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Nursing032219.pdf
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Commonwealth of Virginia
REGULATIONS
GOVERNING THE PRACTICE OF NURSING
VIRGINIA BOARD OF NURSING
Title of Regulations: 18 VAC 90-19-10 et seq.
Statutory Authority: §§ 54.1-2400 and Chapter 30 of Title 54.1 of the Code of Virginia
Revised Date: March 22, 2019
9960 Mayland Drive, Suite 300 (804) 367-4515 (TEL)
Henrico, VA 23233-1463 (804) 527-4455 (FAX)
email: [email protected]
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TABLE OF CONTENTS
TABLE OF CONTENTS ................................................................................................................. 2
Part I General Provisions ................................................................................................................. 4
18VAC90-19-10. Definitions. ............................................................................................. 4
18VAC90-19-20. Delegation of authority. ......................................................................... 4
18VAC90-19-30. Fees. ....................................................................................................... 4
18VAC90-19-40. Duplicate license. ................................................................................... 6
18VAC90-19-50. Identification; accuracy of records. ........................................................ 6
18VAC90-19-60. Data collection of nursing workforce information. ................................ 6
18VAC90-19-70. Supervision of licensed practical nurses. ............................................... 7
Part II Multistate Licensure Privilege ............................................................................................. 7
18VAC90-19-80. Issuance of a license with a multistate licensure privilege..................... 7
18VAC90-19-90. (Repealed.) ............................................................................................. 7
18VAC90-19-100. (Repealed.) ........................................................................................... 7
Part III Licensure and Renewal; Reinstatement .............................................................................. 7
18VAC90-19-110. Licensure by examination. ................................................................... 7
18VAC90-19-120. Licensure by endorsement. ................................................................... 8
18VAC90-19-130. Licensure of applicants from other countries. ...................................... 9
18VAC90-19-140. Provisional licensure of applicants for licensure as registered
nurses. .................................................................................................................... 10
18VAC90-19-150. Renewal of licenses. ........................................................................... 12
18VAC90-19-160. Continued competency requirements for renewal of an active
license. ................................................................................................................... 12
18VAC90-19-170. Documenting compliance with continued competency
requirements. ......................................................................................................... 14
18VAC90-19-180. Inactive licensure................................................................................ 15
18VAC90-19-190. Reinstatement of lapsed licenses or license suspended or revoked. .. 16
18VAC90-19-200. Restricted volunteer license and registration for voluntary
practice by out-of-state licensees. ......................................................................... 17
Part IV Clinical Nurse Specialists ................................................................................................. 17
18VAC90-19-210. Clinical nurse specialist registration. ................................................. 17
18VAC90-19-220. Clinical nurse specialist practice. ....................................................... 18
Part V Disciplinary and Delegation Provisions ............................................................................. 18
18VAC90-19-230. Disciplinary provisions. ..................................................................... 18
Part VI Delegation of Nursing Tasks and Procedures ................................................................... 20
18VAC90-19-240. Definitions for delegation of nursing tasks and procedures. .............. 20
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18VAC90-19-250. Criteria for delegation. ....................................................................... 20
18VAC90-19-260. Assessment required prior to delegation. ........................................... 21
18VAC90-19-270. Supervision of delegated tasks. .......................................................... 22
18VAC90-19-280. Nursing tasks that shall not be delegated. .......................................... 22
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CHAPTER 19
REGULATIONS GOVERNING THE PRACTICE OF NURSING
Part I
General Provisions
18VAC90-19-10. Definitions.
In addition to words and terms defined in §§ 54.1-3000 and 54.1-3030 of the Code of Virginia, the
following words and terms when used in this chapter shall have the following meanings unless the
context clearly indicates otherwise:
"Active practice" means activities performed, whether or not for compensation, for which an active
license to practice nursing is required.
"Board" means the Board of Nursing.
"CGFNS" means the Commission on Graduates of Foreign Nursing Schools.
"Contact hour" means 50 minutes of continuing education coursework or activity.
"National certifying organization" means an organization that has as one of its purposes the
certification of a specialty in nursing based on an examination attesting to the knowledge of the
nurse for practice in the specialty area.
"NCLEX" means the National Council Licensure Examination.
"NCSBN" means the National Council of State Boards of Nursing.
"Primary state of residence" means the state of a person's declared fixed, permanent, and principal
home or domicile for legal purposes.
18VAC90-19-20. Delegation of authority.
The executive director shall be delegated the authority to issue licenses and certificates and execute
all notices, orders, and official documents of the board unless the board directs otherwise.
18VAC90-19-30. Fees.
