A growing number of states allow family nurse practitioners (FNPs) to practice without physician supervision, including prescribing medications. Simultaneously, the cost of those medications is skyrocketing, leaving low-income patients scrambling for ways to pay. For nurse practitioners, safe prescribing practices are essential. FNPs are responsible for ensuring that patients adhere to medication directions and overcome the many barriers to compliance – including cost and availability. Marilyn W. Edmunds, Ph.D., NP and editor in chief of The Journal of Nurse Practitioners, said NPs need to be vigilant about their patients’ access to the medications they need. “More than ever before, NPs need to make sure to ask their patients about whether they are able to afford their medications or if they are omitting or cutting doses because of cost. Patients need to feel that we understand their problems and will try to assist them as much as possible,” Edmunds said in “Escalating Cost of Medications May Influence Prescribing.” “Patients need to know you are working with them. Advocate for your patients as possible with pharmaceutical representatives in your offices and at conferences.” Safe prescribing practices for nurse practitioners come as a result of study and practice. RNs who enroll in post-master’s nursing programs, including online master’s in nursing, to become FNPs learn about pharmacology and best practices for helping patients.

FNP Prescriptive Authority

According to the American Association of Nurse Practitioners (AANP), more than 290,000 NPs are licensed in the United States. Of them, 95.7% prescribe medications, writing an average of 20 prescriptions a day. Overall, NPs hold some form of prescriptive authority, including for prescribing controlled substances, in all 50 states and the District of Columbia. However, each state has rules about the level of prescriptive authority. In some cases, doctors must oversee an FNP’s prescriptions. Regardless, the primary role of an FNP is to treat a whole patient, not just the disease. The focus is particularly helpful to patients who are trying to manage multiple conditions.

NP Prescribing Habits

One of the most important jobs in primary care is overseeing patients who have chronic medical conditions. Because those patients usually take multiple medications, FNPs must have a deep understanding of pharmacology. A recent study that looked at the prescribing habits of NPs, physician assistants (PAs) and primary care physicians (PCPs) found that PCPs are more likely to prescribe a newly approved medication, regardless of how new it is. That is, NPs and PAs may be more circumspect when it comes to new medicines. The study also noted that NPs and PAs, in general, spend more time counseling and educating patients than PCPs. But since PCPs generally treat older, more complex patients they may be more likely to prescribe from a broader medication armamentarium, according to the study, New Chronic Disease Medication Prescribing By Nurse Practitioners, Physician Assistants, And Primary Care Physicians: A Cohort Study. “Differences in the rate and speed of drug adoption between PCPs, NPs, and PAs may have important implications for care and overall costs at the population level as NPs and PAs continue taking on a larger role in prescribing,” study authors stated.

Helping Patients Get Medications

One of the benefits of family nurse practitioners to low-income areas is their expertise in medication management. FNPs have extensive knowledge of pharmacology and can help patients manage their chronic health problems. FNPs also understand the ethical and legal implications of prescribing medications, including the considerations from the ongoing opioid crisis. When training to be FNPs, RNs learn how to evaluate and determine patient needs, select the appropriate medications based on patient conditions and examine the possibility of side effects or drug interactions. FNPs are also alert to possible prescribing errors while keeping medication costs in mind. They can help low-income patients gain access to expensive medications by providing samples, coupons and exclusive pharmaceutical company programs. As advanced practice registered nurses, RNs who undertake a post master’s FNP certificate program learn best practices to help patients of all ages. Through Duquesne University’s online master’s in nursing programs, RNs can help patients their medications.