A summary of Virginia’s collaboration, agreement, filing, supervision, prescribing, and specialty rules for NPs and the physicians who collaborate with them.
Collaborating Physician Required? Yes
Physician Involvement: Low
Agreement Name: Practice agreement
On-Site Requirements: None
Chart Review: Periodic review, at a cadence the NP and physician set; no fixed count
Controlled Substances: Allowed; no state credential and no state DEA registration required
Reduced Supervision / Transition Requirements: 5,400 hours to independent practice
Virginia NP Collaboration Requirements Summary
Most Virginia nurse practitioners must practice under a written practice agreement with a collaborating physician (called a “patient care team physician”), but Virginia offers a full path to independent practice. Day to day the physician’s involvement is light: there is no meeting cadence, no on-site or proximity requirement, and no fixed chart-review count. After the equivalent of three years (5,400 hours) of full-time clinical experience under a practice agreement, an NP can attest to that experience and receive a license to practice without an agreement.
Source: Va. Code § 54.1-2957
Type of Collaborative Relationship
Virginia NPs practice under a written practice agreement with a collaborating physician until they qualify for autonomous practice. The physician’s role is limited — no required meetings, availability standard, or in-person presence — and after three years (5,400 hours) of full-time clinical experience the NP can apply to practice independently. Simply serving on a patient care team does not, by itself, make the physician legally responsible for the NP’s care.
Source: Va. Code § 54.1-2957
What is an NP’s scope of practice in Virginia?
Virginia NPs may assess, diagnose, treat, and prescribe within the category in which they are certified and licensed. Until they qualify for autonomous practice, they do so under a written practice agreement with a collaborating physician; once autonomous, they practice within that same certified category without an agreement.
Do NPs need a collaborating physician in Virginia?
Yes, until they qualify for autonomous practice. An NP must have a written practice agreement with a patient care team physician until completing the equivalent of three years (5,400 hours) of full-time clinical experience, after which the agreement is no longer required.
Can NPs practice independently in Virginia?
Yes, after transitioning. An NP with a current, unrestricted license (other than a CRNA, and with separate rules for CNMs and CNSs) can practice autonomously after completing the equivalent of three years — 5,400 hours — of full-time clinical experience under a practice agreement and receiving board approval.
How many NPs can a physician supervise in Virginia?
Up to six. A physician may serve on a patient care team, or enter into a practice agreement, with no more than six NPs at one time — except that the limit is ten for NPs licensed in the psychiatric-mental health category.
Who can be a collaborating physician in Virginia?
A physician who practices with a patient population and in a practice area within the NP’s certification. The collaborating (patient care team) physician’s practice must fall within the category for which the NP is certified and licensed.
Are there proximity or in-person requirements in Virginia?
No. Virginia sets no geographic, travel, or in-person presence requirement for the collaborating physician.
Collaboration Agreement Requirements
Virginia’s agreement is called a practice agreement — a written or electronic statement jointly developed by the NP and the patient care team physician. It must provide for periodic review of health records at a cadence the clinicians set, physician input in complex cases and emergencies and for referrals, a description of the NP’s prescriptive authority (including which controlled substances the NP may or may not prescribe), and the NP’s authority for signatures and certifications. The physician must sign the agreement or be clearly named in it. Virginia does not provide a template, set a review or renewal schedule, or require a back-up physician.
Source: Va. Code § 54.1-2957(D)
What must be included in an NP collaborative agreement in Virginia?
The agreement must cover periodic health-record review, physician input for complex cases, emergencies, and referrals, a description of the NP’s prescriptive authority (including which controlled substances are or are not authorized), the physician’s name or signature, and the NP’s authority for signatures and certifications. It also describes the procedures to be followed and the acts the NP may perform within their specialty.
What is the collaborative agreement called in Virginia?
A practice agreement. It is a written or electronic statement jointly developed by the NP and the patient care team physician.
Who has to sign the collaborative agreement in Virginia?
The patient care team physician must sign it, or be clearly named in it. For agreements authorizing controlled-substance prescribing, the physician must either sign or be clearly identified as the physician who entered into the agreement.
How often must the agreement be reviewed or renewed in Virginia?
No, Virginia sets no specific review or renewal schedule for the practice agreement.
