SB263: Nurse practitioners; moves responsibility for licensure and regulation to Board of Nursing.
Be it enacted by the General Assembly of Virginia:
1. That §§ 13.1-543, 13.1-1102, 22.1-270, 32.1-11.5, 32.1-134.2, 54.1-2701, 54.1-2901, 54.1-2914, 54.1-3000, 54.1-3001, 54.1-3301, 54.1-3303, 54.1-3401, 54.1-3408, and 63.2-2203 of the Code of Virginia are amended and reenacted and that the Code of Virginia is amended by adding in Chapter 30 of Title 54.1 an article numbered 8, consisting of sections numbered 54.1-3044 through 54.1-3048, as follows:
§ 13.1-543. Definitions.
A. As used in this chapter:
"Eligible employee stock ownership plan" means an employee stock ownership plan as such term is defined in § 4975(e) (7) of the Internal Revenue Code of 1986, as amended, sponsored by a professional corporation and with respect to which:
1. All of the trustees of the employee stock ownership plan are individuals who are duly licensed or otherwise legally authorized to render the professional services for which the professional corporation is organized under this chapter; however, if a conflict of interest exists for one or more trustees with respect to a specific issue or transaction, such trustees may appoint a special independent trustee or special fiduciary, who is not duly licensed or otherwise legally authorized to render the professional services for which the professional corporation is organized under this chapter, which special independent trustee shall be authorized to make decisions only with respect to the specific issue or transaction that is the subject of the conflict;
2. The employee stock ownership plan provides that no shares, fractional shares, or rights or options to purchase shares of the professional corporation shall at any time be issued, sold, or otherwise transferred directly to anyone other than an individual duly licensed or otherwise legally authorized to render the professional services for which the professional corporation is organized under this chapter, unless such shares are transferred as a plan distribution to a plan beneficiary and subject to immediate repurchase by the professional corporation, the employee stock ownership plan or another person authorized to hold such shares; however:
a. With respect to a professional corporation rendering the professional services of public accounting or certified public accounting:
(1) The employee stock ownership plan may permit individuals who are not duly licensed or otherwise legally authorized to render these services to participate in such plan, provided such individuals are employees of the corporation and hold less than a majority of the beneficial interests in such plan; and
(2) At least 51% percent of the total of
allocated and unallocated equity interests in the corporation sponsoring such
employee stock ownership plan are held (i) by the trustees of such employee
stock ownership plan for the benefit of persons holding a valid CPA certificate
as defined in § 54.1-4400, with unallocated shares allocated for these purposes
pursuant to § 409(p) of the Internal Revenue Code of 1986, as amended, or (ii)
by individual employees holding a valid CPA certificate separate from any
interests held by such employee stock ownership plan; and
b. With respect to a professional corporation rendering the professional services of architects, professional engineers, land surveyors, landscape architects, or certified interior designers, the employee stock ownership plan may permit individuals who are not duly licensed to render the services of architects, professional engineers, land surveyors, or landscape architects, or individuals legally authorized to use the title of certified interior designers to participate in such plan, provided such individuals are employees of the corporation and together hold not more than one-third of the beneficial interests in such plan, and that the total of the shares (i) held by individuals who are employees but not duly licensed to render such services or legally authorized to use a title and (ii) held by the trustees of such employee stock ownership plan for the benefit of individuals who are employees but not duly licensed to render such services or legally authorized to use a title, shall not exceed one-third of the shares of the corporation; and
3. The professional corporation, the trustees of the employee stock ownership plan, and the other shareholders of the professional corporation comply with the foregoing provisions of the plan.
"Professional business entity" means any entity as defined in § 13.1-603 that is duly licensed or otherwise legally authorized under the laws of the Commonwealth or the laws of the jurisdiction under whose laws the entity is formed to render the same professional service as that for which a professional corporation or professional limited liability company may be organized, including, but not limited to, (i) a professional limited liability company as defined in § 13.1-1102, (ii) a professional corporation as defined in this subsection, or (iii) a partnership that is registered as a registered limited liability partnership registered under § 50-73.132, all of the partners of which are duly licensed or otherwise legally authorized to render the same professional services as those for which the partnership was organized.
