Administrative Code

Virginia Administrative Code
1/25/2022

Chapter 30. Regulations Governing the Licensure of Nurse Practitioners

Part I
General Provisions

18VAC90-30-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Approved program" means a nurse practitioner education program that is accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs/Schools, American College of Nurse Midwives, Commission on Collegiate Nursing Education, or the National League for Nursing Accrediting Commission or is offered by a school of nursing or jointly offered by a school of medicine and a school of nursing that grant a graduate degree in nursing and that hold a national accreditation acceptable to the boards.

"Autonomous practice" means practice in a category in which a nurse practitioner is certified and licensed without a written or electronic practice agreement with a patient care team physician in accordance with 18VAC90-30-86.

"Boards" means the Virginia Board of Nursing and the Virginia Board of Medicine.

"Certified nurse midwife" means an advanced practice registered nurse who is certified in the specialty of nurse midwifery and who is jointly licensed by the Boards of Medicine and Nursing as a nurse practitioner pursuant to § 54.1-2957 of the Code of Virginia.

"Certified registered nurse anesthetist" means an advanced practice registered nurse who is certified in the specialty of nurse anesthesia, who is jointly licensed by the Boards of Medicine and Nursing as a nurse practitioner pursuant to § 54.1-2957 of the Code of Virginia, and who practices under the supervision of a doctor of medicine, osteopathy, podiatry, or dentistry but is not subject to the practice agreement requirement described in § 54.1-2957.

"Clinical nurse specialist" means an advanced practice registered nurse who is certified in the specialty of clinical nurse specialist and who is jointly licensed by the Boards of Medicine and Nursing as a nurse practitioner pursuant to § 54.1-2957 of the Code of Virginia.

"Collaboration" means the communication and decision-making process among members of a patient care team related to the treatment and care of a patient and includes (i) communication of data and information about the treatment and care of a patient, including exchange of clinical observations and assessments, and (ii) development of an appropriate plan of care, including decisions regarding the health care provided, accessing and assessment of appropriate additional resources or expertise, and arrangement of appropriate referrals, testing, or studies.

"Committee" means the Committee of the Joint Boards of Nursing and Medicine.

"Consultation" means the communicating of data and information, exchanging of clinical observations and assessments, accessing and assessing of additional resources and expertise, problem solving, and arranging for referrals, testing, or studies.

"Licensed nurse practitioner" means an advanced practice registered nurse who has met the requirements for licensure as stated in Part II (18VAC90-30-60 et seq.) of this chapter.

"National certifying body" means a national organization that is accredited by an accrediting agency recognized by the U.S. Department of Education or deemed acceptable by the National Council of State Boards of Nursing and has as one of its purposes the certification of nurse anesthetists, nurse midwives, or nurse practitioners, referred to in this chapter as professional certification, and whose certification of such persons by examination is accepted by the committee.

"Patient care team physician" means a person who holds an active, unrestricted license issued by the Virginia Board of Medicine to practice medicine or osteopathic medicine.

"Practice agreement" means a written or electronic statement, jointly developed by the collaborating patient care team physician and the licensed nurse practitioner that describes the procedures to be followed and the acts appropriate to the specialty practice area to be performed by the licensed nurse practitioner in the care and management of patients. The practice agreement also describes the prescriptive authority of the nurse practitioner, if applicable. For a nurse practitioner licensed in the category of certified nurse midwife, the practice agreement is a statement jointly developed with the consulting physician or a certified nurse midwife with at least two years of clinical experience. For a nurse practitioner licensed in the category of clinical nurse specialist, the practice agreement shall be between the nurse practitioner and a consulting physician.

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 § 1.1, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 15, Issue 7, eff. January 20, 1999; Volume 19, Issue 19, eff. July 2, 2003; Volume 21, Issue 11, eff. March 9, 2005; 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.

18VAC90-30-20. Delegation of authority.

