What was envisioned as a 3-part series will actually be more. There is a lot more history to share. Click here for Gale’s last installment in this series.
To recap Part 2, in 1992 the Joint Subcommittee (JSC) appointed a task force to review prescribing regulations for nurse practitioners (NPs) and certified nurse midwives. From this group’s work, major rule revisions for prescriptive authority were implemented in March 1994.
Stakeholders for change
The same task force was reconvened in July 1994 to review NP rules in their entirety and propose revisions to the JSC for consideration. The task force received a lot of input:
At the request of the task force, a special work group was appointed by the JSC to review the NP education program requirements and approval process. Suggestions from that special work group were incorporated into the task force’s final Rules revision recommendations.
Although some compromises were inevitable in the process (example: some of the original SOP language was deleted), additional significant changes were made in NP Rules as a result of the task force’s additional work.
The JSC accepted the final task force report, made some minor changes and submitted the proposed Rule revisions for adoption by both the Board of Nursing (BON) and the Medical Board in July 1995. The formal Rules revision process was completed in December 1995 and the new NP Rules became effective January 1, 1996.
Tangible results of the new Rules included a shorter application and a streamlined application process that decreased time from application to approval. Because approval to practice was no longer tied to an NP’s practice site (instead it was linked to the primary supervising physician), it was less complicated for NPs with locum tenems assignments and NPs with multiple practice settings to obtain additional approvals to practice. Adding a backup supervising physician became as simple as keeping a signed and dated agreement at the practice site.
The new ability to prescribe a 30-day supply of specific drugs for the treatment of ADD/ADHD was an improvement in the day-to-day practice of many nurse practitioners, especially those in pediatrics.
More philosophical gains were the recognition of the independent accountability of NPs and the acknowledgment that there was an NP SOP rather than the implication that NPs practiced solely at physicians’ direction.
Although it was understood that NP Rules would require additional scrutiny and revision over time, this did not diminish task force members’ appreciation for the power of the process or the utility of the results.
The NP Rules that went into effect January 1, 1996 included:
Coming up next
“Collaboration” becomes a hot topic of conversation among North Carolina’s advanced practice registered nurses (APRNs) and physicians.