{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/54.1-2957.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/54.1-2957.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/54.1-2957.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/54.1-2957.html"}],"law_id":64164,"edition_id":1,"section_id":64164,"structure_id":14243,"section_number":"54.1-2957","catch_line":"Licensure and practice of advanced practice registered nurses; certified nurse midwives; independent practice of certified nurse midwives","history":"Code 1950, \u00a7 54-274; 1950, p. 98; 1958, c. 161; 1962, c. 127; 1966, c. 657; 1970, c. 69; 1973, cc. 105, 514, 529; 1975, c. 508; 1976, c. 15; 1980, c. 157; 1982, c. 220; 1985, cc. 303, 347; 1986, c. 377; 1988, c. 765; 2006, c. 750; 2012, c. 213; 2015, c. 107; 2016, cc. 308, 409, 495; 2018, c. 776; 2019, cc. 92, 137; 2021, Sp. Sess. I, cc. 1, 157, 396; 2022, cc. 197, 563; 2023, c. 183; 2024, c. 404; 2025, cc. 544, 557.","full_text":"A\n\nAs used in this section, “clinical experience” means the postgraduate delivery of health care directly to patients pursuant to a practice agreement with a patient care team physician.B\n\nThe Board of Medicine and the Board of Nursing shall jointly prescribe the regulations governing the licensure of advanced practice registered nurses. It is unlawful for a person to practice as an advanced practice registered nurse in the Commonwealth unless he holds such a joint license.C\n\nEvery nurse practitioner who does not meet the requirements of subsection I shall maintain appropriate collaboration and consultation, as evidenced in a written or electronic practice agreement, with at least one patient care team physician. A nurse practitioner who meets the requirements of subsection I may practice without a written or electronic practice agreement. A certified nurse midwife shall practice pursuant to subsection H. A clinical nurse specialist shall practice pursuant to subsection J. A certified registered nurse anesthetist shall practice under the supervision of a licensed doctor of medicine, osteopathy, podiatry, or dentistry. An advanced practice registered nurse who is appointed as a medical examiner pursuant to § 32.1-282 shall practice in collaboration with a licensed doctor of medicine or osteopathic medicine who has been appointed to serve as a medical examiner pursuant to § 32.1-282. Collaboration and consultation among advanced practice registered nurses and patient care team physicians may be provided through telemedicine as described in § 38.2-3418.16.\n\t\t\tPhysicians on patient care teams may require that an advanced practice registered nurse be covered by a professional liability insurance policy with limits equal to the current limitation on damages set forth in § 8.01-581.15.\n\t\t\tService on a patient care team by a patient care team member shall not, by the existence of such service alone, establish or create liability for the actions or inactions of other team members.D\n\nThe Boards of Medicine and Nursing shall jointly promulgate regulations specifying collaboration and consultation among physicians and advanced practice registered nurses working as part of patient care teams that shall include the development of, and periodic review and revision of, a written or electronic practice agreement; guidelines for availability and ongoing communications that define consultation among the collaborating parties and the patient; and periodic joint evaluation of the services delivered. Practice agreements shall include provisions for (i) periodic review of health records, which may include visits to the site where health care is delivered, in the manner and at the frequency determined by the advanced practice registered nurse and the patient care team physician and (ii) input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. Evidence of a practice agreement shall be maintained by an 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 advanced practice registered nurse’s clinical privileges or the electronic or written delineation of duties and responsibilities in collaboration and consultation with a patient care team physician.E\n\nThe Boards of Medicine and Nursing may issue a license by endorsement to an applicant to practice as an advanced practice registered nurse if the applicant has been licensed as an advanced practice registered nurse under the laws of another state and, pursuant to regulations of the Boards, the applicant meets the qualifications for licensure required of advanced practice registered nurses in the Commonwealth. An advanced practice registered nurse to whom a license is issued by endorsement may practice without a practice agreement with a patient care team physician pursuant to subsection I if such application provides an attestation to the Boards that the applicant has completed the equivalent of at least three years of full-time experience, as determined by the Boards, in accordance with the laws of the state in which the nurse practitioner was licensed.F\n\nPending the outcome of the next National Specialty Examination, the Boards may jointly grant temporary licensure to advanced practice registered nurses.G\n\nIn the event a physician who is serving as a patient care team physician dies, becomes disabled, retires from active practice, surrenders his license or has it suspended or revoked by the Board, or relocates his practice such that he is no longer able to serve, or for other good cause, and an advanced practice registered nurse is unable to enter into a new practice agreement with another patient care team physician, the advanced practice registered nurse may continue to practice upon notification to the designee or his alternate of the Boards and receipt of such notification. Such advanced practice registered nurse may continue to treat patients without a patient care team physician for an initial period not to exceed 60 days, provided that the advanced practice registered nurse continues to prescribe only those drugs previously authorized by the practice agreement with such physician and to have access to appropriate input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. The designee or his alternate of the Boards shall grant permission for the advanced practice registered nurse to continue practice under this subsection for another 60 days, provided that the advanced practice registered nurse provides evidence of efforts made to secure another patient care team physician and of access to physician input. At the conclusion of the second 60-day period, provided that the advanced practice registered nurse provides evidence of the continued efforts to secure another patient care team physician and of access to physician input, the designee or his alternate of the Boards may grant permission for the advanced practice registered nurse to continue practicing under the management and leadership of a nurse practitioner licensed by the Boards of Medicine and Nursing who (i) meets the requirements of subsection I, (ii) routinely practiced with a patient population and in a practice area within the category for which the advanced practice registered nurse was certified and licensed, and (iii) has been authorized to practice without a written or electronic practice agreement for at least three years.H\n\nEvery certified nurse midwife shall practice in accordance with regulations adopted by the Boards and consistent with the Standards for the Practice of Midwifery set by the American College of Nurse-Midwives governing such practice. A certified nurse midwife who has practiced fewer than 1,000 hours shall practice in consultation with a licensed physician or an independent practice midwife, in accordance with a practice agreement. Such practice agreement shall address the availability of the licensed physician or independent practice midwife for routine and urgent consultation on patient care. Evidence of the practice agreement shall be maintained by the certified nurse midwife and provided to the Boards upon request. 