Frequently Asked Questions
Printer-Friendly Version

Nurse Practitioner

  1. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What is Nurse Practitioner Registration?

  2. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What is Initial Approval to Practice?

  3. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Is physician supervision required for Nurse Practitioner practice in North Carolina?

  4. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Is current national certification required in order to renew the Nurse Practitioner approval to practice?

  5. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What is an Approval Number?

  6. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Are Certified Nurse Practitioners required to have a NPI number?

  7. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What if I change jobs or primary supervising physicians?

  8. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What is the turn-around time for completed applications?

  9. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Do I need an Registered Nurse license in order to be approved to practice as a Nurse Practitioner?

  10. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Is current national certification required to receive registration or approval to practice?

  11. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Must I include a photo on both the Registration and the Initial Approval to Practice Application documents?

  12. [Registration/Approval to Practice (Initial and Subsequent Renewal)] If I am planning to function as a Nurse Practitioner in an office with one or more satellite sites, which site name should I place on the Nurse Practitioner Approval to Practice application?

  13. [Registration/Approval to Practice (Initial and Subsequent Renewal)] 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 Nurse Practitioner approval?

  14. [Registration/Approval to Practice (Initial and Subsequent Renewal)] I have just been initially approved to practice as a Nurse Practitioner, but my Nurse Practitioner renewal is due in a few months. Do I need to obtain 50 contact hours in order to renew for the first time?

  15. [Registration/Approval to Practice (Initial and Subsequent Renewal)] My Nurse Practitioner approval to practice was made inactive for failure to renew. How do I reinstate?

  16. [Supervision / Scope of Practice] How is the Nurse Practitioners scope of practice defined in North Carolina?

  17. [Supervision / Scope of Practice] What is the legal age rages for the Nurse Practitioner roles?

  18. [Supervision / Scope of Practice] Is physician supervision a requirement for Nurse Practitioner practice in North Carolina?

  19. [Supervision / Scope of Practice] Is a collaborative practice agreement required for Nurse Practitioner practice in North Carolina?

  20. [Supervision / Scope of Practice] How long must Nurse Practitioner compliance audit documentation be maintained and available upon request for Board review?

  21. [Supervision / Scope of Practice] What should I do when I discontinue my relationship with my primary supervising physician?

  22. [Supervision / Scope of Practice] Are primary supervising physicians and back-up supervising physicians responsible for the medical acts of Nurse Practitioners?

  23. [Supervision / Scope of Practice] How many supervising physicians are required to be designated for each Nurse Practitioner?

  24. [Supervision / Scope of Practice] Must a Nurse Practitioner have a back-up supervising physician?

  25. [Supervision / Scope of Practice] How many Nurse Practitioners can a physician supervise in North Carolina?

  26. [Supervision / Scope of Practice] I have just changed primary supervising physicians. Do I have to begin the QIP process over; monthly meetings x 6 months and then twice yearly?

  27. [Supervision / Scope of Practice] Can the meetings (monthly x6 then biannually) with the primary supervising physician be conducted electronically?

  28. [Supervision / Scope of Practice] Is on-site presence of supervising physician required at all times the Nurse Practitioner is performing tasks pursuant to the collaborative practice agreement?

  29. [Supervision / Scope of Practice] What should a Nurse Practitioner do if an emergency affects the ability of her/his primary supervising physician to function in the supervisory capacity?

  30. [Supervision / Scope of Practice] What are the required credentials for physician supervision?

  31. [Supervision / Scope of Practice] Is Surgical First Assist activities within the Nurse Practitioner scope of practice?

  32. [Supervision / Scope of Practice] Is it in the scope of practice for a Psychiatric-Mental Health Nurse Practitioner to perform multidisciplinary evaluations?

  33. [Supervision / Scope of Practice] Does a Nurse Practitioner have authority to sign a death certificate?

  34. [Supervision / Scope of Practice] Can a Nurse Practitioner delegate to an Unlicensed Assistive Personnel (UAP)?

  35. [Supervision / Scope of Practice] What are the North Carolina Division of Medical Assistance (DMA) certification requirements for Nurse Practitioners providing behavioral health outpatient services?

  36. [Supervision / Scope of Practice] Do Nurse Practitioners have signatory authority for death certificates?

  37. [Supervision / Scope of Practice] Do Nurse Practitioners have signatory authority for FL-2 Forms?

  38. [Supervision / Scope of Practice] Do Nurse Practitioners have hospital admission privileges in North Carolina?

