Historically, the American Medical Association (AMA) has continuously contended the progression of nursing practice, in particular advanced nursing practice (Keeling & Bigbee, 2005). They have done so by opposing the advances of nursing practice claiming the broader and more specialized roles of advanced practice nurses (APNs), which includes diagnosing and prescribing, encroaches on physician practice and claim nurses are not educationally sufficiently prepared to take on these roles (Summers & Summers, 2007). The medical profession posits APNs should be supervised by physicians in their advance practice roles. Examples of such opposition are evident in for example AMA’s posting of a recent speech given by Nancy Nielsen (2009) stating that the AMA will oppose a proposed bill to allow APNs to classify themselves as primary care providers; or as presented and discussed at the recent 34th AMA Annual Meeting (AMA, 2010), in which a strong opposition to autonomous practice of APNs was discussed and the position of physician supervision of APNs practice was advocated.
This opposition not only hinders the advancement of cost efficient healthcare, it also stands in direct opposition to the newly proposed Patient Protection and Affordable Care Act (U.S. Congress, 2010), which recognizes APNs practice and working relationship with physicians to be one of collaboration, not submission, and recognizes the need for the expansion and recognition of APNs’ role in order to increase the availability of healthcare to all Americans.
In order to allow for APNs to be efficient in providing care to their patients, those APNs diagnosing and treating patients, need to be able to have the authority to prescribe treatments, inclusive of medications, for their patients. Prescriptive authority is regulated at the state level and practices on how APNs can prescribe vary widely between States (Saxe, 2005). This paper will specifically explore the prescriptive authorities for APNs in the State of California and examine the CNS’s inclusion in this policy.
Policy In Question
In the State of California, the Business and Professions Code pertaining to Healing Arts, makes provisions for Nurse Practitioners (NPs) and Certified Nurse-Midwives (CNMs) to gain prescriptive authority (CA BRN, 2002, CA BRN, 2010). This policy stipulates this privilege to be accompanied with the stringent criteria that NPs and CNMs can only furnish prescriptions and medical devices under the supervision of a physician or under standard protocols sanctioned by physicians. The California Board of Registered Nursing (CA BRN) along with the State’s Business and Professions Code do not however, advocate for the inclusion of Clinical Nurse Specialists (CNSs) amongst those APNs authorized to be able to furnish (California’s legal terminology for “ordering” medications) prescriptions (CA BRN, 2003).
The only CA BRN policy affecting CNSs and signed into legislation as assembly bill (AB) 90 (Cunneen) in...