Respond separately by supporting or expanding on the practice focused question identified by your colleague or sharing additional perspectives on the issue described by your colleague. Add references for each response.

Colleague 1 Evidence-Based Practice (EBP) in nursing is approaching a situation with inquiry and engagement, adhering to the nursing process by addressing the issue or problem using the most reliable evidence available (Stannard, 2021). This definition is sufficiently broad to encompass perioperative nurses engaged in diverse roles and environments, from surgery suites to academia, while also being precise enough to identify the practice that offers an evidence-informed solution to an emergent issue or problem. Florida advanced practice registered nurses have diligently endeavored for many years to practice to the maximum extent of their training and education; nevertheless, medical groups have obstructed whatever advancement they have sought to achieve. During the 2020 legislative session, House Bill 607, known as the Direct Care Workers bill, was enacted, permitting nurse practitioners in designated primary care fields to practice independently (Stone-Gale, 2023). This nonetheless necessitates numerous Advanced Practice Registered Nurses in the state to possess a joint practice agreement. Consequently, additional efforts are required to eliminate those practice barriers.

The gap in practice that I can explore for the duration of this course is the issue of obtaining contracts with insurance companies as an NP owned clinic (in the state of Florida), who does not have an MD on staff. Insurance companies, such as Aetna, United Healthcare, Blue Cross Blue Shield, etc. all want an MD on staff in order to reimburse for services rendered. This is the case even if the MD is not physically in the office and never sees a patient. The application to be able to register for contracts with these companies only take applications once a year. In order to formally obtain a new contract with an insurance company (in the state of Florida), the NP must use a credentialing company, which costs anywhere from $1500-$3000 initially, and once the insurance is approved, the office/practice is then billed $200 annually (How Much Does Physician Credentialing Cost? | Physician Practice Specialists, 2017).

This issue is common for a NP- ran clinic for the state of Florida, and is specific for NP-owned outpatient clinics/offices. Having an MD on staff has no change in what is practiced by the NP. This issue has been addressed and is an ongoing issue for my preceptor, who owns her own practice. Currently, she is only able to accept Medicare (traditional only), Signa and all Tricare (for Life and Prime), or patients must be self-pay. My preceptor currently offers a "DPC" (direct primary care) program for those whose insurance she does not take. DPC, wherein consumers remit a fixed charge for their healthcare, in conjunction with the strategic application of technology, empowers patients, establishes the authentic "medical home," and transforms providers' perceptions of patient care (Lamberts & Sacopulos, 2023). The cost per appointment (self-pay) is $85 per appointment, this does not include a $100 enrollment fee. In the state of Florida, FNP's have only been able to be autonomous for 4-5 years. According to my preceptor, some MDs will charge NP's an upwards of $600 per month, just to have their name on the practice, but won't actually see a patient.

References

How much does physician credentialing cost? | Physician Practice Specialists. (2017, November 2). Physician Practice Specialists. https://physicianpracticespecialists.com/credentialing/how-much-does-physician-credentialing-cost/

Lamberts, R., & Sacopulos, M. (2023). Thinking About a Direct Primary Care Practice? The Journal of Medical Practice Management, 38(4), 196-200. https://doi.org/10.55834/halmj.8842751466

Stannard, D. (2021). Problem Identification: The First Step in EvidenceBased Practice. AORN Journal, 113(4), 377-378. https://doi.org/10.1002/aorn.13359

Stone-Gale, V. (2023). Blessings and barriers: Achieving autonomous practice in Florida. Journal of the American Association of Nurse Practitioners, 35(6), 332-333. https://doi.org/10.1097/jxx.0000000000000889

Colleague 2

Practice Focus Question

Improving practice and community health, according to the Translating Research Into Practice framework, begins with summarizing the evidence and identifying local barriers (Agency for Healthcare Research and Quality, 2017). The first step of identifying the practice topic and evaluating the literature. The topic selected was substance abuse among the youth, as it was noted that there was no targeted intervention for this public health concern.

A brief review of the literature revealed that youth between the ages of 10 and 24 are at a significant risk for adverse health outcomes associated with substance use, while also being at risk for substance abuse based on cognitive and social conditions (Nawi et al., 2021; Pozuelo et al., 2022; Semwal et al., 2025). Recognizing these increased risks, the search focused on the adverse outcomes associated with substance abuse among the youth. According to Pozuelo et al. (2022), substance abuse can lead to a range of risky behaviors including unprotected sex, drinking and driving, and exposure to unsafe environments. Furthermore, substance abuse has been linked to increased self-harm and suicidality among the youth (Shoib et al., 2024; Zhang et al., 2024). The final phase of reviewing the evidence focused on interventions in the literature. According to Deep et al. (2024), programs that help strengthen the youth's sense of self and promote engagement in positive behaviors are the most effective strategies for the prevention of substance abuse for this age cohort. While targeted community-based prevention strategies have demonstrated some success, Onyenwe et al. (2024) asserted that today's generation of youth is more engaged in the online environment. The researchers explained that tailored interventions, interactive education, and targeted messages can be delivered through online platforms easily accessible through mobile devices and computers. Therefore, Onyenwe et al. (2024) stated that future progress in preventing substance use for the target population should incorporate online

interventions.

At this point, the topic of developing a substance abuse prevention program for at-risk youth emerged. According to Gallagher Ford and Melnyk (2019), the topic can then be translated into a PICOT question that is based in the reviewed evidence. For this topic, the evidence supports the focused practice question: "In youth at-risk of abusing substances (P), how do online drug prevention courses (I) compared with government-sponsored initiatives (C) affect the onset of substance abuse?

References

Agency for Healthcare Research and Quality. (2017). Action plan for translating research into practice: Gap analysis and tests of change: Facilitator guide Links to an external site.. https://www.ahrq.gov/hai/tools/mvp/modules/cusp/action-plan-trip-fac-guide.html

Deep, P. D., Ghosh, N., Gaither, C., & Rahaman, M. S. (2024). The factors affecting substance use and the most effective mental health interventions in adolescents and young adults.Psychoactives,3(4), 461-475. https://doi.org/10.3390/psychoactives3040028Links to an external site.

Gallagher Ford, L., & Melnyk, B. M. (2019). The underappreciated and misunderstood PICOT question: A critical step in the EBP processLinks to an external site.. Worldviews on Evidence-Based Nursing, 16 (6), 422-423. https://doi.org/10.1111/wvn.12408Links to an external site.

Nawi, A. M., Ismail, R., Ibrahim, F., Hassan, M. R., Manaf, M. R. A., Amit, N., ... & Shafurdin, N. S. (2021). Risk and protective factors of drug abuse among adolescents: a systematic review.BMC public health,21, 1-15. https://doi.org/10.1186/s12889-021-11906-2Links to an external site.

Onyenwe, C. A., Onwumere, C., & Odilibe, I. P. (2024). Public health strategies for preventing youth substance use: A review of prevention programs and conceptual approaches.International Journal of Biology and Pharmacy Research Updates,3(1), 12-19. https://doi.org/10.53430/ijbpru.2024.3.1.0022Links to an external site.

Pozuelo, J. R., Desborough, L., Stein, A., & Cipriani, A. (2022). Systematic review and meta-analysis: depressive symptoms and risky behaviors among adolescents in low-and middle-income countries.Journal of the American academy of child & adolescent psychiatry,61(2), 255-276. https://doi.org/10.1016/j.jaac.2021.05.005Links to an external site.

Semwal, J., Vallabh, V., Uniyal, A., Shrivastava, A., Bijalwan, R., & Nagrath, D. (2025). Substance abuse among Adolescents and Youth (10-24 years): Assessing the prevalence