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HB1747 - Clinical Nurse Specialists (CNSs) Jointly licensed by Boards of Nursing and Medicine as Nurse Practitioners (LNPs)

Published on May 27, 2021

Subject: IMPORTANT MESSAGE from Jay Douglas, Executive Director of the Virginia Board of Nursing, on behalf of the Joint Boards of Nursing and Medicine, Virginia Department of Health Professions

HB1747: Clinical Nurse Specialists (CNSs) Jointly licensed by Boards of Nursing and Medicine as Nurse Practitioners (LNPs)
On March 18, 2021, Governor Northam signed into law HB 1747 which repeals § 54.1-3018.1 and amends §§ 54.1-2900, 54.1-2901, 54.1-2957, 54.1-2957.01 of the Virginia Code affecting the licensure and practice of CNSs as follows: 

  1. CNSs as Licensed Nurse Practitioners (LNPs):
    1. On July 1, 2021, CNSs currently registered by the Board of Nursing and who have completed an advanced graduate-level education CNS program will be jointly licensed by the Boards of Nursing and Medicine to practice as a nurse practitioner without prescriptive authority (RX Authority). 
    2. All eligible current active Clinical Nurse Specialists registered by the Board of Nursing will be issued a new Nurse Practitioner license in the category of clinical nurse specialist (#0024) which may be verified through License Lookup.
  2. Practice Agreement Requirement
    1. On July 1, 2021, all CNSs (whether they have prescriptive authority or not – see #3 below) will be required to practice in consultation with a licensed physician in accordance with a practice agreement between the CNS and the licensed physician.
    2. The practice agreement must address the availability of the physician for routine and urgent consultation on patient care as well as Schedule II-V drugs, if applicable.
    3. The practice agreement will be maintained by the CNS and only provided to the Boards upon request.
  3. CNS Prescriptive Authority
    1. A CNS may be granted RX Authority upon submission of satisfactory evidence of qualification as set forth in regulations of the Boards of Medicine and Nursing.  
    2. CNSs may prescribe
      1. Schedules II through V controlled substances in accordance with any prescriptive authority included in a practice agreement
      2. Schedule VI controlled substances without the requirement for inclusion of such prescriptive authority in a practice agreement.
    3. Submissions of evidence qualifying a CNS for RX Authority will be accepted on or after July 1st and thereafter using the following procedure:
      1. To add RX Authority to your new Nurse Practitioner license, submit a completed paper application along with the $35 application fee to the Board of Nursing after July 1, 2021. Click here for the Nurse Practitioner Application Instruction Checklist (see page 2) for the requirements to add RX Authority to your new Nurse Practitioner license, which is also posted on the Board of Nursing webpage.
      2. The qualifications for initial approval of prescriptive authority are found in 18VAC90-40-40 of the Regulations for Prescriptive Authority for Nurse Practitioners
      3. Once an RX Authority application is approved, RX Authority will be clearly designated as a ‘specialization’ on your LNP record and in License Lookup.

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Virginia Board of Nursing
Jay P. Douglas, MSM, RN, CSAC, FRE, Executive Director
Cynthia M. Swineford, MSN, RN, CNE, President