority to perform more complex tasks such as diagnosing and treating illnesses. While they share some overlapping responsibilities with doctors, NPs typically have a more focused area of practice. They are known for spending more time on patient education and follow-up care.

Below are some of the common tasks that NPs usually perform:

  • Collect and document medical histories and symptoms.
  • Conduct physical examinations.
  • Request diagnostic tests, like lab tests or X-rays.
  • Review test findings.
  • Identify and address illnesses, diseases, and health issues.
  • Develop patient care plans.
  • Recommend medication.
  • Provide referrals to specialists.
  • Offer guidance on maintaining good health.

How Does the Ability to Prescribe Medication Vary Among Nurse Practitioners?

Nurse practitioners may be granted one of three levels of scope of practice depending on the state in which they practice: Full Practice, Reduced Practice, or Restricted Practice. These levels determine how much care NPs can provide, including their ability to prescribe medications. The level of scope of practice defines the authority of an NP to perform specific medical functions, including prescribing medications. This directly affects their daily responsibilities and the care they can offer to their patients.

Full Practice

This represents the highest level of autonomy for NPs. In states that offer full practice authority, NPs can evaluate and assess patients, make diagnoses, order and interpret diagnostic tests, and prescribe medications without a supervising physician. This level of practice allows NPs to operate more independently, providing comprehensive care to patients and prescribing medications as needed. States that grant full practice authority include:

  • Alaska
  • Arizona
  • Colorado
  • Connecticut
  • Guam
  • Hawaii
  • Idaho
  • Iowa
  • Maine
  • Maryland
  • Minnesota
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Mexico
  • North Dakota
  • Northern Mariana Islands
  • Oregon
  • Rhode Island
  • South Dakota
  • Vermont
  • Washington, D.C.
  • Wyoming

Reduced Practice

Under the reduced practice scope, NPs have limited autonomy compared to full practice. They must enter into a collaborative agreement with a physician to provide patient care. This doesn’t necessarily mean that a physician needs to oversee every action or decision an NP makes, but there is a formalized supervisory relationship. Depending on the specific state laws, NPs might be able to prescribe medications and perform certain other duties outlined under full practice, but with some restrictions. States with reduced practice authority include:

  • Alabama
  • American Samoa
  • Arkansas
  • Delaware
  • Illinois
  • Indiana
  • Kansas
  • Kansas
  • Kentucky
  • Louisiana
  • Mississippi
  • New Jersey
  • New York
  • Pennsylvania
  • Puerto Rico
  • Utah
  • Virgin Islands
  • West Virginia
  • Wisconsin

Restricted Practice

The most constrained level of practice, restricted practice, requires NPs to work under the close supervision of a physician throughout their careers. In this setup, NPs may be prohibited from performing certain tasks available under full practice, such as prescribing medications. The nature of this collaboration typically involves more direct oversight by a physician, limiting the NP’s autonomy in patient care decision-making, including the authority to prescribe medications. States with restricted practice authority include:

  • California
  • Florida
  • Georgia
  • Massachusetts
  • Michigan
  • Missouri
  • North Carolina
  • Oklahoma
  • South Carolina
  • Tennessee
  • Texas
  • Virginia

Who Can Legally Prescribe Medications?

Two female medical professionals

The authority to prescribe medications is significantly different among Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Advanced Practice Registered Nurses (APRNs), which includes NPs. Here are the details to clarify the differences:

Registered Nurses (RNs): RNs have completed either an associate’s or a bachelor’s degree in nursing and have passed the NCLEX-RN licensing exam. Their role primarily involves patient care, including checking vital signs, providing patient education, updating medical records, and administering medications as prescribed by a physician or an APRN. However, RNs need the authority to prescribe medications in any state, as their training focuses on patient care rather than diagnosing conditions or prescribing treatments.

Licensed Practical Nurses (LPNs): In some states, LPNs, also known as Licensed Vocational Nurses (LVNs), have completed a practical nursing program and passed the NCLEX-PN exam. Their scope of practice is more limited compared to RNs. It includes providing basic nursing care, monitoring patients, and reporting changes in patient conditions to RNs or physicians. Like RNs, LPNs do not have the authority to prescribe medications. Their role is supportive and focuses on direct patient care under the supervision of RNs or physicians.

Advanced Practice Registered Nurses (APRNs): APRNs represent a group of nurses with advanced degrees (most commonly, a Master’s of Science in Nursing or a Doctor of Nursing Practice) and specialized training in specific areas of healthcare, such as nurse practitioners (NPs), clinical nurse specialists (CNSs), nurse anesthetists (CRNAs), and nurse midwives (CNMs). APRNs have a broader scope of practice than RNs and LPNs, including diagnosing conditions, ordering and interpreting diagnostic tests, and prescribing medications.

Nurse Practitioners (NPs), a subset of APRNs, have significant education and clinical training beyond the RN level. They focus on advanced patient care, including pharmacology and managing various health conditions. This advanced training enables NPs to assess patient symptoms, diagnose, and prescribe appropriate treatments, including medications.

What Types of Medication Can Nurse Practitioners Prescribe?

