The Mayday Scholars Program for 2001-2002 provided an opportunity to boards of nursing to present their experiences in monitoring the prescribing practices of advanced practice nurses and to research ways for improving their own investigation processes as professional disciplinary agencies for prescribing practices related to pain management. The Alabama Board of Nursing was interested in participating in the program based on its commitment to accountability for public protection. A gradual increase in disciplinary cases involving violations of prescribing practices by certified registered nurse practitioners (CRNPs) prompted our inquiry as to whether a proactive monitoring system was needed to determine compliance with regulations for advanced practice nurses in collaborative practice.In this article, we discuss selected elements related to pain management and regulatory factors, including nursing, that affect the treatment of pain. We present a brief overview of the evolution of advanced practice nursing, with an emphasis on the nurse practitioners movement, and prescription practices and pain management by nurse practitioners.
Nurses are on the front lines of pain management, yet in Alabama and eleven other states they are not legally authorized to prescribe any controlled pain medications. In this survey of certified registered nurse practitioners in Alabama, 83 percent of the nurses responding to a question about the connection between prescriptive authority and pain management said that the lack of prescriptive authority for controlled substances delays pain management treatment, and 88 percent of those proffering an opinion about the importance of prescriptive authority said that expanding their prescriptive authority to include those medications would improve patient outcomes.At the same time, however, many nurses indicated that they are not adequately prepared to prescribe and manage pain medications. Fifty-five percent of the nurses responding to a question about whether they were prepared to make decisions when working under protocols related to controlled substances answered no. And 44 percent of the respondents to a question about the nurse practitioner educational curricula said that they did not feel their education had adequately prepared them for prescribing controlled pain medications.
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