1. What changes in prescriptive authority have taken place in the United States in the past ten years? What are the implications of limited prescriptive authority for the advanced practice registered nurse (APRN)?
2. The advanced practice registered nurse role requires an intensive set of clinical skills, knowledge, and integrative abilities that synthesizes nursing knowledge. What does interprofessional collaboration mean to you? Provide examples with your rationale.
1. Changes in Prescriptive Authority for APRNs in the Past Ten Years
Over the last decade, there has been a significant expansion of prescriptive authority for Advanced Practice Registered Nurses (APRNs) across the United States. These changes have primarily been driven by legislative efforts to improve healthcare access, especially in underserved areas, and to address provider shortages.
- Full Practice Authority (FPA): Many states have transitioned to granting full practice authority, allowing APRNs to evaluate patients, diagnose conditions, interpret diagnostic tests, and initiate treatment plans, including prescribing medications, without physician oversight. As of 2025, 27 states, Washington D.C., and two U.S. territories allow APRNs full practice authority.
- Removal of Collaborative Agreements: Some states have eliminated or reduced the requirement for APRNs to have a collaborative agreement with a physician for prescribing medications.
- Expansion of Controlled Substance Prescriptions: Certain states have expanded the ability of APRNs to prescribe controlled substances, with varying schedules of controlled drugs allowed based on state regulations.
- Telehealth and Prescribing: The COVID-19 pandemic accelerated changes in telehealth regulations, allowing APRNs to prescribe medications remotely, further expanding access to care.
Implications of Limited Prescriptive Authority:
- Barriers to Patient Access: Limited prescriptive authority can hinder an APRN’s ability to provide comprehensive care, particularly in rural or underserved areas where physician collaboration may not be readily available.
- Delays in Care Delivery: Dependence on physician oversight can create delays in initiating treatment, impacting patient outcomes.
- Professional Autonomy: Restricted authority may limit the scope of practice, preventing APRNs from fully utilizing their education and training.
- Healthcare Costs: Collaboration requirements can increase healthcare costs due to additional administrative or supervisory expenses.
2. Interprofessional Collaboration in APRN Practice
Interprofessional collaboration is the cooperative and coordinated effort between healthcare professionals from different disciplines to provide high-quality, patient-centered care. It involves mutual respect, shared decision-making, and the integration of diverse expertise to achieve optimal health outcomes.
What Interprofessional Collaboration Means to Me:
To me, interprofessional collaboration is a cornerstone of effective healthcare delivery. It emphasizes teamwork, respect for individual roles, and a collective focus on the patient’s well-being. Collaboration ensures that care is holistic, considering the patient’s medical, emotional, social, and psychological needs.
Examples and Rationale:
- Chronic Disease Management: In managing a patient with diabetes, an APRN collaborates with an endocrinologist, a dietitian, and a pharmacist. The APRN provides primary care and education, the endocrinologist addresses specialized treatment needs, the dietitian develops a personalized nutrition plan, and the pharmacist ensures appropriate medication management. This team-based approach improves glycemic control and reduces complications.
- Mental Health Care: For a patient with depression, the APRN may collaborate with a psychiatrist, a social worker, and a primary care provider. The APRN manages pharmacologic therapy while the psychiatrist provides specialized mental health care, and the social worker connects the patient with community resources. This holistic approach enhances patient outcomes and quality of life.
- Palliative Care: An APRN works alongside hospice nurses, a chaplain, and a social worker to provide comfort care to a terminally ill patient. Each professional contributes unique skills, from symptom management to emotional and spiritual support.
Rationale:
Interprofessional collaboration leverages the strengths of each discipline, avoids duplication of efforts, and promotes continuity of care. It is especially vital in complex cases requiring input from multiple specialties. For APRNs, collaboration enhances practice by allowing them to draw from the collective expertise of the healthcare team, ultimately improving patient satisfaction and outcomes.