I am a practicing Clinical Nurse Specialist with decades of experience delivering high-quality diabetes and endocrine care. In Virginia, my prescriptive authority depends on a collaborative agreement with a physician. My most recent physician collaborator fulfilled the required review of medical records but never questioned my clinical decision-making. This reflects my expertise and competence in providing specialty nursing care, including medication prescribing and adjustment.

A 2021 report on APRN oversight, commissioned by the Virginia General Assembly, recommended aligning state laws and regulations with the APRN Consensus Model. This would grant all APRNs in Virginia independent practice and prescriptive authority, while placing regulatory authority solely under the Virginia Board of Nursing. The report also noted that 34 jurisdictions across the United States allow Clinical Nurse Specialists to practice independently, without evidence of reduced quality of care or breaches in scope of practice. Claims by organizations such as the American Medical Association and the Medical Society of Virginia that APRNs require physician oversight are not supported by evidence. Despite this, the report’s recommendations have not been implemented.

I believe the Virginia Board of Nursing is fully equipped to regulate professional nursing practice.

In my work, I provide expert nursing care, education, and support for individuals living with diabetes. I do not seek to function as a physician. Instead, I approach patient care through a nursing lens—focusing on therapeutic communication, assessment of physical and psychological status, and consideration of socioeconomic challenges. My goal is to improve health outcomes through timely care, ongoing support, and a whole-person approach that identifies and addresses gaps in self-management.

This perspective differs from the traditional physician model, which emphasizes diagnosis, medication management, and procedural interventions. Both roles are essential but distinct.

From a workforce standpoint, there are simply not enough endocrinologists—293 as of 2026—to meet the needs of the 733,302 Virginians living with diabetes (2021 data). As the healthcare workforce ages, this gap is likely to widen.

Finally, nursing has been ranked the most trusted profession for 23 consecutive years. This trust reflects the public’s confidence in nurses’ honesty and ethical standards. Nursing should regulate nursing, and physicians should regulate physicians.