Running head: NURSE PRACTITIONER PRACTICE SCOPE1 NURSE PRACTITIONER PRACTICE SCOPE7 Nurse Practitioner Practice Scope Kimberly Colbert Chamberlain University ENGL147N Advanced English Composition July, 2019 Nurse Practitioner Scope of Practice A nurse practitioner is not a doctor. All studies and statistics aside, the simple fact is that the two professions are not the same. They follow different courses of study, have different qualification standards, and have different levels of clinical training. There is no question that nurse practitioners will continue to fill a major role in medicine. The question is: what should that role be? That role should be independent practice by nurse practitioners, and the elimination of the physician supervision requirement in the states which have not already moved to allow independent practice; opponents of this do not have sufficient evidence to support their position. 1st Counter-Argument Opponents of expanding scope of practice believe that the intent of the nursing profession in promoting is the replacement of physicians with nurses. According to Dr. Rebekah Bernard, the push to increase nurse practitioner scope of practice is simply the promotion of that agenda to replace physicians with nurses, without considering the training and educational differences between doctors and nurse practitioners. Dr. Bernard cites lobbying and media activities as attempts to obscure the educational and training differences between doctors and nurses (Bernard, 2019). 1st Rebuttal There is no research or data to support this position. The medical schools are not producing enough graduates to fill the growing need for primary care physicians. North Carolina has attempted to alleviate the shortage by mandating that state medical schools graduate at least fifty percent of their students in primary care specialties. At five years after graduation, only thirteen percent were working as primary care physicians (Skipper, 2019). To the contrary, nurse practitioners are seen as a way to increase the reach of primary care medicine. The United States as a country has problems in providing primary care. There aren’t enough physicians in general, and there is an extreme lack of primary care physicians in rural and low income areas. Nurse practitioners are more likely to practice in rural areas than primary care medical doctors (Buerhaus, 2019). Research indicates that regulations restricting scope of practice actually restrict access to healthcare. Independent nurse practitioners are more likely than physicians to work with rural and underserved populations, something they can’t do if they are required to be supervised by a physician. There is no research or data to support this position. The medical schools are not producing enough graduates to fill the growing need for physicians. It is estimated that there will be a shortage of nearly 50,000 primary care physicians by 2030. To the contrary, n ...

1. Running head: NURSE PRACTITIONER PRACTICE SCOPE1
NURSE PRACTITIONER PRACTICE SCOPE7
Nurse Practitioner Practice Scope
Kimberly Colbert
Chamberlain University
ENGL147N Advanced English Composition
July, 2019
Nurse Practitioner Scope of Practice
A nurse practitioner is not a doctor. All studies and statistics
aside, the simple fact is that the two professions are not the
same. They follow different courses of study, have different
qualification standards, and have different levels of clinical
training. There is no question that nurse practitioners will
continue to fill a major role in medicine. The question is: what
should that role be? That role should be independent practice
by nurse practitioners, and the elimination of the physician
supervision requirement in the states which have not already

2. moved to allow independent practice; opponents of this do not
have sufficient evidence to support their position.
1st Counter-Argument
Opponents of expanding scope of practice believe that the intent
of the nursing profession in promoting is the replacement of
physicians with nurses. According to Dr. Rebekah Bernard, the
push to increase nurse practitioner scope of practice is simply
the promotion of that agenda to replace physicians with nurses,
without considering the training and educational differences
between doctors and nurse practitioners. Dr. Bernard cites
lobbying and media activities as attempts to obscure the
educational and training differences between doctors and nurses
(Bernard, 2019).
1st Rebuttal
There is no research or data to support this position. The
medical schools are not producing enough graduates to fill the
growing need for primary care physicians. North Carolina has
attempted to alleviate the shortage by mandating that state
medical schools graduate at least fifty percent of their students
in primary care specialties. At five years after graduation, only
thirteen percent were working as primary care physicians
(Skipper, 2019). To the contrary, nurse practitioners are seen
as a way to increase the reach of primary care medicine. The
United States as a country has problems in providing primary
care. There aren’t enough physicians in general, and there is an
extreme lack of primary care physicians in rural and low income
areas. Nurse practitioners are more likely to practice in rural
areas than primary care medical doctors (Buerhaus, 2019).
Research indicates that regulations restricting scope of practice
actually restrict access to healthcare. Independent nurse
practitioners are more likely than physicians to work with rural
and underserved populations, something they can’t do if they
are required to be supervised by a physician.
There is no research or data to support this position. The
medical schools are not producing enough graduates to fill the
growing need for physicians. It is estimated that there will be a