A. The boards hereby delegate to the executive director of the Virginia Board of Nursing the authority to issue the initial licensure and the biennial renewal of such licensure to those persons who meet the requirements set forth in this chapter, to grant authorization for autonomous practice to those persons who have met the qualifications of 18VAC90-30-86, and to grant extensions or exemptions for compliance with continuing competency requirements as set forth in subsection E of 18VAC90-30-105. Questions of eligibility shall be referred to the Committee of the Joint Boards of Nursing and Medicine.

B. All records and files related to the licensure of nurse practitioners shall be maintained in the office of the Virginia Board of Nursing.

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 § 1.2, eff. June 22, 1989; amended, Virginia Register Volume 18, Issue 15, eff. May 8, 2002; Volume 25, Issue 5, eff. December 25, 2008; Volume 36, Issue 22, eff. July 22, 2020.

18VAC90-30-30. Committee of the Joint Boards of Nursing and Medicine.

A. The presidents of the Boards of Nursing and Medicine respectively shall each appoint three members from their boards to the Committee of the Joint Boards of Nursing and Medicine; at least one of the appointees from the Board of Nursing shall be a licensed nurse practitioner. The purpose of this committee shall be to administer the Regulations Governing the Licensure of Nurse Practitioners, 18VAC90-30-10 et seq.

B. The committee, in its discretion, may appoint an advisory committee. Such an advisory committee shall be comprised of four licensed physicians and four licensed nurse practitioners, of whom one shall be a certified nurse midwife, one shall be a certified registered nurse anesthetist and two shall be nurse practitioners from other categories. Appointment to the advisory committee shall be for four years; members may be appointed for one additional four-year period.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR495-02-1 and VR465-07-1 § 1.3, eff. June 22, 1989; amended, Virginia Register Volume 15, Issue 7, eff. January 20, 1999; Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-30-40. (Repealed.)

Historical Notes

Derived from VR495-02-1 and VR465-07-1 § 1.4, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; repealed, Virginia Register Volume 15, Issue 7, eff. January 20, 1999.

18VAC90-30-50. Fees.

A. Fees required in connection with the licensure of nurse practitioners are:

1. Application

$125

2. Biennial licensure renewal

$80

3. Late renewal

$25

4. Reinstatement of licensure

$150

5. Verification of licensure to another jurisdiction

$35

6. Duplicate license

$15

7. Duplicate wall certificate

$25

8. Handling fee for returned check or dishonored credit card or debit card

$50

9. Reinstatement of suspended or revoked license

$200

10. Autonomous practice attestation

$100

B. For renewal of licensure from July 1, 2017, through June 30, 2019, the following fee shall be in effect:

Biennial renewal

$60

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 § 1.5, eff. June 22, 1989; amended, Virginia Register Volume 17, Issue 13, eff. April 11, 2001; Volume 22, Issue 12, eff. March 22, 2006; Volume 27, Issue 20, eff. July 6, 2011; Volume 33, Issue 18, eff. May 31, 2017; Volume 36, Issue 11, eff. March 5, 2020; Volume 36, Issue 22, eff. July 22, 2020.

Part II
Licensure

18VAC90-30-60. Licensure, general.

A. No person shall perform services as a nurse practitioner in the Commonwealth of Virginia except as prescribed in this chapter and when licensed by the Boards of Nursing and Medicine.

B. The boards shall license applicants who meet the qualifications for licensure as set forth in 18VAC90-30-80 or 18VAC90-30-85.

C. The boards may issue a restricted volunteer license for practice in accordance with provisions of § 54.1-2957.001 of the Code of Virginia.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR495-02-1 and VR465-07-1 § 2.1, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 21, Issue 11, eff. March 9, 2005; Volume 32, Issue 7, eff. December 30, 2015.

18VAC90-30-70. Categories of licensed nurse practitioners.

A. The boards shall license nurse practitioners consistent with their specialty education and certification in the following categories (a two-digit suffix appears on licenses to designate category):

1. Adult/geriatric acute care nurse practitioner (01);

2. Family nurse practitioner (02);

3. Pediatric/primary care nurse practitioner (03);

4. Adult/geriatric primary care nurse practitioner (07);

5. Certified registered nurse anesthetist (08);

6. Certified nurse midwife (09);

7. Neonatal nurse practitioner (13);

8. Women's health nurse practitioner (14);

9. Psychiatric nurse/mental health practitioner (17);

10. Pediatric/acute care nurse practitioner (18); and

11. Clinical nurse specialist (19).

B. Other categories of licensed nurse practitioners shall be licensed if the Committee of the Joint Boards of Nursing and Medicine determines that the category meets the requirements of this chapter.

