Nev. legislation passes, allows NPs to prescribe certain drugs

In an expansion of nurse practitioners' scope of practice, Nevada Gov. Brian Sandoval signed a bill this week allowing NPs to write prescriptions (PDF) without the supervision of a physician.

Current Nevada law allows advanced practice registered nurses to prescribe drugs only if they have a written practice agreement with a supervising physician. The new law eliminates that restriction effective July 1. "Nurses won't have to have the behind-the-scenes piece of paper to practice," said Tay Kopanos, vice president of state government affairs for the American Academy of Nurse Practitioners.

As a compromise with physicians, a provision was added to the bill that NPs who have less than two years or 2,000 hours of clinical experience will still require a written practice agreement with a physician before they can prescribe schedule II drugs such as codeine, hydrocodone and Ritalin.

“The nursing leadership said, 'That's not ideal, but we can live with that,'” Kopanos said. “We're anticipating that this will increase access in rural and underserved communities.”

Koponas explained that in some of these communities, it can be hard for NPs to enter a practice agreement with a physician as many doctors do not want to enter into such agreements unless they employ or practice in the same facility as the NP.

A representative from the Nevada State Medical Association was not available for comment. But in testimony before the Nevada legislature Feb. 27, Dr. Robin Titus, representing the NSMA and the Nevada Academy of Family Physicians, said that while the NSMA “strongly supports the professional working relationship with nurses,” it opposed the bill and opposed the elimination of the written practice agreement.

“Removing the requirement does not produce any more advanced practice nurses than we have now,” Titus testified. “It makes the ones we have more independent, and possibly more isolated,” she said.

Angela Golden, president of the American Association of Nurse Practitioners, commended Sandoval and the legislature for the passage of the new law.

"Nevada now keeps pace with 16 other states and the District of Columbia, which offer patients full and direct access to nurse practitioner services and moves into alignment with national recommendations,” Golden said in a news release. “We urge lawmakers in other states that are considering similar legislation to follow suit and take steps toward closing the gap between the care that nurse practitioners are educated to provide and the care that dated regulations allow them to deliver.”

Also in Nevada, the American College of Emergency Physicians cheered the failure of a bill that sought to cap emergency care expenses. The bill died without being voted on.

Follow Andis Robeznieks on Twitter: @MHARobeznieks