  39. [Supervision / Scope of Practice] What are the minimum number of hours required to maintain the Nurse Practitioner approval to practice?

  40. [Supervision / Scope of Practice] What are the regulatory requirements for a Nurse Practitioner to provide psychiatric-mental health care for patients?

  41. [Prescriptive Authority] May a Nurse Practitioner prescribe controlled substances?

  42. [Prescriptive Authority] May a Nurse Practitioner prescribe refills for Schedule controlled substances?

  43. [Prescriptive Authority] What is a NPI number?

  44. [Prescriptive Authority] What is the Board’s position on treating family members.

  45. [Prescriptive Authority] May Women’s Health Nurse Practitioners (WHNP) and Certified Nurse Midwives (CNM) treat men?

  46. [Prescriptive Authority] Where can I find information about the new controlled substance prescribing rules?

  47. [Prescriptive Authority] Is a pharmacy permit to dispense required for a Nurse Practitioner to distribute sample medications to patients?

  48. [Practice] Do North Carolina rules for Nurse Practitioners apply to those employed by the federal government and working in a federal facility?

  49. [Practice] What information must be on the Nurse Practitioner's name badge when the Nurse Practitioner is involved in the direct provision of health care to patients?

  50. [Practice] What does the Medical Board’s Position Statement on Referral Fees and Fee Splitting mean?

  51. [Practice] Can Nurse Practitioners engage in telehealth/telemedicine?

  52. [Practice] Can Nurse Practitioners practice in roles that are outside of their area of certification?

  53. [Practice] Can a Nurse Practitioner practice below his/her highest level of licensure and education?

  54. [Education] Does the North Carolina Board of Nursing approve post-licensure and graduate-level nursing education programs in North Carolina and in other states?

  55. [Education] Do Nurse Practitioner students need a Registered Nurse license to do clinical rotations in North Carolina?

  56. [Education] Who may precept a nurse practitioner student in clinical settings?

  57. [Education] Is a Doctorate required for entry into practice as a Nurse Practitioner?

  58. [Education] Is there a minimum number of pharmacology hours within the required annual 50 continuing education hours AND is there a requirement for continuing education hours that focus on controlled substances/diversion/addiction?

  1. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What is Nurse Practitioner Registration?

    Registered Nurses that have completed an accredited Nurse Practitioner 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 Nurse Practitioners seeking approval to practice after December 31, 2004. A Certificate of Registration will be emailed to the Nurse Practitioner after the application is processed by the Board of Nursing. Registration does not confer the authority to practice. (See Approval to Practice below)

  2. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What is Initial Approval to Practice?

    Initial approval to practice is first-time approval to practice as an Nurse Practitioner in North Carolina. An online application for Initial Approval to Practice must be completed and approved by the North Carolina Medical Board and Board of Nursing (the Boards) prior to beginning employment as an Nurse Practitioner. 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.

  3. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Is physician supervision required for Nurse Practitioner practice in North Carolina?

    Yes. Per 21 NCAC 36 .0801 (1) (10) DEFINITIONS, A collaborative practice agreement with a primary supervising physician licensed by the North Carolina Medical Board is required for Nurse Practitioner approval to practice in North Carolina.

  4. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Is current national certification required in order to renew the Nurse Practitioner approval to practice?

    Yes. Nurse Practitioners seeking renewal of the Nurse Practitioner approval to practice in North Carolina must provide current evidence of maintaining certification as a nurse practitioner by a national credentialing body identified in 21 NCAC 36 .0801(8) of this Section See 21 NCAC 36 .0806.

  5. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What is an Approval Number?

    The approval number is a unique number assigned to the Certified Nurse Practitioner at the time of initial approval. This number must be included on all prescriptions written by the Certified Nurse Practitioner.

  6. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Are Certified Nurse Practitioners required to have a NPI number?

    No. A National Provider Identifier (NPI) number is not a requirement for approval as a Certified Nurse Practitioner in North Carolina. A NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI is a payer/reimbursement requirement. The North Carolina Board of Nursing does not have jurisdiction in payer issues. You are advised to contact payers directly to determine in a NPI number is required for reimbursement.

  7. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What if I change jobs or primary supervising physicians?

    Certified Nurse Midwives that change jobs or add new supervising physician(s) must complete the "Add Physician" online application via the Nurse Gateway. The Certified Nurse Practitioner shall not practice until notification of approval has been received. The approval letter and certificate will be emailed to the Certified Nurse Practitioner upon FINAL approval to practice with the new supervising physician. The approval can also be verified on the Board's website by selecting Verify License.