C. Nurse practitioners licensed prior to January 15, 2016, may:

1. Retain the specialty category in which they were initially licensed; or

2. If the specialty category has been subsequently deleted and if qualified by certification, be issued a license in a specialty category listed in subsection A of this section that is consistent with such certification.

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 § 2.2, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 15, Issue 7, eff. January 20, 1999; Volume 19, Issue 19, eff. July 2, 2003; Volume 21, Issue 11, eff. March 9, 2005; Volume 32, Issue 7, eff. January 15, 2016; Volume 38, Issue 4, eff. November 10, 2021.

18VAC90-30-80. Qualifications for initial licensure.

A. An applicant for initial licensure as a nurse practitioner shall:

1. Hold a current, active license as a registered nurse in Virginia or hold a current multistate licensure privilege as a registered nurse;

2. Submit evidence of a graduate degree in nursing or in the appropriate nurse practitioner specialty from an educational program designed to prepare nurse practitioners that is an approved program as defined in 18VAC90-30-10. Evidence shall include a transcript that shows that the applicant has successfully completed core coursework that prepares the applicant for licensure in the appropriate specialty;

3. Submit evidence of professional certification that is consistent with the specialty area of the applicant's educational preparation issued by an agency accepted by the boards as identified in 18VAC90-30-90;

4. File the required application; and

5. Pay the application fee prescribed in 18VAC90-30-50.

B. Provisional licensure may be granted to an applicant who satisfies all requirements of this section with the exception of subdivision A 3 of this section, provided the board has received evidence of the applicant's eligibility to sit for the certifying examination directly from the national certifying body. An applicant may practice with a provisional license for either six months from the date of issuance or until issuance of a permanent license or until he receives notice that he has failed the certifying examination, whichever occurs first.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR495-02-1 and VR465-07-1 § 2.3, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 15, Issue 7, eff. January 20, 1999; Volume 21, Issue 11, eff. March 9, 2005; Volume 21, Issue 21, eff. July 27, 2005; Volume 22, Issue 26, eff. November 18, 2006; Errata, 24:18 May 12, 2008; amended, Virginia Register Volume 24, Issue 24, eff. September 3, 2008; Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-30-85. Qualifications for licensure by endorsement.

A. An applicant for licensure by endorsement as a nurse practitioner shall:

1. Provide verification of licensure as a nurse practitioner or advanced practice nurse in another United States jurisdiction with a license in good standing, or, if lapsed, eligible for reinstatement;

2. Submit evidence of professional certification that is consistent with the specialty area of the applicant's educational preparation issued by an agency accepted by the boards as identified in 18VAC90-30-90; and

3. Submit the required application and fee as prescribed in 18VAC90-30-50.

B. An applicant shall provide evidence that includes a transcript that shows successful completion of core coursework that prepares the applicant for licensure in the appropriate specialty.

C. An applicant for licensure by endorsement who is also seeking authorization for autonomous practice shall comply with subsection F of 18VAC90-30-86.

Statutory Authority

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

Historical Notes

Derived from Virginia Register Volume 21, Issue 11, eff. March 9, 2005; amended, Virginia Register Volume 25, Issue 5, eff. December 25, 2008; Volume 36, Issue 22, eff. July 22, 2020.

18VAC90-30-86. Autonomous practice for nurse practitioners other than nurse midwives, certified registered nurse anesthetists, or clinical nurse specialists.

A. A nurse practitioner with a current, unrestricted license, other than someone licensed in the category of certified nurse midwife, certified registered nurse anesthetist, or clinical nurse specialist, may qualify for autonomous practice by completion of the equivalent of two years of full-time clinical experience as a nurse practitioner until July 1, 2022. Thereafter, the requirement shall be the equivalent of five years of full-time clinical experience to qualify for autonomous practice.