Is a backup physician required in Virginia?
No, Virginia sets no requirement for a backup physician.
Board Filing Requirements
No, Virginia does not require NPs to file the practice agreement with the board, and there is no recurring filing or termination-notice requirement. The NP must, however, keep evidence of the agreement and provide it to the boards on request. Virginia does provide leeway if a collaboration ends unexpectedly.
Source: Va. Code § 54.1-2957(D)
Do you have to file the collaborative agreement with the board in Virginia?
No. The agreement is not filed with the board, but the NP must maintain evidence of it and produce it to the boards upon request.
Can an NP start practicing as soon as they file in Virginia?
Not applicable. Because there is no filing requirement, there is no filing-based waiting period. An NP practices under the terms of the practice agreement.
What are the termination and notice requirements in Virginia?
No routine termination notice is required. If a collaboration ends unexpectedly (for example, the physician’s death, relocation, or retirement), an NP who notifies the Board of Medicine may continue under the agreement’s scope for 60 days, with an additional 60 days if the NP shows efforts to find a new collaborator.
Collaboration Compliance
Virginia’s ongoing obligations are light: the practice agreement must provide for periodic review of patient charts, but the manner and frequency are left to the NP and physician, and there is no meeting cadence, availability standard, co-signing, or record-retention requirement. The NP must simply be able to produce evidence of the agreement on request.
Source: 18 VAC 90-30-120(D)
How many charts must a collaborating physician review in Virginia?
No fixed number. The agreement must provide for periodic review of patient charts, but the manner and frequency are determined by the NP and the patient care team physician.
How often must an NP and collaborating physician meet in Virginia?
No, Virginia sets no required meeting cadence.
How long must collaboration records be kept in Virginia?
Virginia sets no fixed retention period. The NP must maintain evidence of the practice agreement and provide it to the boards upon request.
Prescribing Rules
Virginia NPs may prescribe, including controlled substances, and the state adds no extra credential, no state DEA registration, and no schedule-based supply limits beyond federal law. Which controlled substances an NP may prescribe is set within the practice agreement.
Source: Va. Code § 54.1-2957.01
Can an NP prescribe controlled substances in Virginia?
Yes. An NP may prescribe controlled substances as described in the practice agreement, which states the controlled substances the NP is or is not authorized to prescribe; Virginia imposes no additional state requirement for controlled-substance prescribing.
Can an NP prescribe Schedule II drugs in Virginia?
Yes, when authorized in the practice agreement. Virginia’s master data sets no schedule-based restriction or supply limit specific to NPs beyond federal law; prescribing must follow federal law and the terms of the agreement.
What schedule drugs can an NP prescribe in Virginia?
The controlled substances authorized in the NP’s practice agreement. Virginia does not, in the master data, list schedule-by-schedule NP restrictions; the agreement specifies which controlled substances the NP may or may not prescribe.
Does an NP need a DEA license in Virginia?
No state DEA registration is required. Virginia imposes no state-level DEA registration requirement; a federal DEA registration is still required to prescribe controlled substances under federal law.
Can an NP prescribe independently (without physician sign-off) in Virginia?
Yes, once autonomous. An NP authorized to practice without a practice agreement prescribes on their own; before that, prescriptive authority — including controlled substances — is exercised under the practice agreement.
Specialty & Telehealth Requirements
Virginia sets no telehealth-specific rules for NPs, but it does have specialty-specific requirements. Certified nurse midwives may practice without an agreement after 1,000 hours; clinical nurse specialists are independent except when prescribing controlled substances; and CRNAs, along with NPs appointed as medical examiners, must always practice with a collaborating physician.
Source: Va. Code § 54.1-2957(H), (J)
Are there telehealth or telemedicine requirements for NPs in Virginia?
No, Virginia sets no telehealth-specific requirement for NPs.
Are there specialty-specific requirements for NPs in Virginia?
Yes. Certified nurse midwives may practice independently after 1,000 hours; clinical nurse specialists are independent except for prescribing controlled substances; and CRNAs and NPs appointed as medical examiners must always practice with a collaborating physician.
How do you verify a collaborating physician’s license in Virginia?
Through the Virginia Board of Medicine’s license lookup. A physician’s license status can be confirmed with the licensing board.
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