A. Fees required by the board are:
1. Application for licensure by examination - RN $190
2. Application for licensure by endorsement - RN $190
3. Application for licensure by examination - LPN $170
4. Application for licensure by endorsement - LPN $170
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5. Reapplication for licensure by examination $50
6. Biennial licensure renewal - RN $140
7. Biennial inactive licensure renewal - RN $70
8. Biennial licensure renewal - LPN $120
9. Biennial inactive licensure renewal - LPN $60
10. Late renewal - RN $50
11. Late renewal - RN inactive $25
12. Late renewal - LPN $40
13. Late renewal - LPN inactive $20
14. Reinstatement of lapsed license - RN $225
15. Reinstatement of lapsed license - LPN $200
16. Reinstatement of suspended or revoked license $300
17. Duplicate license $15
18. Replacement wall certificate $25
19. Verification of license $35
20. Transcript of all or part of applicant or licensee records $35
21. Returned check charge $35
22. Application for CNS registration $130
23. Biennial renewal of CNS registration $80
24. Reinstatement of lapsed CNS registration $125
25. Verification of CNS registration to another jurisdiction $35
26. Late renewal of CNS registration $35
B. For renewal of licensure or registration from July 1, 2017, through June 30, 2019, the following
fees shall be in effect:
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1. Biennial licensure renewal - RN $105
2. Biennial inactive licensure renewal - RN $52
3. Biennial licensure renewal - LPN $90
4. Biennial inactive licensure renewal - LPN $45
5. Biennial renewal of CNS registration $60
18VAC90-19-40. Duplicate license.
A duplicate license for the current renewal period shall be issued by the board upon receipt of the
required information and fee.
18VAC90-19-50. Identification; accuracy of records.
A. Any person regulated by this chapter who provides direct client care shall, while on duty, wear
identification that is clearly visible and indicates the appropriate title for the license, registration, or
student status under which he is practicing in that setting. Name identification on a badge for
identification of health care practitioners shall follow the policy of the health care setting in which
the nurse is employed. Any person practicing in hospital emergency departments, psychiatric and
mental health units and programs, or in health care facilities units offering treatment for clients in
custody of state or local law-enforcement agencies may use identification badges with first name
and first letter only of last name and appropriate title.
B. A licensee who has changed his name shall submit as legal proof to the board a copy of the
marriage certificate, a certificate of naturalization, or court order evidencing the change. A duplicate
license shall be issued by the board upon receipt of such evidence and the required fee.
C. Each licensee shall maintain an address of record with the board. Any change in the address of
record or in the public address, if different from the address of record, shall be submitted by a
licensee electronically or in writing to the board within 30 days of such change. All notices required
by law and by this chapter to be mailed by the board to any licensee shall be validly given when
mailed to the latest address of record on file with the board.
18VAC90-19-60. Data collection of nursing workforce information.
A. With such funds as are appropriated for the purpose of data collection and consistent with the
provisions of § 54.1-2506.1 of the Code of Virginia, the board shall collect workforce information
biennially from a representative sample of registered nurses, licensed practical nurses, and certified
nurse aides and shall make such information available to the public. Data collected shall be
compiled, stored, and released in compliance with § 54.1-3012.1 of the Code of Virginia.
B. The information to be collected on nurses shall include (i) demographic data to include age, sex,
and ethnicity; (ii) level of education; (iii) employment status; (iv) employment setting or settings
such as in a hospital, physician's office, or nursing home; (v) geographic location of employment;
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(vi) type of nursing position or area of specialty; and (vii) number of hours worked per week in each
setting. In addition, the board may determine other data to be collected as necessary.
18VAC90-19-70. Supervision of licensed practical nurses.
Licensed practical nursing shall be performed under the direction or supervision of a licensed
medical practitioner, a registered nurse, or a licensed dentist.
Part II
Multistate Licensure Privilege
18VAC90-19-80. Issuance of a license with a multistate licensure privilege.
To be issued a license with a multistate licensure privilege by the board or to change the primary
state of residency, a nurse shall comply with the regulations adopted by the Interstate Commission of
Nurse Licensure Compact Administrators (https://www.ncsbn.org/enlcrules.htm) and provisions of
Article 6.1 (§ 54.1-3040.1 et seq.) of Chapter 30 of Title 54.1 of the Code of Virginia in effect at the
time of the application.
18VAC90-19-90. (Repealed.)
18VAC90-19-100. (Repealed.)
Part III
Licensure and Renewal; Reinstatement
18VAC90-19-110. Licensure by examination.
A. The board shall authorize the administration of the NCLEX for registered nurse licensure and
practical nurse licensure.
B. A candidate shall be eligible to take the NCLEX examination (i) upon receipt by the board of the
completed application, the fee, and an official transcript or attestation of graduation from the
nursing education program and (ii) when a determination has been made that no grounds exist upon
which the board may deny licensure pursuant to § 54.1-3007 of the Code of Virginia.
C. To establish eligibility for licensure by examination, an applicant for the licensing examination
shall:
1. File the required application, any necessary documentation and fee, including a criminal history
background check as required by § 54.1-3005.1 of the Code of Virginia.
2. Arrange for the board to receive an official transcript from the nursing education program that
shows either:
a. That the degree or diploma has been awarded and the date of graduation or conferral; or
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b. That all requirements for awarding the degree or diploma have been met and that specifies the
date of conferral.
