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 which grant a graduate degree in nursing and which hold a national accreditation acceptable to the boards.

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

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

"Controlling institution" means the college or university offering a nurse practitioner education program.

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

"Licensed physician" means a person licensed by the Board of Medicine to practice medicine or osteopathy osteopathic medicine.

"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.

"Preceptor" means a physician or a licensed nurse practitioner who supervises and evaluates the nurse practitioner student.

"Protocol" means a written statement, jointly developed by the collaborating physician(s) and the licensed nurse practitioner(s), that directs and describes the procedures to be followed and the delegated medical acts appropriate to the specialty practice area to be performed by the licensed nurse practitioner(s) in the care and management of patients.

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.

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 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

§54.1-103, 54.1-2400, 54.1-2912.1, and 54.1-2957.01 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.

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 and 54.1-2957 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.

18VAC90-30-80. 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 U.S. 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.

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, Volume 25, Issue 5, eff. December 25, 2008.

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 application for renewal notice of the license shall be mailed by the committee to the last known address 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 complete the application and return it with his signature attesting 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 54.1-3005 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.

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 on or after January 1, 2004, 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 at least 1.0% of its 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 grant an extension of the deadline for continuing competency requirements for up to one year for good cause shown upon a written request from the licensee prior to the renewal date.

F. E. The boards may delegate to the committee 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

§ 54.1-103, 54.1-2400, 54.1-2912.1, and 54.1-2957.01 of the Code of Virginia.

Historical Notes

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

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, if

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

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

1. Petition for a reinstatement and pay the reinstatement fee;

2. Present evidence that he is currently licensed as a Registered Nurse 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 54.1-3005 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.

Part III
Practice of Licensed Nurse Practitioners

18VAC90-30-120. Practice of licensed nurse practitioners other than certified nurse midwives.

A. A nurse practitioner licensed in a category other than certified nurse midwife shall be authorized to engage in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician.

B. The practice of licensed nurse practitioners shall be based on specialty education preparation as a nurse practitioner in accordance with standards of the applicable certifying organization and written protocols as defined in 18VAC90-30-10.

C. The licensed nurse practitioner shall maintain a copy of the written protocol and shall make it available to the boards upon request.  The written protocol shall include the nurse practitioner's authority for signatures, certifications, stamps, verifications, affidavits, referral to physical therapy, and endorsements provided it is:

1. In accordance with the specialty license of the nurse practitioner and with the scope of practice of the supervising physician;

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

3. Not in conflict with federal law or regulation.

D. A certified registered nurse anesthetist shall practice in accordance with the functions and standards defined by the American Association of Nurse Anesthetists (Scope and Standards for Nurse Anesthesia Practice, Revised 2005) and under the medical direction and supervision of a doctor of medicine or a doctor of osteopathy osteopathic medicine or the medical direction and supervision of a dentist in accordance with rules and regulations promulgated by the Board of Dentistry.

E. For purposes of this section, the following definitions shall apply:

"Collaboration" means the process by which a nurse practitioner, in association with a physician, delivers health care services within the scope of practice of the nurse practitioner's professional education and experience and with medical direction and supervision, consistent with this chapter.

"Medical direction and supervision" means participation in the development of a written protocol including provision for periodic review and revision; development of guidelines for availability and ongoing communications that provide for and define consultation among the collaborating parties and the patient; and periodic joint evaluation of services provided, e.g., chart review, and review of patient care outcomes. Guidelines for availability shall address at a minimum the availability of the collaborating physician proportionate to such factors as practice setting, acuity, and geography.

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.

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

A. A nurse practitioner licensed as a certified nurse midwife shall be authorized to engage in practices constituting the practice of medicine in collaboration and consultation with a licensed physician.

B. The practice of certified nurse midwives shall be based on specialty education preparation as a nurse practitioner and in accordance with standards of the applicable certifying organization and written protocols as defined in 18VAC90-30-10.

C. The licensed nurse practitioner shall maintain a copy of the written protocol and shall make it available to the boards upon request. The written protocol shall include the nurse practitioner's authority for signatures, certifications, stamps, verifications, affidavits, referral to physical therapy, and endorsements provided it is:

1. In accordance with the specialty license of the nurse practitioner and within the scope of practice of the supervising physician;

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

3. Not in conflict with federal law or regulation.

D. A certified nurse midwife, in collaboration and consultation with a duly licensed physician, shall practice in accordance with the Standards for the Practice of Nurse-Midwifery (Revised 2003) defined by the American College of Nurse-Midwives.

