A regulation to expand the scope of practice of certified registered nurse practitioners (CRNPs) is now in effect. It was published in the Pennsylvania Bulletin on Dec. 12, 2009, the final step in the regulatory process.
One of the biggest changes regards prescribing Schedule II controlled substances (CSII). Previously, a CRNP was allowed to prescribe a CSII for 72 hours, but now they can prescribe for up to 30 days if specified in the collaborative agreement. The State Board of Nursing has posted an online form for changing a CRNP’s prescriptive authority.
A CRNP must apply for and receive prescriptive authority approval from the nursing board before prescribing and dispensing any drugs.
CRNPs who currently have prescriptive authority, but wish to change the drug categories, controlled substances, or timeframes on an existing collaborative agreement, must file a prescriptive authority change form and wait until the nursing board issues a prescriptive authority approval number. This can be done through Pennsylvania Department of State’s license verification page or by contacting the State Board of Nursing at (717) 783-7142.
A CRNP may not prescribe and dispense any drug prior to being issued a prescriptive authority approval number. For more information, review the nursing board’s list of frequently asked questions.
The final regulation includes a definition of collaboration between a CRNP and a physician; a requirement for a written, signed collaborative agreement; and a requirement that a CRNP prescribe within his or her specialty.
However, among remaining concerns, the regulations:
- Eliminate the ratio of four CRNPs with prescriptive authority to one collaborating physician
- Do not require patients to be notified if they will be seeing a CRNP
- Delete the requirement that the collaborating physician attest to his or her knowledge of the drug the CRNP will prescribe
The Pennsylvania Medical Society opposed the regulation when it was first introduced in 2008, fearing that it would expand the scope of practice of CRNPs without adequate safeguards to protect patient safety and quality of care.
While many of the Medical Society’s concerns were addressed through negotiations with the state Board of Nursing, some concerns remained. For this reason, the Medical Society took no position on the final regulation.