3. File a new application and reapplication fee if:
a. The examination is not taken within 12 months of the date that the board determines the applicant
to be eligible; or
b. Eligibility is not established within 12 months of the original filing date.
D. The minimum passing standard on the examination for registered nurse licensure and practical
nurse licensure shall be determined by the board.
E. Any applicant suspected of giving or receiving unauthorized assistance during the examination
may be noticed for a hearing pursuant to the provisions of the Administrative Process Act (§ 2.2-
4000 et seq. of the Code of Virginia) to determine eligibility for licensure or reexamination.
F. Practice of nursing pending receipt of examination results.
1. A graduate who has filed a completed application for licensure in Virginia and has received an
authorization letter issued by the board may practice nursing in Virginia from the date of the
authorization letter. The period of practice shall not exceed 90 days between the date of successful
completion of the nursing education program, as documented on the applicant's transcript, and the
publication of the results of the candidate's first licensing examination.
2. Candidates who practice nursing as provided in subdivision 1 of this subsection shall use the
designation "R.N. Applicant" or "L.P.N. Applicant" on a nametag or when signing official records.
3. The designations "R.N. Applicant" and "L.P.N. Applicant" shall not be used by applicants
beyond the 90-day period of authorized practice or by applicants who have failed the examination.
G. Applicants who fail the examination.
1. An applicant who fails the licensing examination shall not be licensed or be authorized to practice
nursing in Virginia.
2. An applicant for licensure by reexamination shall file the required board application and
reapplication fee in order to establish eligibility for reexamination.
3. Applicants who have failed the examination for licensure in another United States jurisdiction but
satisfy the qualifications for licensure in this jurisdiction may apply for licensure by examination in
Virginia. Such applicants shall submit the required application and fee. Such applicants shall not,
however, be permitted to practice nursing in Virginia until the requisite license has been issued.
18VAC90-19-120. Licensure by endorsement.
A. A graduate of an approved nursing education program who has been licensed by examination in
another United States jurisdiction and whose license is in good standing, or is eligible for
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reinstatement if lapsed, shall be eligible for licensure by endorsement in Virginia provided the
applicant satisfies the same requirements for registered nurse or practical nurse licensure as those
seeking initial licensure in Virginia.
1. Applicants who have graduated from approved nursing education programs that did not require a
sufficient number of clinical hours as specified in 18VAC90-27-100 may qualify for licensure if
they can provide evidence of at least 960 hours of clinical practice with an active, unencumbered
license in another United States jurisdiction.
2. Applicants whose basic nursing education was received in another country shall meet the
requirements of 18VAC90-19-130 for a CGFNS credentials review and examination of English
proficiency. However, those requirements may be satisfied if the applicant can provide evidence
from another United States jurisdiction of:
a. A CGFNS credentials evaluation for educational comparability; and
b. Passage of an English language proficiency examination approved by the CGFNS, unless the
applicant met the CGFNS criteria for an exemption from the requirement.
3. A graduate of a nursing school in Canada where English was the primary language shall be
eligible for licensure by endorsement provided the applicant has passed the Canadian Registered
Nurses Examination and holds an unrestricted license in Canada.
B. An applicant for licensure by endorsement who has submitted a criminal history background
check as required by § 54.1-3005.1 of the Code of Virginia and the required application and fee and
has submitted the required form to the appropriate credentialing agency for verification of licensure
may practice for 30 days upon receipt of an authorization letter from the board. If an applicant has
not received a Virginia license within 30 days and wishes to continue practice, he shall seek an
extension of authorization to practice by submitting a request and evidence that he has requested
verification of licensure.
C. If the application is not completed within one year of the initial filing date, the applicant shall
submit a new application and fee.
18VAC90-19-130. Licensure of applicants from other countries.
A. With the exception of applicants from Canada who are eligible to be licensed by endorsement,
applicants whose basic nursing education was received in another country shall be scheduled to take
the licensing examination provided they meet the statutory qualifications for licensure. Verification
of qualification shall be based on documents submitted as required in subsection B or C of this
section.
B. Such applicants for registered nurse licensure shall:
1. Submit evidence from the CGFNS that the secondary education and nursing education are
comparable to those required for registered nurses in the Commonwealth;
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2. Submit evidence of passage of an English language proficiency examination approved by the
CGFNS, unless the applicant meets the CGFNS criteria for an exemption from the requirement; and
3. Submit the required application and fee for licensure by examination.
C. Such applicants for practical nurse licensure shall:
1. Submit evidence from the CGFNS that the secondary education and nursing education are
comparable to those required for practical nurses in the Commonwealth;
2. Submit evidence of passage of an English language proficiency examination approved by the
CGFNS, unless the applicant meets the CGFNS criteria for an exemption from the requirement; and
3. Submit the required application and fee for licensure by examination.
D. An applicant for licensure as a registered nurse who has met the requirements of subsections A
and B of this section may practice for a period not to exceed 90 days from the date of approval of an
application submitted to the board when he is working as a nonsupervisory staff nurse in a licensed
nursing home or certified nursing facility.
