Administrative Code

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Virginia Administrative Code
Title 18. Professional And Occupational Licensing
Agency 90. Board of Nursing
Chapter 30. Regulations Governing the Licensure of Advanced Practice Registered Nurses

18VAC90-30-120. Practice of licensed  advanced practice registered nurses other than certified registered nurse anesthetists, certified nurse midwives, or clinical nurse specialists.

A. An advanced practice registered nurse licensed in a category other than certified registered nurse anesthetist, certified nurse midwife, or clinical nurse specialist shall be authorized to render care in collaboration and consultation with a licensed patient care team physician as part of a patient care team or if determined by the boards to qualify in accordance with 18VAC90-30-86, authorized to practice autonomously without a practice agreement with a patient care team physician.

B. The practice shall be based on specialty education preparation as an advanced practice registered nurse in accordance with standards of the applicable certifying organization, as identified in 18VAC90-30-90.

C. All advance practice registered nurses licensed in any category other than certified registered nurse anesthetist, certified nurse midwife, or clinical nurse specialist shall practice in accordance with a written or electronic practice agreement as defined in 18VAC90-30-10 or in accordance with 18VAC90-30-86.

D. The written or electronic practice agreement shall include provisions for:

1. The periodic review of patient charts or electronic patient records by a patient care team physician and may include provisions for visits to the site where health care is delivered in the manner and at the frequency determined by the patient care team;

2. Appropriate physician input in complex clinical cases and patient emergencies and for referrals; and

3. The advanced practice registered nurse's authority for signatures, certifications, stamps, verifications, affidavits, and endorsements provided it is:

a. In accordance with the specialty license of the advanced practice registered nurse and within the scope of practice of the patient care team physician;

b. Permitted by § 54.1-2957.02 or applicable sections of the Code of Virginia; and

c. Not in conflict with federal law or regulation.

E. The practice agreement shall be maintained by the advanced practice registered nurse and provided to the boards upon request. For advanced practice registered nurses providing care to patients within a hospital or health care system, the practice agreement may be included as part of documents delineating the nurse practitioner's clinical privileges or the electronic or written delineation of duties and responsibilities; however, the advanced practice registered nurse shall be responsible for providing a copy to the boards upon request.

Statutory Authority

§§ 54.1-2400 and 54.1-2957 of the Code of Virginia.

Historical Notes

Derived from VR495-02-1 and VR465-07-1 §§ 3.1 and 3.2, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 15, Issue 7, eff. January 20, 1999; Volume 17, Issue 7, eff. January 17, 2001; Volume 21, Issue 21, eff. July 27, 2005; Volume 23, Issue 14, eff. April 18, 2007; Volume 24, Issue 10, eff. February 20, 2008; Volume 25, Issue 5, eff. December 25, 2008; Volume 31, Issue 21, eff. July 15, 2015; Volume 33, Issue 1, eff. October 5, 2016; Volume 36, Issue 22, eff. July 22, 2020; Volume 38, Issue 4, eff. November 10, 2021; Volume 40, Issue 4, eff. November 8, 2023.

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