Government

Nurse Practitioners Rally, Hoping to Write Prescriptions

By: Kevin Derby | Posted: March 24, 2010 5:22 PM

Health care continued to dominate the Florida Legislature Wednesday -- this time with nurse practitioners demanding to be able to write prescriptions.

More than 300 nurse practitioners rallied at the Capitol to lobby for legislation that would allow them to prescribe medicines. Florida and Alabama are the only two states in the nation that don't allow nurse practitioners to prescribe controlled medicine.

Bills in the House and Senate would change the law. But, neither has much of a chance of passing during the session.

The Senate bill, sponsored by Republican Mike Bennett of Bradenton, has not been placed on a committee calendar. The same is true of the House version of the bill, sponsored by Rep. Juan Carlos Zapata, R-Miami.

These bills drew upon a Senate Health Care Committee report that recommended allowing advanced registered nurse practitioners (ARNPs) to write prescriptions. ARNPs are required to hold a master's degree and education on drug prescriptions.

Dr. Christopher Salso, president of the Florida Nurse Practitioner Network, is pointing fingers at the Florida Medical Association and two legislators for blocking this reform.

“The Florida Medical Association is protecting its pocketbook, not patients, when it opposes giving qualified nurse practitioners the appropriate prescriptive authority to help patients,” Salso said.

The FMA responded in a statement, saying, "There is no such thing as a nurse practitioner who is 'qualified' to prescribe controlled substances.”

The FMA said, “The ability to prescribe controlled substances is limited to medical doctors for a reason: to protect patient safety. Physicians go to medical school to learn how to prescribe controlled substances safely and without interacting with other medications. ARNPs do not.”

The FNPN also pointed to Rep. Nick Thompson, R-Fort Myers, and Sen. Don Gaetz, R-Niceville, for blocking attempts to allow nurses to write prescriptions.

Speaking to the nurses who came to the Capitol, Bennett bristled, saying Gaetz and Thompson were in the way. Bennett brought up Thompson’s ambitions to be a judge and said that Thompson’s obstructing the legislation showed he was not up to the task. Bennett asked the cheering crowd, “How can you possibly be a judge if you don't hear both sides?”

Rep. Yolly Roberson, D-Miami, a strong supporter of the nurses and an RN herself, urged the nurses to continue to push the issue. Said Roberson, “There are two things that legislators understand -- money and numbers -- and we have both.”

Referring to efforts to block nurse practitioners from writing prescriptions, Rep. Michelle Rehwinkel Vasilinda, D-Tallahassee, said, “This foolishness has to stop.”

Saying she understood nursing issues due to her mother’s 50 years as a nurse, Rehwinkel Vasilinda said, “Nurses and nurse practitioners need to have more a hand in this nation’s, and certainly in Florida’s, health care.”

The FMA countered, “Florida lawmakers are working to protect patients from those who would attempt to prescribe narcotics to Floridians without the training required by Florida law, and that is the safe, accountable and common-sense thing to do.”

Supporters of the legislation conceded that there was little hope of their measures passing. Roberson conceded as much but urged the nurses to continue the fight in years to come. She also said if she is elected to Congress, she will continue the fight up in Washington.

Supporters of the nurse practitioners insist that time is on their side. There are more than 13,000 nurse practitioners in Florida and that number continues to grow.

“The argument that nurse practitioners don’t have adequate training has been proven false in 48 other states,” said Bennett.

Salso insisted, “We are the solution to tomorrow’s health care.”

The FMA said, “ARNPs do not have the training nor the qualifications necessary to prescribe these medications. If they want to prescribe controlled substances, they can go to medical school and receive the proper training to do so.”

Kevin Derby, a reporter for Sunshine State News, can be reached at kderby@sunshinestatenews.com or (850) 727-0859.


