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Michigan: Bill Would Increase Prescriptive Power

The Michigan Coalition of Nurse Practitioners (MICNP) has partnered with the state's clinical nurse specialist and nurse midwife organizations to write legislation based the Consensus Model for APRN Regulation by the National Council of State Boards of Nursing (NCSBN). The group's goal is to introduce the bill when the Legislature reconvenes in August.

"This is a tough year for any legislation because Michigan has term limits," said Connie Knapper, NP, president of MICNP. All but nine senators are term limited this year. Of those nine, five are Democrats in a Republican majority Senate. There is jockeying for leadership credentials among the four, Knapper notes, as well as other distractions including budget concerns.

The language of the bill calls for several changes. It proposes updating regulatory language defining nurse practitioners that places them under the title "registered nurse." This change, the bill suggests, will increase patient access to care by increasing retention of the state's nurse practitioner work force. It will also bring increased understanding of the role to potential employers.

New language would clearly define nurse practitioners, nurse midwives and clinical nurse specialists. It would also require education levels equal to state and national NCSBN standards. Separate NP licensure would be required in addition to RN licensure. Continuing education requirements would also be laid out. NPs would obtain increased prescriptive powers if the bill is passed, because the new law would remove the requirement that physicians sign off on NP prescriptions.

Currently, Michigan's NPs have delegated prescriptive authority from their physician colleagues, including the ability to write for drugs on Schedules III through V. But they have limited ability to prescribe Schedule II drugs. An NP may prescribe a Schedule II drug for 72 hours when discharging a patient from the hospital. There are no exceptions to this rule, including for hospice or treatment of attention deficit-hyperactivity disorder.

The proposed bill would provide NPs with autonomous prescriptive authority, including Schedule II drugs, as long as they complete graduate-level pharmacology, pathophysiology and physical assessment coursework. NPs without that education would remain under the delegated prescriptive authority regime currently in place.

At press time in July, the legislation was in its second draft form. It had already been reviewed by the Board of Nursing and the Michigan Department of Community Health. Knapper said both groups expressed support for the bill, which hasn't been the case in the past. Local media has also published details of the bill. "Of course, if it doesn't succeed, we will start all over again in 2011," Knapper said.

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