E. For purposes of this section, the following definition shall apply:

"Collaboration and consultation" means practice in accordance with the Standards for the Practice of Midwifery (Revised 2003) defined by the American College of Nurse-Midwives to include participation in the development of a written protocol including provision for periodic review and revision; development of guidelines for availability and ongoing communications that provide for and define consultation among the collaborating parties and the patient; periodic joint evaluation of services provided; and review of patient care outcomes. Guidelines for availability shall address at a minimum the availability of the collaborating physician proportionate to such factors as practice setting, acuity, and geography.

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, Volume 25, Issue 5, eff. December 25, 2008.

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 place on probation, censure or reprimand a nurse practitioner take other disciplinary action upon proof that the nurse practitioner:

1. Has had his 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 held himself out or represented himself to the public that he the nurse practitioner is a physician, or is able to, or will practice independently of a physician;

3. Has exceeded his 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; or

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

Statutory Authority

§ 54.1-103, 54.1-2400, 54.1-2912.1, and 54.1-2957.01 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.

18VAC90-30-230. Hearings 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. The 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, Issue 12, eff. March 21, 2007; Volume 25, Issue 5, eff. December 25, 2008.

Part I
General Provisions

18VAC90-40-10. Definitions.

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

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

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

"Nonprofit health care clinics or programs" means a clinic organized in whole or in part for the delivery of health care services without charge or when a reasonable minimum fee is charged only to cover administrative costs.

"Nurse practitioner" means a registered nurse who has met the additional requirements of education and examination for licensure as a nurse practitioner in the Commonwealth for licensure as a nurse practitioner as stated in 18VAC90-30.

"Practice agreement" means a written agreement jointly developed by the supervising physician and the nurse practitioner that describes and directs the prescriptive authority of the nurse practitioner.

"Supervision" means that the physician documents being readily available for medical consultation by with the licensed nurse practitioner or the patient, with the physician maintaining ultimate responsibility collaborating with the nurse practitioner for the agreed-upon course of treatment and medications prescribed.

Statutory Authority

§ 54.1-2400 and 54.1-2957.01 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 1.1, eff. August 15, 1992; amended, Virginia Register Volume 16, Issue 21, eff. August 2, 2000; Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-40-20. Authority and administration of regulations.

A. The statutory authority for this chapter is found in §§ 54.1-2957.01, 54.1-3303, 54.1-3401, and 54.1-3408 of the Code of Virginia.

B. Joint boards of nursing and medicine.

1. The Committee of the Joint Boards of Nursing and Medicine shall be appointed to administer this chapter governing prescriptive authority.

2. The boards hereby delegate to the Executive Director of the Virginia Board of Nursing the authority to issue the initial authorization and biennial renewal to those persons who meet the requirements set forth in this chapter and to grant extensions or exemptions for compliance with continuing competency requirements as set forth in subsection E of 18VAC90-40-55. Questions of eligibility shall be referred to the committee.

3. All records and files related to prescriptive authority for nurse practitioners shall be maintained in the office of the Board of Nursing.

Statutory Authority

§ 54.1-103, 54.1-2400, 54.1-2912.1, and 54.1-2957.01 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 1.2, eff. August 15, 1992; amended, Virginia Register Volume 13, Issue 20, eff. July 23, 1997; Volume 18, Issue 15, eff. May 8, 2002; Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-40-40. Qualifications for initial approval of prescriptive authority.

An applicant for prescriptive authority shall meet the following requirements:

1. Hold a current, unrestricted license as a nurse practitioner in the Commonwealth of Virginia; and

2. Provide evidence of one of the following:

a. Continued professional certification as required for initial licensure as a nurse practitioner; or

b. Satisfactory completion of a graduate level course in pharmacology or pharmacotherapeutics obtained as part of the nurse practitioner education program within the five years prior to submission of the application; or

c. Practice as a nurse practitioner for no less than 1000 hours and 15 continuing education units related to the area of practice for each of the two years immediately prior to submission of the application; or

d. Thirty contact hours of education in pharmacology or pharmacotherapeutics acceptable to the boards taken within five years prior to submission of the application. The 30 contact hours may be obtained in a formal academic setting as a discrete offering or as noncredit continuing education offerings and shall include the following course content:

(1) Applicable federal and state laws;

(2) Prescription writing;

(3) Drug selection, dosage, and route;

(4) Drug interactions;

(5) Information resources; and

(6) Clinical application of pharmacology related to specific scope of practice.

3. Submit a practice agreement between the nurse practitioner and the supervising physician as required in 18VAC90-40-90 of this chapter. The practice agreement must be approved by the boards prior to issuance of prescriptive authority; and

4. File a completed application and pay the fees as required in 18VAC90-40-70 of this chapter.

Statutory Authority

§ 54.1-2400 and 54.1-2957.01 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 2.2, eff. August 15, 1992; amended, Virginia Register Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-40-50. Renewal of prescriptive authority.

