V.I. Code tit. 27, § 101a (2019)
2019 US Virgin Islands Code|Title 27 - Professions and Occupations|Chapter 1 - Medicine, Surgery, Dentistry, Pharmacy, Nursing and Nurse-Midwifery|Subchapter V - Advanced Practice Registered Nurse|§ 101a. General provisions

 (a) Qualifications. A person is qualified for licensure as an advanced practice registered nurse if that person: (1) has applied in writing in form and substance satisfactory to the Board and has not violated a provision of this chapter or the rules adopted under this chapter. The Board may take into consideration any felony conviction of the applicant, but a conviction does not operate as an absolute bar to licensure; (2) holds a current license to practice as a registered nurse in the Virgin Islands; (3) has successfully completed requirements to practice as, and holds a current, national certification as, a nurse midwife, clinical nurse specialist, nurse practitioner or nurse anesthetist from the appropriate national certifying body as determined by rule of the Board; (4) has paid the required fees as set by rule; (5) has successfully completed a post-basic, advanced- practice, formal education program in the area of his nursing specialty. The Board shall maintain a separate roster of advanced practice nurses licensed under this section and their licenses shall indicate advanced practice registered nurse; (6) In addition to meeting the requirements of subsection (a), except paragraph (5) of that subsection, beginning July 1, 2005, or 12 months after the adoption of final rules to implement this section, whichever is sooner, applicants for initial licensure must have a graduate degree appropriate for national certification in a clinical, advanced- practice nursing specialty. The Board shall provide by rule for APRN licensure of registered nurses who apply for licensure after July 1, 2005; and (7) submit evidence of completion of a program described in subparagraph (5) of subsection (a) or in subsection (b). (b) Written collaborative agreements.  (1) No person may engage in the practice of advanced practice nursing except when licensed under this section and pursuant to a written collaborative agreement with a collaborating physician. (2)  (A) A written collaborative agreement must describe the working relationship of the advanced practice nurse with the collaborating physician. Collaboration does not require an employment relationship between the collaborating physician and advanced practice registered nurse. Collaboration means the relationship under which an advanced practice nurse works with a collaborating physician in an active clinical practice to deliver health care services in accordance with (i) the advanced practice nurse's training, education, and experience and (ii) medical practice as documented in a jointly developed written collaborative agreement. (B) The agreement must be defined to promote the exercise of professional judgment by the advanced practice registered nurse commensurate with his education and experience. The services to be provided by the advanced practice registered nurse must be services that the collaborating physician generally provides to his patients in the normal course of his clinical medical practice. The agreement need not describe the exact steps that an advanced practice registered nurse must take with respect to each specific condition, disease, or symptom, but must specify which authorized procedures require a physician's presence as the procedures are being performed. The collaborative relationship under an agreement may not be construed to require the personal presence of a physician at all times at the place where services are rendered. Methods of communication must be available for consultation with the collaborating physician in person or by telecommunications in accordance with established written guidelines as set forth in the written agreement. (3) Physician medical consultation under an agreement is adequate if a collaborating physician: (A) participates with the advanced practice registered nurse in the formulation and approval of the agreement, and in periodically reviewing medical services provided to patients by the advanced practice registered nurse in order to maintain compliance with the agreement; (B) is on site at least once a week to provide medical consultation; and (C) is available in person or through secured telecommunications for consultation on medical problems, complications, emergencies or patient referral. (4) A copy of the signed, written collaborative agreement must be submitted to the Board and the Composite Virgin Islands Board of Medical Examiners from both the advanced practice registered nurse, and the collaborating physician and must be annually updated. An advanced practice registered nurse shall inform each collaborating physician of all collaborative agreements he has signed and provide a copy of these to any collaborating physician, upon request. (c) Prescriptive authority.  (1) The APRN may prescribe and administer drugs and medical devices to the extent established by the Rules and Regulations of the Board. This authority may, but is not required to, include prescription and dispensing of legend drugs and legend controlled substances categorized as Schedule IV, or V controlled substances, as defined in title 19 Virgin Islands Code, section 595 (Virgin Islands Controlled Substances Law). (2) To prescribe Schedule IV, or V controlled substances under this section, an advanced practice registered nurse must obtain a mid-level practitioner controlled substance license. Medication orders must be reviewed periodically by the collaborating physician. (3) The collaborating physician shall file with the Board and the Composite Virgin Islands Board of Medical Examiners notice of prescriptive authority in accordance with rules of the Board. Upon the Board's receipt of authority to prescribe Schedule IV, or V controlled substances, the licensed advanced practice registered nurse is eligible to register for a mid-level practitioner controlled substance license under section 599, title 19. (4) Nothing in this subchapter may be construed to limit the delegation of tasks or duties by a physician to a licensed practical nurse, a registered professional nurse, or other personnel. (d) Title.  (1) No person may use any words, abbreviations, figures, letters, title, sign, card, or device tending to imply that he or she is an advanced practice registered nurse, including but not limited to using the titles or initials “Advanced Practice Registered Nurse” “APRN”, “Certified Nurse Midwife” “C.N.M.”, “Certified Nurse Practitioner” “C.N.P.”, “Clinical Nurse Specialist” “C.N.S.”, “Certified Nurse Anesthetist” C.N.A. or similar titles or initials, with the intention of indicating practice as an advanced practice registered nurse without meeting the requirements of this section. No advanced practice registered nurse may use the title of doctor or associate with his name or any other term to indicate to other persons that he is qualified to engage in the general practice of medicine. (2) An advanced practice registered nurse shall verbally identify himself as an advanced practice nurse including specialty certification to each patient. (3) Nothing in this section may be construed to relieve a physician of professional or legal responsibility for the care and treatment of persons attended by him or to relieve an advanced practice registered nurse of the professional or legal responsibility for the care and treatment of persons attended by him. (e) Continuing education. The Board shall adopt rules pertaining to continuing education for persons licensed under this subchapter which require 30 hours of continuing education per two-year license renewal cycle. The rules may not be inconsistent with requirements of relevant, national certifying bodies or State or national professional associations. The rules must also address variances in part or in whole for good cause, including but not limited to illness or hardship. The continuing education rules must assure that licensees are given the opportunity to participate in programs sponsored by or through their State or national professional associations, hospitals, or other providers of continuing education. Each licensee is responsible for maintaining records of completion of continuing education and must be prepared to produce the records when requested by the Board. (f) Grounds for disciplinary action.  (1) The Board may refuse to issue or to renew, or may revoke, suspend, place on probation, censure or reprimand, or take other disciplinary action as the Board may consider appropriate with regard to a license issued under this subchapter, including the issuance of fines not to exceed $5,000 for each violation, for any one or combination of the grounds for discipline set forth in this subsection or for any one or combination of the following causes: (A) Gross negligence in the practice of advanced practice nursing. (B) Exceeding the terms of a collaborative agreement or the prescriptive authority delegated to the advanced practice registered nurse by his collaborating physician or alternate collaborating physician in guidelines established under a written collaborative agreement. (C) Making a false or misleading statement regarding licensee's skill or the efficacy or value of the medicine, treatment, or remedy prescribed by him in the course of treatment. (D) Prescribing, selling, administering, distributing, giving, or self administering a drug classified as a controlled substance, designated product, or narcotic for other than medically accepted therapeutic purposes. (E) Promotion of the sale of drugs, devices, appliances, or goods provided for a patient in a manner to exploit the patient for financial gain. (F) Violating federal, state, or territorial laws or regulations relating to controlled substances. (G) Willfully or negligently violating the confidentiality between advanced practice registered nurse, collaborating physician, and patient, except as required by law. (H) Failure of a licensee to report to the Board any adverse final action taken against such licensee by another licensing jurisdiction, including any jurisdiction of the United States or any foreign, state or country, any peer review body, any health care institution, a professional or nursing or advanced practice nursing society or association, a governmental agency, a law enforcement agency, or a court or a liability claim relating to acts or conduct similar to acts or conduct that would constitute grounds for action as defined in this section. (I) Failure of a licensee to report to the Board surrender by the licensee of a license or authorization to practice nursing or advanced practice nursing in another state or jurisdiction, or current surrender by the licensee of membership on any nursing staff or organized health care professional staff or in any nursing, advanced practice nurse, or professional association or society while under disciplinary investigation by any of those authorities or bodies for acts or conduct similar to acts or conduct that would constitute grounds for action as defined in this section. (J) Failing, within 60 days to provide information in response to a written request made by the Board. (K) Failure to establish and maintain records of patient care and treatment as required by law. (L) Any violation of any section of this subchapter. When the Board has received written reports concerning incidents required to be reported in subparagraphs (H) and (I), the licensee's failure to report the incident to the Board under those subparagraphs may not be the sole grounds for disciplinary action. (2) In enforcing this section, the Board, upon a showing of a possible violation, may compel an individual licensed to practice under this subchapter, or who has applied for licensure under this subchapter, to submit to a mental or physical examination or both, as required by and at the expense of the Board. The Board may order the examining physician to present testimony concerning the mental or physical examination of the licensee or applicant. No information may be excluded by reason of any common law or statutory privilege relating to communications between the licensee or applicant and the examining physician. The examining physician must be specifically designated by the Board. The individual to be examined may have, at the individual's own expense, another physician of the individual's choice present during all aspects of this examination. Failure of an individual to submit to a mental or physical examination when directed shall be ground for suspension of the individual's