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 the licensed physician or independent practice midwife with whom the certified nurse midwife has entered into a practice agreement stating (i) that such licensed physician or independent practice midwife has provided consultation to the certified nurse midwife pursuant to a practice agreement meeting the requirements of this section and (ii) the period of time for which such licensed physician or independent practice midwife practiced in collaboration and consultation with the certified nurse midwife pursuant to the practice agreement. 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.\n\t\t\tFor the purposes of this subsection, “independent practice midwife” means a licensed certified midwife who is authorized to practice without a practice agreement pursuant subsection D of § 54.1-2957.04 and has practiced independently for two years or a certified nurse midwife who is authorized to practice without a practice agreement pursuant to this subsection and has practiced independently for two years.I\n\nA nurse practitioner who has completed the equivalent of at least three years of full-time clinical experience, as determined by the Boards, may practice in the practice category in which he is certified and licensed without a written or electronic practice agreement upon receipt by the nurse practitioner of an attestation from either (i) the patient care team physician or (ii) an attesting nurse practitioner who assumed management and leadership of a nurse practitioner pursuant to subsection G and has met the requirements of this subsection for at least three years stating (a) that the patient care team physician or attesting nurse practitioner has served as a patient care team physician or attesting nurse practitioner, respectively, on a patient care team with the nurse practitioner pursuant to a practice agreement meeting the requirements of this section and § 54.1-2957.01; (b) that while a party to such practice agreement, the patient care team physician or attesting nurse practitioner routinely practiced with a patient population and in a practice area included within the category for which the nurse practitioner was certified and licensed; and (c) the period of time for which the patient care team physician or attesting nurse practitioner practiced with the nurse practitioner under such a practice agreement. A copy of such attestation shall be submitted to the Boards together with a fee established by the Boards. Upon receipt of such attestation and verification that a nurse practitioner satisfies the requirements of this subsection, the Boards shall issue to the nurse practitioner a new license that includes a designation indicating that the nurse practitioner is authorized to practice without a practice agreement. In the event that a nurse practitioner is unable to obtain the attestation required by this subsection, the Boards may accept other evidence demonstrating that the applicant has met the requirements of this subsection in accordance with regulations adopted by the Boards.\n\t\t\tA nurse practitioner authorized to practice without a practice agreement pursuant to this subsection shall (1) only practice within the scope of his clinical and professional training and limits of his 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.J\n\nA clinical nurse specialist licensed by the Boards of Medicine and Nursing who does not prescribe controlled substances or devices may practice in the practice category in which he is certified and licensed without a written or electronic practice agreement. Such clinical nurse specialist shall (i) only practice within the scope of his clinical and professional training and limits of his knowledge and experience and consistent with the applicable standards of care, (ii) consult and collaborate with other health care providers based on the clinical condition of the patient to whom health care is provided, and (iii) establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers.\n\t\t\tA clinical nurse specialist licensed by the Boards who prescribes controlled substances or devices shall practice in consultation with a licensed physician in accordance with a practice agreement between the clinical nurse specialist and the licensed physician. 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 a clinical nurse specialist and provided to the Boards upon request. The practice of clinical nurse specialists shall be consistent with the standards of care for the profession and with applicable laws and regulations.","order_by":null,"text":{"0":{"id":233596,"text":"As used in this section, “clinical experience” means the postgraduate delivery of health care directly to patients pursuant to a practice agreement with a patient care team physician.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":233597,"text":"The Board of Medicine and the Board of Nursing shall jointly prescribe the regulations governing the licensure of advanced practice registered nurses. It is unlawful for a person to practice as an advanced practice registered nurse in the Commonwealth unless he holds such a joint license.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":233598,"text":"Every nurse practitioner who does not meet the requirements of subsection I shall maintain appropriate collaboration and consultation, as evidenced in a written or electronic practice agreement, with at least one patient care team physician. A nurse practitioner who meets the requirements of subsection I may practice without a written or electronic practice agreement. A certified nurse midwife shall practice pursuant to subsection H. A clinical nurse specialist shall practice pursuant to subsection J. A certified registered nurse anesthetist shall practice under the supervision of a licensed doctor of medicine, osteopathy, podiatry, or dentistry. An advanced practice registered nurse who is appointed as a medical examiner pursuant to § 32.1-282 shall practice in collaboration with a licensed doctor of medicine or osteopathic medicine who has been appointed to serve as a medical examiner pursuant to § 32.1-282. Collaboration and consultation among advanced practice registered nurses and patient care team physicians may be provided through telemedicine as described in § 38.2-3418.16.\n\t\t\tPhysicians on patient care teams may require that an advanced practice registered nurse be covered by a professional liability insurance policy with limits equal to the current limitation on damages set forth in § 8.01-581.15.\n\t\t\tService on a patient care team by a patient care team member shall not, by the existence of such service alone, establish or create liability for the actions or inactions of other team members.