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Running head: ANALYSIS OF A U.S. HEALTHCARE POLICY

Analysis of a U.S. Healthcare Policy

Abigail Rodriguez

Grand Canyon University: NSG 436

July 12, 2020

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ANALYSIS OF A U.S. HEALTHCARE POLICY
Analysis of a U.S. Healthcare Policy

Clinical nurse specialists (CNS) are expert clinicians who are certified in a specialty of

choice through advanced education and training. CNS, hold the title of advanced practice

registered nurses (APRNs) and go through vigorous schooling, earning multiple degrees and

certifications as they provide patient consultation and care across a variety of healthcare areas

(NP Schools, 2020). In extension to their scope of practice, the healthcare policy House Bill:

2068 (2019) grants CNS the privileges to prescribe and dispense pharmacological agents. The

purpose of this paper is to analyze the House Bill: 2068 policy, identify the different

stakeholders, describe the positive and negative aspects, determine the factors that impact

nursing practice and suggest recommendations to ensure positive client outcomes.

House Bill 2068: Clinical Nurse Specialists Prescribing Pharmaceuticals

House Bill: 2068 is a policy that allows clinical nurse specialists to prescribe and

dispense medications in limitation to those who have the same education and training related to

prescribing as Nurse Practitioners. Additionally, the policy specifies that the CNS is limited in

specific licensed institutions and in opioid prescribing (Busby & Hays, 2019). The ability to

prescribe and dispense medications is also limited to locations, only allowed in outpatient

treatment centers that either provide behavioral health or federally qualified community health

facilities that utilize the services of a CNS (Arizona Nurses Association, 2019). Furthermore, the

provisions of the bill specify the importance of effective communication between healthcare

professionals. Consequently, the CNS must notify a medical director or healthcare professional

who is managing a patient’s care within one business day after writing a new prescription or

changing an existing dosage unless protocols in the facility read otherwise (Arizona Nurses

Association, 2019).
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Major Stakeholders

The major stakeholders in this healthcare policy include clinical nurse specialists,

patients, and legislators. The clinical nurse specialists are directly affected because the policy

expands their scope of practice significantly. By completing their courses and training, they can

implement prescribing and dispensing medications in the workplace. Patients are greatly

impacted as well, as they are the ones to receive care services. The policy increases access to

healthcare with potential lower costs, which is a direct influence on patients. Legislators, or state

and local representatives as well as members of health committees are major stakeholders

through the process of enforcing the policy. The ultimate decision on whether the policy passes

or not is based off of their votes (Gentzler, 2019).

Positive and Negative Aspects of the Policy

The House Bill: 2068 policy comes with many positives to healthcare. To begin with, by

allowing CNS to practice to the full extent of their education and training, including prescribing

authority, the state would benefit from enhanced competition, including potentially lowering

costs (compared to physicians), and greater access to care (Arizona Nurses Association, 2019).

By expanding their scope of practice, CNS have the potential to provide timelier and more

responsive safe and effective services for patient management. The American Association of

Colleges of Nursing reported that CNS practice has been linked to the following: reduced

hospital stays, reduced ER visits, fewer complications for hospitalized patients, and increased

patient satisfaction (Ridenour, 2019, para. 2). In addition, states that do not offer “full practice

authority” lack CNS providers. Before the HB: 2068 bill was passed, Arizona had few CNS due

in part to the limited scope of practice. With the passing of this bill it is expected that more CNS

will practice in Arizona resulting in more access to health care for the community. However, the
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policy does have limitations that impact its influence to healthcare. The provisions state that

CNS cannot prescribe or dispense in inpatient facilities which limits their impact. Another

negative aspect to the policy is the limitations on opioid prescribing. House Bill 2068 (2019)

states the CNS may not prescribe a schedule II controlled substance that is an opioid unless the

facility protocols say otherwise or if the medication is being utilized for medication-assisted

treatment for substance abuse disorders. Consequently, the scope of the CNS is still being

withheld with various restrictions.

Policy Impact on Nursing Practice and Effective and Equitable Care

Legislative, regulatory, and financial factors are important components to deliberate

through the development and implementation of a new healthcare policy. The House Bill: 2068

policy has similarities with the Advanced Registered Nurse Consensus Model, which is a

regulatory model granted by the Arizona State Legislature. The APRN Consensus Model

provides guidance and uniformity in the regulation of APRN roles (NCSBN, 2020, para. 1).

Furthermore, the policy states educational requirements, training, and national certifications as

regulations set for the clinical nurse specialists to implement the policy within their scope of

practice. These regulations are obligatory to ensure safe and effective care to the public. House

Bill 2068 (2019) states that the regulations include the educational training nurse practitioners

undergo to prescribe and dispense pharmacological agents, and successful completion of a

nationally recognized certification entity.

Proposed Policy Changes

The House Bill: 2068 policy will significantly impact healthcare through the many

advantages it proposes. Although effective as it is, there are a few suggestions that could

potentially make the policy even stronger. To begin with, the policy consists of many provisions
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that the CNS must abide to. Some are necessary, for example the importance of effective

communication between healthcare providers, however, some limitations can be tweaked. For

example, because the CNS is unable to prescribe category II opioids, the provision can be

revised to “CNS requires second approval from an APRN, psychiatrist, or physician for category

II opioid pharmaceuticals.” This could benefit hospital settings, where there are many patients in

need of care that exceeds the CNS’s scope. The restrictions that are placed within the bill still

limit the abilities of a CNS, therefore it will be of great benefit to continue to reduce the

limitations placed on these advanced nurses.

Conclusion

The passing of this bill results in several advantages to the healthcare system in Arizona.

CNS can provide similar services at a lower cost than an all-physician workforce would allow

(Kerby, 2019). This results in the public health receiving more access to healthcare by removing

the barriers to a CNS’ practice. While more than 20 states allow CNSs to prescribe and dispense

pharmaceuticals, it would be of great benefit for additional states to pass policies similar to

House Bill: 2068.

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References

Arizona Nurses Association. (2019). HB2068 Fact sheet. Retrieved from

https://cdn.ymaws.com/www.aznurse.org/resource/resmgr/FACT_SHEET_2019_HB206

8_CNS_L.pdf

Busby, K., Hays, R. (2019). 2019 Legislative summary report. Retrieved from

https://cdn.ymaws.com/www.aznurse.org/resource/resmgr/2019_Leg_Report_AzNA_.pd

Clinical Nurse Specialists; Prescribing Authority, H. 2068. (2019).

Gentzler, S. (2019). Arizona clinical nurse specialists one step closer to prescribing authority.

Retrieved from https://stateofreform.com/featured/2019/02/arizona-clinical-nurse-

specialists-one-step-closer-to-prescribing-authority/

Kerby, J. (2019). Disrupting health care costs through local politics. Retrieved from

http://www.grittyrevolution.com/home/disrupting-health-care-costs-through-local-politics

NCSBN. (2020). APRN Consensus model. Retrieved from https://www.ncsbn.org/aprn-

consensus.htm

NP Schools. (2020). How to become a clinical nurse specialist. Retrieved from

https://www.nursepractitionerschools.com/faq/how-to-become-a-cns/

Ridenour, J. (2019, June). From the executive director. Arizona State Board of Nursing

Regulatory Journal, 15(1). Retrieved from

http://www.digitaleditionsonline.com/publication/?m=10619&i=595637&p=4&pp=1