  8. [Registration/Approval to Practice (Initial and Subsequent Renewal)] What is the turn-around time for completed applications?

    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.

  9. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Do I need an Registered Nurse license in order to be approved to practice as a Nurse Practitioner?

    Yes. The Certified Nurse Practitioner must have an active, permanent, unencumbered Registered Nurse license issued in North Carolina or an active, permanent and unencumbered Registered Nurse license with a multistate privilege to practice issued by another compact state. Applications for individuals with a temporary Registered Nurse license in either North Carolina or a compact state cannot be processed.

  10. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Is current national certification required to receive registration or approval to practice?

    Yes. Beginning January 1, 2000, all Nurse Practitioners with first-time approval to practice in North Carolina must provide current evidence of certification as an Nurse Practitioner by a national credentialing body accepted by the Boards. Beginning January 1, 2005, Nurse Practitioners seeking initial approval to practice in North Carolina must be Masters prepared and have current national certification in the Nurse Practitioner’s area of education and intended practice. As part of the registration application process, the Nurse Practitioner must show proof of current national certification. See 21 NCAC 36 .0803 and 21 NCAC 32M .0103.

  11. [Registration/Approval to Practice (Initial and Subsequent Renewal)] Must I include a photo on both the Registration and the Initial Approval to Practice Application documents?

    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.

  12. [Registration/Approval to Practice (Initial and Subsequent Renewal)] If I am planning to function as a Nurse Practitioner in an office with one or more satellite sites, which site name should I place on the Nurse Practitioner Approval to Practice application?

    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 Nurse Practitioner must complete an additional online application for approval to practice for each site where the Nurse Practitioner will have a different primary supervising physician.

  13. [Registration/Approval to Practice (Initial and Subsequent Renewal)] 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 Nurse Practitioner approval?

    Nurse Practitioner rules require that an Nurse Practitioner 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.

  14. [Registration/Approval to Practice (Initial and Subsequent Renewal)] I have just been initially approved to practice as a Nurse Practitioner, but my Nurse Practitioner renewal is due in a few months. Do I need to obtain 50 contact hours in order to renew for the first time?

    Between the time you are initially approved to practice as an Nurse Practitioner and your first renewal, you are not required to obtain 50 contact hours. You are only required to obtain 50 contact hours AFTER your first Nurse Practitioner renewal, and every Nurse Practitioner renewal period (birth month to birth month) thereafter.

  15. [Registration/Approval to Practice (Initial and Subsequent Renewal)] My Nurse Practitioner approval to practice was made inactive for failure to renew. How do I reinstate?

    For reinstatement of approval to practice, the Nurse Practitioner must complete the Nurse Practitioner Reinstatement application and pay the fee via the Nurse Gateway. The Nurse Practitioner will be notified upon reinstatement of the Nurse Practitioner's approval to practice. The approval can also be verified on the Board's website by selecting Verify License.

  16. [Supervision / Scope of Practice] How is the Nurse Practitioners scope of practice defined in North Carolina?

    The population-focused Nurse Practitioner Scope of Practice is defined by the Nurse Practitioner’s formal academic, graduate educational preparation, national certification and maintained competence. The Nurse Practitioner Scope of Practice is set forth and defined by the Nurse Practitioner rules (21 NCAC 36 .0801 (9) and 21 NCAC 36 .0802) & operationalized by the Collaborative Practice Agreement (CPA). The Collaborative Practice Agreement identifies what drugs, devices, medical treatments, tests and procedures that may be prescribed, ordered and performed, would be appropriate for the diagnosis and treatment of the common medical problems seen in your Nurse Practitioner practice sites.

  17. [Supervision / Scope of Practice] What is the legal age rages for the Nurse Practitioner roles?

    Type of Nurse Practitioner Age Range
    Adult, Adult Gerontology (Primary and Acute Care) 18 years old and above (can see 13 years old depending on setting if included in formal curriculum)
    Family Nurse Practitioner 0 - death
    Pediatric Nurse Practitioner 0 - 21 years old
    Neonatal Nurse Practitioner 0 - 2 years old (can see if preemie in NICU)
    Geriatric Nurse Practitioner 55 years old and above (can see 45 years old if in nursing home)
    OB and Women's Nurse Practitioner Females at any age & male patients for expedited partner treatment
  18. [Supervision / Scope of Practice] Is physician supervision a requirement for Nurse Practitioner practice in North Carolina?