"Professional corporation" means a corporation whose
articles of incorporation set forth a sole and specific purpose permitted by
this chapter and that is either (i) organized under this chapter for the sole
and specific purpose of rendering professional service other than that of
architects, professional engineers, land surveyors, or landscape architects, or
using a title other than that of certified interior designers and, except as
expressly otherwise permitted by this chapter, that has as its shareholders or
members only individuals or professional business entities that are duly
licensed or otherwise legally authorized to render the same professional
service as the corporation, including the trustees of an eligible employee
stock ownership plan or (ii) organized under this chapter for the sole and
specific purpose of rendering the professional services of architects,
professional engineers, land surveyors, or landscape architects, or using the
title of certified interior designers, or any combination thereof, and at least
two-thirds of whose shares are held by persons duly licensed within the
Commonwealth to perform the services of an architect, professional engineer,
land surveyor, or landscape architect, including the trustees of an eligible
employee stock ownership plan, or by persons legally authorized within the
Commonwealth to use the title of certified interior designer; or (iii)
organized under this chapter or under Chapter 10 (§ 13.1-801 et seq.) of this
title for the sole and specific purpose of rendering the professional services
of one or more practitioners of the healing arts, licensed under the provisions
of Chapter 29 (§ 54.1-2900 et seq.) of Title 54.1, or one or more nurse
practitioners, licensed under Chapter 29
(§ 54.1-2900 et seq.) 30
(§ 54.1-3000 et seq.) of Title
54.1, or one or more optometrists licensed under the provisions of Chapter 32
(§ 54.1-3200 et seq.) of Title 54.1, or one or more physical therapists and
physical therapist assistants licensed under the provisions of Chapter 34.1 (§
54.1-3473 et seq.) of Title 54.1, or one or more practitioners of the
behavioral science professions, licensed under the provisions of Chapter 35 (§
54.1-3500 et seq.), 36 (§ 54.1-3600 et seq.) or 37 (§ 54.1-3700 et seq.) of
Title 54.1, or one or more practitioners of audiology or speech pathology,
licensed under the provisions of Chapter 26 (§ 54.1-2600 et seq.) of Title
54.1, or one or more clinical nurse specialists who render mental health
services licensed under Chapter 30 (§ 54.1-3000 et seq.) of Title 54.1 and
registered with the Board of Nursing, or any combination of practitioners of
the healing arts, optometry, physical therapy, the behavioral science
professions, and audiology or speech pathology, and all of whose shares are
held by or all of whose members are individuals or professional business
entities duly licensed or otherwise legally authorized to perform the services
of a practitioner of the healing arts, nurse practitioners, optometry, physical
therapy, the behavioral science professions, audiology or speech pathology or
of a clinical nurse specialist who renders mental health services, including
the trustees of an eligible employee stock ownership plan; however, nothing
herein shall be construed so as to allow any member of the healing arts,
optometry, physical therapy, the behavioral science professions, audiology or
speech pathology or a nurse practitioner or clinical nurse specialist to
conduct his practice in a manner contrary to the standards of ethics of his branch
of the healing arts, optometry, physical therapy, the behavioral science
professions, audiology or speech pathology, or nursing, as the case may be.
"Professional service" means any type of personal service to the public that requires as a condition precedent to the rendering of such service or use of such title the obtaining of a license, certification, or other legal authorization and shall be limited to the personal services rendered by pharmacists, optometrists, physical therapists and physical therapist assistants, practitioners of the healing arts, nurse practitioners, practitioners of the behavioral science professions, veterinarians, surgeons, dentists, architects, professional engineers, land surveyors, landscape architects, certified interior designers, public accountants, certified public accountants, attorneys-at-law, insurance consultants, audiologists or speech pathologists, and clinical nurse specialists. For the purposes of this chapter, the following shall be deemed to be rendering the same professional service:
1. Architects, professional engineers, and land surveyors; and
2. Practitioners of the healing arts, licensed under the
provisions of Chapter 29 (§ 54.1-2900 et seq.) of Title 54.1; nurse
practitioners, licensed under the provisions of Chapter 29
(§ 54.1-2900 et seq.) 30
(§ 54.1-3000 et seq.)
of Title 54.1; optometrists, licensed under the provisions of Chapter 32 (§
54.1-3200 et seq.) of Title 54.1; physical therapists and physical therapist
assistants, licensed under the provisions of Chapter 34.1 (§ 54.1-3473 et seq.)
of Title 54.1; practitioners of the behavioral science professions, licensed
under the provisions of Chapters 35 (§ 54.1-3500 et seq.), 36 (§ 54.1-3600 et
seq.), and 37 (§ 54.1-3700 et seq.) of Title 54.1; and one or more clinical
nurse specialists who render mental health services, licensed under Chapter 30
(§ 54.1-3000 et seq.) of Title 54.1 and are registered with the Board of
Nursing.
B. Persons who practice the healing art of performing professional clinical laboratory services within a hospital pathology laboratory shall be legally authorized to do so for purposes of this chapter if such persons (i) hold a doctorate degree in the biological sciences or a board certification in the clinical laboratory sciences and (ii) are tenured faculty members of an accredited medical college or university that is an "educational institution" within the meaning of § 23-14.
§ 13.1-1102. Definitions.
A. As used in this chapter:
"Professional business entity" means any entity as defined in § 13.1-603 that is duly licensed or otherwise legally authorized under the laws of the Commonwealth or the laws of the jurisdiction under whose laws the entity is formed to render the same professional service as that for which a professional corporation or professional limited liability company may be organized, including, but not limited to, (i) a professional limited liability company as defined in this subsection, (ii) a professional corporation as defined in subsection A of § 13.1-543, or (iii) a partnership that is registered as a registered limited liability partnership under § 50-73.132, all of the partners of which are duly licensed or otherwise legally authorized to render the same professional services as those for which the partnership was organized.
