Nurses practice in a complex web of prescription privileges. Some nurses in some states have certain prescription privileges, while others don't have privileges or have privileges limited to only certain patient populations and prescriptions. Those privileges also vary depending on the nurse's level of education and form of licensure. Nurses also differ from license to license and state to state in the prescriptions to which they have access to prescribe, administer, or give samples. In this complex regulatory milieu, nurses frequently face serious state nursing board disciplinary charges for abuse of prescription privileges. If you are one of those nurses, the Lento Law Firm's premier Professional License Defense Team is available to help you defend and defeat your prescription abuse disciplinary charges. Call 888.535.3686 or complete this contact form now for our highly effective defense representation and your best disciplinary outcome.
Nurse Licensure Levels and Prescription Privileges
To understand nurse prescription privileges, begin with an outline of the progressive levels of nurse education and licensure. Generally, the greater the education and higher level of licensure, the greater the likelihood that the nurse will have prescription privileges or other dispensing and administration privileges of prescription medications. The opposite is then, of course, also true: the lowest level of nurse, based on education and licensure requirements, will generally have the least privileges to access, handle, administer, dispense, or prescribe controlled medications. Here is an outline of the nursing education and licensure levels from top to bottom, recognizing that states and educational programs differ in their labels and that some overlap of levels may occur:
- advanced practice registered nurses (APRNs), also known as nurse practitioners (NPs) and considered to be a crossover or mid-level practitioner between nursing and medical care;
- registered nurses (RNs), typically earned with at least a two-year and more likely a four-year degree, playing the central role in patient care;
- licensed practical nurses (LPNs), typically earned in a one-year program and providing nursing support services;
- Certified nursing assistants (CNAs) are usually employed in nursing home or home healthcare roles.
Nursing schools and programs also educate and train, and state nursing boards also license specialty nurses, generally holding registered nurse credentials supplemented with additional specialty education and training. Specialty nurses may include:
- certified nurse midwives (CNMs), often treated from a regulatory standpoint like APRNs;
- family nurse practitioners (FNPs) with training equal to or approaching that of an APRN;
- certified registered nurse anesthetists (CRNAs), also often treated like APRNs;
- oncology nurses, typically licensed as CRNAs but with additional oncology training;
- charge nurses, typically a registered nurse with managerial and supervisory duties over other nurses; and
- doctor of nursing practice (DNP), with doctorate education and teaching, policy, or management responsibility but typically having no distinctive licensure beyond the APRN license.
Nurse Prescription Privileges
Any national summary of nurse prescription privileges is difficult because nurses face state to state regulation, not national licensure. Your state legislature may have adopted nursing laws, and your state nursing board may have promulgated nursing regulations, that are starkly different from the nursing laws and regulations in another state, including especially as to prescription privileges. Nurse prescription privileges are also in a state of flux, often expanding prescription privileges piecemeal, given the many different pressures on healthcare delivery systems. Thus, any information here is not as to your individual prescription privileges, which will instead depend on your specific state of licensure. Here, though, are a few guides as to national patterns of state nurse prescription privileges:
- advanced practice registered nurses (APRNs) generally have a greater likelihood of prescription privileges than nurses with lower levels of education and licensure. Most or all states grant some form of prescription privilege to APRNs. Most states also grant APRNs dispensing privileges, while some states also permit APRNs to distribute prescription samples;
- certified nurse midwives (CNMs) also generally have prescription privileges relating to their birthing practices. Most or all states grant some form of prescription privilege to CNMs, while more than half of states grant CNMs dispensing privileges;
- clinical nurse specialists (CNSs) such as oncology nurses and family practice nurses (FNPs) may likewise have prescription privileges. Approximately thirty-seven states grant CNSs some prescription privileges. About half the states allow CNSs to dispense medications, and about a dozen states permit CNSs to distribute samples;
- registered nurses (RNs) generally have no prescription privileges but may have dispensing privileges. About one third of states grant RNs dispensing privileges but may restrict those privileges to contraceptives, drugs for sexually transmitted diseases, or other specific medications;
- licensed practical nurses (LPNs) and certified nurse assistants (CNAs) have no prescription privileges and generally have no dispensing privileges but may have authority to administer some medications under supervision.