3. shortage of nearly 50,000 primary care physicians by 2030. To
the contrary, nurse practitioners are seen as a way to increase
the reach of primary care medicine that the medical schools
cannot solve. The United States as a country has problems in
providing primary care. There aren’t enough physicians in
general, and there is an extreme lack of primary care physicians
in rural and low income areas. Nurse practitioners are more
likely to practice in rural areas than primary care medical
doctors (Buerhaus, 2019). Research indicates that regulations
restricting scope of practice actually restrict access to
healthcare. Independent nurse practitioners are more likely than
physicians to work with rural and underserved populations,
something they can’t do if they are required to be supervised by
a physician
2nd Counter-Argument
The educational differences between nurse practitioners and
physicians as reason to restrict independent practice. A primary
care physician will have nearly 15.000 of clinical training,
while a nurse practitioner will have a fraction of that; it’s
possible to complete the nurse practitioner program with as few
as 500 clinical hours. This difference in training proves that
nurse practitioners cannot be allowed to practice without the
supervision of a primary care physician. There are significant
concerns over patient safety when a nurse practitioner is
allowed to practice independently; nurse practitioners are more
likely than physicians to make mistakes. (Cheney, 2019).
2nd Rebuttal
The emphasis on educational differences masks the fact that
nurse practitioners aren’t expected to be doctors. They are
expected to be highly skilled clinicians operating in a narrow
range of practice. All nurse practitioners must complete a
master’s or doctoral program, and will have a great deal of
clinical training (Buerhaus, 2019). Nurse practitioners offer a
solution to basic primary care. Increasing scope of practice
doesn’t mean that nurses replace doctors; it means that they can

4. perform primary care services consistent with their training and
professional standards. Primary care clinicians typically treat
the ordinary things for which people seek treatment; high blood
pressure, diabetes, asthma, arthritis, and back pain. They
perform physicals and provide vaccinations. These are not
typically complicated cases; they’re the ones a step higher than
taking two aspirin. This is what nurse practitioners are trained
to do. They’re not expected to know everything about
everything, but to be competent in their limited area of training.
There is no evidence to support the idea that limitations on
scope of practice are necessary to protect patients from low
quality providers (Buerhaus, 2019).
3rd Counter-Argument
Removing physician supervision negatively impacts patient
care. There is nothing simple about diagnosing a patient.
Physicians make mistakes, but they’re not the same type of
mistakes made by nurse practitioners. There are countless
examples of nurse practitioners misdiagnosing patients or
missing the diagnosis entirely, a consequence of their lack of
training and education. Nurse practitioners are responsible for
excessive or inappropriate testing. They order more tests, scans
and labs than physicians, increasing the cost of care. Claims of
improper prescribing and management of controlled substances
are rising (Bernard, 2018).
3rd Rebuttal
There is no indication that physician supervision improves
patient care. A 2018 Cochran evidence review found that nurse
practitioners are rated more highly than physicians and spend
more time with their patients than physicians. The review
found that patient outcomes in several areas were similar for
physicians and nurse practitioners, and that there were no
differences in the number of test and prescriptions written
(Greene, 2018).

5. Conclusion
There is no evidence that restrictions on the scope of practice
by nurse practitioners serve any useful purpose. Practicing
within the scope of their training, they are the equal of
physicians performing the same treatments, and are often rated
more highly than doctors in patient surveys.
Nurse practitioners are not meant to be replacements for
physicians, but are meant to broaden the reach of primary care.
References
.
Bernard, R. (2018), Independent Practice: Both Nurse
Practitioners and Physicians Should be
Outraged. Retrieved from
https://www.kevinmd.com/blog/2018/01
Buerhaus P. Nurse Practitioners: A
Solution
to America’s Primary Care Crisis. Missouri State Board of
Nursing Newsletter. 2019;21(1):16-23. https://search-ebscohost-
com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true
&db=ccm&AN=134467647&site=
eds-live&scope=site. Accessed July 21, 2019
Cheney, C. (2019) Why Physician Assistants and Nurse
Practitioners Need Supervision.
Retrieved from (https://www.healthleadersmedia.com/welcome-
ad?toURL=/clinical-
care/why-physician-assistants-and-nurse-practitioners-need-