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":233599,"text":"The Boards of Medicine and Nursing shall jointly promulgate regulations specifying collaboration and consultation among physicians and advanced practice registered nurses working as part of patient care teams that shall include the development of, and periodic review and revision of, a written or electronic practice agreement; guidelines for availability and ongoing communications that define consultation among the collaborating parties and the patient; and periodic joint evaluation of the services delivered. Practice agreements shall include provisions for (i) periodic review of health records, which may include visits to the site where health care is delivered, in the manner and at the frequency determined by the advanced practice registered nurse and the patient care team physician and (ii) input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. Evidence of a practice agreement shall be maintained by an 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 advanced practice registered nurse’s clinical privileges or the electronic or written delineation of duties and responsibilities in collaboration and consultation with a patient care team physician.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":233600,"text":"The Boards of Medicine and Nursing may issue a license by endorsement to an applicant to practice as an advanced practice registered nurse if the applicant has been licensed as an advanced practice registered nurse under the laws of another state and, pursuant to regulations of the Boards, the applicant meets the qualifications for licensure required of advanced practice registered nurses in the Commonwealth. An advanced practice registered nurse to whom a license is issued by endorsement may practice without a practice agreement with a patient care team physician pursuant to subsection I if such application provides an attestation to the Boards that the applicant has completed the equivalent of at least three years of full-time experience, as determined by the Boards, in accordance with the laws of the state in which the nurse practitioner was licensed.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"5":{"id":233601,"text":"Pending the outcome of the next National Specialty Examination, the Boards may jointly grant temporary licensure to advanced practice registered nurses.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E","next_prefix":"G"},"6":{"id":233602,"text":"In the event a physician who is serving as a patient care team physician dies, becomes disabled, retires from active practice, surrenders his license or has it suspended or revoked by the Board, or relocates his practice such that he is no longer able to serve, or for other good cause, and an advanced practice registered nurse is unable to enter into a new practice agreement with another patient care team physician, the advanced practice registered nurse may continue to practice upon notification to the designee or his alternate of the Boards and receipt of such notification. Such advanced practice registered nurse may continue to treat patients without a patient care team physician for an initial period not to exceed 60 days, provided that the advanced practice registered nurse continues to prescribe only those drugs previously authorized by the practice agreement with such physician and to have access to appropriate input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. The designee or his alternate of the Boards shall grant permission for the advanced practice registered nurse to continue practice under this subsection for another 60 days, provided that the advanced practice registered nurse provides evidence of efforts made to secure another patient care team physician and of access to physician input. At the conclusion of the second 60-day period, provided that the advanced practice registered nurse provides evidence of the continued efforts to secure another patient care team physician and of access to physician input, the designee or his alternate of the Boards may grant permission for the advanced practice registered nurse to continue practicing under the management and leadership of a nurse practitioner licensed by the Boards of Medicine and Nursing who (i) meets the requirements of subsection I, (ii) routinely practiced with a patient population and in a practice area within the category for which the advanced practice registered nurse was certified and licensed, and (iii) has been authorized to practice without a written or electronic practice agreement for at least three years.","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F","next_prefix":"H"},"7":{"id":233603,"text":"Every certified nurse midwife shall practice in accordance with regulations adopted by the Boards and consistent with the Standards for the Practice of Midwifery set by the American College of Nurse-Midwives governing such practice. A certified nurse midwife who has practiced fewer than 1,000 hours shall practice in consultation with a licensed physician or an independent practice midwife, in accordance with a practice agreement. Such practice agreement shall address the availability of the licensed physician or independent practice midwife for routine and urgent consultation on patient care. Evidence of the practice agreement shall be maintained by the certified nurse midwife and provided to the Boards upon request. 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 the licensed physician or independent practice midwife with whom the certified nurse midwife has entered into a practice agreement stating (i) that such licensed physician or independent practice midwife has provided consultation to the certified nurse midwife pursuant to a practice agreement meeting the requirements of this section and (ii) the period of time for which such licensed physician or independent practice midwife practiced in collaboration and consultation with the certified nurse midwife pursuant to the practice agreement. 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.\n\t\t\tFor the purposes of this subsection, “independent practice midwife” means a licensed certified midwife who is authorized to practice without a practice agreement pursuant subsection D of § 54.1-2957.04 and has practiced independently for two years or a certified nurse midwife who is authorized to practice without a practice agreement pursuant to this subsection and has practiced independently for two years.","type":"section","prefixes":["H"],"prefix":"H","entire_prefix":"H","prefix_anchor":"H","level":1,"prior_prefix":"G","next_prefix":"I"},"8":{"id":233604,"text":"A nurse practitioner who has completed the equivalent of at least three years of full-time clinical experience, as determined by the Boards, may practice in the practice category in which he is certified and licensed without a written or electronic practice agreement upon receipt by the nurse practitioner of an attestation from either (i) the patient care team physician or (ii) an attesting nurse practitioner who assumed management and leadership of a nurse practitioner pursuant to subsection G and has met the requirements of this subsection for at least three years stating (a) that the patient care team physician or attesting nurse practitioner has served as a patient care team physician or attesting nurse practitioner, respectively, on a patient care team with the nurse practitioner pursuant to a practice agreement meeting the requirements of this section and § 54.1-2957.01; (b) that while a party to such practice agreement, the patient care team physician or attesting nurse practitioner routinely practiced with a patient population and in a practice area included within the category for which the nurse practitioner was certified and licensed; and (c) the period of time for which the patient care team physician or attesting nurse practitioner practiced with the nurse practitioner under such a practice agreement. A copy of such attestation shall be submitted to the Boards together with a fee established by the Boards. Upon receipt of such attestation and verification that a nurse practitioner satisfies the requirements of this subsection, the Boards shall issue to the nurse practitioner a new license that includes a designation indicating that the nurse practitioner is authorized to practice without a practice agreement. In the event that a nurse practitioner is unable to obtain the attestation required by this subsection, the Boards may accept other evidence demonstrating that the applicant has met the requirements of this subsection in accordance with regulations adopted by the Boards.