NURSE PRACTITIONER
FREQUENTLY ASKED QUESTIONS
1. Q. What is NP Registration?
A. RNs that have completed an accredited NP program and have national certification may complete an online application for Registration so they may use the title Nurse Practitioner. Registration is required for all NPs seeking approval to practice after December 31, 2004. A Certificate of Registration will be mailed to the NP after the application is processed by the Board of Nursing. Registration does not confer the authority to practice. (See approval to practice below.)
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2. Q. What is Initial Approval to Practice?
A. Initial approval to practice is first-time approval to practice as an NP in North Carolina. An online application for Initial Approval to Practice must be completed and approved by the NC Medical Board and Board of Nursing (the Boards) prior to beginning employment as an NP. The application identification document, including a photo of the NP, is signed by the NP and the primary supervising physician and mailed to the Board of Nursing in hard copy with original signatures. In addition to the online application, all supporting documentation must be received by the Board of Nursing before the application can be processed. The application instructions indicate what information must be submitted.
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3. Q. What is Registration/Initial Approval to Practice?
A. This is a combined online application that consists of both the Registration and Initial Approval to Practice applications. There is only one identification document for this combined application which will need a photo and signatures of the NP and the primary supervising physician.
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4. Q. What is an Approval Number?
A. The NP’s approval number is a unique number assigned to the NP at the time of initial approval. This number must be included on all prescriptions written by the NP.
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5. Q. What if I change jobs or primary supervising physicians?
A. NPs that make these and other practice changes must complete a new approval to practice online application (subsequent approval to practice) and mail the required documents (identification document with or without picture – picture required if inactive six months or more) to the Board of Nursing. The NP will receive a letter from the Board of Nursing notifying the NP that they are approved to practice. The change or additional practice information must be posted on the Board of Nursing’s website – www.ncbon.com – verify license or the letter from the Board of Nursing received before the NP starts their new job.
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6. Q. What is the turn-around time for completed applications?
A. All online applications are received by the Board of Nursing office on a daily basis. Due to the volume of applications received, please allow fifteen (15) business days for processing the application from the time all required documents are received in the Board office.
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7. Q. Do I need an RN license in order to be approved to practice as a Nurse Practitioner?
A. Yes. The NP must have an active, permanent, unencumbered RN license issued in North Carolina or an active, permanent and unencumbered RN license with a multistate privilege to practice issued by another compact state. Applications for individuals with a temporary RN license in either NC or a compact state can not be processed.
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8. Q. Is current national certification required in order to receive registration or approval to practice?
A. Yes. Beginning January 1, 2000, all NPs with first-time approval to practice in North Carolina must provide current evidence of certification as an NP by a national credentialing body accepted by the Boards.. Beginning January 1, 2005, NPs seeking initial approval to practice in North Carolina must be Masters prepared and have current national certification in the NP’s area of education and intended practice. As part of the registration application process, the NP must show proof of current national certification. See 21 N.C. Administrative Code 36 .0803 and 21 N.C. Administrative Code 32M .0103.
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9. Q. Must I include a photo on both the Registration and the Initial Approval to Practice Application documents?
A. Yes. A photo must be attached to the Registration application as well as to the Approval to Practice Application or with the combined application – Registration and Initial Approval - only one photo is required.
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10. Q. If I am planning to function as an NP in an office with one or more satellite sites, which site name should I place on the NP Approval to Practice Application?
A. If the primary supervising physician will be the same individual at all sites, the main office address should be listed as the principle site and the additional satellite sites(s) should be listed under the practice sites section. The NP must complete an additional online application for approval to practice for each site where the NP will have a different primary supervising physician.
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11. Q. I am changing practice site/supervising physician, but I want to keep my current practice site/supervising physician on a PRN basis, what do I do?
A. The NP must complete an online subsequent approval to practice application for the new supervising physician – click add practice, complete the application, and submit the required identification document Remember that for each current approval to practice the NP must maintain a current collaborative practice agreement and documented quality improvement meetings.
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12. Q. Do NC rules for NPs apply to those employed by the federal government and working in a federal facility?
