Nurse Practitioner Regulations in Virginia

Nurse Practitioner Regulations in Virginia


Nurse Practitioner Regulations in Virginia

The Institute of Medicine in its 2010 report titled “The Future of Nursing: Leading Change, Advancing Health” envisions a future where primary care and prevention are core drivers of better and quality care in health and nurses leading healthcare provision (Wakefield et al., 2021). IOM report advocates for expansion of the scope of practice for nurses at state levels to enhance accessibility, reduce costs, and improve quality. States have different regulations on the scope of practice for nurses that impact their ability to offer care. Regulation and practice laws for nurses in the United States include full, restrictive, and reduced. The purpose of this paper is to review and discuss practice agreement for the state of Virginia for nurses.

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Physician Collaboration or Supervision for Nurse Practitioners in Virginia

The Commonwealth of Virginia under the new nursing practice code that will be effective from July 1, 2022 mandate nurses with over five years’ experience to practice autonomously without physician supervision or collaboration. However, the current practice agreement for nurse practitioners is in force and requires nurses to form collaborative agreements with physicians. The Practice Agreement describes the relationship between the parties and the procedures to be followed and acts to be executed by the NP in the course of providing care to patients (Virginia State Law, 2021b). The requirements in the agreement include a description of the NP’s scope of practice and settings, provision for periodic reviews of patient records by the supervising physician, details of certain situations that need the input of the supervising physician, and what the NP can do in case of an emergency and when to make referrals (Virginia State Law, 2021). The agreement also includes categories of drugs and devices the NP can prescribe, guidelines for availability and continual communication between the two parties, and the details concerning periodic joint evaluation of the services offered and patient outcomes. The last component is provision for a periodic review of the practice agreement.

Certification and Licensure in Virginia

The Board of medicine and Board of Nursing jointly develop and prescribe regulations concerning certification and licensure of nurse practitioners (NPs) in the Commonwealth of Virginia. The laws are explicit that one cannot practice in Virginia without holding a joint license from the two regulatory agencies. Nurse practitioners can only practice as part of a patient care team and not independently. The Board of Nursing of Virginia recognizes certified registered nurse anesthetists (CRNA) and certified nurse midwives (CNM) as nurse practitioners and can get an NP license (Virginia State Law, 2021). The joint certification licenses NPs on the basis of graduate nursing education and specialty.

Application Process and Licensure Website for Virginia

The application process for one to be licensed to practice as NP entails endorsement and examination that are completed online at the Virginia Department of Health Professions, Initial Applications. Virginia participates in the Nurse Licensure Compact (NLC) program that allows nurses from compact states to practice in all other compact state using a single multi-state license. Initial applicants can log into the website to make their application to be enrolled and follow all the requirements and provisions as stated in the website by the state’s health department (VNA, 2022b). The Board of Nursing by the Department of Health website is the primary nurse licensure office resource for applicants who wish to practice in Virginia.

Scope of Practice for Nurse Practitioner

Virginia recognizes the scope of practice for NPs as activities and aspects of healthcare provision that the nurse is qualified to do competently based on their training, education and specialty. Further, Virginia does not recognize NPs as primary care providers due to the restrictive practice authority and collaboration agreements that they should possessVirginia Department of Health professionals (2022). Virginia describes specialties like midwifery and anesthetics as specialties but does not consider clinical nurse specialists as nurse practitioners.

A core aspect of practice agreement in Virginia is effective working relationship between the NP and physician as part of a health care team. NP’s practice agreement must adhere to the requirements mentioned earlier like periodic assessment of patient records with provisions on emergency cases and referrals for effective coordination.

Drug Enforcement Agency (DEA) License and NP’s Prescriptive Authority

Nurse practitioners who administer, prescribe and dispense any controlled substance must register with the Drug Enforcement Agency (DEA). The process in Virginia entails making online application to the Department of Justice website for new applicants, calling the DEA registration unit for renewal and reviews, and submission of a completed requisition form (DEA, 2022). The Commonwealth of Virginia allows NPs to prescribe drugs based on their scope of written practice agreement with a physician. Nurse practitioners in Virginia can prescribe Schedule II-IV controlled substances without a collaborative agreement when they meet certain set conditions.

Legislative and Advocacy Activities for NPs in Virginia

Through the Virginia Nurses Association (VNA), NPs in Virginia play an active role in advocating for policies which support the profession and creates a healthier state. Nurses in the state are involved in a host of activities that include the transition to independent practice legislation and bill on health insurance. The nurses are also advocating medical marijuana prescribing power for those who have transitioned to independent practice. The nurses are also engaged in efforts to protect their title in the Code of Virginia and legislative solutions like the creation of a Commission for a Healthy Virginia to support the health and wellbeing of all Virginians (VNA, 2022). The restrictive regulations and policies are critical barriers that hinder NPs from full and independent practice.


Scope of practice authority is a fundamental aspect of nursing and ability to provide quality care. NPs in Virginia practice based on the existing regulatory environment, which is restrictive and requires them to collaborate with physicians. New regulations expected to commence in July will expand the scope of NPs based on experience to practice to full authority without agreements or collaborations with NPs.



Drug Enforcement Administration (DEA) (2022). Registration Procedure.

Virginia Nurses Association (VNA) (2022). Policy & Advocacy.

Virginia State Law (2021) Code of Virginia.

Virginia State Law (2021b) Administrative Code: Practice agreement.

Virginia Nurses Association (VNA) (2022b). Reducing Unnecessary Practice Restrictions.

Virginia Department of Health professionals (2022). Board of Nursing: Application Wizard –

Nurse Practitioner.

Wakefield, M., Williams, D. R., & Le Menestrel, S. (2021). The future of nursing 2020-2030:

            Charting a path to achieve health equity. National Academy of Sciences.


Discussion post:- 3-4 page paper

*Review practice agreements for the state of Virginia.

*Identify whether Virginia requires physician collaboration or supervision for nurse practitioners and, if so, what those requirements are.

*How do you get certified and licensed in Virginia?

*What is the application process for certification in Virginia?

*What is the primary nurse licensure office resource website for Virginia?

*How does Virgnia define the scope of practice of a nurse practitioner?

*What is included in Virginia’s practice agreement?

*How do you get a Drug Enforcement Agency (DEA) license?

*How does Virgnia describe a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules are. Are nurse practitioners authorized to prescribe in Virginia?

*In what legislative and advocacy activities are Virginia’s nurse practitioner organization(s) involved?

* Include summary of your findings on the state of Virginia  based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in Virginia.  Be specific. Also, describe what surprised you from your research. Use APA format and include 3-4 scholarly references.


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