\n\t\t\tA nurse practitioner authorized to practice without a practice agreement pursuant to this subsection shall (1) only practice within the scope of his clinical and professional training and limits of his 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.","type":"section","prefixes":["I"],"prefix":"I","entire_prefix":"I","prefix_anchor":"I","level":1,"prior_prefix":"H","next_prefix":"J"},"9":{"id":233605,"text":"A clinical nurse specialist licensed by the Boards of Medicine and Nursing who does not prescribe controlled substances or devices may practice in the practice category in which he is certified and licensed without a written or electronic practice agreement. Such clinical nurse specialist shall (i) only practice within the scope of his clinical and professional training and limits of his knowledge and experience and consistent with the applicable standards of care, (ii) consult and collaborate with other health care providers based on the clinical condition of the patient to whom health care is provided, and (iii) establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers.\n\t\t\tA clinical nurse specialist licensed by the Boards who prescribes controlled substances or devices shall practice in consultation with a licensed physician in accordance with a practice agreement between the clinical nurse specialist and the licensed physician. 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 a clinical nurse specialist and provided to the Boards upon request. The practice of clinical nurse specialists shall be consistent with the standards of care for the profession and with applicable laws and regulations.","type":"section","prefixes":["J"],"prefix":"J","entire_prefix":"J","prefix_anchor":"J","level":1,"prior_prefix":"I"}},"ancestry":[{"id":14243,"edition_id":1,"name":"Licensure and Certification of Other Practitioners of the Healing Arts","identifier":"4","label":"article","depth":4,"order_by":1,"parent_id":12759,"metadata":{},"date_created":"2026-06-26 03:47:26","date_modified":"2026-06-26 03:47:26","permalink":{"id":242191,"object_type":"structure","relational_id":14243,"identifier":"4","token":"54.1\/III\/29\/4","url":"\/54.1\/III\/29\/4\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12759,"edition_id":1,"name":"Medicine and Other Healing Arts","identifier":"29","label":"chapter","depth":3,"order_by":1,"parent_id":12758,"metadata":{},"date_created":"2026-06-26 03:43:51","date_modified":"2026-06-26 03:43:51","permalink":{"id":241933,"object_type":"structure","relational_id":12759,"identifier":"29","token":"54.1\/III\/29","url":"\/54.1\/III\/29\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12758,"edition_id":1,"name":"Professions and Occupations Regulated by Boards Within the Department of Health Professions","identifier":"III","label":"subtitle","depth":2,"order_by":1,"parent_id":12754,"metadata":{},"date_created":"2026-06-26 03:43:51","date_modified":"2026-06-26 03:43:51","permalink":{"id":241105,"object_type":"structure","relational_id":12758,"identifier":"III","token":"54.1\/III","url":"\/54.1\/III\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12754,"edition_id":1,"name":"Professions and Occupations","identifier":"54.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:51","date_modified":"2026-06-26 03:43:51","permalink":{"id":239313,"object_type":"structure","relational_id":12754,"identifier":"54.1","token":"54.1","url":"\/54.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":83532,"structure_id":14243,"section_number":"54.1-2942","catch_line":"Repealed","url":"\/54.1-2942\/","token":"54.1\/III\/29\/4\/54.1-2942","metadata":false},{"id":78472,"structure_id":14243,"section_number":"54.1-2949","catch_line":"License required","url":"\/54.1-2949\/","token":"54.1\/III\/29\/4\/54.1-2949","metadata":false},{"id":81411,"structure_id":14243,"section_number":"54.1-2950","catch_line":"Requisite training and educational achievements of assistants","url":"\/54.1-2950\/","token":"54.1\/III\/29\/4\/54.1-2950","metadata":false},{"id":64376,"structure_id":14243,"section_number":"54.1-2950.1","catch_line":"Advisory Board on Physician Assistants; 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The record of this law\u2019s original creation isn\u2019t available online. It has been modified 22 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1958, chapter 161; in 1962, chapter 127; in 1966, chapter 657; in 1970, chapter 69; in 1973, chapters 105, 514, and 529; in 1975, chapter 508; in 1976, chapter 15; in 1980, chapter 157; in 1982, chapter 220; in 1985, chapters 303 and 347; in 1986, chapter 377; in 1988, chapter 765; in 2006, chapter 750<\/a>; in 2012, chapter 213<\/a>; in 2015, chapter 107<\/a>; in 2016, chapters 308<\/a>, 409<\/a>, and 495<\/a>; in 2018, chapter 776<\/a>; in 2019, chapters 92<\/a> and 137<\/a>; in 2022, chapters 197<\/a> and 563<\/a>; in 2023, chapter 183<\/a>; in 2024, chapter 404<\/a>; in 2025, chapters 544<\/a> and 557<\/a>.<\/p>","references":[{"id":74380,"section_number":"22.1-271.7","catch_line":"Public middle and high school student-athletes; pre-participation physical examination","order_by":null,"url":"\/22.1-271.7\/"},{"id":71090,"section_number":"32.1-134.2","catch_line":"Clinical privileges for certain practitioners","order_by":null,"url":"\/32.1-134.2\/"},{"id":68053,"section_number":"32.1-263","catch_line":"Filing death certificates; medical certification; investigation by Office of the Chief Medical Examiner","order_by":null,"url":"\/32.1-263\/"},{"id":63078,"section_number":"54.1-2900","catch_line":"Definitions","order_by":null,"url":"\/54.1-2900\/"},{"id":83528,"section_number":"54.1-2901","catch_line":"Exceptions and exemptions generally","order_by":null,"url":"\/54.1-2901\/"},{"id":71447,"section_number":"54.1-2957.01","catch_line":"Prescription of certain controlled substances and devices by licensed advanced practice registered nurses","order_by":null,"url":"\/54.1-2957.01\/"},{"id":83986,"section_number":"54.1-2957.04","catch_line":"Licensure as a licensed certified midwife; practice as a licensed certified midwife; independent practice as a licensed certified midwife; use of title; required disclosures","order_by":null,"url":"\/54.1-2957.04\/"},{"id":74475,"section_number":"54.1-2973.1","catch_line":"Practice of laser hair removal","order_by":null,"url":"\/54.1-2973.1\/"},{"id":54819,"section_number":"54.1-3000","catch_line":"Definitions","order_by":null,"url":"\/54.1-3000\/"},{"id":85523,"section_number":"54.1-3005","catch_line":"Specific