Comments (28)

ojubpcwum
5:03AM NOV 27TH 2013
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2:09PM MAY 26TH 2013
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Judy
6:22PM OCT 24TH 2012
It is NOT the ARNP's running Florida's drug clinics, it is MD's. Floridas "pill mill" is on the map due to MD's not ARNP's. They prescribe successfully in all other states besides Alabama and Florida.
jack
3:39AM SEP 28TH 2011
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3:39AM SEP 28TH 2011
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MOnica Gee
1:04AM FEB 21ST 2011
Once again, this is just another example of the backwards South. The rest of the country and the world are watching.

The Tampa doc is just showing his bigotry - a time honoured tradition I am afraid. The research shows that nurse practitioners provide excellent and equivalent care when compared with GPs treating the same conditions. I find it interesting that you use the phrase "under collaborative" and " supervision" in your comments. It is clear that the Tampa doc has a real sense of superiority. How about just improving access to care to many people who currently cannot access it ? There is no danger here - please. NPs are sued at a rate that is significantly lower than family physicians. Surely if they were so dangerous as you assume, the other 48 states would have halted the practice by now - but its been 40 years. Get over it.
MOnica Gee
1:04AM FEB 21ST 2011
Once again, this is just another example of the backwards South. The rest of the country and the world are watching.

