Discussion on Virginia’s APRNs Prescriptive Authority 

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Discussion on Virginia’s APRNs Prescriptive Authority

The Discussion

Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:

  1. Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a collaborative agreement, and explain why/why not.
  2. Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.
  3. Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.
  4. Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.

Discussion on Virginia’s APRNs Prescriptive Authority.

Discussion on Virginia’s APRNs Prescriptive Authority

The Discussions

Discussion 1

In Virginia, the Boards of Medicine and Nursing both control Advanced Practitioner Registered Nurse (APRN) certification. A collaborative agreement with a physician is required under Virginia’s nurse practice laws. As part of a patient’s care team, the APRN and the physician cooperate (Virginia Law Library, 2020).

Collaboration is a safety mechanism that enables open communication and decision-making in the delivery of a safe and successful treatment plan. As the APRN gains clinical experience (specified as five years of full-time work at 1800 hours per year for a total of 9,000 hours), she or he may be eligible for autonomous practice (Commonwealth of Virginia, 2020, p. 7).

A prescription practice agreement with the collaborating physician who gives prescriptive power is required by the Commonwealth of Virginia. Only the written or electronic practice agreement limits the APRN’s ability to prescribe drugs (Virginia Law Library, 2020).

When prescribing pharmaceuticals, a prescribing agreement is essential to guarantee that the practitioner remains competent in order to offer the requisite level of care to the patient. Another method the Commonwealth of Virginia guarantees patient safety is to restrict a physician’s cooperation with an APRN to six at a time (Commonwealth of Virginia, 2020, p. 7).

The Commonwealth of Virginia allows APRNs to prescribe prohibited medications and devices from Schedule II through Schedule VI as long as the partnering physician has given the APRN prescriptive power and the APRN has established a genuine practitioner-patient connection (Virginia Law Library, 2020).

Discussion on Virginia’s APRNs Prescriptive Authority.

The practitioner must perform an examination, initiate interventions, and schedule follow-up care when prescribing schedule II through VI medications to ensure that the medication is effective and that the patient is not experiencing side effects that may cause the patient to stop taking the medication.

A CNP may treat rashes. As long as the CNP is properly trained to conduct a physical health assessment on a specific age group, can correctly identify and diagnose the rash, and is knowledgeable about the drugs to prescribe while taking into account the patient’s medical history, including comorbidities and current medications (Arcangelo, et al., 2017). The CNP should, in fact, treat rashes throughout one’s life.

The CNP should work with a physician to design a treatment plan and only take on a case if she or he has a good grasp of the rash and/or the secondary ailment that may have caused the rash. Before prescribing a treatment plan, the CNP must be capable of prescribing a treatment plan for the patient’s age group and scheduling a follow-up session. Because of inexperience or a lack of expertise about the age group or rash, the CNP should not treat the patient and should send the patient to a competent practitioner.

Discussion on Virginia’s APRNs Prescriptive Authority.

Discussion 2

Full practice authority is defined by the American Association of Nurse Practitioners (AANP) as the “authorization of nurse practitioners to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing” (AANP 2020).

Full practice permission is now in place in twenty-two states and the District of Columbia. Nurse Practitioners (NPs) must meet uniform educational, licensing, and certification criteria throughout the country. However, there is variability across jurisdictions when it comes to the requirements that allow NPs to practice.

A collaborative agreement with a physician is required in Virginia. In 2018, Virginia passed bill 793, enabling nurse practitioners to graduate to full practice autonomy after five years and nine thousand hours of physician supervision. In Virginia, the autonomous nurse practitioner will develop a strategy for referring difficult and emergency patients to a physician or other suitable clinician. I believe that NP autonomy should be allowed after a time of collaborative practice with a supervising physician. Five years, on the other hand, is much too long. I believe in a national standard to provide the greatest possible healthcare.

Schedule II through VI drugs may be prescribed by nurse practitioners in Virginia. To be eligible for prescriptive power in Virginia, NPs must complete 1000 hours and 30 credit hours of pharmacology coursework. In Virginia, nurse practitioners have a prescription agreement with a physician until they meet the qualifications to operate independently. I agree that a period of supervised practice is acceptable; nevertheless, Buppert (2017) claims that the monitoring lacks proof of improved treatment. As a result, I favor the nationalization of NP standards in order to certify the safest healthcare.

Discussion on Virginia’s APRNs Prescriptive Authority.

Rashes are prevalent and might be challenging to identify for nurse practitioners. These skin diseases may be identified with a comprehensive medical history and physical examination. Rashes may range in severity from diaper rash to acne to herpes zoster (shingles) and can be difficult or simple to cure.

The symptoms, size, and affected region may all assist determine whether or not coordinated care is required. Consultation is required for rashes that do not respond to standard therapy. The collaborative care concept employs an interprofessional team to enhance patient outcomes. Dieticians, physiotherapists, and medical experts might be beneficial additions to the primary care team.

 

Discussion on Virginia's APRNs Prescriptive Authority 

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Frequently Asked Questions (FAQs)

1. Can nurse practitioners in Virginia prescribe medication?

Virginia allows nurse practitioners to dispense Schedule II through VI drugs. To keep their prescription power, NPs must complete eight hours of continuing education in pharmacology or pharmacotherapeutics every other year, according to the Virginia Board of Nursing.

Discussion on Virginia’s APRNs Prescriptive Authority.

2. Do nurse practitioners need a supervising physician in Virginia?

Virginia's APRNs Prescriptive Authority 
Discussion on Virginia’s APRNs Prescriptive Authority 

In Virginia (and many other states), NPs who do not have their own practice must work as part of a patient care team under the supervision of a physician, according to a “Practice Agreement,” or “Collaborative Practice Agreement.”

3. Do nurse practitioners have full practice authority in Virginia?

Governor Ralph Northam signed House Bill 793 in April 2018, allowing Virginia Nurse Practitioners (NPs) to operate independently after completing the equivalent of five years of full-time practice with a collaborating physician.

Additional content on the topic.

References

  • American Association of Nurse Practitioners (AANP) (2020, October 20). State Practice Environment. https://www.aanp.org/advocacy/state/state-practice-environment
  • Buppert, C. (2017). Thoughts About Drafting Bills to Give Nurse Practitioners Full Practice Authority. The Journal for Nurse Practitioners, 13(7), 497 498. http://dx.doi.org.americansentinel.idm.oclc.org/10.1016/j.nurpra.2017.05.015
  • Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach  (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams I Wilkins.
  • Commonwealth of Virginia regulations governing the licensure of nurse practitioners. Retrieved from http://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/Nursepractitioners.pdf
  • Virginia Law Library. (2020). The code of Virginia. Retrieved from https://law.lis.virginia.gov/vacode/54.1-2957.01/ Arcangelo, V. P. & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams &Wilkins.

Discussion on Virginia’s APRNs Prescriptive Authority.Discussion on Virginia's APRNs Prescriptive Authority 

 

 

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