"Professional limited liability company" means a
limited liability company whose articles of organization set forth a sole and
specific purpose permitted by this chapter and that is either (i) organized
under this chapter for the sole and specific purpose of rendering professional
service other than that of architects, professional engineers, land surveyors,
or landscape architects, or using a title other than that of certified interior
designers and, except as expressly otherwise permitted by this chapter, that
has as its members only individuals or professional business entities that are
duly licensed or otherwise legally authorized to render the same professional
service as the professional limited liability company or (ii) organized under
this chapter for the sole and specific purpose of rendering professional
service of architects, professional engineers, land surveyors, or landscape
architects or using the title of certified interior designers, or any
combination thereof, and at least two-thirds of whose membership interests are
held by persons duly licensed within the Commonwealth to perform the services
of an architect, professional engineer, land surveyor, or landscape architect,
or by persons legally authorized within the Commonwealth to use the title of
certified interior designer; or (iii) organized under this chapter for the sole
and specific purpose of rendering the professional services of one or more
practitioners of the healing arts, licensed under the provisions of Chapter 29
(§ 54.1-2900 et seq.) of Title 54.1, or one or more nurse practitioners,
licensed under Chapter 29
(§ 54.1-2900 et seq.) 30
(§ 54.1-3000 et seq.)
of Title 54.1, or one or more optometrists licensed under the provisions of
Chapter 32 (§ 54.1-3200 et seq.) of Title 54.1, or one or more physical
therapists and physical therapist assistants licensed under the provisions of
Chapter 34.1 (§ 54.1-3473 et seq.) of Title 54.1, or one or more practitioners
of the behavioral science professions, licensed under the provisions of Chapter
35 (§ 54.1-3500 et seq.), 36 (§ 54.1-3600 et seq.) or 37 (§ 54.1-3700 et seq.)
of Title 54.1, or one or more practitioners of audiology or speech pathology,
licensed under the provisions of Chapter 26 (§ 54.1-2600 et seq.) of Title
54.1, or one or more clinical nurse specialists who render mental health
services licensed under Chapter 30 (§ 54.1-3000 et seq.) of Title 54.1 and
registered with the Board of Nursing, or any combination of practitioners of
the healing arts, of optometry, physical therapy, the behavioral science
professions, and audiology or speech pathology and all of whose members are
individuals or professional business entities duly licensed or otherwise
legally authorized to perform the services of a practitioner of the healing
arts, nurse practitioners, optometry, physical therapy, the behavioral science
professions, audiology or speech pathology or of a clinical nurse specialist
who renders mental health services; however, nothing herein shall be construed
so as to allow any member of the healing arts, optometry, physical therapy, the
behavioral science professions, audiology or speech pathology or a nurse
practitioner or clinical nurse specialist to conduct that person's practice in
a manner contrary to the standards of ethics of that person's branch of the
healing arts, optometry, physical therapy, the behavioral science professions,
or audiology or speech pathology, or nursing as the case may be.
"Professional services" means any type of personal service to the public that requires as a condition precedent to the rendering of that service or the use of that title the obtaining of a license, certification, or other legal authorization and shall be limited to the personal services rendered by pharmacists, optometrists, physical therapists and physical therapist assistants, practitioners of the healing arts, nurse practitioners, practitioners of the behavioral science professions, veterinarians, surgeons, dentists, architects, professional engineers, land surveyors, landscape architects, certified interior designers, public accountants, certified public accountants, attorneys at law, insurance consultants, audiologists or speech pathologists and clinical nurse specialists. For the purposes of this chapter, the following shall be deemed to be rendering the same professional services:
1. Architects, professional engineers, and land surveyors; and
2. Practitioners of the healing arts, licensed under the
provisions of Chapter 29 (§ 54.1-2900 et seq.) of Title 54.1, nurse practitioners,
licensed under Chapter 29
(§ 54.1-2900 et seq.) 30
(§ 54.1-3000 et seq.)
of Title 54.1, optometrists, licensed under the provisions of Chapter 32 (§
54.1-3200 et seq.) of Title 54.1, physical therapists, licensed under the provisions
of Chapter 34.1 (§ 54.1-3473 et seq.) of Title 54.1, practitioners of the
behavioral science professions, licensed under the provisions of Chapters 35 (§
54.1-3500 et seq.), 36 (§ 54.1-3600 et seq.), and 37 (§ 54.1-3700 et seq.) of
Title 54.1, and clinical nurse specialists who render mental health services
licensed under Chapter 30 (§ 54.1-3000 et seq.) of Title 54.1 and registered
with the Board of Nursing.
B. Persons who practice the healing art of performing professional clinical laboratory services within a hospital pathology laboratory shall be legally authorized to do so for purposes of this chapter if such persons (i) hold a doctorate degree in the biological sciences or a board certification in the clinical laboratory sciences and (ii) are tenured faculty members of an accredited medical college or university that is an "educational institution" within the meaning of § 23-14.
C. Except as expressly otherwise provided, all terms defined in § 13.1-1002 shall have the same meanings for purposes of this chapter.
§ 22.1-270. Preschool physical examinations.
A. No pupil shall be admitted for the first time to any public
kindergarten or elementary school in a school division unless such pupil shall
furnish, prior to admission, (i) a report from a qualified licensed physician, or a licensed
nurse practitioner, or
licensed physician assistant acting under the supervision of a licensed
physician, of a comprehensive physical examination of a scope prescribed by the
State Health Commissioner performed within the 12 months prior to the date such
pupil first enters such public kindergarten or elementary school or (ii)
records establishing that such pupil furnished such report upon prior admission
to another school or school division and providing the information contained in
such report.