The Tampa doc is just showing his bigotry - a time honoured tradition I am afraid. The research shows that nurse practitioners provide excellent and equivalent care when compared with GPs treating the same conditions. I find it interesting that you use the phrase "under collaborative" and " supervision" in your comments. It is clear that the Tampa doc has a real sense of superiority. How about just improving access to care to many people who currently cannot access it ? There is no danger here - please. NPs are sued at a rate that is significantly lower than family physicians. Surely if they were so dangerous as you assume, the other 48 states would have halted the practice by now - but its been 40 years. Get over it.
M. Hartley
1:56PM FEB 7TH 2011
Florida and Alabama are the last laggards to the evolving healthcare system in this country. They are still controlled by people that have enough money to pay off their leaders, and are ignorant of the qualifications, education, and success of the Nurse Practitioner. They will come around eventually when their primary care offices are over booked, and the patients are tired of suffering. Unfortunately for these two states, they just end up looking corrupt, and ignorant. Good luck with those close-minded attitudes. Oh, and any patients that are seeking individualized, holistic, patient-centered care can come on up to Tennessee, and visit the Np's here!
Lourdes Prince
9:17PM APR 1ST 2010
It is interesting to note that Nurse Practitioners, specifically certified nurse midwives who deliver babies in hospitals have full prescriptive authority within the hospital. As a certified nurse midwife, I have delivered over 2,000 babies in the last 12 years in hospitals and can write for controlled medications while in the hospital. As soon as the patient is discharged, I cannot write for a controlled substance at discharge. So unfortunately, upon discharge, the chain of care is broken, as I have to seek a physician to write a prescription for pain management at home. If my patient encounters any problem with her regimen, again I must find a physician to prescribe something different. If my education is enough to qualify me to prescribe controlled medications in hospital, why not at discharge or in the clinic setting?
TampaDoc
7:37AM MAR 26TH 2010
I am a Tampa area family doctor who has worked in my community for nearly 30 years. I have employed both nurse practitioners (NPs) and physician assistants (PAs) during that time and been happy with their work. That being said, this news story is utter rubbish. The idea that nurse practitioners, who complete less than a quarter of the combined didactic and clinical training of a physician, should be allowed to prescribe controlled substances, is outrageous. And the notion that this will improve access to care is even more ridiculous! Physicians everywhere hire nurse practtiitoners and physician assistants to help them reach patients, and the time it takes to ask your supervising doctor to sign off on a prescription for a narcotic, asssuming it is warranted, does not create a barrier to care that costs the state "millions of dollars." It takes minutes if not seconds, and any simpleton knows that a NP, just like an MA, can PHONE IN most controlled substances as a verbal order from their supervising physician. There is no barrier to care here, who do these people think they are fooling? This is propaganda at its most despicable. Nurse practitioners want one thing and one thing only with this legislation, to be treated on equal footing as physicians as independent providers of medicine. In nearly every other state they are attempting full pushes for independence, and now they are doing it in Florida. It is dangerous and it has got to stop! I have said it before and I will say it again, if you want to practice independent medicine, go to medical school! 2 years of part time school do NOT earn you that right. (Few realize that NPs even have less than half of the didactic hours and only a third of the clinical hours of PA training!) And most importantly, as medical community leaders, it is our responsibility to protect our patients. Legislation extending controlled substance privileges, ESPECIALLY during a time when Florida leads the country in prescription drug trafficing opportunities due to our state's weak regulation on controlled substance monitoring, would be irresponsible. If anything, even most DOCTORS should have this controlled substance right restricted!
DLBMH42
9:38PM MAR 4TH 2013
You should be ashamed of yourself! Do your homework!!! If you need any resources contact me.
FNP CT
5:56AM APR 22ND 2012
Give it a rest, you fool. The lack of accuracy in your poorly written statement indicates that you're not as educated as you claim. Firstly, as a general rule, MDs in Florida are mediocre, at best. Florida, in general, has the worst healthcare record in the nation. Secondly, NPs were RNs first! Did you not know that? When you take into consideration the clinical experience of RNs, which is more than what MDs and PAs have going into practice, then you can see how your pathetic claim about "clinical training" relative to NPs is baseless. Thirdly, NPs have a much better sense of patient care--holistic care--versus MDs and PAs. Many national surveys clearly indicate that with regard to general practice and primary care, NPs are favored over MDs and PAs. Check it out. Stop trying to cloud the real issue here. You (although you're in the minority) simply feel threatened by NPs. You know that NPs provide quality, compassionate, cost-effective healthcare to patients!! Get over yourself and your antiquated beliefs. Fourthly, NPs are highly educated professional who have the training and clinical experience to prescribed medications within their scope of practice, which includes controlled substances!! Every other state (except poor healthcare-providing states like FL and AL) allows NPs to prescribe controlled substances. Get with the program, "doctor." Finally, you can't stop NPs. We are here to stay and we are here to take care of patients, not engage in a turf war, like you. It's "doctors" like you who have no genuine sense of patient care and collaborative healthcare.