An applicant for renewal of prescriptive authority shall:

1. Renew biennially at the same time as the renewal of licensure to practice as a nurse practitioner in Virginia.

2. Submit a completed renewal application along with his signature form attesting to compliance with continuing competency requirements set forth in 18VAC90-40-55 and the renewal fee as prescribed in 18VAC90-40-70.

3. Submit a new practice agreement which meets the requirements of 18VAC90-40-90 with the renewal application if there has been a change since the last practice agreement was filed.

Statutory Authority

§ 54.1-103, 54.1-2400, 54.1-2912.1, and 54.1-2957.01 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 2.3, eff. August 15, 1992; amended, Virginia Register Volume 13, Issue 20, eff. July 23, 1997; Volume 18, Issue 15, eff. May 8, 2002; Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-40-55. Continuing competency requirements.

A. In order to renew prescriptive authority, a licensee shall meet continuing competency requirements for biennial renewal as a licensed nurse practitioner. Such requirements shall address issues such as ethical practice, an appropriate standard of care, patient safety, and appropriate communication with patients.

B. In addition to the minimal requirements for compliance with subsection B of 18VAC90-30-105, a A nurse practitioner with prescriptive authority shall obtain a total of eight hours of continuing education in pharmacology or pharmacotherapeutics for each biennium in addition to the minimal requirements for compliance with subsection B of 18VAC90-30-105.

C. The nurse practitioner with prescriptive authority 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 at least 1.0% of its 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 grant an extension of the deadline for continuing competency requirements for up to one year for good cause shown upon a written request from the licensee prior to the renewal date.

F. E. The boards may delegate to the committee the authority to grant an extension or an 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

§ 54.1-103, 54.1-2400, 54.1-2912.1, and 54.1-2957.01 of the Code of Virginia.

Historical Notes

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

18VAC90-40-60. Reinstatement of prescriptive authority.

A. A nurse practitioner whose prescriptive authority has lapsed may reinstate within one renewal period by payment of the current renewal fee and the late renewal fee.

B. A nurse practitioner who is applying for reinstatement of lapsed prescriptive authority after one renewal period shall:

1. File the required application and a new practice agreement as required for renewal in 18VAC90-40-50;

2. Provide evidence of a current, unrestricted license to practice as a nurse practitioner in Virginia;

3. Pay the fee required for reinstatement of a lapsed authorization as prescribed in 18VAC90-40-70; and

4. If the authorization has lapsed for a period of two or more years, the applicant shall provide proof of:

a. Continued practice as a licensed nurse practitioner with prescriptive authority in another state; or

b. Continuing education, in addition to the minimal requirements for current professional certification, consisting of four contact hours in pharmacology or pharmacotherapeutics for each year in which the prescriptive authority has been lapsed in the Commonwealth, not to exceed a total of 16 hours.

C. An applicant for reinstatement of suspended or revoked authorization shall:

1. Request a hearing pursuant to the provisions of the Virginia Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia) to be held before the committee Petition for reinstatement and pay the fee for reinstatement of a suspended or revoked authorization as prescribed in 18VAC90-40-70;

2. Present evidence of competence to resume practice as a nurse practitioner with prescriptive authority; and

3. Pay the fee for reinstatement of a suspended or revoked authorization as prescribed in 18VAC90-40-70; and

4. 3. Meet the qualifications and resubmit the application required for initial authorization in 18VAC90-40-40.

Statutory Authority

§ 54.1-103, 54.1-2400, 54.1-2912.1, and 54.1-2957.01 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 2.4, eff. August 15, 1992; amended, Virginia Register Volume 17, Issue 13, eff. April 11, 2001; Volume 18, Issue 15, eff. May 8, 2002; Volume 25, Issue 5, eff. December 25, 2008.

Part III
Practice Requirements

18VAC90-40-90. Practice agreement.

A. A nurse practitioner with prescriptive authority may prescribe only within the scope of a written practice agreement with a supervising physician to be submitted with the initial application for prescriptive authority.

B. A new practice agreement shall be submitted: 1. With the initial application for prescriptive authority; or 2. With the application for each biennial renewal, if At any time there have been any are changes in supervision the primary supervising physician, authorization to prescribe, or scope of practice; or 3. At any time a change in the primary supervising physician shall occur, the nurse practitioner shall submit a revised practice agreement to the board.

C. The practice agreement shall contain the following:

1. A description of the prescriptive authority of the nurse practitioner within the scope allowed by law and the practice of the nurse practitioner.