Distinction Between Dispensing and Prescribing
The above summary of nurse prescription privileges also mentions dispensing privileges. The difference between prescribing and dispensing is important to the proper application of the licensed authority and limitations. To prescribe a medication is to determine that the patient needs it and should have it. Patients typically associate prescription privileges with physicians, not nurses. However, the above summary shows that advanced practice registered nurses are likely to have prescription privileges. By contrast, dispensing privileges grant no authority to determine that the patient needs and should have medication. Rather, dispensing privileges grant the nurse access to the medication to obtain it from its secure location and provide it to the patient for administration. Registered nurses and licensed practical nurses without dispensing privileges generally depend on pharmacists, physicians, and advanced practice registered nurses for dispensing medications for the nurses to administer.
Forms of Misuse of Prescription Privileges
State nursing board disciplinary charges for abusing or misusing prescription privileges depend on identifying the particular form of misuse or abuse. Any unauthorized action relating to prescribing, dispensing, or administering medications may constitute prescription abuse or misuse. But common forms of nurse prescription misuse or abuse include:
- writing prescriptions for patient populations for which the nurse has no prescription authorization;
- writing prescriptions for medications for which the nurse has no prescription authorization;
- writing prescriptions under the nurse's own name when the nurse has no prescription authority;
- writing authorized prescriptions but diverting the medications for personal use or illicit distribution;
- writing fraudulent prescriptions, forging an authorized prescriber's name to obtain drugs for patient administration;
- writing fraudulent prescriptions, forging an authorized prescriber's name to obtain drugs for personal use or illicit distribution;
- instructing or assisting another in writing unauthorized or forged prescriptions for the other to obtain the drugs for personal use or illicit distribution;
- failing or refusing to report unauthorized prescribing or dispensing by others when aware of the activity and under a duty to report;
- dispensing medications without authority, even if under an authorized prescription;
- dispensing medications with authority and authorized prescription but for purposes other than prescribed;
- administering medications without authority or providing medications to others for unauthorized administration.
Defense of Prescription Privilege Abuse Charges
Our defense of your prescription privilege abuse disciplinary charges will depend on the form or forms of prescription privilege abuse the disciplinary officials allege. But subject to that significant qualification, and depending on the available evidence and other circumstances surrounding your case, we may raise any one or several of the following defenses to disciplinary allegations that you abused or misused prescription privileges:
- you did not commit the alleged actions;
- witnesses alleging your prescription privilege abuse are mistaken, deluded, retaliating with false allegations, or using the allegations to cover up their own abuse or the abuse of others;
- your actions were within your prescription, dispensing, and administration authority, applying the law, rules, and regulations of the jurisdiction;
- you reasonably believed from the direction and instruction of supervising physicians, nurses, or employer representatives that you had the authority to take the actions you did, giving you a safe harbor against discipline;
- your actions were mistaken and accidental, under reasonable belief that conditions were other than as they were, rather than purposeful, deliberate, or reckless;
- your actions caused no harm, injury, or risk of harm or injury;
- while your actions may have violated nursing and prescribing or dispensing standards, your actions violated no other state or federal law regulating controlled substances;
- you voluntarily self-reported, disclosed, and corrected your actions as soon as you discovered that your actions may have violated prescription, dispensing, or administration standards or regulations or
- you were under a temporary unanticipated mental or emotional disability, such as in adverse reaction to a lawfully prescribed medication change, when committing a one-time violation, with no risk of a repeat incident.
