A Policy Evaluation of Statutory Limitations of Advanced Practice Registered Nurses' Prescriptive Authority

Little research examines violations of laws governing the practice of advanced practice registered nurses (APRNs). The purpose of this study was to identify violations of prescribing laws committed by APRNs and to examine the relationship between two major expansions of prescribing laws, one in 1996 and the other in 2003, and the violations committed during the seven year period after each change. The conceptual framework for this study was Benner and colleagues' work on nursing practice breakdown and Patton and Sawicki's policy analysis framework. In this non-experimental descriptive study, violations in prescribing medications committed by APRNs for the period 1989--2009 were identified through document analysis of all APRN licensure discipline records on file with the Board of Nursing in a southern state. Violations were sorted by occurrence date and analyzed for statistical significance of increases in the number of violations before and after the major changes to the law. Kruskal-Wallis H was employed to examine the significance of changes in numbers of violations related to APRNs prescribing following changes to the laws. A statistically significant increase in the ratio of violations committed per licensee was observed during the seven-year period after the 1996 change; no significant increase was noted in the seven-year period after the 2003 change. The violation per licensee ratio for each year reviewed was less than 0.3438%. Data showed APRNs committed few violations per licensee in prescribing medications after the law was changed. Implications for positive social change include that APRNs may provide quality health care with fewer restrictions on their authority to prescribe medications, thereby increasing access to health care.