Survey says: What NPs think of their new prescribing authority
Between August and September 2017, the College invited NPs to share their thoughts about their new authority to prescribe controlled substances and the new NP practice standard.
We sent survey invitations to 3,100 NPs. A total of 904 of them (29 per cent) completed the survey.
What we learned
Ninety-four per cent of the NPs who responded had completed approved controlled substances education. Of these, 80 per cent said they are now prescribing controlled substances in their practice.
Of the respondents who had not completed the education, more than half said time was the most significant factor holding them back. However, they reported that they plan to complete the education in the future. Others felt they did not need to prescribe controlled substances in their current role.
The survey also showed us NPs frequently prescribe controlled substances to treat clients with acute pain, chronic non-cancer pain and anxiety.
The College encourages NPs to use up-to-date evidence and resources to inform their practice. One of these is the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain. It is available on our Controlled Substances Resource page. It strongly recommends that prescribers optimize non-opioid pharmacotherapy and non-pharmacological therapy (rather than a trial of opioids) when considering therapy for patients with chronic non-cancer pain.
The survey included questions about the Nurse Practitioner practice standard, which we updated when the College implemented NPs’ authority to prescribe controlled substances. We asked what challenges NPs had with implementing the new practice standard in their practice. Respondents identified limitations such as organizational barriers, including NP prescribing not being permitted within a practice setting. Other challenges were inter-professional barriers, such as colleagues not understanding the new authority for NPs.
Finally, we asked respondents to suggest additional resources or supports that would help them apply the Nurse Practitioner practice standard and/or prescribe controlled substances safely and effectively.
Responding to the feedback
We received some requests for resources that are related to highly specialized areas of clinical practice. Many of these resources already exist. For example, NPs asked for morphine equivalence tables and information on tapering. This and other content is accessible on the Controlled Substances Resource page.
In addition, we’ve developed new Q&As and are working on a new NP webcast.
We are also sharing anonymized results of this survey with a number of stakeholders. This may inform their development of future resources.
Some NPs have not completed the education because they are not prescribing controlled substances in their current role. In spite of this, the College recommends that these NPs still complete the education, because the content includes more than just information about prescribing controlled substances.
It also includes information that may be relevant to current or future NP practice. For example, information related to federal laws; examples of aberrant behaviour that may indicate misuse, addiction or diversion; misconceptions and client stigmatizations; and ethical considerations.
For more information, see Approved Controlled Substances Education for Nurse Practitioners.