Bill Text: VA HB971 | 2024 | Regular Session | Prefiled
Bill Title: Nurse practitioners; patient care team provider, autonomous practice.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2024-04-04 - Governor: Acts of Assembly Chapter text (CHAP0404) [HB971 Detail]
Download: Virginia-2024-HB971-Prefiled.html
Be it enacted by the General Assembly of Virginia:
1. That §§54.1-2957 and 54.1-2957.01 of the Code of Virginia are amended and reenacted as follows:
§54.1-2957. Licensure and practice of advanced practice registered nurses.
A. As used in this section, :
"clinical Clinical experience"
means the postgraduate delivery of health care directly to patients pursuant to
a practice agreement with a patient care team
physician provider.
"Patient care team provider" or "provider" means a patient care team physician, as defined in § 54.1-2900, or a nurse practitioner who meets the requirements of subsection I, is authorized to practice without a written or electronic practice agreement, and provides management and leadership as a part of a team that provides care to patients.
B. 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.
C. Every nurse practitioner who meets 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 provider. 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 providers
may be provided through telemedicine as described in §38.2-3418.16.
PhysiciansPatient care team providers 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.
Service 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. The Boards of Medicine and Nursing shall jointly promulgate
regulations specifying collaboration and consultation among
physicians patient care team providers
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
provider 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 provider.
E. 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 provider
pursuant to subsection I if such application provides an attestation to the
Boards that the applicant has completed the equivalent of at least five two
years of full-time clinical experience, as determined by the Boards, in
accordance with the laws of the state in which the nurse practitioner was
licensed.
F. Pending the outcome of the next National Specialty Examination, the Boards may jointly grant temporary licensure to advanced practice registered nurses.
G. In the event a physician who is
serving as that
a patient care team physician provider dies, becomes
disabled, retires from active practice, surrenders his license or has it suspended
or revoked by the Board, or Boards, as may be
appropriate, or relocates his practice such that he is no
longer able to serve, and an advanced practice registered nurse is unable to
enter into a new practice agreement with another patient care team physician
provider, 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
provider 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
patient care team provider 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 provider and of access to physician
provider input.
H. 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 certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or a licensed physician, in accordance with a practice agreement. Such practice agreement shall address the availability of the certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician 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 certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician with whom the certified nurse midwife has entered into a practice agreement stating (i) that such certified nurse midwife or licensed physician 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 certified nurse midwife or licensed physician 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.
I. A nurse practitioner who has completed the equivalent of at
least five two
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 the patient care team
physician provider
stating (i) that the patient care team physician provider has served as a
patient care team physician provider 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; (ii) that while a party to
such practice agreement, the patient care team
physician provider
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 (iii) the period of time for which the patient care team physician provider 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.
A nurse practitioner authorized to practice without a practice agreement pursuant to this subsection shall (a) 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, (b) consult and collaborate with other health care providers based on the clinical conditions of the patient to whom health care is provided, and (c) establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers.
J. 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.
A 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.
§54.1-2957.01. Prescription of certain controlled substances and devices by licensed advanced practice registered nurses.
A. In accordance with the provisions of this section and pursuant to the requirements of Chapter 33 (§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 (§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 §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 provider as defined in §
54.1-2957 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 provider, 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 §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 provider, 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 provider, 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 §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
provider, 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 provider or licensed
physician.
2. Physicians or
nurse practitioners shall not serve as a patient care team physician
provider 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 or
nurse practitioner may serve as a patient care team physician
provider 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 "administer" in §54.1-3401 or from receiving and dispensing manufacturers' 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 §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 §54.1-2957 to a patient requiring anesthesia, as part of the periprocedural care of such patient. As used in this subsection, "periprocedural" means the period beginning prior to a procedure and ending at the time the patient is discharged.