1. Applicants who practice nursing as provided in this subsection shall use the designation "foreign
nurse graduate" on nametags or when signing official records.
2. During the 90-day period, the applicant shall take and pass the licensing examination in order to
remain eligible to practice nursing in Virginia.
3. Any person practicing nursing under this exemption who fails to pass the licensure examination
within the 90-day period may not thereafter practice nursing until he passes the licensing
examination.
E. In addition to CGFNS, the board may accept credentials from other recognized agencies that
review credentials of foreign-educated nurses if such agencies have been approved by the board.
18VAC90-19-140. Provisional licensure of applicants for licensure as registered nurses.
A. Pursuant to § 54.1-3017.1 of the Code of Virginia, the board may issue a provisional license to
an applicant for the purpose of meeting the 500 hours of supervised, direct, hands-on client care
required of an approved registered nurse education program.
B. Such applicants for provisional licensure shall submit:
1. A completed application for licensure by examination and fee, including a criminal history
background check as required by § 54.1-3005.1 of the Code of Virginia;
2. Documentation that the applicant has successfully completed a nursing education program; and
3. Documentation of passage of the NCLEX in accordance with 18VAC90-19-110.
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C. Requirements for hours of supervised clinical experience in direct client care with a provisional
license.
1. To qualify for licensure as a registered nurse, direct, hands-on hours of supervised clinical
experience shall include the areas of adult medical/surgical nursing, geriatric nursing,
maternal/infant (obstetrics, gynecology, neonatal) nursing, mental health/psychiatric nursing,
nursing fundamentals, and pediatric nursing. Supervised clinical hours may be obtained in
employment in the role of a registered nurse or without compensation for the purpose of meeting
these requirements.
2. Hours of direct, hands-on clinical experience obtained as part of the applicant's nursing education
program and noted on the official transcript shall be counted towards the minimum of 500 hours
and in the applicable areas of clinical practice.
3. For applicants with a current, active license as an LPN, 150 hours of credit shall be counted
towards the 500-hour requirement.
4. 100 hours of credit may be applied towards the 500-hour requirement for applicants who have
successfully completed a nursing education program that:
a. Requires students to pass competency-based assessments of nursing knowledge as well as a
summative performance assessment of clinical competency that has been evaluated by the
American Council on Education or any other board-approved organization; and
b. Has a passage rate for first-time test takers on the NCLEX that is not less than 80%, calculated on
the cumulative results of the past four quarters of all graduates in each calendar year regardless of
where the graduate is seeking licensure.
5. An applicant for licensure shall submit verification from a supervisor of the number of hours of
direct client care and the areas in which clinical experiences in the role of a registered nurse were
obtained.
D. Requirements for supervision of a provisional licensee.
1. The supervisor shall be on site and physically present in the unit where the provisional licensee is
providing clinical care of clients.
2. In the supervision of provisional licensees in the clinical setting, the ratio shall not exceed two
provisional licensees to one supervisor at any given time.
3. Licensed registered nurses providing supervision for a provisional licensee shall:
a. Notify the board of the intent to provide supervision for a provisional licensee on a form provided
by the board;
b. Hold an active, unrestricted license or multistate licensure privilege and have at least two years of
active clinical practice as a registered nurse prior to acting as a supervisor;
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c. Be responsible and accountable for the assignment of clients and tasks based on their assessment
and evaluation of the supervisee's clinical knowledge and skills;
d. Be required to monitor clinical performance and intervene if necessary for the safety and
protection of the clients; and
e. Document on a form provided by the board the frequency and nature of the supervision of
provisional licensees to verify completion of hours of clinical experience.
E. The provisional status of the licensee shall be disclosed to the client prior to treatment and shall
be indicated on identification worn by the provisional licensee.
F. All provisional licenses shall expire six months from the date of issuance and may be renewed
for an additional six months. Renewal of a provisional license beyond the limit of 12 months may
be granted and shall be for good cause shown. A request for extension of a provisional license
beyond 12 months shall be made at least 30 days prior to its expiration.
18VAC90-19-150. Renewal of licenses.
A. Licensees born in even-numbered years shall renew their licenses by the last day of the birth
month in even-numbered years. Licensees born in odd-numbered years shall renew their licenses by
the last day of the birth month in odd-numbered years.
B. A nurse shall be required to meet the requirements for continued competency set forth in
18VAC90-19-160 to renew an active license.
C. A notice for renewal of license shall be sent by the board to the last known address of the
licensee. The licensee shall complete the renewal form and submit it with the required fee.
D. Failure to receive the renewal form shall not relieve the licensee of the responsibility for
renewing the license by the expiration date.
