[NPInfo] Re: DNP Autonomy

[Shelby Havens]

Paula:
 
You are absolutely correct. The "prescriptive authority" with which the pharmacists are empowered in the VA Healthcare System consists of merely reviewing a coag profile and titrating a patient's dose of Coumadin, or making a command decision to substitute Mevacor for Zocor per formulary restrictions.     
 
I would suspect that the physical therapists' "prescriptive authority" is similarly limited to something like recognizing that a patient who has been referred to them by a provider has some minor condition, in addition to the problem for which they were referred, such as a muscle strain or swollen joint, and they can "prescribe" hot packs, ice, or some other benign therapy.  
 
I am reminded of "nursing orders" that we had back in the early 1980's when I was a student at a large progressive teaching hospital. An RN could independently order white petrolatum for chapped lips or lotion for dry skin, without a physician's order, and the pharmacy would fill the order and deliver it to the unit. Wow, I really felt independent!     
 
My idea of "autonomous practice" is that a patient comes to me, and I do everything necessary to diagnose and treat the patient or independently manage their condition, including but not limited to taking a history, performing examinations, ordering diagnostic studies, referring to specialists as needed, and prescribing treatments, without being supervised by someone in another profession. It would also include being paid directly for my services, without having to pay someone to supervise me, or without being in a master-servant type of relationship with a supervisor/employer if I chose to hang out my shingle and set up a private practice.  
 
When I get my taxes done, the tax preparer does everything independently, without being supervised by any other professional. When I go to my lawyer, he can write a will or give me legal advise without being supervised by anyone, and I write a check to him directly. Heck, even when I get my hair cut, the cosmotologist, whose license is posted on the wall right above her work station, can trim and style my hair all by herself, with no collaborator! She takes responsibility for knowing the potential effects of hair dye, permanent wave solution, and other chemicals she uses in her practice. Clients can suffer allergic reactions, scalp burns, and other adverse reactions to the products she uses, and no physician is overseeing her work. Of course, the Department of Health comes around periodically to inspect the salon, but they are not her supervisor. 
 
I guess one's perspective depends on how you look at things. I don't see pharmacists, physical therapists, or lab technologists as independent practitioners. They are dependent professions. To say that they are independent raises questions like yours, Paula, and creates confusion. What pharmacists do isn't MY idea of independent practice, but I guess it may seem independent to others. 
 
Best Regards,
 
Shelby Havens, ARNP
 
 
 
 
 
> Subject: Re: [NPInfo] Re: DNP Autonomy> Date: Sun, 2 Dec 2007 06:48:05 -0600> To: npinfo at nurse.net> > While I don't want physicians to limit the pharmacists' scope of > practice inappropriately, if the pharmacist doesn't examine the > patient, take a history, make the diagnosis, and follow up with the > patient, I'm not sure why they would initiate or modify medications.> Make recommendations and catch errors? Absolutely.> But to order something independently or change something the Advanced > Practice Clinician or MD ordered for his/her patient?> When would that be appropriate?> > Paula J> > On Dec 1, 2007, at 8:17 PM, Carla Anderson wrote:> > One thing I might comment on regarding Pharmacists, however, and > > I do not know much about what they go through is this: One > > pharmacist recently told me, that in the past, they had "language > > in their scope that allowed them to "initiate or modify" > > medications along with a collaborating provider..but apparently the > > AMA threatened to sue the Pharmacy board if they did not remove the > > language. The Pharmacy board, became afraid, backed down and erased > > the key words "initiate" and "modify", which of course nullified > > the entire premise, and hence that part of the scope. I asked why > > the Board of Pharmacy did not get more involved to change things at > > the legislative level if they felt they were practicing below their > > level of training and competence, and the pharmacist just said > > they have always been afraid to buck the AMA, but that they remain > > very frustrated with the level of regulation.> > Carla /Portland, OR> > _______________________________________________> NPInfo mailing list> NPInfo at nurse.net> http://lists.nurse.net/mailman/listinfo/npinfo> *****************************
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