Protocol · NP · Virginia
Practice Protocol for Nurse Practitioners in Virginia
Required. Virginia law names the instrument a Practice Agreement, and the clinical protocol is the content that instrument carries. Below: the board that governs it, what it must contain, and the terms it has to carry.
Autonomous-practice designation must be applied for and granted — it is not automatic upon hitting the hours threshold.
Independent practice requires: equivalent of ≥3 years full-time clinical experience — § 54.1-2957(I) itself only says 'as determined by the Boards,' but 18VAC90-30-86 defines full-time as 1,800 hours/year, i.e. 5,400 hours total (confirmed directly against the regulation text; a commonly-repeated secondary-source figure of ≈4,500 hours appears to be an error propagated across NP-advice sites); attestation from a patient care team physician who supervised the experience, or (per H.B. 971, eff. 7/1/2024) an 'attesting nurse practitioner' who has held autonomous-practice status ≥3 years.
What a Virginia Practice Agreement must contain
Governed by the Virginia Board of Nursing and the Virginia Board of Pharmacy. Each numbered item is a statutory requirement the Practice Agreement must satisfy.
Unless the Nurse Practitioner qualifies to practice without a practice agreement under Va. Code § 54.1-2957(I), the Nurse Practitioner shall practice pursuant to a written or electronic practice agreement with the Physician, acting as patient care team physician, as required by Va. Code § 54.1-2957 and 18VAC90-30-120. The practice agreement shall provide for the Physician's availability for consultation and collaboration, guidelines for input on complex clinical cases, emergencies, and referrals, and a process for periodic joint evaluation of the services delivered under this Agreement. This Agreement is subject to the regulations of the Virginia Board of Nursing and the Virginia Board of Medicine.
Source: Va. Code § 54.1-2957
A Nurse Practitioner who has completed the equivalent of at least three years of full-time clinical experience in the practice category in which the Nurse Practitioner is certified and licensed may obtain from the Virginia Boards of Medicine and Nursing a license designation authorizing the Nurse Practitioner to practice without any practice agreement, upon the Boards' receipt of a qualifying attestation. Where the Nurse Practitioner holds that designation, this Agreement's practice-agreement terms as to the Nurse Practitioner are not themselves required by Virginia law as a condition of the Nurse Practitioner's authority to practice, and instead serve only to define the working relationship, referral pathways, and any Medical Director oversight the Parties choose to maintain. Virginia law does not otherwise fix a numerical limit on the number of Nurse Practitioners for whom a physician may serve as patient care team physician.
- The Practice Agreement also carries 1 scope, 1 education and 1 registration clauses, authored in the document itself.
Statutes and rules these clauses cite
- Va. Code § 54.1-2957statute
Licensure and practice of advanced practice registered nurses, including the practice agreement requirement (subsection C/D) and the autonomous-practice attestation pathway for experienced nurse practitioners (subsection I). Contains no numerical cap on the number of nurse practitioners a physician may serve as patient care team physician for.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the Practice Agreement has to carry, from Virginia's supervision rules.
Proximity
Available remotely (no on-site requirement)
No codified mile/minute radius or on-site requirement; practice agreement need only address availability for routine and urgent consultation (§ 54.1-2957, 18VAC90-40-90).
Supervision ratio
Up to 6 at a time
No more than 6 NPs per patient care team physician at any one time (18VAC90-40-90). Psychiatric-mental-health NPs have a separate, higher cap — see the dedicated `pmhnp` entry below rather than this general NP figure.
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Prescriptive scope (Schedules II–VI) must be specified in the practice agreement (§ 54.1-2957.01); autonomous-practice NPs prescribe within their own scope without agreement-based restriction.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Limited Liability Company (PLLC) under § 13.1-1102 — advanced practice registered nurses (APRNs, which includes NP) are explicitly listed as an eligible independent owner; no physician ownership required. Alternatively a Professional Corporation under § 13.1-543 with all shares held by licensed/authorized individuals.
NPs may independently own their own PLLC regardless of autonomous-practice status — this ownership pathway existed prior to, and is legally separate from, the § 54.1-2957 autonomous-practice clinical reform above.
About Virginia's rules
No provider type below has a codified chart-review percentage, countersignature rule, or numeric proximity radius — all are left to the practice agreement. CPOM (ownership) is governed by Title 13.1's PC/PLLC statutes, which explicitly list APRNs (NP/CRNA/CNM/CNS) as eligible independent owners but do not enumerate PAs — the PA ownership pathway is an inference from that omission, not a confirmed holding. Virginia has no independent corporate-practice-of-medicine common-law doctrine (a 1992 AG opinion, secondary-sourced only).
Other clinicians in Virginia: see the state overview.