Student
12:16AM JAN 17TH 2011
Tampa Doc,
When it all comes down to the administration of the medication prescribed; who are the ones catching medication errors made by the "Docs"? Short answer is the nurses. One of our most important jobs is to keep patients safe, one way we accomplish this task is to study pharmacology extensively. We learn contra-indications for the medications "you" are prescribing.
Denise
11:44AM JUL 31ST 2010
I am a nurse practitioner with a doctorate in nursing practice in California and I am able to prescribe narcotics. Let's be clear, many of the older physicians had no credentials, they were practicing in the Army and became medical doctors. Believe me these physicians did provide safer patient-center care, then most of the newer physicians. Therefore experience plays a big part in the health care delivery system. Before you become a nurse practitioner, you have a wealth of medical background. You should see those new interns on the floor about to kill their patients with their lack of knowledge and their feeling of superiority "I am the doctor". Nurses save their butts every day on the floor. So enough with going to school to become a doctor if you want to prescribe narcotics. I am sure that NP should not do surgery or other complex procedures behond their scope of practice, but basic procedures, general physical exam, minor medical conditions, and prescription of narcotics should not be part of it. Your concerns are not about safety of care because if it was, you would be thrilled to have the assistance of NPs for simpler conditions so that you could concentrate on more complex problems and provide safer and more efficient care to your patients. This is an economic concern and you feel threathen that you have to share a little piece of the pie with NPs. You feel threathen for your job, because as nurses we tend to nurture our patients and see them as a whole rather than a specific disease, and our patients sense that and want to back to us where they can be treated as human beings, rather than you physicians who mostly worry about the bottom line (MONEY).
Denise
11:39AM JUL 31ST 2010
I am a nurse practitioner with a doctorate in nursing practice in California and I am able to prescribe narcotic. Let's be clear, many of the older physician had no credentials, they were practicing in the army and became medical doctors. Believe me these physicians did provide safer patient-center care, then most of the newer physicians. Therefore experience plays a big part in the health care delivery system. Before you become a nurse practitioner, you have a wealth of medical background. You should see those new interns on the floor about to kill patients with their lack of knowledge and their feeling of superiority "I am the doctor". Nurses safe their butts every day. So enough with going to school to become a doctor if you want to prescribe narcotics. I am sure that NP may should not do surgery or other complex procedures behond their scope of practice, but basic procedures, general physical exam, minor medical conditions, and prescription of narcotics is not one of them. Your concerns are not about safety of care because if it was, you would be thrilled to have the assistance of NPs for simpler conditions so that you could concentrate on more complex problems and provide safer and more efficient care to your patients. This is an ecoomic concer and you feel threathen that you have to share a little piece of the pie with NPs. You feel threathemn for your job, because as nurses we tend to nurture our patients and see them as a whole rather than a specific disease, and patietnts sense that and want to back to their NPs where they can be threated as human beings.
msa
9:14PM APR 4TH 2010
Wow, are you angry! I am an NP who doesnt want the headaches of prescribing controlled substances but if the 48 of 50 states have allowed this privilige why not Florida? Require further coursework or certification. While 50% of PA programs are now Master's level- all ARNP programs are Master's level, which means a Bachelors is a prerequisite, therefore the didactic portion of your argument is void . And I do agree that PA's have more clinical hours but students can choose to learn in a clinical rotation or slide by the skin of their teeth. Each has their attributes and downfalls.
As far as FL leading in prescription drug trafficking- please check your glass house, as physicians are doing the prescribing or signing blank prescriptions for office staff to fill in.
You can call in a very limited number of prescribed substances- please check with your pharmacist-
NP2010
3:48PM NOV 22ND 2010
Wow! You said a mouthful there! I live in Alabama, the only other state in the entire United States where NP's can't write controlled substance prescriptions! Not to mention the fact that we can't work anywhere without the agency being listed with the collaborating physicians agreement. I'm not sure if I want the headache of prescribing controlled substances but I should have the opportunity, if 48 other states have the right! This issue really angers me because most of us (NP's) have worked for many years as RN's before we became NP's and have 10x the experience as some of the physicians I have worked with in my career! I honestly believe it is all about the almighty dollar. The Board of Medicine can say what they want but the reality is they are afraid we are going to get just a little more compensation than we did as floor RN's. I truly don't understand the issue since we do most of their work anyway! And, most of us don't mind because we love being with our patients. And, as far as the PA's, don't even get me started! They are just as arrogant as physicians... and I have been in offices where the PA wrote the RX for narcotics after my surgery and signed the