E. The license shall automatically lapse if the licensee fails to renew by the expiration date.
F. Any person practicing nursing during the time a license has lapsed shall be considered an illegal
practitioner and shall be subject to prosecution under the provisions of § 54.1-3008 of the Code of
Virginia.
G. Upon renewal, all licensees shall declare their primary state of residence. If the declared state of
residence is another compact state, the licensee is not eligible for renewal.
18VAC90-19-160. Continued competency requirements for renewal of an active license.
A. To renew an active nursing license, a licensee shall complete at least one of the following
learning activities or courses:
1. Current specialty certification by a national certifying organization, as defined in 18VAC90-19-
10;
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2. Completion of a minimum of three credit hours of post-licensure academic education relevant to
nursing practice, offered by a regionally accredited college or university;
3. A board-approved refresher course in nursing;
4. Completion of nursing-related, evidence-based practice project or research study;
5. Completion of publication as the author or co-author during a renewal cycle;
6. Teaching or developing a nursing-related course resulting in no less than three semester hours of
college credit, a 15-week course, or specialty certification;
7. Teaching or developing nursing-related continuing education courses for up to 30 contact hours;
8. Fifteen contact hours of workshops, seminars, conferences, or courses relevant to the practice of
nursing and 640 hours of active practice as a nurse; or
9. Thirty contact hours of workshops, seminars, conferences, or courses relevant to the practice of
nursing.
B. To meet requirements of subdivision A 8 or A 9 of this section, workshops, seminars,
conferences, or courses shall be offered by a provider recognized or approved by one of the
following:
1. American Nurses Credentialing Center American Nurses Association;
2. National Council of State Boards of Nursing;
3. Area Health Education Centers (AHEC) in any state in which the AHEC is a member of the
National AHEC Organization;
4. Any state nurses association;
5. National League for Nursing;
6. National Association for Practical Nurse Education and Service;
7. National Federation of Licensed Practical Nurses;
8. A licensed health care facility, agency, or hospital;
9. A health care provider association;
10. Regionally or nationally accredited colleges or universities;
11. A state or federal government agency;
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12. The American Heart Association, the American Health and Safety Institute, or the American
Red Cross for courses in advanced resuscitation; or
13. The Virginia Board of Nursing or any state board of nursing.
C. Dual licensed persons.
1. Those persons dually licensed by this board as a registered nurse and a licensed practical nurse
shall only meet one of the continued competency requirements as set forth in subsection A of this
section.
2. Registered nurses who also hold an active license as a nurse practitioner shall only meet the
requirements of 18VAC90-30-105 and, for those with prescriptive authority, 18VAC90-40-55.
D. A licensee is exempt from the continued competency requirement for the first renewal following
initial licensure by examination or endorsement.
E. The board may grant an extension for good cause of up to one year for the completion of
continuing competency requirements upon written request from the licensee 60 days prior to the
renewal date. Such extension shall not relieve the licensee of the continuing competency
requirement.
F. The board may grant an exemption for all or part of the continuing competency requirements due
to circumstances beyond the control of the licensee such as temporary disability, mandatory military
service, or officially declared disasters.
G. Continued competency activities or courses required by board order in a disciplinary proceeding
shall not be counted as meeting the requirements for licensure renewal.
18VAC90-19-170. Documenting compliance with continued competency requirements.
A. All licensees are required to maintain original documentation of completion for a period of two
years following renewal and to provide such documentation within 30 days of a request from the
board for proof of compliance.
B. Documentation of compliance shall be as follows:
1. Evidence of national certification shall include a copy of a certificate that includes name of
licensee, name of certifying body, date of certification, and date of certification expiration.
Certification shall be initially attained during the licensure period, have been in effect during the
entire licensure period, or have been recertified during the licensure period.
2. Evidence of post-licensure academic education shall include a copy of transcript with the name of
the licensee, name of educational institution, date of attendance, name of course with grade, and
number of credit hours received.
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3. Evidence of completion of a board-approved refresher course shall include written
correspondence from the provider with the name of the licensee, name of the provider, and
verification of successful completion of the course.
4. Evidence of completion of a nursing research study or project shall include an abstract or
summary, the name of the licensee, role of the licensee as principal or coprincipal investigator, date
of completion, statement of the problem, research or project objectives, methods used, and summary
of findings.
5. Evidence of authoring or co-authoring a published nursing-related article, paper, book, or book
chapter shall include a copy of the publication that includes the name of the licensee and publication
date.
6. Evidence of teaching a course for college credit shall include documentation of the course
offering, indicating instructor, course title, course syllabus, and the number of credit hours.
Teaching a particular course may only be used once to satisfy the continued competency
requirement unless the course offering and syllabus has changed.
7. Evidence of teaching a course for continuing education credit shall include a written attestation
from the director of the program or authorizing entity including the date or dates of the course or
courses and the number of contact hours awarded. If the total number of contact hours totals less
than 30, the licensee shall obtain additional hours in continuing learning activities or courses.