license until the individual submits to the examination, if the Board finds, after notice and hearing, that the refusal to submit to the examination was without reasonable cause. If the Board finds an individual unable to practice because of the reasons set forth in this section, the Board may require that individual to submit to care, counseling, or treatment by physicians approved or designated by the Board as a condition, term, or restriction for continued, reinstated, or renewed licensure to practice; or, in lieu of care, counseling, or treatment, the Board may file a complaint to immediately suspend, revoke, the license or otherwise discipline the individual. An individual disciplined whose license was granted, continued, reinstated, renewed, or supervised subject to terms, conditions, or restrictions, and who fails to comply with the terms, conditions, or restrictions, shall be referred to the Board for a determination as to whether the individual shall have his license suspended immediately, pending a hearing by the Board. In instances in which the Board immediately suspends an individual's license under this section, a hearing on that individual's license must be convened by the Board within 15 days after the suspension and must be completed without appreciable delay. The Board has the authority to review the subject individual's record of treatment and counseling regarding the impairment to the extent permitted by applicable federal statutes and regulations safeguarding the confidentiality of medical records. An individual licensed under this subchapter and affected under this section shall be afforded an opportunity to demonstrate to the Board that he can resume practice in compliance with acceptable and prevailing standards under the provisions of his license. (g) Reports relating to professional conduct and capacity; entities required to report.  (1)  (A) Health care institutions. The chief administrator or executive officer of a health care institution licensed by the Department of Health, shall report to the Board when a licensee's organized, professional, staff clinical privileges are terminated or are restricted based on a final determination, in accordance with that institution's bylaws or rules and regulations, that (i) a licensee has either committed an act or acts that may directly threaten patient care and that are not of an administrative nature or (ii) that a licensee may be mentally or physically disabled in a manner that may endanger patients under that person's care. The chief administrator or officer shall also report if a licensee accepts voluntary termination or restriction of clinical privileges in lieu of formal action based upon conduct related directly to patient care and not of an administrative nature, or in lieu of formal action seeking to determine whether a licensee may be mentally or physically disabled in a manner that may endanger patients under that person's care. The Board shall provide by rule for the reporting to it of all instances in which a person licensed under this title, who is impaired by reason of age, drug, or alcohol abuse or physical or mental impairment, is under supervision and, where appropriate, is in a program of rehabilitation. Reports submitted under this subsection are strictly confidential and may be reviewed and considered only by the members of the Board or authorized staff as provided by rule of the Board. Provisions shall be made for the periodic report of the status of any such reported person not less than twice annually in order that the Board has current information upon which to determine the status of that person. The filing of reports submitted under this subsection must be construed as the filing of a report for purposes of subsection (3) of this section. (B) Professional associations. The President or Chief Executive Officer of an association or society of persons licensed under this chapter, operating within the Virgin Islands, shall report to the Board when the association or society renders a final determination that a person licensed under this title has committed unprofessional conduct related directly to patient care or that a person may be mentally or physically disabled in a manner that may endanger patients under the person's care. (C) Professional liability insurers. Every insurance company that offers policies of professional liability insurance to persons licensed under this chapter, or any other entity that seeks to indemnify the professional liability of a person licensed under this chapter, shall report to the Board the settlement of any claim or cause of action, or final judgment rendered in any cause of action that alleged negligence in the furnishing of patient care by the licensee, when the settlement or final judgment is in favor of the plaintiff. (D) Attorney General. The Attorney General shall report to the Board all instances in which a person licensed under this chapter is convicted or otherwise found guilty of the commission of a felony. (E) Agencies. All agencies, boards, commissions, departments, or other instrumentalities of the government of the Virgin Islands shall report to the Board any instance arising in connection with the operations of the agency, including the administration of any law by the agency, in which a person licensed under this subchapter has either committed an act or acts that may constitute a violation of this subchapter, that may constitute unprofessional conduct related directly to patient care, or that indicates that a person licensed under this subchapter may be mentally or physically disabled in a manner that may endanger patients under that person's care. (2) Mandatory reporting. All reports required under items (H) and (I) of subsection (f)(1) of this section and under this paragraph must be submitted to the Board in a timely fashion. The reports must be filed in writing within 60 days after a determination that a report is required under this chapter. All reports must contain the following information: (A) The name, address, and telephone number of the person making the report. (B) The name, address, and telephone number of the person who is the subject of the report. (C) The name or other means of identification of any patient or patients whose treatment is a subject of the report, except that no medical records may be