2. An authorization for categories of drugs and devices within the requirements of § 54.1-2957.01 of the Code of Virginia.

3. The signatures of the primary supervising physician and any secondary physician who may be regularly called upon in the event of the absence of the primary physician.

Statutory Authority

§ 54.1-2400 and 54.1-2957.01 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 3.2, eff. August 15, 1992; amended, Virginia Register Volume 16, Issue 21, eff. August 2, 2000; Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-40-100. Supervision and site visits.

A. In accordance with § 54.1-2957.01 of the Code of Virginia, physicians who enter into a practice agreement with a nurse practitioner for prescriptive authority shall supervise and direct, at any one time, no more than four nurse practitioners with prescriptive authority.

B. Except as provided in subsection C of this section, physicians shall regularly practice in any location in which the licensed nurse practitioner exercises prescriptive authority.

1. A separate practice setting may not be established for the nurse practitioner.

2. A supervising physician shall conduct a monthly regular, random review of patient charts on which the nurse practitioner has entered a prescription for an approved drug or device.

C. Physicians who practice with a certified nurse midwife or with a nurse practitioner employed by or under contract with local health departments, federally funded comprehensive primary care clinics, or nonprofit health care clinics or programs shall:

1. Either regularly practice at the same location with the nurse practitioner or provide supervisory services to such separate practices by making regular site visits for consultation and direction for appropriate patient management. The site visits shall occur in accordance with the protocol, but no less frequently than once a quarter.

2. Conduct a monthly regular, random review of patient charts on which the nurse practitioner has entered a prescription for an approved drug or device.

Statutory Authority

§ 54.1-2400 and 54.1-2957.01 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 3.3, eff. August 15, 1992; amended, Virginia Register Volume 13, Issue 20, eff. July 23, 1997; Volume 19, Issue 7, eff. January 15, 2003; Volume 24, Issue 6, eff. January 11, 2008; Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-40-121. Prescribing for self or family.

A. Treating or prescribing shall be based on a bona fide practitioner-patient relationship, and prescribing shall meet the criteria set forth in § 54.1-3303 of the Code of Virginia.

B. A nurse practitioner shall not prescribe a controlled substance to himself or a family member, other than Schedule VI as defined in § 54.1-3455 of the Code of Virginia, unless the prescribing occurs in an emergency situation or in isolated settings where there is no other qualified practitioner available to the patient, or it is for a single episode of an acute illness through one prescribed course of medication.

C. When treating or prescribing for self or family, the nurse practitioner shall maintain a patient record documenting compliance with statutory criteria for a bona fide practitioner-patient relationship.

Statutory Authority

§ 54.1-2400 54.1-2957.01 and 54.1-3303 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 25, Issue 5, eff. December 25, 2008.

Part IV
Discipline

18VAC90-40-130. Grounds for disciplinary action.

The boards may deny approval of prescriptive authority, revoke or suspend authorization, or take other disciplinary actions against a nurse practitioner who:

1. Exceeds his authority to prescribe or prescribes outside of the written practice agreement with the supervising physician;

2. Has had his license as a nurse practitioner suspended, revoked or otherwise disciplined by the boards pursuant to 18VAC90-30-220 and 18VAC85-70-220;

3. Fails to comply with requirements for continuing competency as set forth in 18VAC90-40-55.

Statutory Authority

§ 54.1-103, 54.1-2400, 54.1-2912.1, and 54.1-2957.01 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 4.1, eff. August 15, 1992; amended, Virginia Register Volume 18, Issue 15, eff. May 8, 2002; Volume 25, Issue 5, eff. December 25, 2008.

18VAC90-40-140. Hearings Administrative proceedings.

A. The Except as provided for delegation of proceedings to an agency subordinate in 18VAC90-30-240, the Committee of the Joint Boards of Nursing and Medicine shall conduct all hearings prescribed herein and shall take action on behalf of the boards.

B. 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 18VAC90-40-130 nurse practitioner with prescriptive authority shall be subjective to the grounds for disciplinary action set forth in 18VAC90-30-220.

C. When the license of a nurse practitioner has been suspended or revoked by the joint boards, prescriptive authority shall be suspended pending a hearing simultaneously with the institution of proceedings for a hearing.

D. Any violation of law or of this chapter may result in disciplinary action including the revocation or suspension of prescriptive authority and may also result in additional sanctions imposed on the license of the nurse practitioner by the joint boards or upon the license of the registered nurse by the Board of Nursing.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 § 4.2, eff. August 15, 1992; amended, Virginia Register Volume 23, Issue 12, eff. March 21, 2007; Volume 25, Issue 5, eff. December 25, 2008.