If the pupil is a homeless child or youth as defined in § 22.1-3, and for that reason cannot furnish the report or records required by (i) or (ii) of this subsection, and the person seeking to enroll the pupil furnishes to the school division an affidavit so stating and also indicating that, to the best of his knowledge, such pupil is in good health and free from any communicable or contagious disease, the school division shall immediately refer the student to the local school division liaison, as described in the federal McKinney-Vento Homeless Education Assistance Improvements Act of 2001, as amended (42 U.S.C. § 11431 et seq.) (the Act), who shall, as soon as practicable, assist in obtaining the necessary physical examination by the county or city health department or other clinic or physician's office and shall immediately admit the pupil to school, as required by such Act.
B. The physician, or licensed
nurse practitioner,
or licensed physician assistant acting under the supervision of a licensed
physician, making a report of a physical examination required by this section
shall, at the end of such report, summarize the abnormal physical findings, if
any, and shall specifically state what, if any, conditions are found that would
identify the child as handicapped.
C. Such physical examination report shall be placed in the child's health record at the school and shall be made available for review by any employee or official of the State Department of Health or any local health department at the request of such employee or official.
D. Such physical examination shall not be required of any child whose parent shall object on religious grounds and who shows no visual evidence of sickness, provided that such parent shall state in writing that, to the best of his knowledge, such child is in good health and free from any communicable or contagious disease.
E. The health departments of all of the counties and cities of the Commonwealth shall conduct such physical examinations for medically indigent children without charge upon request and may provide such examinations to others on such uniform basis as such departments may establish.
F. Parents of entering students shall complete a health information form which shall be distributed by the local school divisions. Such forms shall be developed and provided jointly by the Department of Education and Department of Health, or developed and provided by the school division and approved by the Superintendent of Public Instruction. Such forms shall be returnable within 15 days of receipt unless reasonable extensions have been granted by the superintendent or his designee. Upon failure of the parent to complete such form within the extended time, the superintendent may send to the parent written notice of the date he intends to exclude the child from school; however, no child who is a homeless child or youth as defined in subdivision 6 of § 22.1-3 shall be excluded from school for such failure to complete such form.
§ 32.1-11.5. Pilot programs for obstetrical and pediatric care in underserved areas.
A. The Board may approve pilot programs to improve access to (i) obstetrical care, which for the purposes of this section includes prenatal, delivery, and post-partum care; and (ii) pediatric care in areas of the Commonwealth where these services are severely limited. The proposals for such pilot programs shall be jointly developed and submitted to the Board by nurse practitioners licensed in the category of certified nurse midwife, certain perinatal centers as determined by the Board, obstetricians, family physicians, and pediatricians.
B. Nurse practitioners licensed by the Boards
of Medicine and Board
of Nursing in the category of certified nurse midwife who
participate in a pilot program shall associate with perinatal centers
recommended by the Board and community obstetricians, family physicians, and
pediatricians and, notwithstanding any provision of law or regulation to the
contrary, shall not be required to have physician supervision to provide
obstetrical services to women with low-risk pregnancies who consent to receive
care under the pilot program arrangements. Further, notwithstanding any
provision of law or regulation to the contrary, a nurse practitioner licensed
by the Boards of Medicine
and Board
of Nursing in the category of certified nurse midwife
holding a license for prescriptive authority may prescribe Schedules III
through VI controlled substances without the
requirement for either medical direction or supervision or a written agreement
between the licensed nurse practitioner and a licensed physician.
Such perinatal center shall provide administrative oversight by (i) assisting
in the development of appropriate clinical care protocols and clinical
collaboration, (ii) accepting transfers when necessary, and (iii) providing
clinical consultation when requested. Removal
of the requirement for physician supervision for participating nurse
practitioners licensed by the Boards of Medicine and Nursing in the category of
certified nurse midwife shall not extend beyond the pilot programs or be
granted to certified nurse midwives who do not participate in approved pilot
programs. Further, the removal of the requirement of physician supervision
shall not authorize nurse Nurse
practitioners licensed by the Boards
of Medicine and Board
of Nursing in the category of certified nurse midwife shall not be authorized to provide
care to women with high-risk pregnancies or care that is not directly related
to a low-risk pregnancy and delivery. Nurse practitioners licensed by the Boards of Medicine
and Board
of Nursing in the category of certified nurse midwife
participating in a pilot program shall maintain professional liability
insurance as recommended by the Division of Risk Management of the Department
of the Treasury.
C. The Department shall convene stakeholders, including nurse
practitioners licensed by the Boards
of Medicine and Board
of Nursing in the category of certified nurse midwife,
obstetricians, family physicians and pediatricians to establish protocols to be
used in the pilot programs no later than October 1, 2005. The
protocols shall include a uniform risk-screening tool for pregnant women to
assure that women are referred to the appropriate provider based on their risk
factors.
D. Pilot program proposals submitted for areas where access to obstetrical and pediatric care services is severely limited shall include mutually agreed upon protocols consistent with evidence-based practice and based on national standards that describe criteria for risk assessment, referral, and backup and shall also document how the pilot programs will evaluate their model and quality of care.