    Yes. In concert with 21 NCAC 36.0804 (a)(4), prior to the performance of any medical acts, the Nurse Practitioner shall have a collaborative practice agreement with a primary supervising physician. The statutory requirement for physician supervision of nurse practitioner practice remains the same, regardless of the Nurse Practitioner’s level of education or practice setting.

  19. [Supervision / Scope of Practice] Is a collaborative practice agreement required for Nurse Practitioner practice in North Carolina?

    Yes. In concert with 21 NCAC 36 .0801(4) and 21 NCAC 36 .0810 (2) a Collaborative Practice Agreement (CPA) is an requirement for Nurse Practitioner approval to practice in North Carolina. The CPA is a written arrangement between the Nurse Practitioner and the primary supervising for continuous availability to each other for ongoing supervision, consultation, collaboration, referral and evaluation of care provided by the Nurse Practitioner. The CPA shall be signed and dated by the Nurse Practitioner and the primary supervising physician annually and when there are changes in the practice agreement. The CPA shall be maintained at each practice site. When the Nurse Practitioner practices in multiple satellite sites under the same CPA, the CPA may be maintained in at the administrative or central practice site.

  20. [Supervision / Scope of Practice] How long must Nurse Practitioner compliance audit documentation be maintained and available upon request for Board review?

    Either electronic or paper documentation regarding registration and approval to practice, collaborative practice agreement(s), quality improvement process meetings, and continuing education shall be maintained for the previous five years made available upon request to the Board. See The NP Survival Guide to NCBON Compliance Review Audits

  21. [Supervision / Scope of Practice] What should I do when I discontinue my relationship with my primary supervising physician?

    The Nurse Practitioner’s approval to practice is terminated when the Nurse Practitioner discontinues working within the approved Nurse Practitioner collaborative practice agreement, and the Nurse Practitioner 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: request inactive status (no fee).

  22. [Supervision / Scope of Practice] Are primary supervising physicians and back-up supervising physicians responsible for the medical acts of Nurse Practitioners?

    Primary supervising physicians are responsible at all times for the medical acts of the Nurse Practitioners they supervise. Back-up supervising physicians are only responsible for the medical acts of Nurse Practitioners when they are actively supervising the Nurse Practitioner.

  23. [Supervision / Scope of Practice] How many supervising physicians are required to be designated for each Nurse Practitioner?

    A Nurse Practitioner is only required to have one primary supervising physician.

  24. [Supervision / Scope of Practice] Must a Nurse Practitioner have a back-up supervising physician?

    While it is not required that an Nurse Practitioner have a back-up supervising physician, Nurse Practitioners 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 Nurse Practitioner 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 Nurse Practitioner, primary supervising physician and the back-up supervising physician(s).

  25. [Supervision / Scope of Practice] How many Nurse Practitioners can a physician supervise in North Carolina?

    Neither law nor rule limit the number of Nurse Practitioners a physician may supervise if the physician can provide adequate supervision of said number. See the NCMB position statement on Physician supervision of other licensed health care practitioners.

  26. [Supervision / Scope of Practice] I have just changed primary supervising physicians. Do I have to begin the QIP process over; monthly meetings x 6 months and then twice yearly?

    Yes. Each time a Nurse Practitioner enters into a supervisory relationship with a new primary supervising physician, the Quality Improvement Process begins, anew. Per 21 NCAC 36 .0810 (5)(a) Nurse Practitioner-Physician Consultation. The following requirements establish the minimum standards for consultation between the Nurse Practitioner and primary supervising physician(s):(a) During the first six months of a collaborative practice agreement between a Nurse Practitioner and the primary supervising physician, there shall be monthly meetings for the first six months to discuss practice relevant clinical issues and quality improvement measures.

  27. [Supervision / Scope of Practice] Can the meetings (monthly x6 then biannually) with the primary supervising physician be conducted electronically?

    Yes. 21 NCAC 36 .0810 (4) (a)-(c) addresses the rules for the QIP. There are no prescriptive rules indicating how the QIP must be accomplished. (4)(a) states “the primary supervising physician and the Nurse Practitioner shall develop a process for the ongoing review of the care provided in each practice site including a written plan for evaluating the quality of care provided for one or more frequently encountered clinical problems.” In a manner that is appropriate for their collaborative relationship. Both the primary supervising physician and the Nurse Practitioner must sign and date attendance at the meeting. A verified electronic signature is acceptable.   

