Monitoring and investigating certified registered nurse practitioners in pain management.

Journal of Law, Medicine & Ethics, 31 (2003): 101–118. © 2003 by the American Society of Law, Medicine & Ethics. he Mayday Scholars Program for 2001–2002 provided an opportunity to boards of nursing to present their experiences in monitoring the prescribing practices of advanced practice nurses and to research ways for improving their own investigation processes as professional disciplinary agencies for prescribing practices related to pain management.1 The Alabama Board of Nursing was interested in participating in the program based on its commitment to accountability for public protection. A gradual increase in disciplinary cases involving violations of prescribing practices by certified registered nurse practitioners (CRNPs)2 prompted our inquiry as to whether a proactive monitoring system was needed to determine compliance with regulations for advanced practice nurses in collaborative practice. In this article, we discuss selected elements related to pain management and regulatory factors, including nursing, that affect the treatment of pain. We present a brief overview of the evolution of advanced practice nursing, with an emphasis on the nurse practitioners movement, and prescription practices and pain management by nurse practitioners. Next, we present research results about nurse practitioners approved for practice in Alabama, their perceptions of their preparation for prescriptive practice in pain management, and their experiences in collaborative practice related to prescriptive authority for pain management. Then, we share the experiences of the Alabama Board of Nursing in monitoring and investigating nurse practitioners for compliance with prescriptive authority. Finally, we show how evidence obtained from research can have rapid application to regulatory concerns, and conclude with an open agenda for future research related to pain management and regulation. The survey presented in this article employed an evidence-based approach using an action research design to address the survey’s priorities.3 Research questions centered on: • barriers to pain management experienced by nurse practitioners; • autonomy exercised by nurse practitioners in making decisions for dosage and administration of controlled substances when operating under a protocol for collaborative practice; and • opportunities to improve the investigation process of a board of nursing when collaborative practice is required for prescribing practices related to pain management.