8. Evidence of contact hours of continuing learning activities or courses shall include the name of
the licensee, title of educational activity, name of the provider, number of contact hours, and date of
activity.
9. Evidence of 640 hours of active practice in nursing shall include documentation satisfactory to
the board of the name of the licensee, number of hours worked in calendar or fiscal year, name and
address of employer, and signature of supervisor. If self-employed, hours worked may be validated
through other methods such as tax records or other business records. If active practice is of a
volunteer or gratuitous nature, hours worked may be validated by the recipient agency.
18VAC90-19-180. Inactive licensure.
A. A registered nurse or licensed practical nurse who holds a current, unrestricted license in
Virginia may, upon a request on the renewal application and submission of the required fee, be
issued an inactive license. The holder of an inactive license shall not be entitled to practice nursing
in Virginia or practice on a multistate licensure privilege but may use the title "registered nurse" or
"licensed practical nurse."
B. Reactivation of an inactive license.
1. A nurse whose license is inactive may reactivate within one renewal period by:
a. Payment of the difference between the inactive renewal and the active renewal fee; and
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b. Providing attestation of completion of at least one of the learning activities or courses specified in
18VAC90-19-160 during the two years immediately preceding reactivation.
2. A nurse whose license has been inactive for more than one renewal period may reactivate by:
a. Submitting an application;
b. Paying the difference between the inactive renewal and the active renewal fee; and
c. Providing evidence of completion of at least one of the learning activities or courses specified in
18VAC90-19-160 during the two years immediately preceding application for reactivation.
3. The board may waive all or part of the continuing education requirement for a nurse who holds a
current, unrestricted license in another state and who has engaged in active practice during the
period the Virginia license was inactive.
4. The board may request additional evidence that the nurse is prepared to resume practice in a
competent manner.
5. The board may deny a request for reactivation to any licensee who has been determined to have
committed an act in violation of § 54.1-3007 of the Code of Virginia or any provision of this
chapter.
18VAC90-19-190. Reinstatement of lapsed licenses or license suspended or revoked.
A. A nurse whose license has lapsed may be reinstated within one renewal period by:
1. Payment of the current renewal fee and the late renewal fee; and
2. Providing attestation of completion of at least one of the learning activities or courses specified in
18VAC90-19-160 during the two years immediately preceding reinstatement.
B. A nurse whose license has lapsed for more than one renewal period shall:
1. File a reinstatement application and pay the reinstatement fee;
2. Provide evidence of completing at least one of the learning activities or courses specified in
18VAC90-19-160 during the two years immediately preceding application for reinstatement; and
3. Submit a criminal history background check as required by § 54.1-3005.1 of the Code of
Virginia.
C. The board may waive all or part of the continuing education requirement for a nurse who holds a
current, unrestricted license in another state and who has engaged in active practice during the
period the Virginia license was lapsed.
D. A nurse whose license has been suspended or revoked by the board may apply for reinstatement
by filing a reinstatement application, fulfilling requirements for continuing competency as required
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in subsection B of this section, and paying the fee for reinstatement after suspension or revocation.
A nurse whose license has been revoked may not apply for reinstatement sooner than three years
from entry of the order of revocation.
E. The board may request additional evidence that the nurse is prepared to resume practice in a
competent manner.
18VAC90-19-200. Restricted volunteer license and registration for voluntary practice by out-
of-state licensees.
A. A registered or practical nurse may be issued a restricted volunteer license and may practice in
accordance with provisions of § 54.1-3011.01 of the Code of Virginia.
B. Any licensed nurse who does not hold a license to practice in Virginia and who seeks registration
to practice on a voluntary basis under the auspices of a publicly supported, all volunteer nonprofit
organization that sponsors the provision of health care to populations of underserved people shall:
1. File a complete application for registration on a form provided by the board at least five business
days prior to engaging in such practice. An incomplete application will not be considered;
2. Provide evidence of current, unrestricted licensure in a United States jurisdiction;
3. Provide the name of the nonprofit organization and the dates and location of the voluntary
provision of services;
4. Pay a registration fee of $10; and
5. Provide an attestation from a representative of the nonprofit organization attesting to its
compliance with provisions of subdivision 11 of § 54.1-3001 of the Code of Virginia.
Part IV
Clinical Nurse Specialists
18VAC90-19-210. Clinical nurse specialist registration.
A. Initial registration. An applicant for initial registration as a clinical nurse specialist shall:
1. Be currently licensed as a registered nurse in Virginia or hold a current multistate licensure
privilege as a registered nurse;
2. Submit evidence of current national clinical nurse specialist certification as required by § 54.1-
3018.1 of the Code of Virginia or have an exception available from March 1, 1990, to July 1, 1990;
and
3. Submit the required application and fee.
B. Renewal of registration.
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1. Registration as a clinical nurse specialist shall be renewed biennially at the same time the
registered nurse license is renewed. If registered as a clinical nurse specialist with a multistate
licensure privilege to practice in Virginia as a registered nurse, a licensee born in an even-numbered
year shall renew his license by the last day of the birth month in even-numbered years and a
licensee born in an odd-numbered year shall renew his license by the last day of the birth month in
odd-numbered years.
