Nursing License Requirements in Virginia
The state of Virginia is rich in nursing history. Virginia's first hospital school of nursing was established at St. Luke’s Hospital in Richmond in the year 1886, while the first baccalaureate nursing program in the South began at the University of Virginia in 1928. The Virginia State Association of Nurses was one of the first three state nursing associations in the United States. Today, the US Bureau of Labor Statistics reports 39,320 certified nursing assistants (CNAs), 21,060 licensed practical nurses (LPNs) and 64,750 registered nurses (RNs) were employed in Virginia as of May 2018. In addition, Virginia employed 850 certified registered nurse anesthetists (CRNAs), 4,710 nurse practitioners (NPs) and 170 certified nurse midwives (CNMs). There is no separate data on clinical nurse specialists (CNSs), who are grouped with RNs by the BLS. CNSs are not considered advanced practice registered nurses (APRNs) in Virginia.
The Virginia Board of Nursing, under the auspices of the Department of the Health Professions, is responsible for oversight of training, licensing and discipline for all categories of nursing personnel in Virginia. As a nursing compact state, Virginia allows a nurse to hold a multi-state license and to practice in more than one state. APRNs in Virginia are jointly regulated by the Board of Medicine and the Board of Nursing; CNSs are regulated only by the Board of Nursing.
CNA – A CNA in Virginia must complete a training program that is state-approved and includes a minimum of 120 hours of classroom and skill training. Candidates must pass both a written and hands-on clinical skills test to become certified. The test is called the National Nurse Aide Assessment Program (NNAAP), administered by Pearson Vue and the NACES Plus Foundation. A fee is required for testing. The applicant has two years to pass the examination after training before retraining is required. A certificate of completion from the program is required. The applicant must pass a criminal background check and answer questions about legal and disciplinary history that could affect his or her ability to practice safely. Virginia also certifies Advanced Certified Nurse Aides (ACNAs) and Registered Medication Aides (RMAs). The ACNA must complete an additional 120-hour training program and have been a CNA for at least three years. A recommendation from an RN is also required. There is an additional fee to become an ACNA. RMAs must first have verifiable credentials as a Personal Care Aide, Home Health Aide, Direct Care Aide, Nursing Assistant, Certified Nursing Assistant or RN/LPN student, and be free of barrier crimes. Candidates must complete either the 32-hour or the 68-hour Medication Aide Class. The first qualifies an individual to assist patients with self-administered medications in settings such as group homes and day care centers. The second qualifies an individual to administer medications in assisted living and skilled nursing facilities and to take the State Registered Medication Aide Exam.
LPN – to become an LPN in Virginia, an applicant must first complete a Board-approved practical nursing training program. Applicants must submit fingerprints and complete a criminal background check, provide an Official Attestation of Graduation or official transcript, proof of primary state of residence and evidence of any name changes. The applicant must also pass the NCLEX-PN examination.
RN – RNs must meet the same requirements for licensure as LPNs but must complete a nursing diploma, associate degree or baccalaureate program in professional nursing and pass the NCLEX-RN examination.
APRN – In Virginia, CRNAs, NPs and CNMs are licensed, while CNSs are registered. The candidate must first meet all requirements for an RN license. Applicants must complete a graduate-level (masters or doctoral) program in nursing approved by the Joint Boards. The practitioner must be certified in his/her specialty. APRNs who apply for prescriptive authority must meet the following qualifications:
- National certification in the practitioner’s specialty
- Completion of a graduate level course in pharmacology or pharmacotherapeutics within five years of applying for prescriptive authority OR
- A minimum of 1000 hours of APRN practice and 15 continuing education hours related to the practitioner's nursing specialty in each of the two years prior to application OR
- Completion of 30 contact hours of education in pharmacology or pharmacotherapeutics approved by the Boards within five years of applying for prescriptive authority.
CNAs – certification renewal is required every two years by the last day of the individual’s birth month. The applicant must provide proof of a minimum of eight hours of employment as a CNA within the preceding 24 months. Medication Aides must renew annually by the last day of the birth month. Medication aides must complete approved training in the administration of medications through a percutaneous gastrostomy tube to renew. All CNAs are required to complete continuing education provided by the facility in which they work. Medication aides must also complete four hours of population-specific training in medication administration or an approved refresher course in medication administration. Fees are required for renewal.
LPNs and RNs must meet one of the following requirements for license renewal, which occurs every two years:
- Current specialty certification by a national credentialing body recognized by the Board
- Completion of a Board-approved refresher course
- Completion of a minimum of three credit hours of post-licensure academic education related to nursing practice offered by a regionally accredited college or university
- Completion of a nursing-related evidence-based practice project or research study
- Completion of a publication as the author co-author during a renewal cycle
- 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
- Teaching or developing nursing-related continuing education courses for up to 30 contact hours
- Fifteen (15) contact hours of continuing education activities relevant to the practice and 640 hours of active practice within the previous two (2) years
- Thirty (30) contact hours of continuing education relevant to the practice of nursing.
APRNs – Renewal is required every two years. An APRN in Virginia must maintain national certification or complete 40 contact hours of continuing education in a specialty area approved by the Board in the 24 months preceding the application for renewal. Licensees who wish to renew prescriptive authority must complete an additional eight hours in pharmacology, with a minimum of two hours related to prescribing controlled substances. A Practice Agreement Form is also required for APRNs who hold prescriptive authority.
