APRNs Prescriptive Authority in Virginia State

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?

In the State of Virginia, the nurse practice act requires the APRN to have a written or electronic practice collaborative agreement with at least one patient care team provider and it’s regulated by the Board of Medicine and the Board of Nursing equally (Virginia Law Library, 2020).

In my opinion, I believe it is good for APRN to have a collaboration agreement for a specific period or hours. I believe this to be true with most professions, I find it is beneficial for both patient and practitioners to have someone to discuss difficult cases or issues with or treatment plans. As a new nurse, I remember thinking it was great having a preceptor for two weeks, but I also saw the charge nurse as that person I could collaborate with. I feel like after some time or even a certain number of hours that a APRN should be able to have autonomy and no longer be required to have a collaboration agreement or must work under a physician. In fact, in Virginia after five years of full-time experience or 9,000 hours over the five years the APRN can apply for autonomous practice (Commonwealth of Virginia, 2020). I believe this allows the APRN who want the autonomy to apply for it and those who want to continue to collaborate that option as well.

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.

Virginia’s Nurse Practice Act requires the APRN to have a prescribing agreement with a physician for Schedule II through VI. The NP must disclose to patients that they are a licensed nurse practitioner, and the patient care team physician can not have more than six nurse practitioners at one time (Virginia Law Library, 2020).

Prescribing medications can be a tricky process as I often find patients try to obtain a prescription during an appointment. For example, when I worked for a pediatrics office it seemed the parents were always looking for antibiotics when they were bringing their children in for a sick visit even if it was viral and we explained the antibiotics would not help. I believe if the APRN provides education, gathers a through history and physical exam, is familiar with the medication, side effects, contraindications, etc.… they should be allowed to prescribe without a prescribing agreement. As Arcangelo, Peterson, and Wilbur state in their book Pharmacotherapies for Advanced Practice (2017,p.7), “it is essential for the practitioner to understand the responsibility involved in prescribing that drug or drugs and to consider seriously which class of medication is most appropriate for the patient.” If they have passed the boards and are held to the same standards and regulations as any other provider, I do not see why they can not prescribe without a prescribing agreement with a physician. I also, believe allowing the APRN to prescribe continues continuity of care as they are the most familiar with the patient and their history. I believe if we were to rely on another provider just to prescribe without knowing the patient that would be a huge mistake and a potential for errors.

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.

The APRN can schedule II to VI in Virginia. Our APRN’s in Virginia are not allowed to prescribe a Class I drug. Class I drugs are the most dangerous drugs and potential for addiction and abuse is high. These are not approved for medical usage in the United States. So, I believe that the classes our APRN are approved to prescribe are appropriate.

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.

Anytime a patient presents with a rash the main thing that needs to be done is a detailed skin history, and health assessment. Finding out the cause of the rash is the main way to heal or get rid of the rash. I know that trying to get into a dermatologist is extremely hard as they seem to be overwhelmed with patients. I believe if we educate a APRN on what to look for and on the different types of rashes and causes they should be allowed to treat rashes. If the APRN is not sure of what is causing the rash or how to treat they should reach out and collaborate with their care team physician as they would with any other issue or concern or refer the patient out to another provider. If the APRN has the proper training, performs a full physical and history is able to diagnose and knows the treatment for the rash they shouldn’t need to collaborate or send to a consultant (Arcangelo, Peterson, & Wilbur, 2017).

References

Arcangelo, V. P. & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams &Wilkins.

Commonwealth of Virginia regulations governing the licensure of nurse practitioner.  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/

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