6. supervision-say-physician-groups
Greene, J. (2018). Nurse practitioners provide quality primary
care at a lower cost than
physicians. Managed Care (Langhorne, Pa.), 27(11), 34.
Retrieved from https://search-ebscohost
com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true
&db=mdc&AN=30620307&site=eds-live&scope=site
Skipper, M. T. (2019). Positive Partnerships: Rural
Communities and the Primary Care Nurse
Practitioner. North Carolina Medical Journal, 80(3), 174–177.
https://doi-
org.chamberlainuniversity.idm.oclc.org/10.18043/ncm.80.3.174

7. Running head: Vegan Diets- Good Or Bad1
VEGAN DIETS- GOOD OR BAD2
The Good & Bad Side of Vegan Diets
Cindy S Pemberton
Chamberlain University
ENGL 147N- 60265
August 2019
The Good & Bad Side of Vegan Diets

8. Are vegan diets the healthy choice for all or do they
carry health concerns unknown to most? There have been long
debates on vegan diets, are they good or are they bad, that is the
question; does everyone who switches over to a vegan diet know
everything there is to know prior to making that change. Do the
experts and doctors give enough information for patients to be
able to make a sensible decision that will not jeopardize their
health? Those considering a vegan diet need to do their
homework and research all the facts, to gain knowledge and a
better understanding; the fact is the good does outweighs the
bad in veganism.
1st Counter-Argument (your oppositions’ point)
Vegan diets have been shown to be deficient in some required
nutrients that are needed to maintain heart health (“Active
Living”, 2011, para. 16). In the article written by Adriana
Barton, he explains that a vegan diet has deficiencies in iron,
zinc, B12 and omega 3 fatty acids, which are vital in
maintaining a decreased risk of heart disease and stroke (2011).
These claims were obtained in research that was done by Dr. Li,
professor of nutrition at The University of Hangzhou, China;
and David Jenkins a professor of nutritional sciences at The
University of Toronto. The research that was done by very
credible professionals should lead one to believe that the theory
was well investigated before making this claim, therefore it

9. adds much credibility to the claim and they are well
substantiated.
Vegan diets pose risks to overall heart health, in that
they lack Omega-3 fatty acids, like DHA, ALA and EPA, which
are essential for a healthy heart (Nordqvist, 2017), and other
body functions. While it is a known fact that one can take
supplements to substitute the nutrients lost in a vegan diet, all
supplements come with side effects; Omega-3 fatty acids are
naturally found in grass fed beef, dairy, mackerel and wild
salmon, which are not eaten by a true vegan (2017). There are
no side effects in getting essential nutrients in their natural
state. It is also recommended to get needed nutrients from
natural sources (2017). In essence vegan diets do not love ones
heart and the heart is one of the most important organs in the
human body, it behooves everyone to take extra care of it.
The body needs a wide variety of nutrients to be able to
function at an optimal one hundred percent. The experts
conclude that a vegan diet does not have sufficient nutrients
needed to be heart healthy. While some may be able to switch to
a vegan diet rely on supplements to maintain heart health and
deal with side effects, the person that is already suffering with
heart related issues needs to be extremely concerned when
monitoring heart health; a vegan diet would not be the best
choice. Great consideration should be made prior to switching

