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Florida Nurse Practitioners Hope To Gain Prescribing Privileges

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Jim Quinlan sees about 25 patients a day. As a pediatric nurse practitioner, he determines the medication and dosage to treat each child’s illness.

But he can’t sign most prescriptions.

Florida is the only state that does not allow nurse practitioners to prescribe controlled substances.

But that could soon change.

Quinlan, owner of Williston Pediatrics, has been a nurse for nearly 40 years and a nurse practitioner for about 25 years. He started the practice with his wife in 2000 and employs a part-time pediatrician who sees patients — and signs almost every prescription.

If the doctor isn’t in, parents may have to wait one to three days to get their child’s prescription.

“I’m in my mid-sixties, I’ve been practicing for decades,” he said. “I still come under the same restrictions as somebody who just got a fresh degree out of UF.”

Nurse practitioners’ credibility is hurt by the inability to write these prescriptions — especially since every other state allows nurse practitioners more prescribing authority, Quinlan said.

Two bills in the state legislature would allow nurse practitioners and physician assistants to prescribe controlled substances.

The change would allow them to practice medicine to the full extent of their training, said Willa Fuller, executive director of the Florida Nurses Association.

The bills, SB676, which unanimously passed the Banking and Insurance Committee Jan. 26, and its companion, HB423, which is waiting to be heard by the House, would cut out the step of obtaining a doctor’s signature.

As a result, patients could see shorter wait times and fewer trips to the doctor, she said.

“Nobody wants to be in pain or wants to see their family member in pain,” Fuller said.

But people in pain wouldn’t be the only ones to benefit. Patients who are prescribed stimulants such as Ritalin, Concerta and Adderall for attention deficit hyper activity disorder (ADHD) also need a doctor’s signature in Florida.

Sometimes parents of children with ADHD have to make two trips to get their children’s prescription renewed — one to see a nurse practitioner to get a diagnosis, one to see a doctor to write the prescription, she said.

Sen. Denise Grimsley, R-Sebring, a registered nurse and sponsor of the Senate bill, said in statement that the measure is long overdue. Two committees, one in 1996 and the other in 2008, both recommended extending controlled substance prescribing authority to nurse practitioners.

“This legislation will help make medical care more readily available while maintaining the high standards of training required to prescribe these controlled substances,” she said.

Both bills would allow nurse practitioners and physician assistants to prescribe seven-day supplies of what are known as Schedule II controlled substances, which include painkillers such as Vicodin and OxyContin, as well as amphetamines used for ADHD.

The Senate bill would require the creation of a state committee to recommend certain controlled substances nurse practitioners would be barred from prescribing or only allowed to prescribe under limited circumstances, according to a Senate staff analysis.

As written, the bill could include restrictions on certain substances, such as ADHD medications, but nothing in the bill’s text is final, according to the Florida Association of Nurse Practitioners.

Senate President Andy Gardiner, R-Orlando, supports the bill. He said in a press release, “This legislation will help expand the availability of quality medical care by allowing skilled practitioners with advanced medical training to better meet the needs of their patients.”

Multiple calls by WUFT News to the Florida Medical Association, which has opposed the bill in recent years, were not returned. But Mary Thomas, assistant general counsel for the FMA, supported the bill at a Senate committee hearing in January.

Sen. Eleanor Sobel voiced concerns over the seven-day prescription limit during the hearing. She said she was concerned about people overusing medication by obtaining multiple seven-day refills.

Grimsley said they’d have to figure out a way to monitor the refills, but issues like pill mills were created by doctors, not nurse practitioners. The bill has safety provisions in place, which would include a committee of three doctors, three nurse practitioners, and one pharmacist to determine which drugs cannot be prescribed.

Dr. Casady Gaines works with Quinlan at Williston Pediatrics. She said she understands issues others have with the legislation, but she supports it because the nurse practitioners she works with are able to make the call when they need to reach out to someone with more training.

She said it’s a burden having to sign all of the prescriptions, especially for simple issues like renewals.

With Quinlan’s years of practice, she said he’s more than capable of writing the prescriptions for controlled substances.

“I know he knows what he’s doing,” she said.

Quinlan, who holds a doctorate of nursing practice (the highest level of nursing), said even if nurse practitioners gain prescribing privileges he would continue to work with Gaines.

“I wouldn’t say ‘Well, I don’t need you anymore,’ because we’ve been practicing for such a long time,” he said. “She’s an integral part of the practice.”

He said while he is comfortable practicing without a doctor, some nurse practitioners would never dream of practicing alone. But he values the symbiotic relationship with his pediatrician.

“I’ll come and ask her for advice, but she’ll turn around and come and ask me for advice,” he said. “That’s the kind of practice that a lot of nurse practitioners would love to have.”

About Ariella Phillips

Ariella is a reporter for WUFT News and can be contacted by calling 352-392-6397 or emailing news@wuft.org.

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