Generally, NPs can prescribe a wide range of medications, including:

Prescription Drugs: NPs can prescribe most prescription drugs, including medications for chronic conditions such as diabetes, hypertension, and asthma.

Controlled Substances: In many states, NPs are authorized to prescribe controlled substances, including opioids, for pain management. However, this authority often has specific restrictions and requirements, such as additional certification or training in pain management and substance abuse. The level of autonomy NPs have in prescribing controlled substances also varies by state, with some requiring a collaborative agreement with a physician.

Antibiotics: NPs can prescribe antibiotics to treat bacterial infections. This is a common aspect of their practice, especially for family nurse practitioners and those working in primary care settings.

Mental Health Medications: Psychiatric nurse practitioners, who have specialized training in mental health, can prescribe psychotropic medications for conditions such as depression, anxiety, and bipolar disorder. Their advanced training enables them to assess, diagnose, and manage mental health conditions, including prescribing appropriate medication.

Hormonal Contraceptives: Women’s health nurse practitioners and family nurse practitioners often prescribe hormonal contraceptives as part of reproductive health and family planning services.

Immunizations: NPs can prescribe vaccines to protect against influenza, measles, and human papillomavirus (HPV).

Are There Special Considerations For Nurse Practitioners Prescribing in Specialized Care Areas?

Yes, they do. Specialized NPs must align their prescribing practices with the specific health needs of their patient populations and adhere to any additional regulatory requirements or certifications for their specialty area.

Special Considerations in Psychiatry

Psychiatric Nurse Practitioners (Psych NPs) focus on mental health care. They are authorized to prescribe psychotropic medications to manage mental health conditions such as depression, anxiety, bipolar disorder, and schizophrenia. Their training includes an in-depth understanding of psychopharmacology, enabling them to choose the appropriate medication based on a comprehensive assessment of the patient’s mental health condition, medical history, and potential drug interactions.

In some states, Psych NPs may need a specific certification to prescribe certain controlled substances, and they might be required to collaborate with or have oversight from a psychiatrist or other medical doctor.

Case Example: A Psych NP working in a community health center may prescribe SSRIs for depression, antipsychotics for schizophrenia, or mood stabilizers for bipolar disorder, along with providing psychotherapy and monitoring for side effects and efficacy of treatment.

Special Considerations in Pediatrics

Pediatric Nurse Practitioners (Pediatric NPs) care for infants, children, and adolescents. Prescribing medications in this population requires careful consideration of dosages, which are often weight-based, and an understanding of the pharmacokinetics and pharmacodynamics of medications in growing bodies.

Pediatric NPs must stay informed about vaccines, the pediatric immunization schedule, and the latest guidelines on using antibiotics and other medications in children to avoid over-prescription and resistance.

Case Example: A Pediatric NP may prescribe amoxicillin for a child with bacterial otitis media or an asthma controller medication for a child with asthma, considering the child’s weight, age, and any potential for growth suppression.

Special Considerations in Gerontology

Adult-Gerontology Nurse Practitioners (AGNPs) specialize in the care of older adults. They must consider the increased sensitivity to medications in this population, potential comorbidities, and the higher risk of polypharmacy.

AGNPs need to be familiar with the Beers Criteria, which lists potentially inappropriate medications for older adults due to the higher risk of side effects or interactions in this population.

Case Example: An AGNP might prescribe a lower dose of antihypertensive medication for an elderly patient with hypertension, taking into account renal function and the risk of orthostatic hypotension, which can lead to falls.

What Are the Benefits of Having Pre-Prescribing Rights for Nurse Practitioners?

Nurse practitioner discussing prescription medications with patient

Granting prescribing rights to nurse practitioners has significantly impacted patient care, healthcare access, and the healthcare system. These benefits align closely with emphasizing patient-centered care, disease prevention, and promoting healthy lifestyles. Below are the key advantages of nurse practitioners having the authority to prescribe medications:

  • Expanding Care in Underserved Areas: NPs often serve in rural and underserved communities where physicians may be scarce. Prescribing rights enable them to provide comprehensive care, including medication management, thus improving healthcare access for populations with limited or no access to these services.
  • Reducing Wait Times for Patients: By having the ability to prescribe, NPs can alleviate some of the burdens on the healthcare system, reducing wait times for appointments with physicians and specialists. This is particularly beneficial in primary care settings, where NPs can manage and treat various health conditions.
  • Continuity of Care: NPs are known for taking a holistic approach to patient care, considering the physical, psychological, and social aspects of a patient’s health. Prescribing rights allow them to implement comprehensive care plans that include medication therapy, lifestyle changes, and preventive measures, enhancing the continuity of care for patients.
  • Proactive Health Management: NPs emphasize disease prevention and health promotion. Their prescribing rights enable them to recommend and prescribe preventive medications, such as vaccines and drugs that lower the risk of disease development, and advise on healthy lifestyle choices.
  • Reducing Healthcare Costs: Studies have shown NPs can provide high-quality care at a lower cost than physician-led care. This is partly due to the lower cost of NP services and partly because of their focus on preventive care, which can reduce the need for more expensive treatments and hospital admissions.
  • Positive Outcomes: Research has consistently shown that patient outcomes under NP care, including patient satisfaction, hospital readmission rates, and mortality rates, are comparable to or better than those under physician care. The ability to prescribe medications contributes significantly to these outcomes by ensuring that patients receive timely, effective treatment.

