In the United States, patients, particularly low-income individuals and those without health insurance, face limitations in accessing physician-based medical care. At the same time, primary care, including family planning and sexual health services, has never been more important. Increasing nurses’ scope of practice can help provide access to these critical services.
Over the past several decades, advanced practice registered nurses (APRNs) have become an integral part of the health care system. APRNs, including nurse practitioners (NP), certified nurse midwives (CNM), clinical nurse specialists (CNS) and certified registered nurse anesthetists (CRNA), must have at least a Masters degree and are trained to treat a specific patient population. (CRNAs are not analyzed in this brief since they do not regularly provide sexual and reproductive health care.) APRNs provide patient assessments, diagnose diseases and conditions, order tests, prescribe medications and direct patient care. Some states allow APRNs to dispense medications under certain conditions and others permit APRNs to provide drug samples to patients. States vary in how APRNs are licensed: some states allow APRNs to practice independently, others require APRNs to work within a collaborative practice agreement with a physician and other states generally allow APRNs to work independently, but require a collaborative practice agreement with a physician in order to prescribe medications.
In fact, many states have adopted the "consensus model" which provides uniform requirements for APRNs across Some states have also expanded the types of services registered nurses (RN) can provide. Starting in the 1980s, some states authorized RNs to dispense medications, including contraceptives and STI medications, as a way to increase access to medical care for individuals obtaining services at outpatient health clinics, such as health departments or family planning clinics. These laws are in addition to physician orders that delegate duties to RNs.
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- Most or all states grant prescriptive authority to APRNs as part of licensing.
- 37 states grant prescriptive authority to CNSs.
- 50 states grant prescriptive authority to NPs.
- 50 states grant prescriptive authority to CNMs.
Less than half the states allow RNs to dispense drugs and most states permit APRNs to dispense medications or provide samples.
16 states allow RNs to dispense some medications, including contraceptives and drugs for STI care in outpatient settings, such as a health department or a family planning clinic.
- 26 states allow CNSs to dispense drugs and another 11 permit CNSs to provide drug samples.
- 29 states allow NPs to dispense drugs and another 13 permit NPs to provide drug samples.
- 29 states allow CNMs to dispense drugs and another 12 permit CNMs to provide drug samples.
- United States: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming