The ability for a nurse to write prescriptions is not universal across the profession; this authority is specifically granted to Advanced Practice Registered Nurses (APRNs). Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) are not authorized to write prescriptions. The power to prescribe is a function of advanced clinical training and a postgraduate degree. This training allows APRNs to diagnose conditions, develop treatment plans, and order pharmacological agents. This comprehensive scope of practice enables APRNs to serve as primary care providers in many settings. The extent of their prescriptive authority is governed by a patchwork of state-level regulations and practice models.
Advanced Practice Roles and Education
The nurses authorized to prescribe medications are Advanced Practice Registered Nurses (APRNs). This designation encompasses four primary roles:
- Nurse Practitioner (NP)
- Certified Nurse Midwife (CNM)
- Certified Registered Nurse Anesthetist (CRNA)
- Clinical Nurse Specialist (CNS)
The Nurse Practitioner is the most common role associated with primary care and prescriptive authority. CNMs also possess broad prescriptive authority, particularly for medications related to women’s health and obstetrics.
To qualify as an APRN, an individual must first be a licensed Registered Nurse. They must then complete an advanced education program, typically at the Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) level. This graduate-level training includes specialized coursework in advanced pathophysiology, advanced physical assessment, and advanced pharmacology. Many APRN programs also require a minimum of 500 hours of supervised direct patient care clinical experience.
Upon completion of their degree, candidates must pass a national certification examination specific to their APRN role and patient population focus. This rigorous process ensures APRNs possess the specialized knowledge to diagnose and manage patient conditions. The authority to prescribe is distinct from the APRN license itself, often requiring a separate application and registration with state boards and federal agencies.
Understanding Prescribing Limitations
APRNs can prescribe a wide range of medications, but the specific agents they order are determined by their clinical specialty and the federal classification of the drug. Prescriptive authority is tied to their population focus; for example, a Pediatric NP prescribes within pediatric guidelines. APRNs commonly prescribe medications like antibiotics, antihypertensives, and antidepressants. The authority to prescribe controlled substances represents the most regulated area.
Controlled substances are categorized into Schedules II through V based on their potential for abuse and medical utility. Schedule II drugs have the highest abuse potential. To prescribe controlled substances, APRNs must register with the U.S. Drug Enforcement Administration (DEA). They must also complete specific continuing education focused on safe prescribing practices, including pain management.
Many states place specific limitations on Schedule II prescribing, such as restricting the supply to a short duration, often a seven-day limit for acute pain. Other limitations dictate the circumstances of the prescription, such as requiring consultation before prescribing controlled substances to children under the age of two. In some jurisdictions, APRNs must check a state’s Prescription Monitoring Program (PMP) before ordering specific controlled medications to prevent misuse.
State Regulations and Practice Models
The degree of independence an APRN has in prescribing is governed by state laws, which define their scope of practice through three primary models.
Full Practice Authority
This model allows APRNs to evaluate, diagnose, order and interpret diagnostic tests, and prescribe medications without the supervision or mandatory collaboration of a physician. This model is recommended by national nursing organizations and allows APRNs to manage patient care independently under the authority of the state Board of Nursing.
Reduced Practice Authority
This model limits the APRN’s ability to engage in at least one element of advanced practice. It often requires a regulated collaborative agreement with a physician to prescribe certain medications. The APRN may have some independence but must operate within the constraints of a formal agreement that outlines the terms of their collaboration.
Restricted Practice Authority
This is the most restrictive model. It requires career-long supervision, delegation, or team management by a physician for the APRN to provide patient care. This significantly impacts the APRN’s ability to prescribe autonomously. This variability means that prescriptive authority can differ widely depending on the state in which they practice.