Teaching Prescriptive Authority Through Active Learning
At the author’s university, advanced practice nursing (APN) students take a required Internet-delivered graduate pharmacology course. On course completion, students are prepared to select, monitor, and alter effective pharmacological therapy for patients with problems commonly seen in primary care and to write prescriptions appropriately. One important aspect of APN practice is prescriptive authority. As the class comprises students from as many as 20 states with varying laws and regulations, this presented a teaching challenge.
A prescriptive authority assignment was developed to meet this teaching challenge that uses active learning based on Knowles’ (1990) theory of andragogy. The theory assumes that adults need to know why they need to know information, approach learning as problem solving, need to learn experientially, and learn best when the topic is of value to them. Nurse educators have effectively used active learning strategies such as case studies, problem solving, and discussion forums in online courses to promote critical thinking (Halstead & Billings, 2005). Active learning strategies accommodate different learning styles and have been used successfully in online nursing courses to achieve learning outcomes (Phillips, 2005).
The purposes of the prescriptive authority assignment are for students to demonstrate an understanding of prescriptive authority laws for APNs in their state, select appropriate pharmacological therapy for a case study patient, and demonstrate proper prescription writing. Students access APN prescriptive authority information on their state’s Board of Nursing Web site and respond to the following questions specific to their state and future APN role:
- What documents and information are required to obtain prescriptive authority?
- If a written collaborative practice agreement is required, what information must be included in that agreement?
- Which schedules of controlled substances, if any, can you prescribe?
- What additional registration must you obtain before you can prescribe controlled substances? Which form(s) do you complete as an APN?
- What are the continuing education requirements to renew your prescriptive authority?
Students post their responses to these questions to the course faculty for evaluation and feedback. In addition, they also post their responses to the class discussion board. This initiates lively discussion about the similarities and differences among states and among APN roles. As a result of this assignment, students sometimes discovered that APNs in the role they had chosen to pursue did not have prescriptive authority in their state. Other students found that legislation was in progress for prescriptive authority or prescribing scheduled drugs, and the class followed the state bills as the process unfolded.
The case study included in this prescriptive authority assignment is a pediatric patient with acute otitis media. Advanced practice nursing students must write a prescription using an online prescription blank, which they send to the course faculty for individual evaluation and feedback. Students must provide rationale for their choice of pharmacotherapy and calculate the dosage and duration of therapy appropriately for the age and weight of the child. They cite steps taken to minimize errors in writing the prescription and include patient teaching and plans for follow up.
Student feedback about this assignment on course evaluations has been positive. Representative comments include “Thank you for this informative and worthwhile assignment” and “This assignment has been extremely helpful.” Students commented that the assignment was not only practical, but also opened their eyes to the variations in prescriptive authority legislation among states. The online active learning strategies used with this assignment prepare students to know why and how to access information they will need to apply for their prescriptive authority wherever they may practice.
The challenge of how to teach students from many states about prescriptive authority became an opportunity for learning for both the teacher and the students. By completing an assignment that incorporated an experiential problem solving approach to learning about a topic of value to the students, each student learned about prescriptive authority laws and regulations specific to their state and all of the states of the other students. Students participated actively on class discussion boards and learned about the process more directly than they would have if the teacher had simply given a lecture about prescriptive authority. Faculty who teach online courses can use this active learning approach to achieve learning objectives and to meet the challenge of tailoring learning to the needs of the learner.
Roberta Hoebeke, PhD, FNP-BC
University of Southern Indiana
College of Nursing and
- Halstead, JA & Billings, DM2005. Teaching and learning in online learning communities. In Billings, DM & Halstead, JA (Eds.), Teaching in nursing: A guide for faculty (2nd ed., 423–439). St. Louis, MO: Elsevier.
- Knowles, MS1990. The adult learner: A neglected species (4th ed.). Houston, TX: Gulf.
- Phillips, JM2005. Strategies for active learning in online continuing education. The Journal of Continuing Education in Nursing, 36, 77–83.