Factors Affecting Prescription Abuse Defense
Our defense of your prescription privilege abuse disciplinary charges will also depend on your evidence and information. We can help you identify, acquire, organize, analyze, and present your defense exoneration and mitigation evidence. Factors affecting our evaluation and presentation of your defense may include:
- whether you have a substance abuse issue and are willing to seek treatment voluntarily without alternative to discipline referral;
- whether an alternative to discipline program is available and, if so, what terms and conditions it imposes;
- whether colleagues, employer representatives, or licensing officials know, suspect, or believe you have a substance abuse issue;
- the quantity and type of medication misprescribed, dispensed, or administered, including its hazard, the expense of its loss, and its value for illicit distribution;
- the person or persons to and for whom you prescribed, dispensed, or administered the disputed medication and their condition, harm, injury, or contrary beneficial effect;
- the criminal laws that may apply to your actions and whether prosecutors and law enforcement are investigating and pursuing potential criminal charges;
- others involved in the alleged prescription privilege abuse or misuse, and their authority and position relative to your own authority and position, including who solicited and directed whom; and
- who complained of the prescription privilege abuse and what was their motivation or concern, including whether the public, colleagues, or others are aware of the complaints.
Commonly Abused Medications
Given their trusted role in patient care, including, in some cases, prescribing, dispensing, and administering medications, nurses have uncommon access to prescription medication and, thus, uncommon opportunities to abuse prescription and dispensing privileges. The question then becomes what prescription drugs nurses commonly abuse. The National Institute on Drug Abuse reports that the most commonly abused prescription drugs fall into three classes: (1) opioids and morphine derivatives such as Vicodin and Demerol for pain relief and sedation; (2) depressants such as Seconal, Xanax, and Ambien for well being, sedation, and anxiety relief; and (3) stimulants such as Dexedrine, Adderall, and Ritalin for exhilaration, energy, and alertness. While violating rules and standards on prescription privileges do not directly depend on the particular medication, the medication and its quantity, properties, salability, risks, and typical use or misuse may influence the disciplinary outcome. We will be prepared to help you address those issues.
Prescription Drug Misuse By Nurses
The outcome of state nursing board disciplinary charges for prescription privilege abuse may also depend on whether the accused nurse has a substance abuse issue and, if so, whether the alleged prescription privilege abuse is related to that issue. Prescription drug abuse by nurses is a well-documented and well-known phenomenon among disciplinary officials and the broader nursing profession. A medical journal article reports high prescription drug abuse rates among nurses relative to the general population. Nearly one in ten nurses abuse prescription drugs, when the rate of prescription drug abuse in the general population is about half that figure. Nurses abuse illicit drugs less often than the general population but abuse prescription drugs more often, plainly due to their access to medications preferred for their relative safety. The American Nurses Association accordingly takes a strong stand that nurses need and deserve substantial drug abuse education.
Sympathy and compassion aside for the moment, though, state nursing board disciplinary officials may regard the nurse with a substance abuse disorder as a significantly greater disciplinary subject than a nurse who simply misprescribed for no reason or other reasons. Nurses who divert medications for personal abuse reflect impairment, dishonesty, and theft risks. It may not be to your benefit to claim and disclose arguable substance abuse issues when your better course may be to promptly address and correct those issues, ensuring that they are not a necessary part of your defense, all of course, depending on the facts.
Alternative to Discipline Programs
You may be thinking of your state nursing board's alternative to discipline or nurses' assistance program. Many states have such programs, like the Pennsylvania Nurse Peer Assistance Program (PNAP). Don't, however, jump at the thought of enrolling in such a program, particularly as a way to forestall or avoid discipline for abusing prescription privileges. Although the laws and practices vary from state to state, many states require you to relinquish your nursing license to enter an alternative to discipline program. Many other states limit program participation to nurses who have not violated disciplinary rules, especially as to diversion of prescription medication. You may not qualify, and even if you do qualify, you may have to give up your license or suffer license restrictions for an indefinite duration. You may also find yourself jumping through unnecessary hoops, including onerous drug testing, reporting, and monitoring requirements, for up to years at a time. Consult us before agreeing to any program offer. You may be far better off getting your own treatment while letting us help you defend the disciplinary charges.
