Barriers to prescriptive practice for psychiatric/mental health clinical nurse specialists

Prescriptive authority for advanced practice psychiatric nurses (APPNs) has recently been legislated in many states. APPNs in Minnesota were granted prescriptive authority in 1995, but from 1995 to 1996 only 17 of 80 qualified APPNs in that state had received prescriptive authority. A survey on the barriers encountered in obtaining prescriptive authority was mailed to the 80 APPNs who completed a psychopharmacology course required for prescriptive authority. Of the 54 (67.5%) APPNs who returned the questionnaire, 43 registered for the course for the purpose of prescriptive authority but only 17 of these respondents had received prescriptive authority. The major barriers to obtaining prescriptive authority reported by these APPNs were work setting limitations, personal comfort with prescribing, and ability to develop a collaborative agreement with a psychiatrist. Based on these APPNs' responses, suggestions are given for: increasing the acceptance of the prescriber role, developing support for the prescriber role, obtaining equitable reimbursement, and simplifying the process of obtaining prescriptive authority.