                                 CODE OF VIRGINIA

PRESCRIPTION OF CERTAIN CONTROLLED SUBSTANCES AND DEVICES BY LICENSED ADVANCED
PRACTICE REGISTERED NURSES (§ 54.1-2957.01)

A. In accordance with the provisions of this section and pursuant to the
requirements of Chapter 33 (&#xA7; 54.1-3300 et seq.), a licensed advanced
practice registered nurse shall have the authority to prescribe Schedule II
through Schedule VI controlled substances and devices as set forth in Chapter 34
(&#xA7; 54.1-3400 et seq.).

B. An advanced practice registered nurse who does not meet the requirements for
practice without a written or electronic practice agreement set forth in
subsection I of &#xA7; 54.1-2957 shall prescribe controlled substances or
devices only if such prescribing is authorized by a written or electronic
practice agreement entered into by the advanced practice registered nurse and a
patient care team physician or, if the advanced practice registered nurse is
licensed by the Boards of Medicine and Nursing in the category of clinical nurse
specialist, the advanced practice registered nurse and a licensed physician.
Such advanced practice registered nurse shall provide to the Boards of Medicine
and Nursing such evidence as the Boards may jointly require that the advanced
practice registered nurse has entered into and is, at the time of writing a
prescription, a party to a written or electronic practice agreement with a
patient care team physician, or, if the advanced practice registered nurse is
licensed by the Boards of Medicine and Nursing in the category of clinical nurse
specialist, a licensed physician, that clearly states the prescriptive practices
of the advanced practice registered nurse. Such written or electronic practice
agreements shall include the controlled substances the advanced practice
registered nurse is or is not authorized to prescribe and may restrict such
prescriptive authority as described in the practice agreement. Evidence of a
practice agreement shall be maintained by an advanced practice registered nurse
pursuant to &#xA7; 54.1-2957. Practice agreements authorizing an advanced
practice registered nurse to prescribe controlled substances or devices pursuant
to this section either shall be signed by the patient care team physician, or,
if the advanced practice registered nurse is licensed by the Boards of Medicine
and Nursing in the category of clinical nurse specialist, a licensed physician,
or shall clearly state the name of the patient care team physician, or, if the
advanced practice registered nurse is licensed by the Boards of Medicine and
Nursing in the category of clinical nurse specialist, the name of the licensed
physician, who has entered into the practice agreement with the advanced
practice registered nurse.
			It shall be unlawful for an advanced practice registered nurse to prescribe
controlled substances or devices pursuant to this section unless (i) such
prescription is authorized by the written or electronic practice agreement or
(ii) the advanced practice registered nurse is authorized to practice without a
written or electronic practice agreement pursuant to subsection I of &#xA7;
54.1-2957.

C. The Boards of Medicine and Nursing shall promulgate regulations governing the
prescriptive authority of advanced practice registered nurses as are deemed
reasonable and necessary to ensure an appropriate standard of care for patients.
Such regulations shall include requirements as may be necessary to ensure
continued advanced practice registered nurse competency, which may include
continuing education, testing, or any other requirement, and shall address the
need to promote ethical practice, an appropriate standard of care, patient
safety, the use of new pharmaceuticals, and appropriate communication with
patients.

D. This section shall not limit the functions and procedures of certified
registered nurse anesthetists or of any advanced practice registered nurses
which are otherwise authorized by law or regulation.

E. The following restrictions shall apply to any advanced practice registered
nurse authorized to prescribe drugs and devices pursuant to this section:

   1. The advanced practice registered nurse shall disclose to the patient at the
   initial encounter that he is a licensed advanced practice registered nurse.
   Any party to a practice agreement shall disclose, upon request of a patient or
   his legal representative, the name of the patient care team physician, or, if
   the advanced practice registered nurse is licensed by the Boards of Medicine
   and Nursing in the category of clinical nurse specialist, the name of the
   licensed physician, and information regarding how to contact the patient care
   team physician or licensed physician.

   2. Physicians shall not serve as a patient care team physician on a patient
   care team or enter into a practice agreement with more than six advanced
   practice registered nurses at any one time, except that a physician may serve
   as a patient care team physician on a patient care team with up to 10 advanced
   practice registered nurses licensed in the category of psychiatric-mental
   health advanced practice registered nurse.

F. This section shall not prohibit a licensed advanced practice registered nurse
from administering controlled substances in compliance with the definition of
&#8220;administer&#8221; in &#xA7; 54.1-3401 or from receiving and dispensing
manufacturers&#8217; professional samples of controlled substances in compliance
with the provisions of this section.

G. Notwithstanding any provision of law or regulation to the contrary, a
certified nurse midwife licensed by the Boards of Medicine and Nursing as such
and holding a license for prescriptive authority may prescribe Schedules II
through VI controlled substances. However, if the certified nurse midwife
licensed by the Boards of Medicine and Nursing in the category of certified
nurse midwife is required, pursuant to subsection H of &#xA7; 54.1-2957, to
practice pursuant to a practice agreement, such prescribing shall also be in
accordance with any prescriptive authority included in such practice agreement.

H. Notwithstanding any provision of law or regulation to the contrary, a
certified registered nurse anesthetist licensed by the Boards of Medicine and
Nursing as such shall have the authority to prescribe Schedule II through
Schedule VI controlled substances and devices in accordance with the
requirements for practice set forth in subsection C of &#xA7; 54.1-2957 to a
patient requiring anesthesia, as part of the periprocedural care of such
patient. As used in this subsection, &#8220;periprocedural&#8221; means the
period beginning prior to a procedure and ending at the time the patient is
discharged.

HISTORY: 1991, cc. 519, 524; 1992, c. 409; 1995, c. 506; 1999, c. 745; 2000, c.
924; 2005, c. 926; 2006, c. 494; 2012, c. 213; 2016, c. 495; 2018, c. 776; 2020,
cc. 100, 161; 2021, Sp. Sess. I, cc. 157, 396; 2022, cc. 197, 667; 2023, c. 183.