2. The clinical nurse specialist shall complete the renewal form and submit it with the required fee.
An attestation of current national certification as a clinical nurse specialist is required unless
registered in accordance with an exception.
3. Registration as a clinical nurse specialist shall lapse if the registered nurse license is not renewed
or the multistate licensure privilege is lapsed and may be reinstated upon:
a. Reinstatement of RN license or multistate licensure privilege;
b. Payment of reinstatement and current renewal fees; and
c. Submission of evidence of continued national certification as a clinical nurse specialist unless
registered in accordance with an exception.
18VAC90-19-220. Clinical nurse specialist practice.
A. The practice of a clinical nurse specialist shall be consistent with the education and experience
required for clinical nurse specialist certification.
B. The clinical nurse specialist shall provide those advanced nursing services that are consistent
with the standards of specialist practice as established by a national certifying organization for
clinical nurse specialists and in accordance with the provisions of Chapter 30 (§ 54.1-3000 et seq.)
of Title 54.1 of the Code of Virginia.
C. Advanced practice as a clinical nurse specialist shall include performance as an expert clinician
to:
1. Provide direct care and counsel to individuals and groups;
2. Plan, evaluate, and direct care given by others; and
3. Improve care by consultation, collaboration, teaching, and the conduct of research.
Part V
Disciplinary and Delegation Provisions
18VAC90-19-230. Disciplinary provisions.
A. The board has the authority to deny, revoke, or suspend a license or multistate licensure privilege
issued, or to otherwise discipline a licensee or holder of a multistate licensure privilege upon proof
that the licensee or holder of a multistate licensure privilege has violated any of the provisions of §
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54.1-3007 of the Code of Virginia. For the purpose of establishing allegations to be included in the
notice of hearing, the board has adopted the following definitions:
1. Fraud or deceit in procuring or maintaining a license means, but shall not be limited to:
a. Filing false credentials;
b. Falsely representing facts on an application for initial license, reinstatement, or renewal of a
license; or
c. Giving or receiving assistance in the taking of the licensing examination.
2. Unprofessional conduct means, but shall not be limited to:
a. Performing acts beyond the limits of the practice of professional or practical nursing as defined in
Chapter 30 (§ 54.1-3000 et seq.) of Title 54.1 of the Code of Virginia, or as provided by §§ 54.1-
2901 and 54.1-2957 of the Code of Virginia;
b. Assuming duties and responsibilities within the practice of nursing without adequate training or
when competency has not been maintained;
c. Obtaining supplies, equipment, or drugs for personal or other unauthorized use;
d. Employing or assigning unqualified persons to perform functions that require a licensed
practitioner of nursing;
e. Falsifying or otherwise altering patient, employer, student, or educational program records,
including falsely representing facts on a job application or other employment-related documents;
f. Abusing, neglecting, or abandoning patients or clients;
g. Practice of a clinical nurse specialist beyond that defined in 18VAC90-19-220 and § 54.1-3000 of
the Code of Virginia;
h. Representing oneself as or performing acts constituting the practice of a clinical nurse specialist
unless so registered by the board;
i. Delegating nursing tasks to an unlicensed person in violation of the provisions of Part VI
(18VAC90-19-240 et seq.) of this chapter;
j. Giving to or accepting from a patient or client property or money for any reason other than fee for
service or a nominal token of appreciation;
k. Obtaining money or property of a patient or client by fraud, misrepresentation, or duress;
l. Entering into a relationship with a patient or client that constitutes a professional boundary
violation in which the nurse uses his professional position to take advantage of the vulnerability of a
patient, a client, or his family, to include actions that result in personal gain at the expense of the
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patient or client, or a nontherapeutic personal involvement or sexual conduct with a patient or
client;
m. Violating state laws relating to the privacy of patient information, including § 32.1-127.1:03 the
Code of Virginia;
n. Providing false information to staff or board members in the course of an investigation or
proceeding;
o. Failing to report evidence of child abuse or neglect as required in § 63.2-1509 of the Code of
Virginia or elder abuse or neglect as required in § 63.2-1606 of the Code of Virginia; or
p. Violating any provision of this chapter.
B. Any sanction imposed on the registered nurse license of a clinical nurse specialist shall have the
same effect on the clinical nurse specialist registration.
Part VI
Delegation of Nursing Tasks and Procedures
18VAC90-19-240. Definitions for delegation of nursing tasks and procedures.
The following words and terms when used in this part shall have the following meanings unless the
content clearly indicates otherwise:
"Delegation" means the authorization by a registered nurse to an unlicensed person to perform
selected nursing tasks and procedures in accordance with this part.
"Supervision" means guidance or direction of a delegated nursing task or procedure by a qualified,
registered nurse who provides periodic observation and evaluation of the performance of the task
and who is accessible to the unlicensed person.
