5310 Discussion Post I
Advanced Practice Registered Nursing: Collaboration, Medication Management, and Patient Safety
Michael Moates, Ed.D.
Non-Degree Seeking Student, Saint Thomas University (MSN at Herzing University)
NURS 5310 Clinical Pharmacotherapeutics
Saint Thomas University
LaDonna Christy (Mylie), PhD, MBA/MSN, RN, NEA-BC, CCRN, NPD-BC, CHSE
January 15, 2026
Collaboration with other healthcare practitioners is critical to the practice of Advanced Practice Registered Nurses (APRNs) due to the complexity of patient care, which often requires interdisciplinary expertise (American Nurses Association, 2015). This collaboration enhances patient safety, reduces errors, and improves outcomes through shared decision-making. APRNs work closely with physicians, pharmacists, and other healthcare professionals to ensure comprehensive care that addresses the physical, emotional, and social needs of patients. By sharing knowledge, skills, and resources, APRNs and other healthcare practitioners can provide more effective and efficient care, leading to better health outcomes and higher patient satisfaction.
When prescribing medications, especially those that can be misused, APRNs must be vigilant for behavioral red flags that may indicate potential misuse (Compton et al., 2014). These red flags include frequent requests for early refills, reporting lost or stolen prescriptions repeatedly, visiting multiple providers for similar symptoms (a practice known as "doctor shopping"), and resisting referrals to specialists or alternative therapies. APRNs should also monitor for changes in patient behavior, such as increased anxiety or agitation when discussing medication, and be aware of the potential for diversion of controlled substances. By recognizing these red flags, APRNs can take steps to prevent misuse, such as adjusting treatment plans, providing education on safe medication use, and referring patients to substance abuse treatment programs when necessary.
Effective communication is essential when working with patients who may be misusing medications (Miller & Rollnick, 2013). Communication barriers, such as language or cultural differences, patient defensiveness or denial, and stigma around substance use, can hinder the APRN's ability to assess and address potential misuse. To overcome these barriers, APRNs should use nonjudgmental open-ended questions, active listening, and empathy to establish trust and encourage honest communication. Motivational interviewing techniques, which focus on exploring and resolving ambivalence, can also be effective in promoting behavior change and reducing misuse. By using these communication skills, APRNs can build strong relationships with patients, address concerns and misconceptions, and provide personalized education and support to promote safe medication use.
Prescription Drug Monitoring Programs (PDMPs) are state-run databases that track controlled substance prescriptions to prevent misuse and diversion (Rutkow et al., 2015). These programs provide APRNs with critical information to inform prescribing decisions, such as a patient's prescription history and potential red flags for misuse. However, PDMPs also raise ethical considerations, such as balancing public health benefits with patient privacy and ensuring data accuracy to avoid wrongful suspicion. APRNs must be aware of these considerations and use PDMPs judiciously, taking care to protect patient confidentiality and avoid biases in data interpretation.
The role of state Nurse Practice Acts is to define the legal scope of practice for APRNs, including prescriptive authority, and establish standards for licensure and discipline to protect public safety (National Council of State Boards of Nursing, 2023). These acts vary by state, with some states granting full prescriptive authority to APRNs, while others require collaborative agreements with physicians or impose restrictions on the types of medications that can be prescribed. APRNs must be aware of the specific laws and regulations in their state and practice accordingly, ensuring that they provide care that is both effective and legally sound.
State-specific elements can also play a significant role in the prescription of controlled substances (Davis & Carr, 2016). For example, some states require mandatory PDMP checks before prescribing certain medications, while others impose limits on opioid dosage or duration. APRNs must be familiar with these regulations and incorporate them into their practice, taking care to balance the need for effective pain management with the risk of misuse and diversion. Additionally, APRNs should be aware of the potential for variations in state laws and regulations, which can impact the care provided to patients who travel or relocate.
