Nurse Practitioner Prescriptive
Privilege History in Tennessee
Historical Perspective of TNA/ANA Involvement
by Louise Browning, CAE
Executive Director, Tennessee Nurses Association
| 1960s | The shortage of physicians provided the opportunity to bring about changes in well-child care in ambulatory settings. |
| 1965 | First nurse practitioner education program in the U.S. at the University of Colorado in response to the shortage. |
| 1969 | TMA, TNA and THA Joint Practice Statement endorsed the expanding role of RNs in coronary care units. |
| 1970 | Vanderbilt University began the first master’s program to prepare nurse practitioners in Tennessee. |
| 1970s | Nurse practitioners were safely writing prescriptions as a delegated medical act in urban and rural areas and in many different settings. |
| 1971 | Nurse practitioners were so well recognized as providers of medical services that President Nixon announced a national commitment to their training. He predicted that NPs would expand the supply of medical care and reduce its cost by performing medical tasks that traditionally had been restricted to MDs.
HEW recommended that states enact amendments to their medical practice acts to codify the authority of physicians to delegate medical tasks to health personnel working under their supervision. |
| 1973 | Tennessee Medical Association amended the medical practice act to include a delegatory clause to authorize delegation of medical acts to nurse practitioners, physician assistants and licensed practical nurses. |
| 1974 | Board of Nursing promulgated rule 32 saying RNs who manage the medical aspects of a patient’s care must have written medical protocols jointly developed by the nurse and the sponsoring physician. |
| 1976 | TNA-TMA Joint Practice Statement said jointly developed written protocols should outline delegated medical tasks and drug management to be used in patient care. |
| 1979 | The Board of Pharmacy tried unsuccessfully to promulgate rules to cover filling prescriptions written by nurse practitioners, but the attorney general refused to approve claiming there was no statutory authority.
Board of Pharmacy issued a memo to all pharmacists warning that pharmacists who fill prescriptions written by anyone other than a doctor, dentist or veterinarian after August 1, 1979, would be violating state and federal laws. A group of plaintiffs, including the Scotts Hill Clinic in Decatur County and the Primary Care Association, obtained a temporary restraining order to keep the Board of Pharmacy from enforcing their warning; and nurse practitioners continued to write prescriptions. Speaker Ned McWherter asked Rep. Paul Starnes to solve this problem. Rep. Starnes took a Special Committee on Primary Care that included Legislators and physicians across the state to look at primary care sites where nurse practitioners were writing prescriptions. |
| 1980 | The Senate passed a bill to authorize nurse practitioners to write prescriptions. The House passed a bill to authorize nurse practitioners to write prescriptions but limited the authorization to certain sites approved by the Primary Care Advisory Board. The Senate concurred in the amendment and the bill became law.
Legislation required that copies of Protocols and Formularies be submitted to Primary Care Advisory Board for site approval. |
| 1994 | Bill passed to delete the site approval process and allow NPs with a certificate of fitness to write prescriptions in any setting under medical protocols. |
| 1995 | Bill passed granting BON joint adoption privilege of Board of Medical Examiners supervision rules. |
| 1996 | Bill passed to delete requirement to mail copies of Protocols to Primary Care Board. Protocols must be maintained at practice site. Copies of Formularies, by category, must be mailed to the Primary Care Board. |
| 1997 | Bill passed to authorize prescription of controlled substances, Schedules II, III, IV, and V, pending joint adoption of rules by the Board of Medical Examiners and the Board of Nursing. Formularies must now be mailed to the Tennessee Board of Nursing rather than the Primary Care Board. |
| 1998 | The Board of Medical Examiners and Board of Nursing jointly approved rules related to prescribing controlled substances, Schedules II-V. |
| 1999 | Board of Nursing Rules and Board of Medical Examiners Rules were promulgated and NPs were issued DEA numbers to prescribe, dispense, administer and procure Schedules II-V controlled drugs. |
| 2003 | Bill passed to “deem” the prescription to be that of the nurse practitioner rather than the physician and to require only the signature of the nurse practitioner. |