"Unlicensed person" means an appropriately trained individual, regardless of title, who receives
compensation, who functions in a complementary or assistive role to the registered nurse in
providing direct patient care or carrying out common nursing tasks and procedures, and who is
responsible and accountable for the performance of such tasks and procedures. With the exception
of certified nurse aides, this shall not include anyone licensed or certified by a health regulatory
board who is practicing within his recognized scope of practice.
18VAC90-19-250. Criteria for delegation.
A. Delegation of nursing tasks and procedures shall only occur in accordance with the plan for
delegation adopted by the entity responsible for client care. The delegation plan shall comply with
provisions of this chapter and shall provide:
1. An assessment of the client population to be served;
2. Analysis and identification of nursing care needs and priorities;
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3. Establishment of organizational standards to provide for sufficient supervision that assures safe
nursing care to meet the needs of the clients in their specific settings;
4. Communication of the delegation plan to the staff;
5. Identification of the educational and training requirements for unlicensed persons and
documentation of their competencies; and
6. Provision of resources for appropriate delegation in accordance with this part.
B. Delegation shall be made only if all of the following criteria are met:
1. In the judgment of the delegating nurse, the task or procedure can be properly and safely
performed by the unlicensed person and the delegation does not jeopardize the health, safety, and
welfare of the client.
2. The delegating nurse retains responsibility and accountability for nursing care of the client,
including nursing assessment, planning, evaluation, documentation, and supervision.
3. Delegated tasks and procedures are within the knowledge, area of responsibility, and skills of the
delegating nurse.
4. Delegated tasks and procedures are communicated on a client-specific basis to an unlicensed
person with clear, specific instructions for performance of activities, potential complications, and
expected results.
5. The person to whom a nursing task has been delegated is clearly identified to the client as an
unlicensed person by a name tag worn while giving client care and by personal communication by
the delegating nurse when necessary.
C. Delegated tasks and procedures shall not be reassigned by unlicensed personnel.
D. Nursing tasks shall only be delegated after an assessment is performed according to the
provisions of 18VAC90-19-260.
18VAC90-19-260. Assessment required prior to delegation.
Prior to delegation of nursing tasks and procedures, the delegating nurse shall make an assessment
of the client and unlicensed person as follows:
1. The delegating nurse shall assess the clinical status and stability of the client's condition;
determine the type, complexity, and frequency of the nursing care needed; and delegate only those
tasks that:
a. Do not require the exercise of independent nursing judgment;
b. Do not require complex observations or critical decisions with respect to the nursing task or
procedure;
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c. Frequently recur in the routine care of the client or group of clients;
d. Do not require repeated performance of nursing assessments;
e. Utilize a standard procedure in which the tasks or procedures can be performed according to
exact, unchanging directions; and
f. Have predictable results and for which the consequences of performing the task or procedures
improperly are minimal and not life threatening.
2. The delegating nurse shall also assess the training, skills, and experience of the unlicensed person
and shall verify the competency of the unlicensed person to determine which tasks are appropriate
for that unlicensed person and the method of supervision required.
18VAC90-19-270. Supervision of delegated tasks.
A. The delegating nurse shall determine the method and frequency of supervision based on factors
that include:
1. The stability and condition of the client;
2. The experience and competency of the unlicensed person;
3. The nature of the tasks or procedures being delegated; and
4. The proximity and availability of the registered nurse to the unlicensed person when the nursing
tasks will be performed.
B. In the event that the delegating nurse is not available, the delegation shall either be terminated or
delegation authority shall be transferred by the delegating nurse to another registered nurse who
shall supervise all nursing tasks delegated to the unlicensed person, provided the registered nurse
meets the requirements of 18VAC90-19-250 B 3.
C. Supervision shall include:
1. Monitoring the performance of delegated tasks;
2. Evaluating the outcome for the client;
3. Ensuring appropriate documentation; and
4. Being accessible for consultation and intervention.
D. Based on an ongoing assessment as described in 18VAC90-19-260, the delegating nurse may
determine that delegation of some or all of the tasks and procedures is no longer appropriate.
18VAC90-19-280. Nursing tasks that shall not be delegated.
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A. Nursing tasks that shall not be delegated are those that are inappropriate for a specific,
unlicensed person to perform on a specific patient after an assessment is conducted as provided in
18VAC90-19-260.
B. Nursing tasks that shall not be delegated to any unlicensed person are:
1. Activities involving nursing assessment, problem identification, and outcome evaluation that
require independent nursing judgment;
2. Counseling or teaching except for activities related to promoting independence in personal care
and daily living;
3. Coordination and management of care involving collaboration, consultation, and referral;
4. Emergency and nonemergency triage;
5. Administration of medications except as specifically permitted by the Virginia Drug Control Act
(§ 54.1-3400 et seq. of the Code of Virginia); and
6. Circulating duties in an operating room.
