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Nursing Regulations in Virginia, Texas and Michigan

Virginia vs. Texas

In 2018, Virginia passed a bill that visibly extended the scope of practice for APRNs. House Bill 793 established relative freedom for nurses in the framework of basic practice – starting from obtaining a health history and ending with diagnosing a patient. APRNs are allowed to treat common and chronic diseases and develop a treatment plan. NP can offer consultations, education, and preventive care. It should be stated that this refers to all NPs – not only to those that got the autonomous practice requirements (Virginia Law, n.d.). However, the significant barrier here is when a nurse may need a physician’s sign-off before proceeding with drug prescriptions or potentially certain diagnostic tests. It might be assumed that the regulatory environment in Virginia is quite flexible, despite it having a number of restrictions – such as an approach requiring practice agreements (Smith et al., 2020). At this point, it seems reasonable to compare this environment with the one in Texas.

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It seems rational to emphasize that in Texas, nursing practice is regulated and restricted to a greater extent than in Virginia. For instance, currently, NPs cannot practice without the supervision of physicians within a 75-mile radius. What is more, these physicians cannot conduct supervision over more than four nurses simultaneously and are to monitor no less than 10% of a nurse’s patient charts monthly on a random basis. However, Texas demonstrates some positive shifts regarding the expansion of nursing freedom. “Proposed House Bill 1792 would allow nurse practitioners with at least 2,080 hours under the delegation of a physician to practice independently” (Portia, W, 2019, para. 6). In particular, this bill will allow NPs to order, perform, and interpret diagnostic tests, as well as treat actual or potential issues related to health. House Bill 1792 might be considered as an analog to Virginia’s House Bill 793.

Virginia vs. Michigan

The regulatory environment in Virginia – since the passing of House Bill 793 – may be characterized as relatively flexible. It provides nurses with a considerable number of opportunities and capabilities. Particularly, APRNs are allowed to obtain a health history, diagnose a patient, and treat common and chronic diseases, as well as develop treatment plans (Smith et al., 2020). Nevertheless, there are still plenty of restrictions, such as the fact that nurses who do not meet the substantially advanced practice requirements, cannot prescribe controlled substances without authorized practice agreements (Virginia Law, n.d.). This indicates the presence of visible barriers for independent and coherent nursing practice. However, it seems that the state is on its way to improve the situation within the mentioned scope by softening the legal restrictions for nurses.

If to compare with Michigan, the regulatory environment in Virginia seems more restrictive. The most visible point here might be the following Michigan’s approach, “Michigan does not have a stand-alone act called the Nurse Practice Act … , we have a consolidated practice act that covers 25 health occupations” (Michigan Department of Licensing and Regulatory Affairs, 2020, para. 1). A title to these is the Occupational Regulation Sections of the Michigan Public Health Code. Such a policy highlights the independence and autonomy of nurses in the state, which is reflected in the absence of the Nurse Practice Act, which is not a characteristic to Virginia. In particular, it allows APRNs to prescribe a nonscheduled prescription drug. In Virginia, this procedure seems to be more complicated and still requires a physician’s approval. Thus, it might be assumed that in Michigan, there is more favorable regulatory environment than in Virginia as it gives more opportunities for independent practice and self-development.


Smith, S., Buchanan, H., & Cloutier, R. (2020). Virginia NP scope of practice. The Nurse Practitioner, 45(2), 33–37. Web.

Portia, W. (2019). Texas nurse practitioners fight for full practice authority. Web.

Virginia Law. (n.d.). § 54.1-2957. Licensure and practice of nurse practitioners. Web.

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Michigan Department of Licensing and Regulatory Affairs. (2020). Nursing FAQ. Web.

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