Reporters of Prescription Privilege Abuse
The outcome of your prescription privilege abuse disciplinary charges may also depend on who reports you for the alleged violations. Patients are not necessarily the most likely reporters unless they observe the accused nurse's medication misuse, medication impairment, or diversion of medications. More likely, the pharmacist, charge nurse, or other employer representative responsible for inventorying prescription drugs and tracking medication records may be your complaining witness. That person may have found an anomaly in the records, tracing it back to your entries or other access. Or that person may be using a concocted allegation to cover up for their own defalcation or the theft or misuse of unknown others when the complaining person is responsible for the loss. The credibility of that complaint based on recordkeeping and inventorying, if not also on other circumstantial evidence rather than direct observation, may go a long way toward determining the success or failure of the disciplinary charges. Our attorneys know how to retain and work with forensic consultants and others to contest a circumstantial charge. We will work closely with you to obtain all available exonerating and mitigating evidence.
State Nursing Board Disciplinary Authority
Your state nursing board has the authority to discipline you for prescription privilege abuse. Your state nursing board operates under your state's Nursing Practice Act or other nursing laws. Nursing Practice Acts across the country routinely authorize state nursing boards not only to license nurses but to discipline on general and specific grounds. Those grounds routinely include prescription privilege abuse. The Colorado Nurses and Nurse Aides Practice Act is an example. Its Section 12-255-120 includes several disciplinary grounds relating to misuse and abuse of medication prescription, dispensing, or administration privileges. Don't expect to dispute your licensing board's authority. Instead, turn to us to help you identify, document, and present your best defense.
Procedures for Prescribing Abuse Charges
Your state's nursing practice act, nursing laws, and nursing rules and regulations will also provide for disciplinary procedures that we can invoke for your protection. While disciplinary procedures vary from state to state, nurses generally have a constitutional right to due process in their nursing license and practice. Nevada's nursing laws are an example. Nevada Statutes Section 632.350 and the following sections detail the due process protections for disciplinary charges against nurses in that state. Those protections include the right to fair notice of the disciplinary charges, a hearing before an impartial decision maker, and the opportunity to both present your evidence and cross-examine the board's incriminating witnesses with our skilled representation. You should also have the right to appeal an adverse decision, either from the administrative law judge making the decision to the state nursing board or from the board making the decision to a civil court or other tribunal.
Attorney Role Defending Prescribing Abuse Charges
Our skilled and experienced attorneys play a critical role in invoking the above protective procedures. Those procedures are not generally self-executing. You may have to affirmatively invoke those procedures with timely and proper notice to the right officials. We can help you do so. We can also identify, acquire, organize, and present your defense evidence, both in informal resolution conferences and at the formal hearing. If you have already lost your formal hearing, we can take any available appeal, identifying the appeal grounds, preparing and filing the appeal brief, and attending any oral argument or hearing. If you have already lost your appeal, we may be able to obtain civil court review and relief.
Sanction Defense and License Reinstatement
Even if you know that you misused or abused your prescription privileges, we may be able to help you with a defense for mitigating any sanctions. Just because you face a credible charge does not mean that you must suffer crippling sanctions. Disciplinary officials may just need to ensure that you no longer face a risk to patient safety. We may be able to negotiate remedial measures in lieu of license suspension or revocation. If you have already lost your license without other available relief, we may be able to seek license reinstatement after the statutory or regulatory period lapses. Let us investigate and exhaust all your available options for relief. Your nursing license, job, and career are worth it.
Premier Attorneys for Nursing License Defense
If you face state nursing board disciplinary charges for abusing or misusing prescription privileges, your best move is to retain the Lento Law Firm's premier Professional License Defense Team. We have helped hundreds of nurses and other professionals with successful license defenses against disciplinary charges of all kinds, including medication issues. We are available in any location across the nation. Call 888.535.3686 or complete this contact form now for the best available defense representation.