10. to a vegan diet for anyone making the conversion. Due to the
major impact on the heart, a move to veganism should be
calculated with caution (2017).
1st Rebuttal (your point)
Vegan diets are a much healthier choice for many proven
reasons. A vegan diet is not bad for your heart, in fact It is
estimated that if everyone ate a vegetarian diet, 1/3 of early
deaths would be prevented (Berger, 2018). Mr. Berger points
out the various health claims by many well regarded doctors,
dieticians and researchers on plant based diets (2018). He goes
on to note that vegetarian diets are not only nutritionally
adequate for humans, but it can also prevent and treat certain
diseases (2018). In particular, he notes a lower risk of heart
disease, high blood pressure, obesity, cancer and chronic
diseases (2018). This is truly an interesting study they did, and
it was fascinating to find out all of the great benefits of being a
vegan. Berger goes on to state that the American Institute of
Cancer Research concluded that more than one third of cancer
cases could be prevented, if patients ate a more healthy diet
(Vegan) and maintained a healthy weight (2018).
A vegan diet does not pose a risk to heart health, studies
have shown that vegan diets can extremely lessen the chance of
developing high blood pressure and heart disease (Lockhart,

11. 2017). A vegan diet does not comprise of meat and meat
products that contain high amounts of fat and calories (2017),
which can clog the arteries and increase the cholesterol level;
these issues are risk factors long associated with heart disease
and stroke. A vegan diet is highly recommended, as it is heart
friendly and does not cause any damage to the heart. A vegan
diet poses no risk to the body’s wellbeing and overall health
maintenance.
A vegan diet can supply the body with the needed
nutrients, in fact vegan diets are increasing in recommendations
by many health care professionals, to patients who want to
institute a more heart healthy diet (Women’s Health Advisor,
2016). Whole grains, vegetables and fruits contain fiber,
vitamins, minerals and folate, which have all been shown to
lower the threat of heart disease substantially (2016). A
vegetarian’s diet can encompass all of the needed elements to
ensure the overall health of one’s heart. Anyone thinking about
making the move to a vegan diet, needs to take the necessary
steps to ensure their overall health is maintained. It is up to the
individual to ensure that their diet has the adequate amount of
fruits, vegetable and whole grains to meet the required balanced
nutritional level; one can accomplish this by consulting a
registered dietician and their primary care physician.
A vegan diet is a healthy choice for anyone, they do not

12. pose any health concerns. Vegan diets are gaining much
popularity and is also being recommended by physicians.
Veganism is already a way of life for many individuals, who
have gained added benefits in switching to it and do not seem to
have any regrets in doing it. The majority of people who have
converted to veganism are very happy, satisfied and all note its
positive changes in their lives (Berger, 2018). A vegan diet is a
great alternative for those that want to give up meat and if done
properly, can incorporate all the needed nutrients to live a
healthy and balance life.

13. References
Berger, M., (2018). Vegetarian Diets May Be Even Better for
Us Than We Thought. Health line.
Retrieved from https://www.healthline.com/health-
news/vegetarian-diets-may-be-better
-than-we-thought#2
Key Elements of a Heart Healthy Diet. (2016). Women’s Health
Advisor, 20(7), 1-7. Retrieved
from https://search-ebscohost-
com.chamberlainuniversity.idm.oclc.org/login.aspx?
direct=true&db=her&AN=11623037&site=eds=live&scope=site
Lockhart, E., (2017). Pros of Switching to A Vegan Diet. Active
Beat - Diet & Nutrition.
Retrieved from https://www.activebeat.com/diet-
nutrition/7-pros-and- cons-of-
switching-to-a-vegetarian-diet/
Nordqvist, C. (2017). "What to know about eating
vegan." Medical News Today. Retrieved from

14. https://www.medicalnewstoday.com/articles/149636.php.
Veganism: A risk to heart health? (2011). Active Living, 20(4),
16. Retrieved from
https://search-ebscohost-
com.chamberlainuniverity.idm.oclc.org/login.aspx?direct=true
&db=s3hAN=65173661&site=eds-live&scope=site
ENGL147N-60265 Discussions Week 7 Discussion: Revision
Plan!

15. "
This is a graded discussion:
25 points possible
due Aug 26 at 1:59am
Week 7 Discussion: Revision
Plan
1 1
Search entries or author
# Reply
Required Resources
Read/review the following resources for this activity:
Textbook: pp. 104-115, 303-305
Lesson
Minimum of 1 scholarly source

16. Apply the following writing resources to your posts:
Link (multimedia presentation): Citing References
in Text
Link (website): APA Citation and Writing
Initial Post Instructions
Part 1: Research & Review
Read and review our required reading and lesson on
revision, editing, and proofing, as well as your returned
rubric and feedback from your instructor.
Part 2: Application
Prior to beginning work on this reflection, refer to the
feedback you have been given by your instructor and
peers over the past weeks plus any additional
experiences you have with the writing process covered
in the course. Reflection is an important part of the
writing process. Examine how the writing process has
been going for you with your essay up to this point.
Then, explain the results of your paper review with your
peers.