1. Full-time clinical experience shall be defined as 1,800 hours per year.

2. Clinical experience shall be defined as the postgraduate delivery of health care directly to patients pursuant to a practice agreement with a patient care team physician.

B. Qualification for authorization for autonomous practice shall be determined upon submission of a fee as specified in 18VAC90-30-50 and an attestation acceptable to the boards. The attestation shall be signed by the nurse practitioner and the nurse practitioner's patient care team physician stating that:

1. The patient care team physician served as a patient care team physician on a patient care team with the nurse practitioner pursuant to a practice agreement meeting the requirements of this chapter and §§ 54.1-2957 and 54.1-2957.01 of the Code of Virginia;

2. While a party to such practice agreement, the patient care team physician routinely practiced with a patient population and in a practice area included within the category, as specified in 18VAC90-30-70, for which the nurse practitioner was certified and licensed; and

3. The period of time and hours of practice during which the patient care team physician practiced with the nurse practitioner under such a practice agreement.

C. The nurse practitioner may submit attestations from more than one patient care team physician with whom the nurse practitioner practiced during the equivalent of five years of practice, but all attestations shall be submitted to the boards at the same time.

D. If a nurse practitioner is licensed and certified in more than one category as specified in 18VAC90-30-70, a separate fee and attestation that meets the requirements of subsection B of this section shall be submitted for each category. If the hours of practice are applicable to the patient population and in practice areas included within each of the categories of licensure and certification, those hours may be counted toward a second attestation.

E. In the event a patient care team physician has died, become disabled, retired, or relocated to another state, or in the event of any other circumstance that inhibits the ability of the nurse practitioner from obtaining an attestation as specified in subsection B of this section, the nurse practitioner may submit other evidence of meeting the qualifications for autonomous practice along with an attestation signed by the nurse practitioner. Other evidence may include employment records, military service, Medicare or Medicaid reimbursement records, or other similar records that verify full-time clinical practice in the role of a nurse practitioner in the category for which the nurse practitioner is licensed and certified. The burden shall be on the nurse practitioner to provide sufficient evidence to support the nurse practitioner's inability to obtain an attestation from a patient care team physician.

F. A nurse practitioner to whom a license is issued by endorsement may engage in autonomous practice if such application includes an attestation acceptable to the boards that the nurse practitioner has completed the equivalent of five years of full-time clinical experience as specified in subsection A of this section and in accordance with the laws of the state in which the nurse practitioner was previously licensed.

G. A nurse practitioner authorized to practice autonomously shall:

1. Only practice within the scope of the nurse practitioner's clinical and professional training and limits of the nurse practitioner's knowledge and experience and consistent with the applicable standards of care;

2. Consult and collaborate with other health care providers based on the clinical conditions of the patient to whom health care is provided; and

3. Establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers.

Statutory Authority

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

Historical Notes

Derived from Virginia Register Volume 36, Issue 22, eff. July 22, 2020; amended, Virginia Register Volume 38, Issue 4, eff. November 10, 2021; Volume 38, Issue 4, eff. November 10, 2021.

18VAC90-30-87. Autonomous practice for nurse practitioners licensed as certified nurse midwives.

A. A certified nurse midwife who has completed 1,000 hours of practice as a certified nurse midwife may practice without a practice agreement upon receipt by the certified nurse midwife of an attestation from a certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician with whom the certified nurse midwife has entered into a practice agreement stating (i) that such certified nurse midwife or licensed physician has provided consultation to the certified nurse midwife pursuant to a practice agreement meeting the requirements of § 54.1-2957 H of the Code of Virginia, and (ii) the period of time for which such certified nurse midwife or licensed physician practiced in collaboration and consultation with the certified nurse midwife pursuant to the practice agreement.

B. A certified nurse midwife authorized to practice without a practice agreement shall consult and collaborate with and refer patients to such other health care providers as may be appropriate for the care of the patient.

