The practice of the Clinical Nurse Specialist as an Advanced Practice Nurse is not distinguished from Professional Registered Nurses. This is inconsistent with national standards and recommendations dating back to the APRN Consensus Model 7/7/2008 which is endorsed by 48 professional nursing organizations. The Future of Nursing published by the Institute of Medicine in 2010 endorses nurses practicing to their full extent of their education and training. Revision is needed to the definition of scope of practice to improve access to quality care for people in the Commonwealth of Virginia.