E. Pilot sites that elect to include birthing centers as part of the system of care shall be in close proximity to a health care facility equipped to perform emergency surgery, if needed. Birthing centers are facilities outside hospitals that provide maternity services. Any birthing center that is part of the pilot program shall, at a minimum, maintain membership in the National Association of Childbearing Centers and annually submit such information as may be required by the Commissioner. The pilot programs shall not provide or promote home births.
F. The Department shall evaluate and report on the impact and effectiveness of the pilot programs in meeting the program goals. The evaluation shall include the number of births, the number of referrals for emergency treatment services, successes and problems encountered, the overall operation of the pilot programs, and recommendations for improvement of the program. The Department shall submit a report to the Joint Commission on Health Care by November 15, 2006, and annually thereafter.
§ 32.1-134.2. Clinical privileges for certain practitioners.
The grant or denial of clinical privileges to licensed
podiatrists and certified nurse midwives licensed as nurse practitioners
pursuant to § 54.1-2957 54.1-3044
by any hospital licensed in this Commonwealth, and the determination by the
hospital of the scope of such privileges, shall be based upon such
practitioner's professional license, experience, competence, ability, and
judgment, and the reasonable objectives and regulations of the hospital in
which such privileges are sought.
§ 54.1-2701. Exemptions.
This chapter shall not:
1. Apply to a licensed physician or surgeon unless he practices dentistry as a specialty;
2. Apply to a nurse practitioner certified licensed
by the Board of Nursing and the Board of
Medicine except that intraoral procedures shall be
performed only under the direct supervision of a licensed dentist;
3. Apply to a dentist or a dental hygienist of the United States Army, Navy, Coast Guard, Air Force, Public Health Service, or Veterans Administration;
4. Apply to any dentist of the United States Army, Navy, Coast Guard, or Air Force rendering services voluntarily and without compensation while deemed to be licensed pursuant to § 54.1-106;
5. Apply to any dentist or dental hygienist who (i) does not regularly practice dentistry in Virginia, (ii) holds a current valid license or certificate to practice as a dentist or dental hygienist in another state, territory, district or possession of the United States, (iii) volunteers to provide free health care to an underserved area of this Commonwealth under the auspices of a publicly supported all volunteer, nonprofit organization that sponsors the provision of health care to populations of underserved people, (iv) files a copy of the license or certificate issued in such other jurisdiction with the Board, (v) notifies the Board at least 15 days prior to the voluntary provision of services of the dates and location of such service, and (vi) acknowledges, in writing, that such licensure exemption shall only be valid, in compliance with the Board's regulations, during the limited period that such free health care is made available through the volunteer, nonprofit organization on the dates and at the location filed with the Board. The Board may deny the right to practice in Virginia to any dentist or dental hygienist whose license has been previously suspended or revoked, who has been convicted of a felony or who is otherwise found to be in violation of applicable laws or regulations; or
6. Prevent an office assistant from performing usual secretarial duties or other assistance as set forth in regulations promulgated by the Board.
§ 54.1-2901. Exceptions and exemptions generally.
A. The
provisions of this chapter shall not prevent or prohibit:
1. Any person entitled to practice his profession under any prior law on June 24, 1944, from continuing such practice within the scope of the definition of his particular school of practice;
2. Any person licensed to practice naturopathy prior to June 30, 1980, from continuing such practice in accordance with regulations promulgated by the Board;
3. Any licensed nurse practitioner from rendering care under the supervision
of a duly licensed physician when such services are authorized by regulations
promulgated jointly by the Board of Medicine and the Board of Nursing or services within
the scope of his licensure and specialty certification;
4. Any registered professional nurse, licensed
nurse practitioner, graduate laboratory technician or other
technical personnel who have been properly trained from rendering care or
services within the scope of their usual professional activities which shall
include the taking of blood, the giving of intravenous infusions and
intravenous injections, and the insertion of tubes when performed under the
orders of a person licensed to practice medicine;
5. Any dentist, pharmacist or optometrist from rendering care or services within the scope of his usual professional activities;
6. Any practitioner licensed or certified by the Board from delegating to personnel supervised by him, such activities or functions as are nondiscretionary and do not require the exercise of professional judgment for their performance and which are usually or customarily delegated to such persons by practitioners of the healing arts, if such activities or functions are authorized by and performed for such practitioners of the healing arts and responsibility for such activities or functions is assumed by such practitioners of the healing arts;
7. The rendering of medical advice or information through telecommunications from a physician licensed to practice medicine in Virginia or an adjoining state to emergency medical personnel acting in an emergency situation;
8. The domestic administration of family remedies;
9. The giving or use of massages, steam baths, dry heat rooms, infrared heat or ultraviolet lamps in public or private health clubs and spas;
10. The manufacture or sale of proprietary medicines in this Commonwealth by licensed pharmacists or druggists;
11. The advertising or sale of commercial appliances or remedies;
12. The fitting by nonitinerant persons or manufacturers of artificial eyes, limbs or other apparatus or appliances or the fitting of plaster cast counterparts of deformed portions of the body by a nonitinerant bracemaker or prosthetist for the purpose of having a three-dimensional record of the deformity, when such bracemaker or prosthetist has received a prescription from a licensed physician directing the fitting of such casts and such activities are conducted in conformity with the laws of Virginia;
13. Any person from the rendering of first aid or medical assistance in an emergency in the absence of a person licensed to practice medicine or osteopathy under the provisions of this chapter;
14. The practice of the religious tenets of any church in the ministration to the sick and suffering by mental or spiritual means without the use of any drug or material remedy, whether gratuitously or for compensation;