Statutory Authority

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

Historical Notes

Derived from Virginia Register Volume 38, Issue 4, eff. November 10, 2021.

18VAC90-30-90. Certifying agencies.

A. The boards shall accept the professional certification by examination of the following:

1. American Midwifery Certification Board;

2. American Nurses Credentialing Center;

3. National Board of Certification and Recertification for Nurse Anesthetists;

4. Pediatric Nursing Certification Board;

5. National Certification Corporation;

6. American Academy of Nurse Practitioners; and

7. American Association of Critical-Care Nurses Certification Corporation.

B. The boards may accept professional certification from other certifying agencies on recommendation of the Committee of the Joint Boards of Nursing and Medicine provided the agency meets the definition of a national certifying body set forth in 18VAC90-30-10 and that the professional certification is awarded on the basis of:

1. Completion of an approved program as defined in 18VAC90-30-10; and

2. Achievement of a passing score on an examination.

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 § 2.4, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 15, Issue 7, eff. January 20, 1999; Volume 19, Issue 19, eff. July 2, 2003; Volume 21, Issue 11, eff. March 9, 2005; Volume 31, Issue 20, eff. July 16, 2015; Volume 31, Issue 21, eff. July 15, 2015.

18VAC90-30-100. Renewal of licensure.

A. Licensure of a nurse practitioner shall be renewed:

1. Biennially at the same time the license to practice as a registered nurse in Virginia is renewed; or

2. If licensed as a nurse practitioner with a multistate licensure privilege to practice in Virginia as a registered nurse, a licensee born in even-numbered years shall renew his license by the last day of the birth month in even-numbered years and a licensee born in odd-numbered years shall renew his license by the last day of the birth month in odd-numbered years.

B. The renewal notice of the license shall be sent to the last known address of record of each nurse practitioner. Failure to receive the renewal notice shall not relieve the licensee of the responsibility for renewing the license by the expiration date.

C. The licensed nurse practitioner shall attest to compliance with continuing competency requirements of current professional certification or continuing education as prescribed in 18VAC90-30-105 and the license renewal fee prescribed in 18VAC90-30-50.

D. The license shall automatically lapse if the licensee fails to renew by the expiration date. Any person practicing as a nurse practitioner during the time a license has lapsed shall be subject to disciplinary actions by the boards.

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 § 2.5, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 18, Issue 15, eff. May 8, 2002; Volume 21, Issue 21, eff. July 27, 2005; Volume 25, Issue 5, eff. December 25, 2008; Volume 25, Issue 17, eff. July 1, 2009; Volume 31, Issue 21, eff. July 15, 2015.

18VAC90-30-105. Continuing competency requirements.

A. In order to renew a license biennially, a nurse practitioner initially licensed on or after May 8, 2002, shall hold current professional certification in the area of specialty practice from one of the certifying agencies designated in 18VAC90-30-90.

B. In order to renew a license biennially, nurse practitioners licensed prior to May 8, 2002, shall meet one of the following requirements:

1. Hold current professional certification in the area of specialty practice from one of the certifying agencies designated in 18VAC90-30-90; or

2. Complete at least 40 hours of continuing education in the area of specialty practice approved by one of the certifying agencies designated in 18VAC90-30-90 or approved by Accreditation Council for Continuing Medical Education (ACCME) of the American Medical Association as a Category I Continuing Medical Education (CME) course.

C. The nurse practitioner shall retain evidence of compliance and all supporting documentation for a period of four years following the renewal period for which the records apply.

D. The boards shall periodically conduct a random audit of their licensees to determine compliance. The nurse practitioners selected for the audit shall provide the evidence of compliance and supporting documentation within 30 days of receiving notification of the audit.

E. The boards may delegate the authority to grant an extension or exemption for all or part of the requirements for circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters.

Statutory Authority

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

Historical Notes

Derived from Virginia Register Volume 18, Issue 15, eff. May 8, 2002; amended, Virginia Register Volume 25, Issue 5, eff. December 25, 2008; Volume 31, Issue 21, eff. July 15, 2015.

18VAC90-30-110. Reinstatement of license.