Laws and ethics related to sample medications and self-prescribing are critical considerations for APRNs (American Medical Association, 2016). The sale of sample medications is illegal under federal law, and self-prescribing or treating family members is prohibited in most states due to the potential for conflicts of interest and compromised objectivity. APRNs should be aware of these laws and ethics, taking care to avoid any actions that could be perceived as unethical or illegal. Instead, APRNs should focus on providing evidence-based care that prioritizes patient safety and well-being, seeking consultation or referral when necessary to ensure the best possible outcomes.
A patient's health beliefs, age, and current medication regimen can significantly affect new prescriptions (Lehne, 2018). Health beliefs, such as cultural views on medication use, can influence adherence and effectiveness, while age-related changes in renal or hepatic function can alter drug metabolism and increase the risk of adverse events. APRNs should take these factors into account when prescribing, adjusting treatment plans to accommodate individual patient needs and minimize potential risks. For example, older adults may require lower doses or more frequent monitoring due to age-related changes in drug metabolism, while patients with certain health beliefs may require additional education or support to ensure safe and effective medication use.
The practice of "doctor shopping" refers to the act of seeking identical prescriptions from multiple providers to misuse medications (Compton et al., 2014). This behavior is a significant concern for APRNs, as it can lead to diversion, overdose, and other adverse events. APRNs should be vigilant for signs of doctor shopping, such as frequent requests for early refills or reports of lost or stolen prescriptions, and take steps to prevent misuse, such as adjusting treatment plans or referring patients to substance abuse treatment programs.
Informed consent is a critical component of APRN practice, particularly when prescribing medications with potential risks or side effects (Beauchamp & Childress, 2019). The four critical features of informed consent include disclosure of risks and benefits, explanation of alternatives, assessment of patient understanding, and voluntary agreement without coercion. APRNs should ensure that patients are fully informed and able to make decisions about their care, providing education and support as needed to promote safe and effective medication use.
The benefits of electronic health records (EHRs) are numerous, including improved coordination of care, reduced medication errors, and enhanced data sharing among providers (Kruse et al., 2018). EHRs provide APRNs with real-time access to patient information, enabling more accurate and efficient care. Additionally, EHRs can facilitate communication among healthcare providers, reducing errors and improving patient outcomes.
Medication reconciliation is a critical process that involves comparing a patient's medication list across care transitions to prevent omissions, duplications, and interactions (The Joint Commission, 2020). This process is essential to reducing adverse events and improving patient safety, as medication errors can have serious consequences, including hospitalization and even death. APRNs should prioritize medication reconciliation, taking care to review and update medication lists at each care transition to ensure continuity and accuracy.
The underutilization of medications can have significant consequences for patient outcomes, including worsening chronic conditions, increased hospitalizations, and higher long-term healthcare costs (Osterberg & Blaschke, 2005). APRNs should be aware of the potential for underutilization, particularly among vulnerable populations, such as older adults or those with limited access to healthcare. By promoting adherence and addressing barriers to medication use, APRNs can help ensure that patients receive the full benefit of their medications, leading to improved health outcomes and reduced healthcare costs.
References:
American Medical Association. (2016). Code of medical ethics.
American Nurses Association. (2015). Nursing: Scope and standards of practice.
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Compton, W. M., et al. (2014). JAMA, 311(3), 309-310.
Davis, G. A., & Carr, D. (2016). Journal of Pain & Palliative Care Pharmacotherapy, 30(2), 142-148.
Kruse, C. S., et al. (2018). Healthcare, 6(2), 42.
Lehne, R. A. (2018). Pharmacology for nursing care (10th ed.). Elsevier.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
National Council of State Boards of Nursing. (2023). Nurse Practice Act.
Osterberg, L., & Blaschke, T. (2005). New England Journal of Medicine, 353(5), 487-493.
Rutkow, L., et al. (2015). JAMA Internal Medicine, 175(10), 1641-1642.
The Joint Commission. (2020). Medication reconciliation.