15. Any legally qualified out-of-state or foreign practitioner from meeting in consultation with legally licensed practitioners in this Commonwealth;
16. Any practitioner of the healing arts licensed or certified and in good standing with the applicable regulatory agency in another state or Canada when that practitioner of the healing arts is in Virginia temporarily and such practitioner has been issued a temporary license or certification by the Board from practicing medicine or the duties of the profession for which he is licensed or certified (i) in a summer camp or in conjunction with patients who are participating in recreational activities, (ii) while participating in continuing educational programs prescribed by the Board, or (iii) by rendering at any site any health care services within the limits of his license, voluntarily and without compensation, to any patient of any clinic which is organized in whole or in part for the delivery of health care services without charge as provided in § 54.1-106;
17. The performance of the duties of any commissioned or contract medical officer, or podiatrist in active service in the army, navy, coast guard, marine corps, air force, or public health service of the United States while such individual is so commissioned or serving;
18. Any masseur, who publicly represents himself as such, from performing services within the scope of his usual professional activities and in conformance with state law;
19. Any person from performing services in the lawful conduct of his particular profession or business under state law;
20. Any person from rendering emergency care pursuant to the provisions of § 8.01-225;
21. Qualified emergency medical services personnel, when acting within the scope of their certification, and licensed health care practitioners, when acting within their scope of practice, from following Durable Do Not Resuscitate Orders issued in accordance with § 54.1-2987.1 and Board of Health regulations, or licensed health care practitioners from following any other written order of a physician not to resuscitate a patient in the event of cardiac or respiratory arrest;
22. Any commissioned or contract medical officer of the army, navy, coast guard or air force rendering services voluntarily and without compensation while deemed to be licensed pursuant to § 54.1-106;
23. Any provider of a chemical dependency treatment program who is certified as an "acupuncture detoxification specialist" by the National Acupuncture Detoxification Association or an equivalent certifying body, from administering auricular acupuncture treatment under the appropriate supervision of a National Acupuncture Detoxification Association certified licensed physician or licensed acupuncturist;
24. Any employee of any assisted living facility who is certified in cardiopulmonary resuscitation (CPR) acting in compliance with the patient's individualized service plan and with the written order of the attending physician not to resuscitate a patient in the event of cardiac or respiratory arrest;
25. Any person working as a health assistant under the direction of a licensed medical or osteopathic doctor within the Department of Corrections, the Department of Juvenile Justice or local correctional facilities;
26. Any employee of a school board, authorized by a prescriber and trained in the administration of insulin and glucagon, when, upon the authorization of a prescriber and the written request of the parents as defined in § 22.1-1, assisting with the administration of insulin or administrating glucagon to a student diagnosed as having diabetes and who requires insulin injections during the school day or for whom glucagon has been prescribed for the emergency treatment of hypoglycemia;
27. Any practitioner of the healing arts or other profession regulated by the Board from rendering free health care to an underserved population of Virginia who (i) does not regularly practice his profession in Virginia, (ii) holds a current valid license or certificate to practice his profession in another state, territory, district or possession of the United States, (iii) volunteers to provide free health care to an underserved area of this Commonwealth under the auspices of a publicly supported all volunteer, nonprofit organization that sponsors the provision of health care to populations of underserved people, (iv) files a copy of the license or certification issued in such other jurisdiction with the Board, (v) notifies the Board at least five business days prior to the voluntary provision of services of the dates and location of such service, and (vi) acknowledges, in writing, that such licensure exemption shall only be valid, in compliance with the Board's regulations, during the limited period that such free health care is made available through the volunteer, nonprofit organization on the dates and at the location filed with the Board. The Board may deny the right to practice in Virginia to any practitioner of the healing arts whose license or certificate has been previously suspended or revoked, who has been convicted of a felony or who is otherwise found to be in violation of applicable laws or regulations. However, the Board shall allow a practitioner of the healing arts who meets the above criteria to provide volunteer services without prior notice for a period of up to three days, provided the nonprofit organization verifies that the practitioner has a valid, unrestricted license in another state;
28. Any registered nurse, acting as an agent of the Department of Health, from obtaining specimens of sputum or other bodily fluid from persons in whom the diagnosis of active tuberculosis disease, as defined in § 32.1-49.1, is suspected and submitting orders for testing of such specimens to the Division of Consolidated Laboratories or other public health laboratories, designated by the State Health Commissioner, for the purpose of determining the presence or absence of tubercle bacilli as defined in § 32.1-49.1;
29. Any physician of medicine or osteopathy or nurse practitioner from delegating to a registered nurse under his supervision the screening and testing of children for elevated blood-lead levels when such testing is conducted (i) in accordance with a written protocol between the physician or nurse practitioner and the registered nurse and (ii) in compliance with the Board of Health's regulations promulgated pursuant to §§ 32.1-46.1 and 32.1-46.2. Any follow-up testing or treatment shall be conducted at the direction of a physician or nurse practitioner; or
30. Any practitioner of one of the professions regulated by
the Board of Medicine who is in good standing with the applicable regulatory
agency in another state or Canada from engaging in the practice of that
profession when the practitioner is in Virginia temporarily with an
out-of-state athletic team or athlete for the duration of the athletic
tournament, game, or event in which the team or athlete is competing; or.
