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Nurse Practitioners: Are They Trained Enough to Manage Drug Therapy?
O N YOU R B EHALF
Nurse Practitioners: Are They Trained Enough to Manage Drug Therapy? by Cathy Worrall, PharmD
I recently attended the first meeting of a 12-member multidisciplinary advisol)' committee for a project to review a pharmacology curriculum that prepares family nurse practitioners for prescriptive authority. Iserve as the pharmacy representative to that committee, which advises staff about barriers preventing nurse practitioners from obtaining prescriptive authority and criteria for evaluating nurse practitioner applications. Currently, 42 states allow family nurse practitioners some degree of prescriptive authority. Eighteen states have granted automatic preSCriptive authority, while 24 require a separate application to a regulatory board to gain the authority to preSCribe. Some states grant authority to prescribe legend drugs only, while others grant full prescriptive authority, including Schedule IT Controlled drugs. This lack of standardization also extends to related issues, including scope of practice and regulation, that affect the nurse practitioner's ability to act as aPrimary care provider. Graduate-level family nurse practitioners receive limited didactic pharmacology training-often only
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Vol S36, No. 4
April 1996
one class, a quarter or semester long. Traditionally trained nurse practitioners (who have a four-year bachelor of science in nursing degree, at least two years of work experience, and a two-year master's degree) generally have taken only two classes in didactic pharmacology training, yet they manage drug therapy in many primary care settings. Even more alarming, "fast track" family nurse practitioner programs are popping up throughout the country. These programs can be completed in as little as four to five years after high school and often require no work experience. Many of these candidates, who may have very little clinical experience, may be granted automatic prescribing authority in a number of states. Many pharmacists believe that they are the most qualifled health care professionals to manage patient drug therapy. PharmD candidates have a minimum of six years of training, and many complete advanced training through residencies and fellowships. Family nurse practitioners, however, believe that they are more qualified to manage drug therapy than pharmacists, who receive no
diagnostic training and minimal or no physical assessment training. In short, the quality of didactic pharmacology education in nurse practitioner programs is alarming. The major difference between pharmacists and nurse practitioners is that pharmaciSts, in general, desire collaborative prescribing authority, while nurse practitioners, despite their limited pharmacology training, want to be recognized as autonomous primary care providers with independent prescriptive authority. As a pharmacology faculty member in a family nursing practitioner program, I have expressed my concern about the brief training in didactic pharmacology. The phannacology course I teach is one quarter long. I discuss four major topicS, including hypertension, diabetes, hyperlipidemia, and anticoagulation, and am allotted one hour for each topic! I think our program is representative of most family nurse practitioner programs. In this time frame, I do not see how a nurse practitioner can be adequately prepared to make safe drug therapy decisions. I feel that it is critical for nurse practitioners to receive additional
didactic training and for more pharmacists to be included in didactic and clinical training programs. Many physicians feel that they are the only health care providers qualified to manage drug therapy for patients, and the American Medical Association (AMA) agrees. "The AMA is not willing to participate in any efforts that would serve to extend the responsibilities of prescribing to individuals less prepared by education and experience, as a matter of patient safety," according to James S. Todd, MD, executive vice president of AMA. The key to providing costeffective, quality health care in this era of reform is collaboration, which requires effective communication, mutual trust and respect, and a common goal-optimizing patient outcomes. Pharmacy leaders must gain the support of physicians, nurses, physician's assistants, and others to empower phannacists as drug therapy managers. We invited nursing representatives to attend APhA's open hearing on empowering pharmacists as drug therapy managers at the Association's Annual Meeting last month in Nashville, Tenn. We hope that this will enhance communication between the professions and encourage open discussion of nonphysician drug therapy management. Cathy Worrall, PharmD a registered nurse, is the critical care clinical pharmacy specialist, Mayo Medical Center Rochester, Minn.
JOwnal of the American Pharmaceutical Association
Nurse Practitioners: Are They Trained Enough to Manage Drug Therapy? by Cathy Worrall, PharmD
I recently attended the first meeting of a 12-member multidisciplinary advisol)' committee for a project to review a pharmacology curriculum that prepares family nurse practitioners for prescriptive authority. Iserve as the pharmacy representative to that committee, which advises staff about barriers preventing nurse practitioners from obtaining prescriptive authority and criteria for evaluating nurse practitioner applications. Currently, 42 states allow family nurse practitioners some degree of prescriptive authority. Eighteen states have granted automatic preSCriptive authority, while 24 require a separate application to a regulatory board to gain the authority to preSCribe. Some states grant authority to prescribe legend drugs only, while others grant full prescriptive authority, including Schedule IT Controlled drugs. This lack of standardization also extends to related issues, including scope of practice and regulation, that affect the nurse practitioner's ability to act as aPrimary care provider. Graduate-level family nurse practitioners receive limited didactic pharmacology training-often only
I
Vol S36, No. 4
April 1996
one class, a quarter or semester long. Traditionally trained nurse practitioners (who have a four-year bachelor of science in nursing degree, at least two years of work experience, and a two-year master's degree) generally have taken only two classes in didactic pharmacology training, yet they manage drug therapy in many primary care settings. Even more alarming, "fast track" family nurse practitioner programs are popping up throughout the country. These programs can be completed in as little as four to five years after high school and often require no work experience. Many of these candidates, who may have very little clinical experience, may be granted automatic prescribing authority in a number of states. Many pharmacists believe that they are the most qualifled health care professionals to manage patient drug therapy. PharmD candidates have a minimum of six years of training, and many complete advanced training through residencies and fellowships. Family nurse practitioners, however, believe that they are more qualified to manage drug therapy than pharmacists, who receive no
diagnostic training and minimal or no physical assessment training. In short, the quality of didactic pharmacology education in nurse practitioner programs is alarming. The major difference between pharmacists and nurse practitioners is that pharmaciSts, in general, desire collaborative prescribing authority, while nurse practitioners, despite their limited pharmacology training, want to be recognized as autonomous primary care providers with independent prescriptive authority. As a pharmacology faculty member in a family nursing practitioner program, I have expressed my concern about the brief training in didactic pharmacology. The phannacology course I teach is one quarter long. I discuss four major topicS, including hypertension, diabetes, hyperlipidemia, and anticoagulation, and am allotted one hour for each topic! I think our program is representative of most family nurse practitioner programs. In this time frame, I do not see how a nurse practitioner can be adequately prepared to make safe drug therapy decisions. I feel that it is critical for nurse practitioners to receive additional
didactic training and for more pharmacists to be included in didactic and clinical training programs. Many physicians feel that they are the only health care providers qualified to manage drug therapy for patients, and the American Medical Association (AMA) agrees. "The AMA is not willing to participate in any efforts that would serve to extend the responsibilities of prescribing to individuals less prepared by education and experience, as a matter of patient safety," according to James S. Todd, MD, executive vice president of AMA. The key to providing costeffective, quality health care in this era of reform is collaboration, which requires effective communication, mutual trust and respect, and a common goal-optimizing patient outcomes. Pharmacy leaders must gain the support of physicians, nurses, physician's assistants, and others to empower phannacists as drug therapy managers. We invited nursing representatives to attend APhA's open hearing on empowering pharmacists as drug therapy managers at the Association's Annual Meeting last month in Nashville, Tenn. We hope that this will enhance communication between the professions and encourage open discussion of nonphysician drug therapy management. Cathy Worrall, PharmD a registered nurse, is the critical care clinical pharmacy specialist, Mayo Medical Center Rochester, Minn.
JOwnal of the American Pharmaceutical Association