  28. [Supervision / Scope of Practice] Is on-site presence of supervising physician required at all times the Nurse Practitioner is performing tasks pursuant to the collaborative practice agreement?

    On-site physical presence is not required; however, the primary or back-up supervising physician and the Nurse Practitioner must be continuously available to each other for consultation by direct communication or telecommunication.

  29. [Supervision / Scope of Practice] What should a Nurse Practitioner do if an emergency affects the ability of her/his primary supervising physician to function in the supervisory capacity?

    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 Nurse Practitioner 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.

  30. [Supervision / Scope of Practice] What are the required credentials for physician supervision?

    The supervising physician must be licensed with the North Carolina Medical Board with a population focus, certification and maintained competence that mirrors or exceed that of the Nurse Practitioner’s population focus to avoid limiting the Nurse Practitioners scope of practice. Per 21 NCAC 36 .0802 SCOPE OF PRACTICE (10), (12), Physician supervision is required for Nurse Practitioner approval to practice in North Carolina.

    (10) "Primary Supervising Physician" means the licensed physician who shall provide ongoing supervision, collaboration, consultation and evaluation of the medical acts performed by the nurse practitioner as defined in the collaborative practice agreement. Supervision shall be in compliance with the following:

    (a) The primary supervising physician shall assure both Boards that the nurse practitioner is qualified to perform those medical acts described in the collaborative practice agreement.

    (b) A physician in a graduate medical education program, whether fully licensed or holding only a resident's training license, shall not be named as a primary supervising physician.

    (c ) A fully licensed physician in a graduate medical education program who is also practicing in a non-training situation may supervise a nurse practitioner in the non-training situation.

    (12) "Supervision" means the physician's function of overseeing medical acts performed by the nurse practitioner.

  31. [Supervision / Scope of Practice] Is Surgical First Assist activities within the Nurse Practitioner scope of practice?

    Yes. See the  FAQ  “Is the Surgical First Assist role within the scope of practice of licensed nurses in North Carolina?”  which clarifies that First Assist role is within Registered Nurse scope of practice.  This role would also, therefore, be within Advanced Practice Registered Nurse (APRN) scope of practice.  The salient issues are formal preparation/education for the role, competence validation, and appropriate policies/procedures in place to support the first assist role. For the Nurse Practitioner, this role would also need to be addressed within the Collaborative Practice Agreement. The Nurse Practitioner functioning as First Assist should have documentation of their formal education and ongoing competence in this role on file should there ever be any need to validate. The North Carolina Board of Nursing (NCBON) does not confer RNFA title as this is a national certification rather than state licensure or approval to practice, so we do not "grandfather" this title. RNFA Certification is obtained via AORN Certification body and the grandfather question would be appropriately directed to them.

    NCBON made conscious decision not to require RNFA Certification in recognition that the formal education and competence validation could be accomplished in ways other than through the AORN course and exam. The AORN RNFA Standards do, however, serve as the national standards of First Assist practice so that any alternative education/competence should include all relevant content and skills and documentation should serve to demonstrate that equivalence.  

    See AORN’s Position Statement on Advanced Practice Registered Nurses in the Perioperative Environment (PDF) which delineates the definition and educational requirements for the APRN who functions in the perioperative environment, including the preoperative, intraoperative, and postoperative patient care areas. This position statement states that:

    ...“the APRN practicing in the perioperative environment as a first assistant at surgery is required, as of January 1, 2016, to acquire the knowledge and skills needed to provide safe, competent surgical first assistant services by completing a program that covers the content of the AORN Standards for RN First Assistant Education Programs, which may be a stand-alone program or may be a portion of a graduate or postgraduate program (e.g., additional coursework included in a graduate APRN program); with certification as a requirement for clinical privileging” (AORN, 2016).

  32. [Supervision / Scope of Practice] Is it in the scope of practice for a Psychiatric-Mental Health Nurse Practitioner to perform multidisciplinary evaluations?

    Yes. In accordance with § 35A-1111 participation in interdisciplinary/multidisciplinary evaluations of psychiatric patients is within the SOP for PMNP practice as long as included in the CPA, the Nurse Practitioner has had education and competence validation in the multidisciplinary evaluation process and it is supported by institutional policy. Institutional policy may be more restrictive by never less restrictive than permitted by law and rule. 