31. Any licensed nurse
practitioner in the category of certified nurse midwife from rendering care in
collaboration and consultation with a duly licensed physician when such
services are authorized by regulations promulgated jointly by the Board of
Medicine and the Board of Nursing.
B. Notwithstanding
any provision of law or regulation to the contrary, a nurse practitioner
licensed by the Boards of Nursing and Medicine in the category of certified
nurse midwife may practice without the requirement for physician supervision
while participating in a pilot program approved by the Board of Health pursuant
to § 32.1-11.5.
§ 54.1-2914. Sale of controlled substances and medical devices or appliances; requirements for vision care services.
A. A practitioner of the healing arts shall not engage in selling controlled substances unless he is licensed to do so by the Board of Pharmacy. However, this prohibition shall not apply to a doctor of medicine, osteopathy or podiatry who administers controlled substances to his patients or provides controlled substances to his patient in a bona fide medical emergency or when pharmaceutical services are not available. Practitioners who sell or dispense controlled substances shall be subject to inspection by the Department of Health Professions to ensure compliance with Chapters 33 (§ 54.1-3300 et seq.) and 34 (§ 54.1-3400 et seq.) of this title and the Board of Pharmacy's regulations. This subsection shall not apply to physicians acting on behalf of the Virginia Department of Health or local health departments.
B. A practitioner of the healing arts who may lawfully sell medical appliances or devices shall not sell such appliances or devices to persons who are not his own patients and shall not sell such articles to his own patients either for his own convenience or for the purpose of supplementing his income. This subsection shall not apply to physicians acting on behalf of the Virginia Department of Health or local health departments.
C. A practitioner of the healing arts may, from within the practitioner's
office, engage in selling or promoting the sale of eyeglasses and may dispense
contact lenses. Only those practitioners of the healing arts who engage in the
examination of eyes and prescribing of eyeglasses may engage in the sale or
promotion of eyeglasses. Practitioners shall not employ any unlicensed person
to fill prescriptions for eyeglasses within the practitioner's office except as
provided in subdivision A 6
of § 54.1-2901. A practitioner may also own, in whole or in part, an optical
dispensary located adjacent to or at a distance from his office.
D. Any practitioner of the healing arts engaging in the examination of eyes and prescribing of eyeglasses shall give the patient a copy of any prescription for eyeglasses and inform the patient of his right to have the prescription filled at the establishment of his choice. No practitioner who owns, in whole or in part, an establishment dispensing eyeglasses shall make any statement or take any action, directly or indirectly, that infringes on the patient's right to have a prescription filled at an establishment other than the one in which the practitioner has an ownership interest.
Disclosure of ownership interest by a practitioner as required by § 54.1-2964 or participation by the practitioner in contractual arrangements with third-party payors or purchasers of vision care services shall not constitute a violation of this subsection.
§ 54.1-3000. Definitions.
As used in this chapter, unless the context requires a different meaning:
"Board" means the Board of Nursing.
"Certified nurse aide" means a person who meets the qualifications specified in this article and who is currently certified by the Board.
"Clinical nurse specialist" means a person who is registered by the Board in addition to holding a license under the provisions of this chapter to practice professional nursing as defined in this section. Such a person shall be recognized as being able to provide advanced services according to the specialized training received from a program approved by the Board, but shall not be entitled to perform any act that is not within the scope of practice of professional nursing.
"Certified massage therapist" means a person who meets the qualifications specified in this chapter and who is currently certified by the Board.
"Massage therapy" means the treatment of soft tissues for therapeutic purposes by the application of massage and bodywork techniques based on the manipulation or application of pressure to the muscular structure or soft tissues of the human body. The terms "massage therapy" and "therapeutic massage" do not include the diagnosis or treatment of illness or disease or any service or procedure for which a license to practice medicine, nursing, chiropractic therapy, physical therapy, occupational therapy, acupuncture, or podiatry is required by law.
"Nurse practitioner" means a person who is licensed or holds a multistate licensure privilege under the provisions of this chapter as a registered nurse and has met additional educational requirements as a nurse practitioner and who holds professional certification in a specialty area consistent with educational preparation issued by an agency approved by the Board.
"Practical nurse" or "licensed practical nurse" means a person who is licensed or holds a multistate licensure privilege under the provisions of this chapter to practice practical nursing as defined in this section. Such a licensee shall be empowered to provide nursing services without compensation. The abbreviation "L.P.N." shall stand for such terms.
"Practical nursing" or "licensed practical nursing" means the performance for compensation of selected nursing acts in the care of individuals or groups who are ill, injured, or experiencing changes in normal health processes; in the maintenance of health; in the prevention of illness or disease; or, subject to such regulations as the Board may promulgate, in the teaching of those who are or will be nurse aides. Practical nursing or licensed practical nursing requires knowledge, judgment and skill in nursing procedures gained through prescribed education. Practical nursing or licensed practical nursing is performed under the direction or supervision of a licensed medical practitioner, a professional nurse, registered nurse or registered professional nurse or other licensed health professional authorized by regulations of the Board.