A. A licensed nurse practitioner whose license has lapsed may be reinstated within one renewal period by payment of the current renewal fee and the late renewal fee.

B. An applicant for reinstatement of license lapsed for more than one renewal period shall:

1. File the required application and reinstatement fee;

2. Be currently licensed as a registered nurse in Virginia or hold a current multistate licensure privilege as a registered nurse; and

3. Provide evidence of current professional competency consisting of:

a. Current professional certification by the appropriate certifying agency identified in 18VAC90-30-90;

b. Continuing education hours taken during the period in which the license was lapsed, equal to the number required for licensure renewal during that period, not to exceed 120 hours; or

c. If applicable, current, unrestricted licensure or certification in another jurisdiction.

4. If qualified for autonomous practice, provide the required fee and attestation in accordance with 18VAC90-30-86.

C. An applicant for reinstatement of license following suspension or revocation shall:

1. Petition for reinstatement and pay the reinstatement fee;

2. Present evidence that he is currently licensed as a registered nurse in Virginia or hold a current multistate licensure privilege as a registered nurse; and

3. Present evidence that he is competent to resume practice as a licensed nurse practitioner in Virginia to include:

a. Current professional certification by the appropriate certifying agency identified in 18VAC90-30-90; or

b. Continuing education hours taken during the period in which the license was suspended or revoked, equal to the number required for licensure renewal during that period, not to exceed 120 hours.

The committee shall act on the petition pursuant to the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia).

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 § 2.6, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 17, Issue 13, eff. April 11, 2001; Volume 21, Issue 21, eff. July 27, 2005; Volume 25, Issue 5, eff. December 25, 2008; Volume 36, Issue 22, eff. July 22, 2020.

Part III
Practice of Licensed Nurse Practitioners

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

A. A nurse practitioner 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 nurse practitioners 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 nurse practitioner's authority for signatures, certifications, stamps, verifications, affidavits, and endorsements provided it is:

a. In accordance with the specialty license of the nurse practitioner 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 nurse practitioner and provided to the boards upon request. For nurse practitioners 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 nurse practitioner 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.

18VAC90-30-121. Practice of nurse practitioners licensed as certified registered nurse anesthetists.

A. A nurse practitioner licensed in a category of certified registered nurse anesthetist shall be authorized to render care under the supervision of a licensed doctor of medicine, osteopathy, podiatry, or dentistry.

B. The practice of a certified registered nurse anesthetist shall be based on specialty education preparation as an advanced practice registered nurse in accordance with standards of the applicable certifying organization and with the functions and standards defined by the American Association of Nurse Anesthetists (Standards for Nurse Anesthesia Practice, Revised 2013).

Statutory Authority

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

Historical Notes

Derived from Virginia Register Volume 24, Issue 10, eff. February 20, 2008; amended, Virginia Register Volume 25, Issue 5, eff. December 25, 2008; Volume 31, Issue 21, eff. July 15, 2015.

18VAC90-30-122. (Repealed.)

Historical Notes

Derived from Virginia Register Volume 31, Issue 21, eff. July 15, 2015; repealed, Virginia Register Volume 33, Issue 1, eff. October 5, 2016.

18VAC90-30-123. Practice of nurse practitioners licensed as certified nurse midwives.

A. A nurse practitioner licensed in the category of certified nurse midwife who has practiced fewer than 1,000 hours shall practice in consultation with a licensed physician in accordance with a practice agreement between the nurse practitioner and the physician or with a certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement. Such practice agreement shall address the availability of the physician or the certified nurse midwife for routine and urgent consultation on patient care.

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

C. A nurse practitioner licensed in the category of a certified nurse midwife shall practice in accordance with the Standards for the Practice of Midwifery (Revised 2011) defined by the American College of Nurse-Midwives.

Statutory Authority

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

Historical Notes

Derived from Virginia Register Volume 33, Issue 1, eff. October 5, 2016; amended, Virginia Register Volume 38, Issue 4, eff. November 10, 2021.

18VAC90-30-124. Direction and supervision of laser hair removal.