17. 1. Detail the 3 most significant issues found in your
draft feedback, placing them in the order of
importance (the basis for a revision plan of
action). As you write, be specific in which areas
you are referring to, such as the introduction,
claim, counterargument, etc., and how it relates
to your experience with the writing process.
2. Research ways to correct the problem, in our
textbook and lesson, library writing references, or
external sources. Provide an example of at least
one corrected based on these resources.
Cite your sources in APA format.
Follow-Up Post Instructions
Respond to at least two peers or one peer and the
instructor. Compare your peers' results to your own and
share resources for improvement. Did your instructor
find similar issues? Which revision and editing
approaches work best for you?
Note: If you see that someone has already received
feedback from two peers, please choose to help a peer
who has yet to obtain feedback.

18. Writing Requirements
Minimum of 3 posts (1 initial & 2 follow-up)
APA format for in-text citations and list of
references
Grading
This activity will be graded using the Discussion
Grading Rubric. Please review the following link:
Link (webpage): Discussion Guidelines
Course Outcomes (CO): 7
Due Date for Initial Post: By 11:59 p.m. MT on
Wednesday
Due Date for Follow-Up Posts: By 11:59 p.m. MT on
Sunday
Unread
$ %
&

19. Subscribe
THERESA GERGELA
(Instructor)
Jun 9, 2019
Edited by THERESA GERGELA on Jun 9 at 8:02pm
# Reply '
"
Welcome to Week 7!
Well, here we are: approaching the final stages of
our pro-con position papers. Revision is a
process that is so important in improving writing,
but is unfortunately often overlooked or
insufficiently applied. Prioritizing text elements of
focus, development, and organization helps to
achieve maximum benefits of revision. Items to
consider include: targeting chosen readers,
ensuring all claims/statements have sufficient
support, engaging the reader with introduction,
and providing paragraphs with a sense of closure.

20. In other words, revision is not mere editing or
proofreading.
Simple strategies, such as employing another
“pair of eyes,” reading the paper aloud to check
for convention errors, setting aside the paper for a
short time before revisiting it, and being willing to
discard parts of what you've done already can all
be helpful. Often it’s easier to critique others’
writing than our own! And, for example, perhaps
it isn’t necessary to reorganize the entire paper;
maybe rewriting the entire introduction, however,
would elevate the essay.
Reviewing the Copy Editing links in the lesson
will, I hope, prove useful. Just improving verb
choice can make a major impact, as can reducing
repetition and/or wordiness. Please think about
these possibilities when composing your initial
discussion post (due by Wednesday), and try and
offer new insight (not previously posted by a peer)
in your two responses (due before or by Sunday).
Peer review can be quite beneficial, both giving
and receiving, as Witte states: "Writers need an
audience. The nature of writing demands it. Often

21. times for students, the teacher is the audience
and the grade is the purpose. This design lacks a
sense of classroom community, where the
audience for student work is embraced, mentored,
and shared." So, I look forward to your posts, as
well as your final essays!
Remember the discussion opens for credit
beginning Monday, July 8. Also please remember
to cite an outside source in initial post.
Theresa
Witte, S. (2013). Preaching what we practice: A
study of revision. Journal of Curriculum &
Instruction, 6(2), 33–59. Retrieved from
https://chamberlainuniversity.idm.oclc.org/login?
url=https://search.ebscohost.com/login.aspx?
direct=true&db=ehh&AN=91248004&site=eds-
live&scope=site
(Previous Next)
July 2019

22. Home
Syllabus
Announcements
Resources
Modules
Files
Grades
People
VoiceThread
Bookstore
Library Guides
Media Gallery

23. My Media
New Webex
Academic Sup-
port
Surveys
Account
Dashboard
Courses
Groups
Calendar
Inbox
Help
8/18/19, 7(00 PM

24. Page 1 of 1