"Practice of a nurse aide" or "nurse aide practice" means the performance of services requiring the education, training, and skills specified in this chapter for certification as a nurse aide. Such services are performed under the supervision of a dentist, physician, podiatrist, professional nurse, licensed practical nurse, or other licensed health care professional acting within the scope of the requirements of his profession.
"Professional nurse," "registered nurse" or "registered professional nurse" means a person who is licensed or holds a multistate licensure privilege under the provisions of this chapter to practice professional nursing as defined in this section. Such a licensee shall be empowered to provide professional services without compensation, to promote health and to teach health to individuals and groups. The abbreviation "R.N." shall stand for such terms.
"Professional nursing," "registered nursing" or "registered professional nursing" means the performance for compensation of any nursing acts in the observation, care and counsel of individuals or groups who are ill, injured or experiencing changes in normal health processes or the maintenance of health; in the prevention of illness or disease; in the supervision and teaching of those who are or will be involved in nursing care; in the delegation of selected nursing tasks and procedures to appropriately trained unlicensed persons as determined by the Board; or in the administration of medications and treatments as prescribed by any person authorized by law to prescribe such medications and treatment. Professional nursing, registered nursing and registered professional nursing require specialized education, judgment, and skill based upon knowledge and application of principles from the biological, physical, social, behavioral and nursing sciences.
§ 54.1-3001. Exemptions.
This chapter shall not apply to the following:
1. The furnishing of nursing assistance in an emergency;
2. The practice of nursing, which is prescribed as part of a study program, by nursing students enrolled in nursing education programs approved by the Board or by graduates of approved nursing education programs for a period not to exceed ninety days following successful completion of the nursing education program pending the results of the licensing examination, provided proper application and fee for licensure have been submitted to the Board and unless the graduate fails the licensing examination within the ninety-day period;
3. The practice of any legally qualified nurse or nurse practitioner of another state who is employed by the United States government while in the discharge of his official duties;
4. The practice of nursing by a nurse who holds a current unrestricted license in another state, the District of Columbia, a United States possession or territory, or who holds a current unrestricted license in Canada and whose training was obtained in a nursing school in Canada where English was the primary language, for a period of thirty days pending licensure in Virginia, if the nurse, upon employment, has furnished the employer satisfactory evidence of current licensure and submits proper application and fees to the Board for licensure before, or within ten days after, employment. At the discretion of the Board, additional time may be allowed for nurses currently licensed in another state, the District of Columbia, a United States possession or territory, or Canada who are in the process of attaining the qualification for licensure in this Commonwealth;
5. The practice of nursing by any registered nurse who holds a current unrestricted license in another state, the District of Columbia, or a United States possession or territory, or a nurse who holds an equivalent credential in a foreign country, while enrolled in an advanced professional nursing program requiring clinical practice. This exemption extends only to clinical practice required by the curriculum;
6. The practice of nursing by any nurse who holds a current unrestricted license in another state, the District of Columbia, or a United States possession or territory and is employed to provide care to any private individual while such private individual is traveling through or temporarily staying, as defined in the Board's regulations, in the Commonwealth;
7. General care of the sick by nursing assistants, companions or domestic servants that does not constitute the practice of nursing as defined in this chapter;
8. The care of the sick when done solely in connection with the practice of religious beliefs by the adherents and which is not held out to the public to be licensed practical or professional nursing;
9. Any employee of a school board, authorized by a prescriber and trained in the administration of insulin and glucagon, when, upon the authorization of a prescriber and the written request of the parents as defined in § 22.1-1, assisting with the administration of insulin or administrating glucagon to a student diagnosed as having diabetes and who requires insulin injections during the school day or for whom glucagon has been prescribed for the emergency treatment of hypoglycemia;
10. The practice of nursing by any nurse who is a graduate of
a foreign nursing school and has met the credential, language, and academic
testing requirements of the Commission on Graduates of Foreign Nursing Schools
for a period not to exceed ninety days from the date of approval of an
application submitted to the Board when such nurse is working as a
nonsupervisory staff nurse in a licensed nursing home or certified nursing
facility. During such ninety-day period, such nurse shall take and pass the
licensing examination to remain eligible to practice nursing in Virginia; no
exemption granted under this subdivision shall be extended; or
11. The practice of nursing by any
nurse or nurse practitioner rendering
free health care to an underserved population in Virginia who (i) does not
regularly practice nursing in
Virginia, (ii) holds a current valid license or
certification or authorization to
practice nursing in another state,
territory, district or possession of the United States, (iii) volunteers to
provide free health care to an underserved area of this Commonwealth under the
auspices of a publicly supported all volunteer, nonprofit organization that
sponsors the provision of health care to populations of underserved people,
(iv) files a copy of the license or certification issued
in such other jurisdiction with the Board, (v) notifies the Board at least five
business days prior to the voluntary provision of services of the dates and
location of such service, and (vi) acknowledges, in writing, that such
licensure exemption shall only be valid, in compliance with
