Perspectives on prescribing: pioneers' narratives and advice.

PURPOSE. To recount "pearls of wisdom" concerning prescriptive privileges of the psychiatric nursing pioneers. METHODS. A thematic analysis of documented "stories" from 32 psychiatric APNs concerning acquisition of and having prescriptive privileges. FINDINGS. A thematic analysis of psychiatric APN stories revealed five major themes related to prescriptive authority: acquisition of knowledge, professional and patient relationships, legislative logistics, balance within the role, and management of anxiety and the sense of responsibility. CONCLUSIONS. Prescriptive authority offers broad opportunities for advanced practice psychiatric nurses. Educational programs include competencies and skills for prescribing, but another learning tool is the use of collective practical knowledge and wisdom offered by psychiatric nurses who are pioneers in the prescribing arena. Search terms: Prescriptive privileges, psychiatric APNs ********** Advanced practice nurses (APNs) throughout the world are offering significant contributions to the health care of an increasing number of individuals. An array of factors have contributed to this increase, not the least of which has been the success of securing prescriptive privileges and the related accountability for independent practice (Hales, Karshmer, Montes-Sandoval, & Fiszbein, 1998). Historically in the United States, APNs with prescriptive privileges have been nurse practitioners, nurse midwives, and nurse anesthetists. Today, however, clinical nurse specialists (CNSs) have expanded their scope of practice to be eligible for prescriptive privileges that correspond to their clinical expertise (Pearson, 1996; TaUey & Brooke, 1992). Psychiatric APNs (CNS and NP) in the United States are particularly visible in this expanded prescribing role. Similarly, extensive changes in healthcare delivery and scientific progress related to the treatment of mental illness offer new role dimensions for psychiatric APNs and an expanded scope for psychiatric nursing practice (Society for Education and Research in Psychiatric-Mental Health Nursing [SERPN], 1994). These expanded roles of APNs are reliant on higher education programs to prepare their graduates to work competently and proficiently in the changing healthcare environment. Colleges of nursing throughout the United States and internationally are designing their curricula to include competencies and skills in new arenas of advanced practice nursing, such as prescriptive privileges. While advanced education in both theory and practice is crucial to the learning needs of prescribing APNs, another useful learning tool, frequently overlooked, is the use of collective practical knowledge and wisdom offered by the pioneers in the prescribing arena. This research study report is designed to recount the "pearls of wisdom" concerning prescriptive privileges of the pioneers in the field of advance practice psychiatric nursing. The principal investigator, through e-mail correspondence with 32 psychiatric APNs with prescriptive authority, collected and documented their "stories" related to both acquiring and having prescriptive privileges. Methods Sample The sample was selected by mailing letters to 668 APNs certified by the American Nurses Credentialing Center (ANCC) as clinical specialists in adult psychiatric nursing who lived in states that permitted prescriptive authority to psychiatric APNs. The letter explained the purpose of the research study as (1) to examine the prescriptive practices and trends of APNs in the field of psychiatric/mental health, and (2) to collect information that might be helpful to New Zealand nurses who were in the initial stages of acquiring prescriptive privileges. The letter outlined the methods for collecting the data, and informed the potential participants that the data would be collected via e-mail while the principal investigator lived in New Zealand for 1 year. …