Prescriptive practice safety and quality assignment
Requirements for APN prescriptive practice in New Jersey
Nurses that practice in New Jersey are well recognized and mandated to perform under
specific laws within their scope of practice. The state recognises all the nurse practitioners,
clinical nurse specialists, nurse midwives, and nurse anesthetists. They are all given different
roles and registered by the Board of Nursing as Advanced Practice Nurses (Philips 2016). That
enables them to practice under the specific bracket of the Division of Consumer Affairs. Even
though they are registered under the same body, they do not have the same licensing authority.
The nurse midwives are certified by a different body known as the Midwifery Liaison
Committee with the title of Certified Nurse Midwives (CNMs). For any APN to be allowed to
practice freely and prescribe medication, they should be registered by the New Jersey Board of
Nurses where they hold a practice nursing license as registered nurses (RN) (Carthon et
al.,2017). An exception is issued for the midwives who have not done general nursing as they
can be registered as certified professional midwife but not a certified nurse midwife.
Basically, the title Advanced Practice Nurse (APN) came into existence in 1999 for all
nurse specialists and nurse anesthetists in New Jersey. They were no longer referred to as RN but
their title changed to APN. Hence according to current statistics there are approximately 4,000
certified advanced practice nurses in a total of 17 specialties (Ladd et al.,2017). The APN in New
Jersey has prescriptive authority and is allowed to do so in the presence of a physician who is
licensed before being allowed to prescribe any medication. Before becoming a APN, all nurses
are required to read and understand the mandated prerequisites in the NJAC. Additionally, the
state allows only the master level upgrading of the clinical nurse specialist and nurse
practitioners and masters prepared certified registered nurse anesthetist.
PRESCRIPTIVE PRACTICE SAFETY AND QUALITY ASSIGNMENT3
There are certain educational and training requirements for any nurse who advances to
APN and hence becomes allowed to prescribe and administer medication in the state. They are
required to submit an application to upgrade from RNs to APNs if they meet the professional
requirements and the relevant criteria for becoming selected. An online application request is
usually sent through email for personal review of their credentials (Joel 2017). Some of the
application requirements that should be provided include; a proof of a professional RN license
that is up to date and withstanding, an application fee of $100 which is non refundable and
should be payable once applied, they should also provide their original transcript which is an
official evidence and form of confirmation that they meet the educational requirements as
stipulated by the state, they should also provide proof of passing their highest level of
examination in their areas of APN specialization, and finally, they should confirm that the APN
license held in another state is withstanding, already expired, or another status that is not career
compromising (Chesney & Duderstadt 2017).
One of their educational requirements is that they should be through with their Masters
level program and well performed with an official proof of their excelling already sent to the
board. Additionally, they should have completed and graduated with level 3 credit course in
pharmacology in an institute that is well accredited and recognised by the state laws. The
institution should be accredited by a National accrediting agency which is recognised by the
board. If the APN has not undergone the course for pharmacology, it should then be comprised
in their Masters training program or otherwise they cannot be allowed to advance to APN. They
should have undertaken atleast 45hrs of pharmacology while still studying for the Masters
program (Gadbois et al.,2015). In cases where the board is uncertain of the number of hours
completed by the applicant, they communicate to the dean of the institution who is then required
PRESCRIPTIVE PRACTICE SAFETY AND QUALITY ASSIGNMENT4
to communicate the total period of the course and specific hours undertaken. Sometimes the
nurses may have taken the course a long time ago and thus the board may require evidence as
proof of completion. The nurses are then supposed to send proof of the pharmacology
requirements by submitting either a transcript for a level 3 credit pharmacology course
completed within five years before submitting APN application to the board of New Jersey or a
continuing educational program certificate which demonstrate more than 30hrs of contact
undertaking the pharmacokinetic and pharmacodynamic principles of various pharmacologic
agents.
CDC guidelines for prescribing CDS for chronic non-cancer pain
Before administration of analgesics for the management of chronic non cancer pain, there
are some state policies and regulations stipulated by the state of New Jersey as guided by the
Center for Disease Control (CDC). Chronic pain is one of the reasons for seeking medical
attention among the American patients. Most of the time opioid analgesics are prescribed for
management of chronic pain. Hence, there has been an increase in capita prescription of the
opioid analgesics in US healthcare facilities (Austin et al.,2019). Opioids act as analgesics
through the central and peripheral nervous system on the kappa and delta receptors to inhibit the
transmission of nociceptive input and perception of pain. There are two types of opioid
analgesics; the short acting and the long acting. However, both have some effects that led to the
introduction of abuse deterrent opioid formulations (ADFs) which help decrease the abuse of
opioids. According to the administration guidelines, the use of ADF opioids is recommended
instead of the non ADF opioids unless when stated otherwise by the state laws. That is because
of the reduced cases of abuse, overdose, and diversion of abuse deterrent oxycontin.
PRESCRIPTIVE PRACTICE SAFETY AND QUALITY ASSIGNMENT5
All indications for use of opioids in management of chronic non-cancer pain should be
well adhered to. They should be only administered when alternative methods and options for the
management of pain have failed or they cannot be used, when the pain is affecting the quality of
life and functioning of the patient, when the potential benefits for opioid use much outweigh the
risks and harm of use, and after thorough education with the patient about all the risks, benefits,
and other available alternatives for the management of pain. They should only be continued
when confirmed to have benefits on the patients that are well documented. Many patients who
have limitations to use of other types of analgesics such as NSAIDs due to various systems
effects are indicated to use opioids which have less effects on the renal and hepatic system
(Rosenquist & Fishman 2019) . Risk assessment should involve assessment of patient’s history
on substance abuse, baseline urine drug screening, and monitoring through the state prescription
drug monitoring program. The main risk assessment tools are the screener and opioid assessment
for patients with pain (SOAPP) and the opioid risk tool (ORT).
PRESCRIPTIVE PRACTICE SAFETY AND QUALITY ASSIGNMENT6
References
Austin, K., Casini, G., & Hutner, B. (2019). (288) Reducing High Dose Narcotic Therapy for
Chronic Non-Cancer Related Pain. The Journal of Pain, 20(4), S46.
Carthon, J. M. B., Sammarco, T., Pancir, D., Chittams, J., & Nicely, K. W. (2017). Growth in
retail-based clinics after nurse practitioner scope of practice reform. Nursing outlook,
65(2), 195-201.
Chesney, M. L., & Duderstadt, K. G. (2017). States' Progress Toward Nurse Practitioner Full
Practice Authority: Contemporary Challenges and Strategies. Journal of Pediatric Health
Care, 31(6), 724-728.
Gadbois, E. A., Miller, E. A., Tyler, D., & Intrator, O. (2015). Trends in state regulation of nurse
practitioners and physician assistants, 2001 to 2010. Medical Care Research and Review,
72(2), 200-219.
Joel, L. A. (2017). Advanced practice nursing: Essentials for role development. FA Davis.
Ladd, E., Sweeney, C. F., Guarino, A., & Hoyt, A. (2017). Opioid prescribing by nurse
practitioners in Medicare part D: impact of state scope of practice legislation. Medical
Care Research and Review, 1077558717725604.
Phillips, S. J. (2016). 28th annual APRN legislative update: advancements continue for APRN
practice. The Nurse Practitioner, 41(1), 21-48.
Rosenquist, R., & Fishman, S. (2019). Use of opioids in the management of chronic non-cancer
pain. UpToDate, Waltham MA. Accessed February, 11.
