Access to NP care in California is limited by state law. Physicians and NPNs must enter into a cooperation agreement for one or more elements of the practice of NPPs. The NP is required to have a cooperation agreement with a supervisory physician for the prescribing of drugs. After four years of practice under the cooperation agreement, an NP can prescribe drugs independently. Ky. Rev. Stat. 314.042 Some medications, such as Adderall, oxycodone, testosterone, ambiens and cough syrup with codeine, still require a collaborative agreement. Of the 5,410 nurses in the state, 1,948 have an agreement to prescribe these more restrictive drugs, according to the Kentucky Board of Nursing. Having this scaffolding would make a big difference for Brenda Pittman, a nurse at Mt.
Sterling, Ky. One doctor withdrew from an agreement with her in June 2013, another last March. In both cases, the medical practices were purchased by large hospital systems that did not allow them to pursue the agreements. Sheila Schuster, a lobbyist for the Coalition of Nurses and Midwives, said replacing the career requirement with the four-year cooperation agreement was “a big step forward in reaffirming independent practice.” The act establishes a six-member committee to establish a list of physicians willing to conclude these agreements. If the nurse cannot find anyone on the list within 30 days, the committee must issue a doctor. After four years, PNs no longer need an agreement to prescribe most drugs. Kopanos and other supporters refer to a 2006 Colorado law that requires a new graduateD NP for the first 1,800 hours of office requires a doctor to approve all prescriptions. Then they must spend an additional 1,800 hours in a formal tutoring agreement with a doctor who must check their prescription regimens. However, at the national level, stakeholders doubt that this approach is truly an innovative compromise. “If it becomes easier for someone to meet an unnecessary burden to meet the requirements, the fact that it is a burden will not be reversed,” said Tay Kopanos, AANP`s vice president for government affairs. She said the cooperative agreement on controlled drugs, which the government considers dangerous and addictive, is a major obstacle. “I called a dozen doctors,” Pittman says, recalling their hectic feud after the agreements ended.
Both times, she was empty and had to close her practice for four days, which caused her to lose about $12,000. “It tasted my budget and a lot of patients complained that they couldn`t be seen, that they couldn`t get their refills,” said Pittman, who, under the new law, no longer needs to be associated with a collaborative doctor to prescribe most drugs. Currently, 19 states require PNs to have a collaborative agreement for the entire career, and another 12 require supervision or team management with a physician, with nurses prescribing by physicians, according to the American Association of Nurse Practitioners (AANP).