A. Federally employed NPs are governed by federal rules and regulations in regard to how they practice while working within federal facilities. However, a federally employed NP who holds a North Carolina approval to practice and wants to maintain the approval to practice must comply with NC rules that pertain to maintaining an active approval to practice (i.e. annual renewal, CE and payment of fees). Also, any NP actively approved to practice is expected to practice competently, act professionally and be of requisite good character no matter where, or for whom, he or she works.
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13. Q. I was recently approved to practice and paid the application fee online. My birthday is now here. Do I need to pay the renewal fee so shortly after receiving my NP approval?
A. Nurse Practitioner rules require that an NP renew the approval to practice online with the Board of Nursing annually by the last day of the birth month unless initial approval was issued within three months of your birth month. The renewal fee is required.
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14. Q. What should I do when I discontinue my relationship with my primary supervising physician?
A. The NP’s approval to practice is terminated when the NP discontinues working within the approved NP collaborative practice agreement, and the NP shall notify the Board of Nursing in writing. See Rules 21 NCAC 36 .0804 (d) and 21 NCAC 32M .0104 (d). This can also be done at: www.ncbon.com – online applications and services - request inactive status (no fee).
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15. Q. If I fail to renew my approval to practice, how much time do I have before my approval to practice is made inactive?
A. All active NPs must renew their approval to practice before the last day of their birth month. After the last day of the birth month, the NP’s approval to practice is automatically placed on inactive status at midnight of the last day of the month.
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16. Q. My NP approval to practice was made inactive for failure to renew. How do I reinstate?
A. For reinstatement of approval to practice, the NP must complete the NP subsequent approval to practice application online, pay the fee online and mail the required documents to the NC Board of Nursing for processing of the subsequent approval to practice application.
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17. Q. May an NP prescribe controlled substances?
A. Yes. An NP may prescribe controlled substances consistent with 21 NCAC 36 .0809 and 21 NCAC 32M .0109. A physician must have DEA registration equal to or greater than the DEA registration of an NP that he or she supervises.
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18. Q. Can an NP prescribe refills for Schedule III and IIIN controlled substances?
A. Yes. Due to a recent NP rule change (21 NCAC 36.0809 and 21 NCAC 32M .0109) effective April 1, 2011, the prohibition on refills for this class of drugs was removed. NPs may now prescribe up to 5 refills for Schedule III and IIIN controlled substances. Dosage units continue to be limited to a 30 day supply for each refill.
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19. Q. May an NP prescribe controlled substances consistent with United States Drug Enforcement Administration (DEA) rule 21 CFR 1306.12 and not violate the Boards’ prescribing rules pertaining to nurse practitioners?
A. Yes.
21 CFR 1306.12 (reprinted below) prohibits the refilling of Schedule II controlled substances.
Nurse Practitioner Rule 21 NCAC 36.0809(b)(2)(B) [21 NCAC 32m.0109(b)(2)(B)] mandates that NP prescriptions for Schedules II, IIN, III, IIIN controlled substances be limited to a 30 day supply.
Per 21 CFR 1306.12(b), under certain circumstances, a provider may issue multiple prescriptions for Schedule II controlled substances that result in a ninety (90) day supply. Those conditions are included in the rule reprinted below.
NPs who comply with 21 CFR 1306.12 are not in violation of the applicable NP rules regarding the prescribing of controlled substances so long as the NP strictly complies with all of the conditions enumerated in 21 CFR 1306.12.
In addition, the Boards’ position on this matter pre-supposes that the NP who prescribes pursuant to 21 CFR 1306.12 follows all other applicable rules pertaining to NP practice in North Carolina. The NP rules may be found in 21 NCAC 36 Section .0800 and 21 NCAC 32M and may be accessed at www.ncbon.com or www.ncmedboard.org.
21 CFR 1306.12
Section 1306.12 Refilling Prescriptions; Issuance of multiple prescriptions.
(a) The refilling of a prescription for a controlled substance listed in Schedule II is prohibited.
(b)(1) An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided the following conditions are met:
(i) Each separate prescription is issued for a legitimate medical purpose by individual practitioner acting in the usual course of professional practice;
(ii) The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription;
(iii) The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse;
(iv) The issuance of multiple prescriptions as described in this section is permissible under the applicable state laws; and
(v) The individual practitioner complies fully with all other applicable requirements under the ACT and these regulations as well as any additional requirements under state law.
