Virginia APRNs Prescriptive Authority discussing

1. The licensure of Advanced practitioner registered nurse (APRN) in the state of Virginia is regulated by the Board of Medicine and the Board of Nursing equally. Virginia’s nurse practice act (NPA) does require a collaborative agreement with a physician. The APRN and the physician collaborate as members of the patient’s care team (Virginia Law Library, 2020). The collaboration is a safety mechanism that ensures open communication and decision making in providing a safe and effective plan of care and treatment. As the APRN  grows and develops clinical experience, which is defined by five years of full-time experience of 1800 hours per year totaling 9,000 hours, she/he may qualify for autonomous practice (Commonwealth of Virginia, 2020, p. 7).

2. The Commonwealth of Virginia requires APRNs to have a prescribing practice agreement with the collaborating physician who provides prescriptive authority.  The APRN can only prescribe medications within the scope of the written or electronic practice agreement (Virginia Law Library, 2020). When prescribing medications, a prescribing agreement is necessary to ensure regulation that requires the practitioner to remain competent to ensure the required standard of care is being provided to the patient.  Another way the Commonwealth of Virginia ensures patient safety is by limiting the number of collaboration a physician can have with an APRN at one time to 6 (Commonwealth of Virginia, 2020, p. 7).

3. The Commonwealth of Virginia grants authority for APRNs to prescribe Schedule II thorough Schedule VI controlled substances and devices as long as the collaborating physician has designated prescriptive authority to the APRN and the APRN has established a bonafide practitioner-patient relationship (Virginia Law Library, 2020).  In prescribing schedule II through VI medications, the practitioner must  perform an examination, initiate interventions and schedule follow up care to ensure that the medication is effective and that the patient is not experiencing side effects which may cause the patient not to complete the treatment.

4. Treatment of rashes does fall in the scope of practice of a CNP.  As long as the CNP meets the criteria of being properly trained to perform a physical health assessment on the specific age group, can properly identify and diagnosis the rash, and has competency in the drugs to prescribe taking in consideration the patient’s medical history including comorbidities and current medications (Arcangelo, et al., 2017).   then yes the CNP should treat rashes across the lifespan.  In developing a treatment plan, the CNP should collaborate with a physician and only take the case as long as she/he has a thorough understanding of the rash and/or the secondary condition that could have caused the rash.  Prior to prescribing a treatment plan, the CNP must be competent in prescribing a treatment plan to the specific age group and be able to provide a follow up appointment with the patient.  If the CNP is relying on the collaborating physician to be the decision maker due to inexperience or or lack of knowledge with the age group or rash, then the CNP should not treat the patient and should refer the patient to a competent practitioner.

References

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 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/

Discussion 1

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.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

   The American Association on Nurse Practitioners (AANP) defines full practice authority 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). Twenty-two states and the District of Columbia currently have full practice authorization. Nurse Practitioners (NP) have consistent requirements nationwide regarding education, licensure, and certification. However, there is an inconsistency between states regarding the conditions which authorize NPs to practice.

The state of Virginia requires a collaborative agreement with a physician. In 2018, Virginia approved bill 793, allowing nurse practitioners with five years and nine thousand hours of physician supervision to advance to full practice autonomy. The autonomous nurse practitioner in Virginia will provide a plan to refer complicated and emergency patients to a physician or appropriate provider. I agree with allowing NP autonomy following a collaborative practice period with a supervising physician. However, five years is an excessive period. I support a national standard to guarantee the best healthcare.

Nurse practitioners in Virginia can prescribe Schedule II to VI medications. Virginia requires 1000 hours and 30 credit hours of pharmacology education for NP to qualify for prescriptive authority. Nurse Practitioners in Virginia have a prescribing agreement with a physician until the NP has met the requirements for independent practice. I agree that a term of monitored practice is reasonable; however, according to Buppert (2017), the supervision lacks evidence that care is enhanced. Therefore, I support nationwide standardization of NP requirements to certify the safest healthcare.

Rashes are common and can be difficult for nurse practitioners to diagnose. A thorough history and physical examination will aid in identifying these skin conditions. From diaper rash to acne to herpes zoster (shingles), rashes occur throughout the lifespan and can be complicated or straightforward to treat. The symptoms, size, and the affected area can help identify the need for collaborative care. Rashes not responding to conventional treatment would require consultation. The collaborative care model works to improve patient outcomes through an inter-professional team. Dieticians, Physiotherapists, or medical specialists are valuable adjuncts to the primary care team.

 

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

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