Administrative Code

Virginia Administrative Code
7/22/2024

Part III. Practice of Licensed 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.

18VAC90-30-121. Practice of  advanced practice registered nurses licensed as certified registered nurse anesthetists.

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

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  advanced practice registered nurses licensed as certified nurse midwives.

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

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

A. An advanced practice registered nurse, 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. Advanced practice registered nurses 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. An advanced practice registered nurse 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. An advanced practice registered nurse 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 advanced practice registered nurse shall ensure that persons the advanced practice registered nurse supervises also receive ongoing training to maintain competency.

E. An advanced practice registered nurse may delegate laser hair removal to a properly trained person under the advanced practice registered nurse's direction and supervision. Direction and supervision shall mean that the advanced practice registered nurse is readily available at the time laser hair removal is being performed. The supervising advanced practice registered nurse 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; amended, Virginia Register Volume 40, Issue 4, eff. November 8, 2023.

18VAC90-30-125. Practice of nurse practitioners licensed as clinical  advanced practice registered nurses.

A. Advanced practice registered nurses licensed in the category of clinical nurse specialist shall practice in consultation with a licensed physician in accordance with a practice agreement between the advanced practice registered nurse 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 an advanced practice registered nurse 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; amended, Virginia Register Volume 40, Issue 4, eff. November 8, 2023.

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 an advanced practice registered nurse shall be prohibited if the license as an advanced practice registered nurse 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; Volume 40, Issue 4, eff. November 8, 2023.

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.

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