powers and duties of Board","order_by":null,"url":"\/54.1-3005\/"},{"id":72064,"section_number":"54.1-3300","catch_line":"Definitions","order_by":null,"url":"\/54.1-3300\/"},{"id":77902,"section_number":"54.1-3300.1","catch_line":"Participation in collaborative agreements; regulations to be promulgated by the Boards of Medicine and Pharmacy","order_by":null,"url":"\/54.1-3300.1\/"},{"id":67450,"section_number":"54.1-3482","catch_line":"Practice of physical therapy; certain experience and referrals required; physical therapist assistants","order_by":null,"url":"\/54.1-3482\/"},{"id":82294,"section_number":"54.1-3482.1","catch_line":"Certain certification required","order_by":null,"url":"\/54.1-3482.1\/"},{"id":62896,"section_number":"8.01-401.2","catch_line":"Chiropractor, physician assistant, advanced practice registered nurse, or optometrist as expert witness","order_by":null,"url":"\/8.01-401.2\/"}],"refers_to":[{"id":65973,"section_number":"32.1-282","catch_line":"Medical examiners","order_by":null,"url":"\/32.1-282\/"},{"id":61286,"section_number":"38.2-3418.16","catch_line":"Coverage for telemedicine services","order_by":null,"url":"\/38.2-3418.16\/"},{"id":71447,"section_number":"54.1-2957.01","catch_line":"Prescription of certain controlled substances and devices by licensed advanced practice registered nurses","order_by":null,"url":"\/54.1-2957.01\/"},{"id":83986,"section_number":"54.1-2957.04","catch_line":"Licensure as a licensed certified midwife; practice as a licensed certified midwife; independent practice as a licensed certified midwife; use of title; required disclosures","order_by":null,"url":"\/54.1-2957.04\/"},{"id":66555,"section_number":"8.01-581.15","catch_line":"Limitation on recovery in certain medical malpractice actions","order_by":null,"url":"\/8.01-581.15\/"}],"permalink":{"id":242333,"object_type":"law","relational_id":64164,"identifier":"54.1-2957","token":"54.1\/III\/29\/4\/54.1-2957","url":"\/54.1-2957\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/54.1-2957\/","token":"54.1\/III\/29\/4\/54.1-2957","dublin_core":{"Title":"Licensure and practice of advanced practice registered nurses; certified nurse midwives; independent practice of certified nurse midwives","Type":"Text","Format":"text\/html","Identifier":"\u00a7 54.1-2957","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> As used in this section, “clinical experience<\/span>” means the postgraduate delivery of health care directly to patients pursuant to a practice agreement with a patient care team<\/span> physician<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The Board<\/span> of Medicine and the Board<\/span> of Nursing shall jointly prescribe the regulations governing the licensure of advanced practice registered nurses<\/span>. It is unlawful for a person to practice as an advanced practice registered nurse<\/span> in the Commonwealth unless he holds such a joint license. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> Every nurse practitioner<\/span> who does not meet the requirements of subsection I shall maintain appropriate collaboration<\/span> and consultation<\/span>, as evidenced in a written or electronic practice agreement, with at least one patient care team<\/span> physician<\/span>. A nurse practitioner<\/span> who meets the requirements of subsection I may practice without a written or electronic practice agreement. A certified nurse midwife<\/span> shall practice pursuant to subsection H. A clinical nurse specialist<\/span> shall practice pursuant to subsection J. A certified registered nurse anesthetist<\/span> shall practice under the supervision of a licensed doctor of medicine, osteopathy, podiatry, or dentistry. An advanced practice registered nurse<\/span> who is appointed as a medical examiner pursuant to § 32.1-282<\/a> shall practice in collaboration<\/span> with a licensed doctor of medicine or osteopathic medicine who has been appointed to serve as a medical examiner pursuant to § 32.1-282<\/a>. Collaboration<\/span> and consultation<\/span> among advanced practice registered nurses<\/span> and patient care team<\/span> physicians<\/span> may be provided through telemedicine as described in § 38.2-3418.16<\/a>.\n\t\t\tPhysicians on patient care teams<\/span> may require that an advanced practice registered nurse<\/span> be covered by a professional liability insurance policy with limits equal to the current limitation on damages<\/span> set forth in § 8.01-581.15<\/a>.\n\t\t\tService on a patient care team<\/span> by a patient care team<\/span> member shall not, by the existence of such service alone, establish or create liability for the actions or inactions of other team members. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The Boards<\/span> of Medicine and Nursing shall jointly promulgate regulations specifying collaboration<\/span> and consultation<\/span> among physicians and advanced practice registered nurses<\/span> working as part of patient care teams<\/span> that shall include the development of, and periodic review and revision of, a written or electronic practice agreement; guidelines for availability and ongoing communications that define consultation<\/span> among the collaborating parties and the patient; and periodic joint evaluation of the services delivered. Practice agreements shall include provisions for (i) periodic review of health records, which may include visits to the site where health care is delivered, in the manner and at the frequency determined by the advanced practice registered nurse<\/span> and the patient care team<\/span> physician<\/span> and (ii) input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. Evidence<\/span> of a practice agreement shall be maintained by an advanced practice registered nurse<\/span> and provided to the Boards<\/span> upon request. For advanced practice registered nurses<\/span> providing care to patients within a hospital or health care system, the practice agreement may be included as part of documents delineating the advanced practice registered nurse<\/span>’s clinical privileges<\/span> or the electronic or written delineation of duties and responsibilities in collaboration<\/span> and consultation<\/span> with a patient care team<\/span> physician<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> The Boards<\/span> of Medicine and Nursing may issue<\/span> a license by endorsement to an applicant to practice as an advanced practice registered nurse<\/span> if the applicant has been licensed as an advanced practice registered nurse<\/span> under the laws<\/span> of another state and, pursuant to regulations of the Boards<\/span>, the applicant meets the qualifications for licensure required of advanced practice registered nurses<\/span> in the Commonwealth. An advanced practice registered nurse<\/span> to whom a license is issued by endorsement may practice without a practice agreement with a patient care team<\/span> physician<\/span> pursuant to subsection I if such application provides an attestation to the Boards<\/span> that the applicant has completed the equivalent of at least three years of full-time experience, as determined by the Boards<\/span>, in accordance with the laws<\/span> of the state in which the nurse practitioner<\/span> was licensed. