Prescribing patterns of advanced practice nurses: contrasting psychiatric mental health CNS and NP practice

Advanced practice nurses (APNs) play a key role in delivering health care and increasingly include prescriptive authority in their practices. To date, few systematic studies have investigated APN prescribing patterns. The purpose of this investigation was to explore the prescriptive practice of APNs, assess differences in prescriptive patterns by specialty, and determine barriers to prescriptive practice. Fifty-one percent (n = 1352) of 2,651 nurse practitioners (NPs) and psychiatric clinical nurse specialists (CNSs) in Massachusetts responded to a self-administered survey; 59% had incorporated prescriptive authority. Identified barriers included fees, the process of obtaining prescriptive authority, and lack of physician supervision. Significantly more psychiatric CNSs than NPs had difficulty obtaining physician supervisors. Prescriptive authority is integral to advanced practice, but differences in ability to implement this in practice exist among specialties.