NP · Virginia
Supervision Agreement for Nurse Practitioners in Virginia
Yes, a written supervising-physician agreement is required. Virginia calls it a Practice Agreement.
Autonomous-practice designation must be applied for and granted — it is not automatic upon hitting the hours threshold.
Independent practice requires: equivalent of ≥3 years full-time clinical experience — § 54.1-2957(I) itself only says 'as determined by the Boards,' but 18VAC90-30-86 defines full-time as 1,800 hours/year, i.e. 5,400 hours total (confirmed directly against the regulation text; a commonly-repeated secondary-source figure of ≈4,500 hours appears to be an error propagated across NP-advice sites); attestation from a patient care team physician who supervised the experience, or (per H.B. 971, eff. 7/1/2024) an 'attesting nurse practitioner' who has held autonomous-practice status ≥3 years.
What the supervision must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Available remotely (no on-site requirement)
No codified mile/minute radius or on-site requirement; practice agreement need only address availability for routine and urgent consultation (§ 54.1-2957, 18VAC90-40-90).
Supervision ratio
Up to 6 at a time
No more than 6 NPs per patient care team physician at any one time (18VAC90-40-90). Psychiatric-mental-health NPs have a separate, higher cap — see the dedicated `pmhnp` entry below rather than this general NP figure.
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Prescriptive scope (Schedules II–VI) must be specified in the practice agreement (§ 54.1-2957.01); autonomous-practice NPs prescribe within their own scope without agreement-based restriction.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Limited Liability Company (PLLC) under § 13.1-1102 — advanced practice registered nurses (APRNs, which includes NP) are explicitly listed as an eligible independent owner; no physician ownership required. Alternatively a Professional Corporation under § 13.1-543 with all shares held by licensed/authorized individuals.
NPs may independently own their own PLLC regardless of autonomous-practice status — this ownership pathway existed prior to, and is legally separate from, the § 54.1-2957 autonomous-practice clinical reform above.
What a supervising physician costs here
Typical monthly cost in Virginia
$500 – $600
Estimate for one Nurse Practitioner. This state's proximity rules add a small premium.
About Virginia's rules
No provider type below has a codified chart-review percentage, countersignature rule, or numeric proximity radius — all are left to the practice agreement. CPOM (ownership) is governed by Title 13.1's PC/PLLC statutes, which explicitly list APRNs (NP/CRNA/CNM/CNS) as eligible independent owners but do not enumerate PAs — the PA ownership pathway is an inference from that omission, not a confirmed holding. Virginia has no independent corporate-practice-of-medicine common-law doctrine (a 1992 AG opinion, secondary-sourced only).
Other clinicians in Virginia: see the state overview.