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> Pending the outcome of the next National Specialty Examination, the Boards<\/span> may jointly grant temporary licensure to advanced practice registered nurses<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> In the event a physician who is serving as a patient care team<\/span> physician<\/span> dies, becomes disabled, retires from active practice, surrenders his license or has it suspended or revoked by the Board<\/span>, or relocates his practice such that he is no longer able to serve, or for other good cause, and an advanced practice registered nurse<\/span> is unable to enter into a new practice agreement with another patient care team<\/span> physician<\/span>, the advanced practice registered nurse<\/span> may continue to practice upon notification to the designee or his alternate of the Boards<\/span> and receipt of such notification. Such advanced practice registered nurse<\/span> may continue to treat patients without a patient care team<\/span> physician<\/span> for an initial period not to exceed 60 days, provided that the advanced practice registered nurse<\/span> continues to prescribe only those drugs previously authorized by the practice agreement with such physician and to have access to appropriate input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. The designee or his alternate of the Boards<\/span> shall grant permission for the advanced practice registered nurse<\/span> to continue practice under this subsection for another 60 days, provided that the advanced practice registered nurse<\/span> provides evidence<\/span> of efforts made to secure another patient care team<\/span> physician<\/span> and of access to physician input. At the conclusion of the second 60-day period, provided that the advanced practice registered nurse<\/span> provides evidence<\/span> of the continued efforts to secure another patient care team<\/span> physician<\/span> and of access to physician input, the designee or his alternate of the Boards<\/span> may grant permission for the advanced practice registered nurse<\/span> to continue practicing under the management and leadership of a nurse practitioner<\/span> licensed by the Boards<\/span> of Medicine and Nursing who (i) meets the requirements of subsection I, (ii) routinely practiced with a patient population and in a practice area within the category for which the advanced practice registered nurse<\/span> was certified and licensed, and (iii) has been authorized to practice without a written or electronic practice agreement for at least three years. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

H.<\/span> Every certified nurse midwife<\/span> shall practice in accordance with regulations adopted by the Boards<\/span> and consistent with the Standards for the Practice of Midwifery set by the American College of Nurse-Midwives governing such practice. A certified nurse midwife<\/span> who has practiced fewer than 1,000 hours shall practice in consultation<\/span> with a licensed physician or an independent practice midwife<\/span>, in accordance with a practice agreement. Such practice agreement shall address the availability of the licensed physician or independent practice midwife<\/span> for routine and urgent consultation<\/span> on patient care. Evidence<\/span> of the practice agreement shall be maintained by the certified nurse midwife<\/span> and provided to the Boards<\/span> upon request. A certified nurse midwife<\/span> who has completed 1,000 hours of practice as a certified nurse midwife<\/span> may practice without a practice agreement upon receipt by the certified nurse midwife<\/span> of an attestation from the licensed physician or independent practice midwife<\/span> with whom the certified nurse midwife<\/span> has entered into a practice agreement stating (i) that such licensed physician or independent practice midwife<\/span> has provided consultation<\/span> to the certified nurse midwife<\/span> pursuant to a practice agreement meeting the requirements of this section and (ii) the period of time for which such licensed physician or independent practice midwife<\/span> practiced in collaboration<\/span> and consultation<\/span> with the certified nurse midwife<\/span> pursuant to the practice agreement. A certified nurse midwife<\/span> 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.\n\t\t\tFor the purposes of this subsection, “independent practice midwife<\/span>” means a licensed certified midwife<\/span> who is authorized to practice without a practice agreement pursuant subsection D of § 54.1-2957.04<\/a> and has practiced independently for two years or a certified nurse midwife<\/span> who is authorized to practice without a practice agreement pursuant to this subsection and has practiced independently for two years. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

I.<\/span> A nurse practitioner<\/span> who has completed the equivalent of at least three years of full-time clinical experience<\/span>, as determined by the Boards<\/span>, may practice in the practice category in which he is certified and licensed without a written or electronic practice agreement upon receipt by the nurse practitioner<\/span> of an attestation from either (i) the patient care team<\/span> physician<\/span> or (ii) an attesting nurse practitioner<\/span> who assumed management and leadership of a nurse practitioner<\/span> pursuant to subsection G and has met the requirements of this subsection for at least three years stating (a) that the patient care team<\/span> physician<\/span> or attesting nurse practitioner<\/span> has served as a patient care team<\/span> physician<\/span> or attesting nurse practitioner<\/span>, respectively, on a patient care team<\/span> with the nurse practitioner<\/span> pursuant to a practice agreement meeting the requirements of this section and § 54.1-2957.01<\/a>; (b) that while a party<\/span> to such practice agreement, the patient care team<\/span> physician<\/span> or attesting nurse practitioner<\/span> routinely practiced with a patient population and in a practice area included within the category for which the nurse practitioner<\/span> was certified and licensed; and (c) the period of time for which the patient care team<\/span> physician<\/span> or attesting nurse practitioner<\/span> practiced with the nurse practitioner<\/span> under such a practice agreement. A copy of such attestation shall be submitted to the Boards<\/span> together with a fee established by the Boards<\/span>. Upon receipt of such attestation and verification that a nurse practitioner<\/span> satisfies the requirements of this subsection, the Boards<\/span> shall issue<\/span> to the nurse practitioner<\/span> a new license that includes a designation indicating that the nurse practitioner<\/span> is authorized to practice without a practice agreement. In the event that a nurse practitioner<\/span> is unable to obtain the attestation required by this subsection, the Boards<\/span> may accept other evidence<\/span> demonstrating that the applicant has met the requirements of this subsection in accordance with regulations adopted by the Boards<\/span>.\n\t\t\tA nurse practitioner<\/span> authorized to practice without a practice agreement pursuant to this subsection shall (1) only practice within the scope of his clinical and professional training and limits of his 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. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