Other Methods of Licensure
In addition to the usual method of initial licensure, Virginia offers other options for qualified candidates.
RN and LPN students who have completed at least one clinical course with a minimum of 40 client care hours may apply for CNA certification.
Endorsement/Reciprocity – CNAs, LPNs, RNs and APRNs who are licensed in other states may apply for licensure by endorsement. The candidate must meet the same requirements for initial licensure or certification in Virginia. Canadian nurses who hold an unrestricted license are also eligible for endorsement if the training was primarily in English and the nurse passed the Canadian Registered Nurse Examination (CRNE) or other Canadian nurse licensing examination after 1970.
A CNA whose certification has lapsed for more than 90 days may apply for reinstatement. The applicant must retake the examination if he or she cannot provide proof of work experience.
Foreign-educated nurses can become licensed in Virginia by meeting the following requirements:
- Complete a criminal background check
- Submit a credential verification by the Commission on Graduates of Foreign Nursing Schools (CGFNS)
- Provide proof of primary state of residence
- Provide a valid social security number.
Individuals trained in the military may be eligible for nursing certification or licensure in Virginia if their training was substantially equivalent to that required by the Board of Nursing. Since programs differ, the applicant should contact the Board for information.
Criminal History Reports
Although no specific type of criminal conviction is an absolute bar to becoming certified or licensed as a nurse aide or nurse in Virginia, the Board does have the authority to refuse to admit a candidate or to suspend or revoke a license or certification. A criminal history report is required at the time of initial licensure and any changes must be reported at the time of renewal. A criminal conviction for any felony or misdemeanor convictions involving moral turpitude may prevent certification, licensure or renewal. Among these are lying, cheating and stealing. For example, reporting false information to the police, shoplifting, petty larceny, welfare fraud, embezzlement or writing checks with insufficient funds may all qualify as crimes or moral turpitude. Even if the crime itself is determined not to affect licensure, if there are indications of impairment due to alcohol or other substance abuse, it may be the basis for denial or revocation. The Board will require an applicant with a criminal conviction to provide:
- A certified copy of all conviction orders, obtained from the courthouse of record
- Evidence that all court-ordered requirements were met
- A letter from the applicant or licensee explaining the factual circumstances leading to the offense
- Letters from nursing employers regarding work performance
- For those with possible impairment issues, evidence of any past treatment and a letter from the applicant’s current treating healthcare provider(s) indicating diagnosis, treatment regimen, compliance with treatment, and ability to practice safely
- A letter from the applicant explaining the factual circumstances of condition or impairment and addressing ongoing efforts to function safely (such as efforts to remain compliant with treatment and maintain sobriety, or attendance at AA/NA meetings).
If the licensee has been disciplined in another state, the board will require the same documentation as noted above.
The Virginia Board of Nursing is charged with protecting the public by assuring that nursing personnel are competent and practice safely and within the laws and regulations of the state of Virginia. Disciplinary actions become part of the public record. When a complaint or criminal history report is filed with the Board, the information will be entered in the Board’s tracking system. The Board will assess the complaint or report and investigate as appropriate. In most cases, the investigation occurs within three months. The evidence gathered is forwarded to the Board for a decision. If the Board determines that a law or regulation has been violated, it may present its findings at an informal conference or hearing. The Board's options include:
- Close the case for lack of evidence
- Make a consent agreement in lieu of public discipline in minor cases
- Settle the complaint with a consent order without a formal hearing
- Issue a reprimand
- Impose fines, terms or conditions such as supplementary education or participation in the Health Practitioner’s Monitoring Program for substance abuse
- Limit or revoke specific privileges
- Suspend or revoke the license or certification in its entirety
- Dismiss the case if a licensee is exonerated.
Scope of Practice
The scope of practice for all levels of nursing personnel is defined through laws and regulations. The concept behind scope of practice is that an individual shall perform only those tasks for which he or she has been properly trained and certified or licensed. CNAs have the most restrictive scope of practice and APRNs have the least restrictive.
CNAs are considered bedside caregivers who require direct supervision by a licensed nurse. They perform such activities as feeding patients and assisting them with ambulation, hygiene and toileting activities. Medication aides may administer medications in defined work settings but may not perform injections with the exception of insulin, glucagon or auto-injectable epinephrine.
LPNS have a more advanced scope of practice compared to a CNA, although they are not independent practitioners and must be supervised by an RN or physician. The LPN can administer most medications and vaccines, and perform TB skin tests. There are few absolute prohibitions about specific tasks and in many cases the employer determines specifics such as intravenous therapy.
RNs have higher levels of responsibility commensurate with their advanced training. RNs are expected to use the nursing process, determine what tasks can be safely delegated to other members of the health care team, assess a patient’s progress and perform tasks that require significant training, clinical judgment and critical thinking skills.
The APRN scope of practice includes many functions of medicine, including making a medical diagnosis, ordering and interpreting laboratory and diagnostic tests, and prescribing medications or medical equipment. Scope of practice is also affected by specialty – only CRNAs administer anesthesia and only CNMs deliver babies. APRNs may perform various procedures such as joint injections or suture lacerations, but they cannot perform surgery.