revealed without the written consent of the patient or patients. (D) A brief description of the facts that gave rise to the issuance of the report, including but not limited to the dates of any occurrences deemed to necessitate the filing of the report. (E) If court action is involved, the identity of the court in which the action is filed, the docket number, and date of filing of the action. (F) Any further pertinent information that the reporting party deems to be an aid in the evaluation of the report. Nothing contained in this section shall be construed to in any way waive or modify the confidentiality of medical reports and committee reports to the extent provided by law. Any information reported or disclosed shall be kept for the confidential use of the Board, the Board's attorneys, the investigative staff, and authorized clerical staff. (3) Immunity from prosecution. An individual or organization acting in goad faith, and not in a willful and wanton manner, in complying with this chapter by providing a report or other information to the Board, by assisting in the investigation or preparation of a report or information, by participating in proceedings of the Board, or by serving as a member of the Board shall not, as a result of such actions, be subject to criminal prosecution or civil damages. (4) Indemnification. Members of the Board, the Board's attorneys, the investigative staff, advanced practice registered nurses or physicians retained under contract to assist and advise in the investigation, and authorized clerical staff shall be indemnified by the Government for any actions (i) occurring within the scope of services on the Board, (ii) performed in good faith, and (iii) not willful and wanton in nature. The Attorney General shall defend all actions taken against those persons unless, the Attorney General determines either that there would be a conflict of interest in the representation or that the actions complained of were not performed in good faith or were willful and wanton in nature. If the Attorney General determines that the actions complained of were not performed in good faith, or were willful and wanton and declines representation, the member shall have the right to employ counsel of his choice at his own expense. The member shall notify the Attorney General within 7 days after receipt of notice of the initiation of an action involving services of the Board. Failure to so notify the Attorney General shall constitute an absolute waiver of the right to a defense and indemnification. The Attorney General shall determine within 7 days after receiving the notice whether he will undertake to represent the member. (5) Deliberations of Board. Upon the receipt of a report called for by this chapter, other than those reports of impaired persons licensed under this chapter required pursuant to the rules of the Board, the Board shall notify in writing by certified mail the person who is the subject of the report. The notification must be made within 30 days after receipt by the Board of the report. The notification shall include a written notice setting forth the person's right to examine the report. Included in the notification must be the address at which the file is maintained, the name of the custodian of the reports, and the telephone number at which the custodian may be reached. The person who is the subject of the report shall submit a written statement responding to, clarifying, adding to, or proposing to amend the report previously filed. The statement shall become a permanent part of the file and must be received by the Board no more than 30 days after the date on which the person was notified of the existence of the original report. The Board shall review all reports received by it and any supporting information and responding statements submitted by persons who are the subject of reports. The review by the Board must be in a timely manner, but in no event shall the Board's initial review of the material contained in each disciplinary file be less than 61 days or more than 180 days after the receipt of the initial report by the Board. When the Board makes its initial review of the materials contained within its disciplinary files, the Board shall, in writing, make a determination as to whether there are sufficient facts to warrant further investigation or action. Failure to make that determination within the time provided shall be deemed to be a determination that there are not sufficient facts to warrant further investigation or action. Should the Board find that there are not sufficient facts to warrant further investigation or action, the report must be accepted for filing and the matter must be deemed closed and so reported. The individual or entity filing the original report or complaint and the person who is the subject of the report or complaint must be notified in writing by the Board of any final action on their report or complaint. (6) Summary reports. The Board shall prepare, on a timely basis, but in no event less than one every other month, a summary report of final actions taken upon disciplinary files maintained by the Board. The summary reports must be sent by the Board to every health care facility licensed by the Department of Health, every professional association and society of persons licensed under this title functioning on a territory-wide basis in the Virgin Islands, all insurers providing professional liability insurance to persons licensed under this Title in the Virgin Islands, and the Virgin Islands Pharmacists Association. (7) Any violation of this section shall constitute a misdemeanor. (8) If a person violates the provisions of this section, an action may be brought in the name of the people of the Virgin Islands, through the Attorney General of the Virgin Islands, for an order enjoining the violation or for an order enforcing compliance with this section. Upon filing of a verified petition in court, the court may issue a temporary restraining order without notice or bond and may preliminarily or permanently enjoin the violation, and if it is established that the person has violated or is violating the injunction, the court may punish the offender for contempt of court. Proceedings under this subsection are in addition to, and not in lieu of, all other remedies and penalties provided for by this section.