J.<\/span> A clinical nurse specialist<\/span> licensed by the Boards<\/span> of Medicine and Nursing who does not prescribe controlled substances or devices may practice in the practice category in which he is certified and licensed without a written or electronic practice agreement. Such clinical nurse specialist<\/span> shall (i) only practice within the scope of his clinical and professional training and limits of his knowledge and experience and consistent with the applicable standards of care, (ii) consult and collaborate with other health care providers based on the clinical condition of the patient to whom health care is provided, and (iii) establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers.\n\t\t\tA clinical nurse specialist<\/span> licensed by the Boards<\/span> who prescribes controlled substances or devices shall practice in consultation<\/span> with a licensed physician in accordance with a practice agreement between the clinical nurse specialist<\/span> and the licensed physician. Such practice agreement shall address the availability of the physician for routine and urgent consultation<\/span> on patient care. Evidence<\/span> of a practice agreement shall be maintained by a clinical nurse specialist<\/span> and provided to the Boards<\/span> upon request. The practice of clinical nurse specialists<\/span> shall be consistent with the standards of care for the profession and with applicable laws<\/span> and regulations. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nLICENSURE AND PRACTICE OF ADVANCED PRACTICE REGISTERED NURSES; CERTIFIED NURSE\nMIDWIVES; INDEPENDENT PRACTICE OF CERTIFIED NURSE MIDWIVES (\u00a7 54.1-2957)\n\nA. As used in this section, “clinical experience” means the\npostgraduate delivery of health care directly to patients pursuant to a practice\nagreement with a patient care team physician.\n\nB. The Board of Medicine and the Board of Nursing shall jointly prescribe the\nregulations governing the licensure of advanced practice registered nurses. It\nis unlawful for a person to practice as an advanced practice registered nurse in\nthe Commonwealth unless he holds such a joint license.\n\nC. Every nurse practitioner who does not meet the requirements of subsection I\nshall maintain appropriate collaboration and consultation, as evidenced in a\nwritten or electronic practice agreement, with at least one patient care team\nphysician. A nurse practitioner who meets the requirements of subsection I may\npractice without a written or electronic practice agreement. A certified nurse\nmidwife shall practice pursuant to subsection H. A clinical nurse specialist\nshall practice pursuant to subsection J. A certified registered nurse\nanesthetist shall practice under the supervision of a licensed doctor of\nmedicine, osteopathy, podiatry, or dentistry. An advanced practice registered\nnurse who is appointed as a medical examiner pursuant to § 32.1-282 shall\npractice in collaboration with a licensed doctor of medicine or osteopathic\nmedicine who has been appointed to serve as a medical examiner pursuant to\n§ 32.1-282. Collaboration and consultation among advanced practice\nregistered nurses and patient care team physicians may be provided through\ntelemedicine as described in § 38.2-3418.16.\n\t\t\tPhysicians on patient care teams may require that an advanced practice\nregistered nurse be covered by a professional liability insurance policy with\nlimits equal to the current limitation on damages set forth in §\n8.01-581.15.\n\t\t\tService on a patient care team by a patient care team member shall not, by\nthe existence of such service alone, establish or create liability for the\nactions or inactions of other team members.\n\nD. The Boards of Medicine and Nursing shall jointly promulgate regulations\nspecifying collaboration and consultation among physicians and advanced practice\nregistered nurses working as part of patient care teams that shall include the\ndevelopment of, and periodic review and revision of, a written or electronic\npractice agreement; guidelines for availability and ongoing communications that\ndefine consultation among the collaborating parties and the patient; and\nperiodic joint evaluation of the services delivered. Practice agreements shall\ninclude provisions for (i) periodic review of health records, which may include\nvisits to the site where health care is delivered, in the manner and at the\nfrequency determined by the advanced practice registered nurse and the patient\ncare team physician and (ii) input from appropriate health care providers in\ncomplex clinical cases and patient emergencies and for referrals. Evidence of a\npractice agreement shall be maintained by an advanced practice registered nurse\nand provided to the Boards upon request. For advanced practice registered nurses\nproviding care to patients within a hospital or health care system, the practice\nagreement may be included as part of documents delineating the advanced practice\nregistered nurse’s clinical privileges or the electronic or written\ndelineation of duties and responsibilities in collaboration and consultation\nwith a patient care team physician.\n\nE. The Boards of Medicine and Nursing may issue a license by endorsement to an\napplicant to practice as an advanced practice registered nurse if the applicant\nhas been licensed as an advanced practice registered nurse under the laws of\nanother state and, pursuant to regulations of the Boards, the applicant meets\nthe qualifications for licensure required of advanced practice registered nurses\nin the Commonwealth. An advanced practice registered nurse to whom a license is\nissued by endorsement may practice without a practice agreement with a patient\ncare team physician pursuant to subsection I if such application provides an\nattestation to the Boards that the applicant has completed the equivalent of at\nleast three years of full-time experience, as determined by the Boards, in\naccordance with the laws of the state in which the nurse practitioner was\nlicensed.\n\nF. Pending the outcome of the next National Specialty Examination, the Boards\nmay jointly grant temporary licensure to advanced practice registered nurses.\n\nG. In the event a physician who is serving as a patient care team physician\ndies, becomes disabled, retires from active practice, surrenders his license or\nhas it suspended or revoked by the Board, or relocates his practice such that he\nis no longer able to serve, or for other good cause, and an advanced practice\nregistered nurse is unable to enter into a new practice agreement with another\npatient care team physician, the advanced practice registered nurse may continue\nto practice upon notification to the designee or his alternate of the Boards and\nreceipt of such notification. Such advanced practice registered nurse may\ncontinue to treat patients without a patient care team physician for an initial\nperiod not to exceed 60 days, provided that the advanced practice registered\nnurse continues to prescribe only those drugs previously authorized by the\npractice agreement with such physician and to have access to appropriate input\nfrom appropriate health care providers in complex clinical cases and patient\nemergencies and for referrals. The designee or his alternate of the Boards shall\ngrant permission for the advanced practice registered nurse to continue practice\nunder this subsection for another 60 days, provided that the advanced practice\nregistered nurse provides evidence of efforts made to secure another patient\ncare team physician and of access to physician input. At the conclusion of the\nsecond 60-day period, provided that the advanced practice registered nurse\nprovides evidence of the continued efforts to secure another patient care team\nphysician and of access to physician input, the designee or his alternate of the\nBoards may grant permission for the advanced practice registered nurse to\ncontinue practicing under the management and leadership of a nurse practitioner\nlicensed by the Boards of Medicine and Nursing who (i) meets the requirements of\nsubsection I, (ii) routinely practiced with a patient population and in a\npractice area within the category for which the advanced practice registered\nnurse was certified and licensed, and (iii) has been authorized to practice\nwithout a written or electronic practice agreement for at least three years.