physician's name himself! So, you tell me. Yes, there are bad people in every occupation under the sun but there are bad people everywhere! BUT, there are also good, honest people, who honestly just want to care for their patients. If, for example, an elderly lady with confirmed DJD comes into the clinic and is obviously in excruciating pain, then it would be nice to help her, instead of having to say, "Well, hold on just a minute, let me call my collaborating physician to get approval to call a RX in." Now, what is the point of being an NP, if I can diagnose and treat a patient in every way, EXCEPT when they have pain or a horrible case of bronchitis? It just doesn't make sense to me. To be honest, I have seriously considered moving to MS, at least they can write controlled substance prescriptions and MNA is fighting for their right to practice independently. I don't see Alabama doing anything. This just upsets me because these patients need us and the physicians because there are simply procedures, which are beyond our scope of practice, so why can't we just all get along?
Vicki Spitzer ARNP
12:22PM MAR 29TH 2010
OH PLEASE Tampa doc. As you must be aware if you have worked with ARNP's, they have been prescribing medications that have the potential to be lethal for over twenty years. But they cannot prescribe medicatons that could ease pain and suffering. This is not about patient safety it is about GREED and control. The problem with the drug trafficing or "PILL MILLS" were created and mushroomed by Doctors! This absurd obstructionistic behavior must stop. Even the senates own well research report supports this legislation. The facts did not support their agenda so they threw it out. The Chair and Vice Chair have been bought out by the FMA! In fact Mrs Soble is married to a doctor and has made it clear she is no friend of nurses. I think if I were you I would be a little more creative in my arguments.
bernadine.henry
12:38PM MAR 26TH 2010
Well, Florida and one other state remains in the dark. I agree that there is a big problem in florida regarding norcotic abuse. How did that happen? who are respobsible to that action? I have worked in physician's offices, where the nurse practitioners are the ones who are acting as detectives against the patients who came into the offices to gain norcotics . while the doctor was busy running from rooms to rooms. Are the nurse practitioners the ones setting up these pain centers at every corner street in Florida? are the nurse practitioners the ones selling norcotics in the offices? Well, I cannot see where you years of education etc have helped in the case of over prescribing norcotics to patients in our state. Your actions have crippled some and have killed many. It is a shame when you pass by a certain physician's offices in Florida and see the drug seekers/ drug addicts standing in line waiting spitting and shaking., looking to their legal drug dealer to again and again give them another high. Mr Michael Jackson, was over dosed at the hands of a well trained doctor wthl many many years of medical education/training. many doctors were involved in his addiction, including specialist., never was a Np implicated. NP are detectives, we are very suspecting, very cautious we would never over prescribe norcotics. We are not looking to hit heads with physicians, nor are we asking to be physicians. We respect physicians and the many years of schooling. We are not looking to compete with doctors, we just want to help to provide care to the thousands of people in Florida, who desirve care. Let us work as a team to attain a common goal. Let us meet even part way.......for the sake of the people of florida.
kris
6:36PM MAR 25TH 2010
FMA said, “ARNPs do not have the training nor the qualifications necessary to prescribe these medications. If they want to prescribe controlled substances, they can go to medical school and receive the proper training to do so.”
Ha, random thought....perhaps if Michael Jackson had seen a Nurse Practitioner he'd still be alive today. Oh yeah, he did, and she referred him to an all-knowing DOCTOR.
Diana Corpstein
5:38PM MAR 25TH 2010
The physicians are protecting their incomes. They have no evidence to support their position. Research for the last 40 years shows ARNPs deliver quality, safe care and patients love them. Physicians are violating a patients right to choose their provider when they block legislation that will allow ARNPs to practice to the extent that their education and training provides. This is money issue. Physicians with ARNPs in collaborative practice make thousands of dollars because ARNPs are paid much less than physicians. Surely with all the health care issues at hand, there are plenty of patients to go around. There are so many physicians that have left AMA because they are spending so much time and money to restrict the practice of ARNPs. Make no mistake it is a money issue, the doctors make plenty off the ARNPs and that is sad for the patients who really could benefit from their services. Why doesnt the AMA try working with the ARNPs instead of against them.
TampaDoc
8:06AM MAR 26TH 2010
This isn't a money issue. There is an access crisis going on, no doctors would lose money by NPs hanging up independent shingles all over town. There are more than enough patients to go around. This is about SAFETY. I'm sure it is hard for nurses to understand this, but doctors DO care about their patient safety. And if I was in this business for money, I would have been a neurosurgeon, not an FP doc! I think the whole mantra that this is about money is an attempt to divert the truth of that matter, which is the issue is about money for the nurses! The nurses obtain more unregulated independence when they get these narcotic rights, thus more opportunities for big dollars from patients who would pay anything for 100 Percocet pills that they can sell on the street for 3 times their value. And yes, NPs and PAs deliver quality safe care, research shows this based on midlevels who worked under collaborative and supervisory relationships with doctors. The Team model of medicine works. The key word here is TEAM. Rather than suggesting the AMA be told to work with ARNPs, why don't the ARNPs try working with the doctors to get the rights they need instead of constantly going to war legislatively to force the public to give you independent practice rights for abbreviated schooling. If practicing independent medicine can be this easy, why would anyone go to medical school in the first place? Just be a nurse, its the same thing, right?
