Monitoring and Investigating Certified Registered Nurse Practitioners in Pain Management

2003 ◽  
Vol 31 (1) ◽  
pp. 12-14
Author(s):  
Jean B. Lazarus ◽  
Belinda (Wendy) Downing
Keyword(s):  
Pain Management ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Registered Nurse ◽  
Controlled Substances ◽  
Prescriptive Authority ◽  
Pain Medications ◽  
Certified Registered Nurse ◽  
Improve Patient

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.

Monitoring and Investigating Certified Registered Nurse Practitioners in Pain Management

2003 ◽  
Vol 31 (1) ◽  
pp. 101-118 ◽  
Author(s):  
Jean B. Lazarus ◽  
Belinda (Wendy) Downing
Keyword(s):  
Pain Management ◽  
Nurse Practitioners ◽  
Registered Nurse ◽  
Advanced Practice Nurses ◽  
Advanced Practice Nursing ◽  
Advanced Practice ◽  
Prescribing Practices ◽  
Practice Nurses ◽  
Prescription Practices ◽  
Certified Registered Nurse

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.

scholarly journals Changing Acute Pain Management to Improve Patient Outcomes

1999 ◽  
Vol 17 (4) ◽  
pp. 277-287 ◽  
Author(s):  
Jo Ann Dalton ◽  
William Blau ◽  
Celeste Lindley ◽  
John Carlson ◽  
Richard Youngblood ◽  
...  
Keyword(s):  
Pain Management ◽  
Patient Outcomes ◽  
Acute Pain ◽  
Acute Pain Management ◽  
Improve Patient

scholarly journals Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review

2021 ◽  
Author(s):  
Ruth Martin-Misener ◽  
Patricia Harbman ◽  
Faith Donald ◽  
Kim Reid ◽  
Kelley Kilpatrick ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Usual Care ◽  
Ambulatory Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Randomised Controlled

Objective: To determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care. Design: A systematic review of randomised controlled trials reported since 1980. Data sources: 10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites. Included studies: Randomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes. Results: 11 trials were included. In four trials of alternative provider ambulatory primary care roles,nurse practitioners were equivalent to physicians in all but care roles,nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros). In two trials of alternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials of complementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly. Conclusions: Nurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.

scholarly journals A realist review protocol of the role and contribution of the advanced nurse practitioner (ANP) in gastroenterology nursing

2021 ◽  
Vol 4 ◽  
pp. 126
Author(s):  
Marlize Barnard ◽  
Mary Casey ◽  
Laserina O'Connor
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Data Extraction ◽  
Realist Review ◽  
Programme Theory ◽  
Quality Patient Care ◽  
Education And Health ◽  
Review Protocol

Background: The role and contribution of advanced nurse practitioners (ANP) has been well researched and found to be of great value for improving quality patient care and enhancing patient outcomes through education and health promotion. However, the role and the contribution of the ANP to gastroenterology nursing have not been evaluated either nationally or internationally. A review to determine the role and contribution of the ANP in gastroenterology nursing will inform on the contribution of the role and whether the role makes a difference to patient outcomes and cost effectiveness of patient care. Objective: This review aims to investigate the nursing role and contribution of the advanced nurse practitioner in gastroenterology. Furthermore, improved understanding of the underlying causal mechanisms explaining how the ANP role in gastroenterology nursing works, will provide a deeper understanding of how, why, for whom and in what contexts the role and contribution of the ANP to gastroenterology nursing are most successful. Methods: A realist review will consolidate evidence on how, when why and where the ANP role in gastroenterology works or fails through identifying programme theories underlying to the role’s introduction. The following steps will be operationalised; locating existing theories, searching the literature, documenting literature selection, engaging in data extraction and synthesis and refining programme theory. As an iterative approach, review cycles will uncover explanatory and contingent theories through context-mechanism-outcome configurations (CMOCc). Due to the variation in context and mechanisms, different outcomes will be likely across different clinical settings although similar patterns may be identified. Conclusions: Due to the theory-oriented approach of realist reviews, the pragmatic consequences of the review, will lend itself to deeper understanding of how the role and contribution of the ANP in gastroenterology nursing works in practice.

States Should Remove Barriers to Advanced Practice Registered Nurse Prescriptive Authority to Increase Access to Treatment for Opioid Use Disorder

2020 ◽  
pp. 152715442097872
Author(s):  
Hayley D. Germack
Keyword(s):  
Substance Use ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Registered Nurse ◽  
Opioid Use Disorder ◽  
Advanced Practice ◽  
Opioid Use ◽  
Access To Treatment ◽  
State Planning ◽  
Prescriptive Authority

In October 2018, President Trump signed into law H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. This piece of legislation addresses treatment, prevention, recovery, and enforcement with particular attention to access in rural areas. It contains numerous provisions to improve needed access to treat substance use disorders and especially opioid use disorder (OUD), including mandatory coverage of medications for OUD, partial elimination of Medicaid payment for inpatient mental health treatment, and state planning grants to increase provider capacity. Many of these provisions would be significantly enhanced by removing barriers to prescriptive authority for Advanced Practice Registered Nurses (APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and other state-specific titles for nurses whose scope allows the prescription of controlled substances. This policy brief includes a history of the role of APRNs in the delivery of medications for OUD, scope of practice restrictions related to prescriptive authority as a barrier in their ability to deliver care for this vulnerable population, and actionable strategies that APRNs can take to advocate for an increased role in providing care.

scholarly journals Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review

2021 ◽  
Author(s):  
Ruth Martin-Misener ◽  
Patricia Harbman ◽  
Faith Donald ◽  
Kim Reid ◽  
Kelley Kilpatrick ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Usual Care ◽  
Ambulatory Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Randomised Controlled

Objective: To determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care. Design: A systematic review of randomised controlled trials reported since 1980. Data sources: 10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites. Included studies: Randomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes. Results: 11 trials were included. In four trials of alternative provider ambulatory primary care roles,nurse practitioners were equivalent to physicians in all but care roles,nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros). In two trials of alternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials of complementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly. Conclusions: Nurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.

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