\n\nH. Every certified nurse midwife shall practice in accordance with regulations\nadopted by the Boards and consistent with the Standards for the Practice of\nMidwifery set by the American College of Nurse-Midwives governing such practice.\nA certified nurse midwife who has practiced fewer than 1,000 hours shall\npractice in consultation with a licensed physician or an independent practice\nmidwife, in accordance with a practice agreement. Such practice agreement shall\naddress the availability of the licensed physician or independent practice\nmidwife for routine and urgent consultation on patient care. Evidence of the\npractice agreement shall be maintained by the certified nurse midwife and\nprovided to the Boards upon request. A certified nurse midwife who has completed\n1,000 hours of practice as a certified nurse midwife may practice without a\npractice agreement upon receipt by the certified nurse midwife of an attestation\nfrom the licensed physician or independent practice midwife with whom the\ncertified nurse midwife has entered into a practice agreement stating (i) that\nsuch licensed physician or independent practice midwife has provided\nconsultation to the certified nurse midwife pursuant to a practice agreement\nmeeting the requirements of this section and (ii) the period of time for which\nsuch licensed physician or independent practice midwife practiced in\ncollaboration and consultation with the certified nurse midwife pursuant to the\npractice agreement. A certified nurse midwife authorized to practice without a\npractice agreement shall consult and collaborate with and refer patients to such\nother health care providers as may be appropriate for the care of the patient.\n\t\t\tFor the purposes of this subsection, “independent practice\nmidwife” means a licensed certified midwife who is authorized to practice\nwithout a practice agreement pursuant subsection D of § 54.1-2957.04 and\nhas practiced independently for two years or a certified nurse midwife who is\nauthorized to practice without a practice agreement pursuant to this subsection\nand has practiced independently for two years.\n\nI. A nurse practitioner who has completed the equivalent of at least three years\nof full-time clinical experience, as determined by the Boards, may practice in\nthe practice category in which he is certified and licensed without a written or\nelectronic practice agreement upon receipt by the nurse practitioner of an\nattestation from either (i) the patient care team physician or (ii) an attesting\nnurse practitioner who assumed management and leadership of a nurse practitioner\npursuant to subsection G and has met the requirements of this subsection for at\nleast three years stating (a) that the patient care team physician or attesting\nnurse practitioner has served as a patient care team physician or attesting\nnurse practitioner, respectively, on a patient care team with the nurse\npractitioner pursuant to a practice agreement meeting the requirements of this\nsection and § 54.1-2957.01; (b) that while a party to such practice\nagreement, the patient care team physician or attesting nurse practitioner\nroutinely practiced with a patient population and in a practice area included\nwithin the category for which the nurse practitioner was certified and licensed;\nand (c) the period of time for which the patient care team physician or\nattesting nurse practitioner practiced with the nurse practitioner under such a\npractice agreement. A copy of such attestation shall be submitted to the Boards\ntogether with a fee established by the Boards. Upon receipt of such attestation\nand verification that a nurse practitioner satisfies the requirements of this\nsubsection, the Boards shall issue to the nurse practitioner a new license that\nincludes a designation indicating that the nurse practitioner is authorized to\npractice without a practice agreement. In the event that a nurse practitioner is\nunable to obtain the attestation required by this subsection, the Boards may\naccept other evidence demonstrating that the applicant has met the requirements\nof this subsection in accordance with regulations adopted by the Boards.\n\t\t\tA nurse practitioner authorized to practice without a practice agreement\npursuant to this subsection shall (1) only practice within the scope of his\nclinical and professional training and limits of his knowledge and experience\nand consistent with the applicable standards of care, (2) consult and\ncollaborate with other health care providers based on the clinical conditions of\nthe patient to whom health care is provided, and (3) establish a plan for\nreferral of complex medical cases and emergencies to physicians or other\nappropriate health care providers.\n\nJ. A clinical nurse specialist licensed by the Boards of Medicine and Nursing\nwho does not prescribe controlled substances or devices may practice in the\npractice category in which he is certified and licensed without a written or\nelectronic practice agreement. Such clinical nurse specialist shall (i) only\npractice within the scope of his clinical and professional training and limits\nof his knowledge and experience and consistent with the applicable standards of\ncare, (ii) consult and collaborate with other health care providers based on the\nclinical condition of the patient to whom health care is provided, and (iii)\nestablish a plan for referral of complex medical cases and emergencies to\nphysicians or other appropriate health care providers.\n\t\t\tA clinical nurse specialist licensed by the Boards who prescribes controlled\nsubstances or devices shall practice in consultation with a licensed physician\nin accordance with a practice agreement between the clinical nurse specialist\nand the licensed physician. Such practice agreement shall address the\navailability of the physician for routine and urgent consultation on patient\ncare. Evidence of a practice agreement shall be maintained by a clinical nurse\nspecialist and provided to the Boards upon request. The practice of clinical\nnurse specialists shall be consistent with the standards of care for the\nprofession and with applicable laws and regulations.\n\nHISTORY: Code 1950, \u00a7 54-274; 1950, p. 98; 1958, c. 161; 1962, c. 127; 1966, c.\n657; 1970, c. 69; 1973, cc. 105, 514, 529; 1975, c. 508; 1976, c. 15; 1980, c.\n157; 1982, c. 220; 1985, cc. 303, 347; 1986, c. 377; 1988, c. 765; 2006, c. 750;\n2012, c. 213; 2015, c. 107; 2016, cc. 308, 409, 495; 2018, c. 776; 2019, cc. 92,\n137; 2021, Sp. Sess. I, cc. 1, 157, 396; 2022, cc. 197, 563; 2023, c. 183; 2024,\nc. 404; 2025, cc. 544, 557.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}