Monique, ARNP, CNM, DNP
7:40PM MAY 4TH 2010
Dear Tampa Doc: Florida is bombarded with over-prescribing of narcotics legally through pain clinics and illegally for profit by prescribers. Yes, prescribers. PHYSICIANS in Florida are over-prescribing and illegally prescribing medications for profit and sale in the black market. It's the Florida good-ole boy's network... guess what... maybe not this year...but it's going to change. ARNPs are the future and YES we are adequately educated!
Vicki Spitzer ARNP
4:39PM MAR 31ST 2010
Tampa Doc What is your real name? It is quite apparent that you are a spokesman for the FMA. We are following the appropriate channels to change legislation as every other state has done or has attempted to do. With the FMA's perspective on ARNP's why in the world would we be foolish enough to trust the medical profession? Again try a little more creative and independent in your thinking on this issue!
20yearTampaRN
12:55AM MAR 28TH 2010
TampaDoc,
I agree with you that this is not a money issue, and that it is a safety issue. I also agree that Florida has a huge narcotics "pushing" problem. However, I have to agree with another writer stating that physicians currently are the only ones with narcotic prescriptive services, and must say that these pain clinics are OUT OF CONTROL. I have to say this is a double-edged sword. I have had three local physicians want to hire me as an ARNP working with ADHD children, for which I have over 13 years experience. I feel I would be very responsible and knowledgeable for prescribing stimulants for this demographic of patient, and so do these physicians that would like to hire me. One M.D. asked me to leave a management position at the hospital for the job with him. I have seen that MOST pediatricians and family practitioners know little about this specialty. Imagine having to stop the doctor, and have the patients wait while you get an "ok" rom a physician for this typer of prescriptions. That would DEFINITELY decrease the access to care, not to mention>>>less patients seen means less accounts receivable. Also as a previous ICU and CCU nurse, I must say that I personally, and other nurses I have worked with also, knew so much more than a good portion of medical students and first year residents. Years of clinical experience are just as significant as the education portion alone. So how does "abbreviated schooling" apply here? Granted, there are nurse that I wouldn't want to see with this prescriptive priviledges, but MANY more physicians. I agree that medicine and nursing(ARNPs) should provide collaberative care. This really is about providing services to the patients. Maybe there can be an answer for both physicians and ARNPs. The AMA can give approval for these priviledges under strict provisions to nurses AND physicians with specific, extended training and scrupulous monitoring of narcotics. By the way, did I tell you I was also married to a physician who practices family medicine, and agrees that most ARNPs are duly qualified for advanced practice and prescribing narcotics.
Diane Scaife
3:28PM MAR 25TH 2010
I applaud all APRNs and supporting representatives in the House and Senate in the state of Florida for continued efforts to bring bills to the schedule allowing prescriptive authority. Certainly part of being "qualified" to prescribe is passing classses related to pharmacology and microbiology as well as all classes related to medications and becoming certified as an APRN. Once again a local group of the AMA cannot get passed the idea that APRNs are qualified health care providers in all aspects within their scope of practice.
Kim
10:06PM NOV 2ND 2010
Yes, and I suppose nobody has ever heard of MDs overdosing their patients on narcotics? MDs NEVER prescribe medications that have harmful interactions? My brother is a pharmacist. I wish I had a dollar for every time he had to call a Doctor and let them know of a mistake in their prescription. MDs are NOT necessarily experts in medication management.
Yvette ARNP (Florida)
11:37PM JAN 14TH 2011
Important to note for anyone still reading this thread, there are medications that I prescribe daily that are not controlled, however have a much greater potential for adverse effect than many of the controlled medications in debate. The only reasons I should not be allowed to prescribe medications that are controlled are if I am not morally responsible enough, not smart enough to determine if the patient is having real pain and or not educated enough to determine what the potential risks and or benefits are for the substance in question. I am surrounded by practices where MD's are now doing hard time for their superior knowledge in controlled substances. Lets not dance around the issue shall we, this has very little to do with how many hours of training any of us have. I have 16 years of hospital and ER experience prior to Graduate school I am not asking for anything more, I just don't want the issue clouded with crap about pharm training. Anyone prescribing medication knows it is a constant struggle to keep up with all the new drug therapies and what is considered safe. I could make a long list of all the medications that have been pulled from the market in the last 2 years. These medications were widely prescribed by ALL! Everyone needs to be careful and constantly re-educated on all prescribing to include controlled substances.

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