Administrative Code

Virginia Administrative Code
7/22/2024

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  advanced practice registered nurses.

A. The boards shall license advanced practice registered nurses 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 advanced practice registered nurses 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. Advanced practice registered nurses 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; Volume 40, Issue 4, eff. November 8, 2023.

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

A. An applicant for initial licensure as an advanced practice registered nurse 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 advanced practice registered nurse specialty from an educational program designed to prepare advanced practice registered nurses 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 the applicant receives notice that the applicant 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; Volume 38, Issue 11, eff. April 1, 2022; Volume 40, Issue 4, eff. November 8, 2023.

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

A. An applicant for licensure by endorsement as an advanced practice registered nurse shall:

1. Provide verification of licensure as a nurse practitioner or advanced practice registered 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; Volume 40, Issue 4, eff. November 8, 2023.

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

A. An advanced practice registered nurse 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 an advanced practice registered nurse 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 advanced practice registered nurse and the advanced practice registered nurse'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 advanced practice registered nurse 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 advanced practice registered nurse was certified and licensed; and

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

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

D. If an advanced practice registered nurse 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 advanced practice registered nurse from obtaining an attestation as specified in subsection B of this section, the advanced practice registered nurse may submit other evidence of meeting the qualifications for autonomous practice along with an attestation signed by the advanced practice registered nurse. 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 an advanced practice registered nurse in the category for which the advanced practice registered nurse is licensed and certified. The burden shall be on the advanced practice registered nurse to provide sufficient evidence to support the advanced practice registered nurse's inability to obtain an attestation from a patient care team physician.

F. An advanced practice registered nurse 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 advanced practice registered nurse 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 advanced practice registered nurse was previously licensed.

G. An advanced practice registered nurse authorized to practice autonomously shall:

1. Only practice within the scope of the advanced practice registered nurse's clinical and professional training and limits of the advanced practice registered nurse'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; Volume 40, Issue 4, eff. November 8, 2023.

18VAC90-30-87. Autonomous practice for  advanced practice registered nurses 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 an advanced practice registered nurse 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 an advanced practice registered nurse 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 advanced practice registered nurse. 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 advanced practice registered nurse 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 an advanced practice registered nurse 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; Volume 40, Issue 4, eff. November 8, 2023.

18VAC90-30-105. Continuing competency requirements.

A. In order to renew a license biennially, an advanced practice registered nurse 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, except for those renewing their licenses in accordance with subsection B of this section.

B. In order to renew a license biennially, advanced practice registered nurses licensed prior to May 8, 2002, or clinical nurse specialists who were registered by the Board of Nursing with a retired certification, 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 advanced practice registered nurse 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 advanced practice registered nurses 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 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; Volume 38, Issue 11, eff. April 1, 2022; Volume 40, Issue 4, eff. November 8, 2023.

18VAC90-30-110. Reinstatement of license.

A. A licensed advanced practice registered nurse 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 advanced practice registered nurse 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; Volume 40, Issue 4, eff. November 8, 2023.

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