(2) Nothing in this paragraph (b) shall be construed as mandating or encouraging individual practitioners to issue multiple prescriptions or to see their patients only once very 90 days when prescribing Schedule II controlled substances. Rather, individual practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so.
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20. Q.Is a pharmacy permit to dispense required for a Nurse Practitioner to distribute sample medications to patients?
A. No.
The Board of Pharmacy has indicated that the registration, permitting, and oversight requirements of Pharmacy Rule .1703 do not apply to an NP who is engaged in traditional sampling – that is, handing out, free of any charge (whether direct or indirect), starter doses or packets of prescription drug samples received from a prescription drug manufacturer in compliance with the Prescription Drug Marketing Act.
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21. Q. Are primary supervising physicians and back-up supervising physicians responsible for the medical acts of NPs?
A. Primary supervising physicians are responsible at all times for the medical acts of the NPs they supervise. Back-up supervising physicians are only responsible for the medical acts of NPs when they are actively supervising the NP.
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22. Q.How many supervising physicians are required to be designated for each NP?
A. An NP is only required to have one primary supervising physician.
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23. Q. How many supervising physicians may an NP have?
A. There is no limit on how many supervising physicians an NP may have. An NP may have multiple primary supervising physicians and multiple back-up supervising physicians.
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24. Q. Must an NP have a back-up supervising physician?
A. While it is not required that an NP have a back-up supervising physician, NPs are encouraged to have a designated physician available to her/him in the absence of her/his primary supervising physician. Back-up supervising physicians must be approved by the NP and the primary supervising physician. Nurse Practitioners must keep a copy of the form on file at all practice sites for which it applies, but do not send this form to either the Board of Nursing or the Medical Board. The form must be signed by the NP, primary supervising physician and the back-up supervising physician(s).
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25. Q. Is on-site presence of supervising physician required at all times the NP is performing tasks pursuant to the collaborative practice agreement?
A. On-site physical presence is not required; however, the primary or back-up supervising physician and the NP must be continuously available to each other for consultation by direct communication or telecommunication.
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26. Q. What does the Medical Board’s Position Statement on Referral Fees and Fee Splitting mean?
A. The position statement is intended to prevent physicians from sharing revenue they have generated on a percentage basis with a non-physician. The Medical Board’s position statement is not intended to prevent the NP employees from receiving a percentage of revenue they have generated (often referred to as a productivity bonus).
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27. Q. What should an NP do if an emergency affects the ability of her/his primary supervising physician to function in the supervisory capacity?
A. Emergency situation is defined as an injury, sudden illness, death or other unforeseen unavailability of the nurse practitioner’s primary supervising physician.
In an emergency situation the staff of both Boards are authorized to grant the nurse practitioner continued approval to practice until a new application is received and processed as follows:
(1) The nurse practitioner shall notify both Boards within two (2) business days of the emergency situation by first calling the Boards and then following up with a letter describing the emergency situation.
(2) The nurse practitioner is given forty-five (45) days from the date of the emergency situation to submit an application for a new primary supervising physician.
(3) The NP may ask for an extension of up to an additional 30 days if he/she is unable after an exercise of due diligence to find another primary supervising physician.
(4) If an application for a new primary supervising physician is not submitted within forty-five (45) days or if an extension is not granted, the nurse practitioner’s approval to practice will terminate.
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28. Q. What information must be on the NP’s name badge when the NP is involved in the direct provision of health care to patients?
A. The NC Badge Law (GS 90-640) requires every health care professional to wear or display a readily visible form of identification to include the individual’s name and the license, approval to practice or listing title when providing patient care. Standard abbreviations for such titles may be used as in Jane Smith, RN, NP. Exceptions to this requirement are outlined in Rule 21 NCAC 36.0231 Exceptions to Health Care Practitioners Identification Requirements.
Consistent with agency policy, the NP may choose to include academic or certification designations on the name badge, but these must be in addition to the NP’s legally approved practice title(s). For example, one might use Jane Smith, RN, NP, MSN or Jane Smith, RN, NP, PhD depending upon one’s level of academic preparation.
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