The transition of nurse practitioners to changes in prescriptive authority

To understand nurse practitioners' (NPs) decisions about whether to obtain prescriptive authority for controlled substances, to describe NPs' experiences with providing or prescribing controlled substances, and to describe the relationship between perceived autonomy and prescriptive authority for controlled substances.

Twelve focus groups were conducted with approximately 100 NPs who attended continuing education conferences. Discussions were audiotaped and transcribed verbatim. Grounded theory approaches were used for data collection and analysis.

A core category of Letting go and taking hold characterized Washington State NPs' experience of the transition to prescribing schedule II-IV medications. Three dimensions of the NPs' transition were Resisting change, Ambivalent about change, and Embracing change.

The core category, Letting go and taking hold, indicated how transition to a new scope of practice extended beyond successful passage of legislation, the importance of examining the nature of professional transition that accompanies successful legislative change, and role development as an ongoing process throughout one's career in response to changes in scope of practice. NPs need preparation for a new scope of practice long before legislation actually passes. Revealing and examining this process can facilitate the goal of achieving fully autonomous NP practice.