Final Thoughts

In conclusion, nurse practitioners can be crucial in addressing the primary care shortage in the US. However, their ability to prescribe medications varies depending on their practice state. While some states grant NPs full practice authority, allowing them to prescribe medications without physician supervision, others limit their autonomy through reduced or restricted practice scopes. As healthcare continues to evolve, it’s important to recognize the valuable contributions that nurse practitioners make to patient care and to ensure they have the necessary authority to provide the best possible care to their patients.

FAQs About Nurse Practitioners

Are nurse practitioners capable of managing diabetes?

Research indicates that nurse practitioners (NPs) positively impact clinical outcomes for patients with type 2 diabetes within primary care settings. They achieve this through their ability to prescribe, modify, and manage medications independently of physicians.

Can nurses issue prescriptions for insulin?

Yes. Since insulin is a prescription drug, it must be prescribed by a healthcare professional with the authority to do so, such as a doctor, nurse practitioner, or physician assistant. As a registered nurse (RN), your role includes the administration of prescribed medication.

What medications can nurse practitioners not prescribe?

Nurse practitioners cannot prescribe Schedule I drugs such as Heroin, LSD, and marijuana since the federal government has determined that they do not have any accepted medical use in the U.S.

Can a nurse practitioner prescribe medication without a doctor?

Yes. In some states and regions, nurse practitioners have “full practice” authority to assess patients, diagnose conditions, and prescribe medications without physician oversight. However, NPs must collaborate with physicians to prescribe medications in other areas.

Can nurse practitioners prescribe antidepressants?

Yes, nurse practitioners can prescribe antidepressants in many jurisdictions, especially if they have psychiatric-mental health training. The scope of their prescriptive authority for these medications may vary based on state laws and specific regulations.

Can nurse practitioners prescribe Adderall?

Yes. Nurse practitioners can prescribe Adderall in states where they are granted prescriptive authority for controlled substances, often requiring a DEA (Drug Enforcement Administration) number and adherence to specific regulatory conditions. Adderall is classified as a Schedule II controlled substance due to its high potential for abuse.

Can nurse practitioners prescribe narcotics?

The ability of nurse practitioners to prescribe narcotics, which are often controlled substances, depends on the state or region’s laws. In many cases, NPs can prescribe these medications if they have a DEA number and comply with state-specific guidelines, which may include limitations on the quantity or duration of the prescription.

Can nurse practitioners prescribe pain medication?

Yes, nurse practitioners can prescribe pain medication, including both non-opioid and opioid medications, depending on their prescriptive authority, which varies by state. Prescribing opioid pain medications may require additional certifications or adherence to specific guidelines.

Can nurse practitioners prescribe birth control?

Nurse practitioners can prescribe birth control, including pills, patches, injections, and intrauterine devices, in most jurisdictions. Their authority to prescribe contraceptives is widely recognized as part of their role in providing comprehensive healthcare.

Can nurse practitioners prescribe benzodiazepines?

Nurse practitioners can prescribe benzodiazepines in states where their prescriptive authority includes controlled substances. However, due to the potential for abuse and dependence, prescribing these medications is subject to state laws, DEA regulations, and often specific training or certification requirements.

Saving on Medications with the Prescriber Partner Program

Nurse practitioners (NPs) are pivotal in healthcare, especially for managing chronic conditions. The Prescriber Partner Program by Buy Canadian Insulin (BCI) empowers NPs to significantly reduce their patients’ medication costs, particularly for those facing financial challenges in affording prescriptions in the U.S.

Nurse Practitioner | Prescriber Program

Program Highlights:

  • Zero-Cost Membership: Joining is free, with no commitment or annual fees.
  • Up to 90% Savings: Patients can save on medications, including top insulin brands like Humalog and Lantus, thanks to lower drug prices in Canada.
  • Easy Access: American patients can purchase discounted medications online or by phone, using a custom coupon code for additional savings.
  • Quality Assurance: Prescriptions are co-signed by Canadian licensed physicians and filled by licensed pharmacies, ensuring high-quality patient care.

This program allows NPs to extend their care, helping patients overcome financial barriers to medication adherence. It’s a step towards making healthcare more accessible and affordable, contributing to better health outcomes.

Nurse practitioners can join the program to support their patients in accessing life-saving medications at a fraction of the U.S. cost. For more information, visit the Prescribing Partner Program page.

Sources

Regis College. (2021, October 29). Can Nurse Practitioners Prescribe Medication? Retrieved from https://online.regiscollege.edu/blog/can-nurse-practitioners-prescribe/

American Medical Association. (Retrieved n.d.). AMA president sounds alarm on national physician shortage. American Medical Association. Retrieved from https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage

Gaines, K. (2021, January 11). Can Nurse Practitioners Prescribe Medication? Nurse.org. https://nurse.org/education/nurse-practitioner-prescribe-medication/

Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human Resources for Health, 15.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594520/