Prescribing competencies for autonomous APRN prescriptive authority: What do nurse prescribers need to know?

Abstract

<p>The United States currently has no reliable and valid model for assessing entry-level autonomous prescriptive competency for advanced practice nurses, despite a decade of legislative expansion in scope and autonomy. Klein and Kaplan (2007) surveyed Washington and Oregon nurse practitioners with prescriptive authority, clinical nurse specialists with and without prescriptive authority; and nurse practitioner students, their preceptors and faculty about the relative importance of prescribing specific competencies(n=180). The original survey used an instrument from the Oregon State Board of Nursing, titled <em>Clinical Practicum in Pharmacological Management Evaluation</em>, containing 31 competencies. The present study used mixed methods to further confirm essential entry-level outcomes used to meet requirements for autonomous prescriptive authority. Three steps of analysis were conducted to determine final domain and competency recommendations: content analysis of original survey comments, principle component analysis (PCA) of competency ratings, and final Q-Sort of revised competencies using Subject Matter Experts (SMEs) with prescriptive authority licensed as CNSs, NPs, or both. PCA of the 31 original competencies identified 4 factors containing 30 items accounting for loadings of .40 or greater for all items. Removal of 1 competency as suggested by content and factor analysis resulted in a Cronbach's alpha of .959, indicating item internal consistency. Two contextually similar items were combined for the final Q-sort analysis resulting in the final 29 competencies in 4 domains titled: Safety, Patient Specific Assessment, Clinical Reasoning, and Clinical Management. Q-Sort by SMEs clearly placed 8 competencies into the Safety domain, 3 between Safety and Patient Specific Assessment, 7 into Patient Specific Assessment, 1 between Patient Specific Assessment and Clinical Reasoning, 2 into Clinical Reasoning, 3 between Safety and Clinical Reasoning, 1 into Clinical Management and 4 in more than two categories. SMEs confirmed item validity but did not confirm discrete domain placement for 11 competencies, indicating a need for further analysis and revision of domain categories in order to confirm regulatory sufficiency.</p>