Nurse Practitioner's Practices and Qualifications

Kindly reply to the below discussion post.
1) Level of independence of practice
A nurse practitioner's (NPs) scope of practice varies by state. Virginia is a restricted practice state and requires an active agreement with a physician if they have yet to attain independent practice authority. A physician may enter a supervisory contract with up to six NPs (Excerpts from the Medical Practice Act of the Code of Virginia Relating to Nursing, 2022). In addition, the state of Virginia recognizes the signature of NPs. It allows them to sign for referrals to physical therapy, sign disability parking permits, sign Do Not Resuscitate (DNR) orders, and sign death certificates (American Association of Nurse Practitioners [AANP], 2022).
Prescribing authority
NPs in Virginia can prescribe Schedule II through Schedule IV-controlled substances (Excerpts from the Medical Practice Act of the Code of Virginia Relating to Nursing, 2022). The caveat is that the NP must have a practice agreement with a physician that details the prescription drugs they can dispense. In addition, applying for initial prescriptive authority requires continued certification as an NP and payment of $35 (Virginia Board of Nursing & Virginia Board of Medicine, 2022). Biennially, the NP must also complete eight hours of pharmacology continuing education to maintain their prescriptive authority (Virginia Board of Nursing & Virginia Board of Medicine, 2022). Once authorized to write prescriptions, the NP must use the DEA number assigned to them and their signature on the prescription (Virginia Board of Nursing & Virginia Board of Medicine, 2022). NPs may not prescribe medications for themselves or family members unless there is an emergency and no other available practitioners (Virginia Board of Nursing & Virginia Board of Medicine, 2022). In addition, there must be a documented provider-patient relationship before dispensing medication in all situations (Virginia Board of Nursing & Virginia Board of Medicine, 2022).
Any limitations of practice
The Boards require a signed agreement between a physician and NP to review patient charts and oversee complex clinical cases (Virginia Board of Nursing & Virginia Board of Medicine, 2022). The NP may apply for independent practice after five years of full-time clinical practice with a service agreement. The NP must pay a fee of $100 for the autonomous practice attestation and submit a physician statement affirming the NP served the required clinical time under the physician's supervision within the agreement (Virginia Board of Nursing & Virginia Board of Medicine, 2022). Once approved, the NP no longer requires a signed contract with a physician to continue their practice. As a result, the NP is issued a new license that designates the NP for independent practice (Excerpts from the Medical Practice Act of the Code of Virginia Relating to Nursing, 2022).
Process for obtaining licensure in your state
In Virginia, the Joint Boards of Nursing and Medicine have specific requirements for initial licensure as an NP. The applicant must have an active RN license in Virginia or a multistate license, provide evidence of graduating from an approved graduate program specific to their population focus, and proof of certification in the chosen specialty by an approved agency (Virginia Board of Nursing & Virginia Board of Medicine, 2022). Two agencies that grant the FNP certification include the American Academy of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC). The AANP examination costs $240 for members or $315 for non-members (2022). The ANCC examination costs $295 for members and $395 for non-members (2023). Once the Boards receive evidence of certification results, the applicant can apply for licensure with the Virginia Department of Health Professions. The initial application cost is $125 and must be renewed biennially for a fee of $80 (Virginia Board of Nursing & Virginia Board of Medicine, 2022). To maintain an active license, every NP must complete 40 hours of continuing education in their specialty approved by a certifying agency and maintain their certification credentials (Virginia Board of Nursing & Virginia Board of Medicine, 2022).
Certification and education requirements for licensure.
Becoming a nurse practitioner (NP) begins with obtaining a bachelor's degree and a registered nurse (RN) licensure. In addition, the RN pursuing an advanced degree must enter a graduate program accredited by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC) (Virginia Board of Nursing & Virginia Board of Medicine, 2022). Every student must complete three advanced courses in health assessment, pathophysiology, and advanced pharmacology (APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee, 2008). These advanced courses assist graduate nurses in expanding their knowledge base by incorporating evidence-based research and practice. The education garnered prepares all NPs to work in a variety of settings. Within each practice setting, there are numerous opportunities to continue professional growth while partnering with a physician, as the state of Virginia requires.
2.) According to recent census data in Fairfax County, Virginia, the population is approximately 1.1 million (Regional Primary Care Coalition, n.d.). Although northern Virginia is wealthy, primary care services are not equally distributed. For example, in the southeastern portion of the county, there is only one primary care physician for every 3,500 residents (Regional Primary Care Coalition, n.d.). Nurse practitioners are more than equipped to meet the need of medically underserved areas. Removing the restrictions to practice independently will increase access to primary care services in underserved communities. In areas with access to healthcare, residents without insurance may need to travel to one of three county health clinics for low-cost or free medical care (Fairfax County Government, n.d.). As a result, emergency departments become the primary care centers for those lacking medical insurance. Fairfax County's uninsured rate is 14% of the population (Regional Primary Care Coalition, n.d.). In partnership with county resources, Inova Partnership for Healthier Communities has begun to connect uninsured families with access to free or low-cost medical care as of 2019 (Fairfax County Government, n.d.).
3.) Increased access to primary healthcare through nurse practitioners reduces health disparities, healthcare costs, and the incidence of chronic illness (American Association of Nurse Practitioners[AANP], 2023). In addition, NPs are more likely to serve in rural locations and underserved communities than medical doctors. Increasing the number of available nurse practitioners in those communities will continue to save the patient and healthcare system from unnecessary medical costs from untreated conditions. In fact, states that restrict an NP's ability to practice have higher healthcare costs and lower rankings in health nationwide (American Association of Nurse Practitioners [AANP], 2023).
References
American Academy of Nurse Practitioners Certification Board. (2022). Fees. 
American Association of Nurse Practitioners. (2022). Virginia State Policy Fact Sheet. 
American Nurses Credentialing Center. (2023). Family Nurse Practitioner Certification (FNP-BC™). 
APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. (July 7, 2008). Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. 
Excerpts from the Medical Practice Act of the Code of Virginia Relating to Nursing, § 54 CFR §§ 1-2957 (2022). 
Fairfax County Government. (n.d.). Free or low cost medical care for adults and families. 
Regional Primary Care Coalition. (n.d.). Fairfax health district. 
Virginia Board of Nursing & Virginia Board of Medicine. (February 2, 2022). Regulations Governing the Licensure of Nurse Practitioners (18 VAC 90-30-10) [Title of Regulations]. Commonwealth of Virginia.