Finding a Collaborating Physician in Virginia
The regulatory landscape for Nurse Practitioners (NPs) can be complex. However, Zivian streamlines the process of finding a collaborating physician. If you are an NP trying to find a collaborating physician in Virginia, we’ve got you covered.
The state of Virginia requires nurse practitioners to collaborate with a physician. Virginia is classified as a Restricted Practice Authority state.
In this post, we break down state regulations and key considerations when identifying, establishing, and sustaining a meaningful collaboration with a physician in Virginia.
Note: State regulations and requirements are subject to change. Always check with your state medical or nursing board to confirm the most up-to-date information.
What is the NP Practice Environment in Virginia?
In which category does the state fall: NP independent practice, transition to independence, or collaboration required?
A collaboration is required with a transition to independence.
NPs with less than five (5) years (note: this was changed from 2 to 5 years effective 7/1/2022) of full-time clinical experience must enter into a written or electronic practice agreement.
NPs with at least five (5) years of full-time clinical experience (1,800 hours per year) may practice “autonomously” by submitting an Application for Autonomous Practice to the Board of Nursing, including a certification from a patient care team physician who practiced with the NP.
Such “autonomous” NPs are not required to have a practice agreement, but they must still “[c]onsult and collaborate with other health care providers” on care delivery and “establish a plan for referral of complex medical cases and emergencies.”
Delegation Authority and Process
Is an agreement required?
NPs with less than five (5) years (note: this was changed from 2 to 5 years effective 7/1/2022) of full-time clinical experience must enter into a written or electronic “practice agreement.”
What form of agreement is required and what are the requirements for the substance of the agreement?
To learn about the components of a Virginia collaboration agreement, contact our team!
Where must the agreement be stored?
The agreement must be maintained by the NP, but no location is specified.
Does the agreement need to be filed with the state?
There is no requirement.
Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)?
No requirement.
Who must sign the agreement?
The collaborating physician must sign or be clearly identified.
How often must the agreement be reviewed/reauthorized?
The collaborative practice agreement must have a provision for review and revision, but no specified frequency is required by law.
What are the qualifications for the collaborating provider (licensure, same scope, active practice in state, etc.)?
The supervising physician must hold “an active, unrestricted license issued by the Virginia Board of Medicine to practice medicine or osteopathic medicine.”
What are the qualifications for the NP?
See licensure requirements specified by the Virginia Board of Nursing.
Is an alternate collaborating physician required?
There is no requirement.
Collaboration Requirements
Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
Physicians enter into a practice agreement with more than six nurse practitioners 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 nurse practitioners licensed in the category of psychiatric-mental health nurse practitioner..
Is there an express requirement to review a certain number/percentage of charts?
The practice agreement should have a provision for the periodic review of health records (which may include visits to the site where health care is delivered). The frequency is not stated.
Is there a requirement to meet and, if so, how often and how?
The practice agreement should have a provision for the periodic review of health records, which may include site visits. But site visits are not expressly required.
Are there proximity requirements (e.g., between the NP/collaborator or practice site)?
There is no requirement.
Are there location-specific requirements (e.g., that collaborator must go to practice site at some frequency)?
The practice agreement should have a provision for the periodic review of health records, which may include site visits. But site visits are not expressly required.
Is remote supervision allowed/are there limitations on remote supervision?
“Collaboration” and “consultation” among NPs and patient care team physicians may be provided through telemedicine.
The term “collaboration” is defined as “the communication and decision making process among members of a patient care team related to the treatment and care of a patient and includes (i) communication of data and information about the treatment and care of a patient, including exchange of clinical observations and assessments, and (ii) development of an appropriate plan of care, including decisions regarding the health care provided, accessing and assessment of appropriate additional resources or expertise, and arrangement of appropriate referrals, testing, or studies.”
The term “consultation” means “the communicating of data and information, exchanging of clinical observations and assessments, accessing and assessing of additional resources and expertise, problem solving, and arranging for referrals, testing, or studies.”
Physician and NP Filing Requirements
Outside of filing the collaboration agreement, must the physician and/or NP file any separate forms? NOTE: timing/frequency should be noted because the state may have requirements for initial filing and/or filing for updates, terminations, etc.
In the event a physician who is serving as a patient care team physician is no longer able to serve, and the NP is unable to enter into a new practice agreement with another patient care team physician, the NP may continue to practice upon notification to the designee or his alternate of the Board of Nursing and receipt of such notification.
Such NP may continue to treat patients without a patient care team physician for an initial period not to exceed 60 days, provided the NP continues to prescribe only those drugs previously authorized by the practice agreement with such physician 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 nurse practitioner to continue practice under this subsection for another 60 days, provided the nurse practitioner provides evidence of efforts made to secure another patient care team physician and of access to physician input.
Prescription Requirements and Controlled Substance Prescribing
What are the prescription requirements?
All prescription drugs/devices in Virginia are considered controlled substances.
The following restrictions shall apply to any nurse practitioner authorized to prescribe drugs and devices pursuant to this section:
The NP shall disclose to the patient at the initial encounter that he is a licensed nurse practitioner. 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 NP 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.
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 nurse practitioners 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 nurse practitioners licensed in the category of psychiatric-mental health nurse practitioner.
See the following resources for further instruction:
See 18 VAC 90-40-150 for treatment of acute pain.
See 18 VAC 90-40-180 for treatment of chronic pain.
See 18 VAC 90-40-250 for use of buprenorphine.
What are the requirements for controlled substance prescribing?
A nurse practitioner licensed by the Boards in the category of clinical nurse specialist who prescribes controlled substances or devices shall practice in consultation with a licensed physician in accordance with a practice agreement between the nurse practitioner and the licensed physician. Such practice agreement shall address the availability of the physician for routine and urgent consultation on patient care. An NP who can practice without a practice agreement may prescribe controlled substances.
Sources
18 VAC 90-30-86
18 VAC 90-30-87 (Nurse Midwives independent practice requirements)
18 VAC 90-40-10