A. A nurse practitioner, as authorized pursuant to § 54.1-2957 of the Code of Virginia, may perform or supervise the performance of laser hair removal upon completion of training in the following:

1. Skin physiology and histology;

2. Skin type and appropriate patient selection;

3. Laser safety;

4. Operation of laser device to be used;

5. Recognition of potential complications and response to any actual complication resulting from a laser hair removal treatment; and

6. A minimum number of 10 proctored patient cases with demonstrated competency in treating various skin types.

B. Nurse practitioners who have been performing laser hair removal prior to August 7, 2019, are not required to complete the training specified in subsection A of this section.

C. A nurse practitioner who delegates the practice of laser hair removal and provides supervision for such practice shall ensure the supervised person has completed the training required in subsection A of this section.

D. A nurse practitioner who performs laser hair removal or who supervises others in the practice shall receive ongoing training as necessary to maintain competency in new techniques and laser devices. The nurse practitioner shall ensure that persons the nurse practitioner supervises also receive ongoing training to maintain competency.

E. A nurse practitioner may delegate laser hair removal to a properly trained person under the nurse practitioner's direction and supervision. Direction and supervision shall mean that the nurse practitioner is readily available at the time laser hair removal is being performed. The supervising nurse practitioner is not required to be physically present but is required to see and evaluate a patient for whom the treatment has resulted in complications prior to the continuance of laser hair removal treatment.

F. Prescribing of medication shall be in accordance with § 54.1-3303 of the Code of Virginia.

Statutory Authority

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

Historical Notes

Derived from Virginia Register Volume 35, Issue 23, eff. August 7, 2019.

18VAC90-30-125. Practice of nurse practitioners licensed as clinical nurse specialists.

A. Nurse practitioners licensed in the category of clinical nurse specialist shall practice in consultation with a licensed physician in accordance with a practice agreement between the nurse practitioner and the licensed physician.

B. Such practice agreement shall address the availability of the physician for routine and urgent consultation on patient care. Evidence of a practice agreement shall be maintained by a nurse practitioner and provided to the boards upon request.

C. The practice of clinical nurse specialists shall be consistent with the standards of care for the profession and with applicable laws and regulations.

Statutory Authority

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

Historical Notes

Derived from Virginia Register Volume 38, Issue 4, eff. November 10, 2021.

18VAC90-30-130. [Reserved]. (Reserved)

18VAC90-30-140. (Repealed.)

Historical Notes

Derived from VR495-02-1 and VR465-07-1 §§ 3.3 and 3.4, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; repealed, Virginia Register Volume 15, Issue 7, eff. January 20, 1999.

18VAC90-30-160. Prohibited practice.

Practice as a licensed nurse practitioner shall be prohibited if the license as a nurse practitioner or a registered nurse is lapsed, inactive, revoked or suspended.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR495-02-1 and VR465-07-1 § 3.5, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 15, Issue 7, eff. January 20, 1999; Volume 24, Issue 24, eff. September 3, 2008.

18VAC90-30-170. (Repealed.)

Historical Notes

Derived from VR495-02-1, VR495-02-1 § 4.2 to 4.5 and VR495-07-1 § 4.1, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; repealed, Virginia Register Volume 15, Issue 7, eff. January 20, 1999; repealed 18VAC90-30-170 through 18VAC90-30-210 comprised former Part IV of this chapter, and set forth criteria for approval of nurse practitioner education programs.

Part IV
Disciplinary Provisions

18VAC90-30-220. Grounds for disciplinary action against the license of a licensed nurse practitioner.

