Pair push for change

2 Collier County advanced nurses at front of prescription power fight

By Dayna Harpster
dharpster@news-press.com

Two women in Collier County are among those leading a charge to allow advanced-degree nurses to prescribe controlled medications — as they can in all states except Florida and Alabama.

Advanced registered nurse practitioners can write prescriptions for medications not regulated by the Controlled Substances Act, such as antibiotics. In Florida, only doctors can order drugs with high abuse potential, such as hydrocodone for pain and Ritalin for attention deficit disorder.

Ann Campbell and Doreen Cassarino, both of Naples, say that allowing greater prescribing privileges will enhance access to care and reduce medical costs.

Campbell, a nursing administrator and the League of Women Voters health care director at the state level, says the current regulation is senseless.

"Nurses who are out in the rural areas might be running a clinic, and they're the only ones who see patients," Campbell said. "They can order antibiotics and make diagnoses. But they can't order this medication. And they're certainly well equipped to handle this.

"The Florida Nurses Association has been trying to get this through the Legislature for three or four years and it hasn't even been brought to a vote."

That's likely due to opposition from the American Medical Association and the Florida Medical Association.

But Campbell and Cassarino have plenty of support - from Lee Memorial Health System, for one.

"We would like to have that authority granted," said Sally Jackson, its director of community projects. "We think it would benefit everyone in the community."

When the Affordable Care Act is fully implemented in 2014 and as many as 50 million more Americans are insured, an already overburdened system could be doomed.

"There's already a shortage of primary care doctors in this state and thousands of people looking for a doctor," Campbell said.

Hospices and nursing homes would benefit from this change, Campbell said. Where a nurse is now in charge and can diagnose and monitor patients, he or she cannot change orders for pain medication or sedation.

"I see a child with ADD, and I can diagnose that. But unfortunately I can't prescribe the medicine," said Cassarino, a nurse practitioner in Naples and president of the Florida Nurse Practitioner Network. "So then the child has to see a physician. And that's another cost, and maybe the mom has to take off work again for another appointment."

Which can take weeks, said Greg Gardner, executive director of the National Alliance for the Mentally Ill in Lee County.

"The primary opponents are our physician colleagues," Cassarino said.

That would include the medical societies of Lee and Collier counties. They say that with more people able to prescribe medications that are often abused, more could end up on the street.

"In a state that is having extraordinary difficulties in controlling the amount of prescriptions that are ending up on the street, this is probably not an ideal time to increase the number of people able to prescribe," said Dr. Craig Sweet, outgoing president of the Lee County Medical Society.

His opinion is echoed by his colleagues in Collier County, according to its medical society executive director Margaret Eadington.

Additional Facts

More information

WHAT IS AN ARNP?

Advanced Registered Nurse Practitioners are registered nurses with graduate-level advanced degrees who have passed a national certification test. 

In 14 states, they may practice independently and may prescribe controlled drugs. In all other states except Florida and Alabama, they may prescribe these drugs with various levels of supervision by doctors or limits to this ability. 
Some cannot order refills or prescribe weight-loss drugs, for instance.

They are regulated by their state boards of nursing.

ARNPs include four categories of nurses: nurse practitioners, certified nurse midwives, clinical nurse specialists or certified registered nurse anesthetists. 

ACCESS TO CARE

Now, more than half of uninsured adults have no regular access to health care, according to the Kaiser Family Foundation. Using the latest census numbers, that would be half of the 24.2 percent of Floridians younger than 65 who are uninsured, among them 31.9 percent in Collier County and 28.2 percent in Lee. 

But that number may be low. Kaiser believes there are many more, as the census figures are based on 2007 totals and therefore don’t account for the recent recession

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