The state of Virginia does not allow the CNS role to be leveraged as an APRN role due to the restrictive nature of privileges.  Many APRN CNS's work as educators or other leadership roles because of these licensing restrictions.  This contributes to the access to care concerns that many areas of the stat are facing that ultimately drives the cost of care.  Academic preparation for the CNS is equivalent to NP if not exceeding (with many institutions now required DNP, as the consensus model originally proposed).  Even as a doctoral prepared CNS I am unable to advance my privileges to prescribe medication and practice fully in an APRN role.  Approximately 36 of the 50 states recognize the full privileges of the CNS preparation and role and, therefore, benefit from their expertise.  Virginia must consider leading, or at least modernizing to match that of the other 36 states, so that this vital APRN role can contribute to the  state’s health care needs.