The boards may deny licensure or relicensure, revoke or suspend the license, or take other disciplinary action upon proof that the nurse practitioner:

1. Has had a license or multistate privilege to practice nursing in this Commonwealth or in another jurisdiction revoked or suspended or otherwise disciplined;

2. Has directly or indirectly represented to the public that the nurse practitioner is a physician, or is able to, or will practice independently of a physician;

3. Has exceeded the authority as a licensed nurse practitioner;

4. Has violated or cooperated in the violation of the laws or regulations governing the practice of medicine, nursing or nurse practitioners;

5. Has become unable to practice with reasonable skill and safety to patients as the result of a physical or mental illness or the excessive use of alcohol, drugs, narcotics, chemicals or any other type of material;

6. Has violated or cooperated with others in violating or attempting to violate any law or regulation, state or federal, relating to the possession, use, dispensing, administration or distribution of drugs;

7. Has failed to comply with continuing competency requirements as set forth in 18VAC90-30-105;

8. Has willfully or negligently breached the confidentiality between a practitioner and a patient. A breach of confidentiality that is required or permitted by applicable law or beyond the control of the practitioner shall not be considered negligent or willful; or

9. Has engaged in unauthorized use or disclosure of confidential information received from the Prescription Monitoring Program, the electronic system within the Department of Health Professions that monitors the dispensing of certain controlled substances.

Statutory Authority

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

Historical Notes

Derived from VR495-02-1 § 5.1, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 18, Issue 15, eff. May 8, 2002; Volume 25, Issue 5, eff. December 25, 2008; Volume 35, Issue 21, eff. July 10, 2019.

18VAC90-30-230. Administrative proceedings.

A. The provisions of the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia) shall govern proceedings on questions of violation of 18VAC90-30-220.

B. Except as provided in 18VAC90-30-240, the Committee of the Joint Boards of Nursing and Medicine shall conduct all proceedings prescribed herein and shall take action on behalf of the boards.

C. When a person's license to practice nursing has been suspended or revoked by the Board of Nursing, the nurse practitioner license shall be suspended pending a hearing simultaneously with the institution of proceedings for a hearing.

D. Sanctions or other terms and conditions imposed by consent orders entered by the Board of Nursing on the license to practice nursing may apply to the nurse practitioner license, provided the consent order has been accepted by the Committee of the Joint Boards of Nursing and Medicine.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR495-02-1 § 5.2, eff. June 22, 1989; amended, Virginia Register Volume 12, Issue 1, eff. November 1, 1995; Volume 23, Issue 12, eff. March 21, 2007; Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-30-240. Delegation of proceedings.

A. Decision to delegate. In accordance with § 54.1-2400 (10) of the Code of Virginia, the Committee of the Joint Boards of Nursing and Medicine (committee) may delegate an informal fact-finding proceeding to an agency subordinate upon determination that probable cause exists that a nurse practitioner may be subject to a disciplinary action.

B. Criteria for delegation. Cases that involve intentional or negligent conduct that caused serious injury or harm to a patient may not be delegated to an agency subordinate, except as may be approved by the chair of the committee.

C. Criteria for an agency subordinate.

1. An agency subordinate authorized by the committee to conduct an informal fact-finding proceeding may include current or past board members and professional staff or other persons deemed knowledgeable by virtue of their training and experience in administrative proceedings involving the regulation and discipline of health professionals.

2. The Executive Director of the Board of Nursing shall maintain a list of appropriately qualified persons to whom an informal fact-finding proceeding may be delegated.

3. The committee may delegate to the executive director the selection of the agency subordinate who is deemed appropriately qualified to conduct a proceeding based on the qualifications of the subordinate and the type of case being heard.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 24, Issue 3, eff. November 29, 2007.

FORMS (18VAC90-30).

Application for Licensure as a Nurse Practitioner, available online at https://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/Forms/

Checklist Instructions: Application for Licensure - Nurse Practitioner (LNP) (rev. 7/2020)

Instructions: Application – Attestation/Authorization for Autonomous Practice – Licensed Nurse Practitioner (LNP) (rev. 1/2019)

Checklist Instructions Reinstatement Application (rev. 8/2018)

Checklist Instructions for Reinstatement Application Following Suspension or Revocation (rev. 8/2018)

Checklist Instructions Application for Restricted Volunteer License (rev. 8/2018)

Forms (18VAC90-30-9999)

Standards for Nurse Anesthesia Practice, revised 2013, American Association of Nurse Anesthetists

Standards for the Practice of Midwifery, revised 2011, American College of Nurse-Midwives

Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.

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