I strongly support the VaCNS recently submitted petition to the Virginia State Board of Health to review the regulations regarding CNS practice in Virginia. The state's interpretation of CNS practice as being covered in nurse licensure would suggest that an associate degree nurse has the requisite skill sets to perform the duties of an advanced practice nurse: CNS as recognized by ANCC and the IOM. The changing population and the acuity of illness dictate advanced academic and clinical experience to meet the challenges ahead in the healthcare delivery system. The constituents/citizens of Virginia deserve the care of the CNS as an APRN. Thank you for consideration on this high priority need for the Commonwealth of Virginia.