  33. [Supervision / Scope of Practice] Does a Nurse Practitioner have authority to sign a death certificate?

    Yes. As stipulated in North Carolina law § 130A-115. Death registration, section (c ) The medical certification shall be completed and signed by the physician in charge of the patient's care for the illness or condition which resulted in death, except when the death falls within the circumstances described in G.S. 130A-383. In the absence of the physician or with the physician's approval, the certificate may be completed and signed by an associate physician, a physician assistant in a manner consistent with G.S. 90-18.1(e1), a nurse practitioner in a manner consistent with G.S. 90-18.2(e1), the chief medical officer of the hospital or facility in which the death occurred or a physician who performed an autopsy upon the decedent under the following circumstances: the individual has access to the medical history of the deceased; the individual has viewed the deceased at or after death; and the death is due to natural causes.

  34. [Supervision / Scope of Practice] Can a Nurse Practitioner delegate to an Unlicensed Assistive Personnel (UAP)?

    A Nurse Practitioner may delegate activities to a UAP who has had competence validation and if supported by institutional policies.  See the following position statements which provide guidance regarding competency assessment, validation and supervision of UAPs.

  35. [Supervision / Scope of Practice] What are the North Carolina Division of Medical Assistance (DMA) certification requirements for Nurse Practitioners providing behavioral health outpatient services?

    The policy changes for the credentialing of Nurse Practitioners in the Outpatient Clinical Coverage Policy 8C is effective beginning January 1, 2017.  This policy is a credentialing and reimbursement policy rather than a professional regulatory policy and will include the following:

    1. Removing the current timeline of July, 2017 for Nurse Practitioners to become Psychiatric Mental Health Nurse Practitioners (PMHNP) in order to continue providing services to Medicaid beneficiaries.
    2. Nurse Practitioners certified as pediatric, adult, geriatric or family Nurse Practitioners not yet certified as Psychiatric Mental Health Nurse Practitioners could be eligible to provide psychiatric services to Medicaid beneficiaries if they meet the following:
      1. Provide documentation to the credentialing body of the LME-MCO that they have 5 full-time years of psychiatric prescribing experience under psychiatric supervision including psychiatric assessments and psychotropic medication prescribing;
      2. A signed supervision agreement with a North Carolina Licensed Psychiatrist that covers prescribing activities; and
      3. A minimum average of 20 hours of Category 1 CME/CEUs focusing on diagnosis and psychopharmacology over the preceding three years.
    3. The LME-MCO credentialing body and Medical Director are responsible for assessing the qualifications of Nurse Practitioners not yet certified as PMHNPs and for monitoring supervision and CME/CEU completions.
  36. [Supervision / Scope of Practice] Do Nurse Practitioners have signatory authority for death certificates?

    The Nurse Practitioner can sign DNRs if the agency policies allow for this and it is included in the collaborative practice agreement with the primary supervising physician. For documentation re: Nurse Practitioners and DNRs, see the following position statement from the North Carolina Medical Board website:  http://www.ncmedboard.org/articles/detail/pas_and_nps_may_sign_death_certificates_oct._1/

  37. [Supervision / Scope of Practice] Do Nurse Practitioners have signatory authority for FL-2 Forms?

    Signatory authority of FL-2 forms is not a state professional regulatory issue; rather it is a federal guideline as noted in the February 23, 201, the North Carolina Division of Aging and Adult Services Change No. 01-10 policy statement “Special Assistance for Adults Program Manual Updates”  document. This federal policy was modified to expand signatory authority of FL-2 forms to include physicians, physician assistants or Nurse Practitioners without the requirement of a physician being present. Nurse Practitioner signatory authority of FL-s forms is reflected in the following sections: I.A Background and II.B.1.

  38. [Supervision / Scope of Practice] Do Nurse Practitioners have hospital admission privileges in North Carolina?

    It depends on the hospital credentialing policies. Admitting and discharging patients may be within the scope of practice for a nurse practitioner provided that: 1) these functions are included in the CPA between the Nurse Practitioner and supervising physician, AND 2) the hospital has policies and procedures allowing Nurse Practitioners to perform these functions. Hospital credentialing is a separate process that is governed by institutional policies over which the North Carolina Board of Nursing has no jurisdiction. An institution may require a higher level, but never a lower level than required by law and rule. If you have questions regarding your hospital credentialing process, your institutional credentialing office would be the appropriate resource for consultation.

  39. [Supervision / Scope of Practice] What are the minimum number of hours required to maintain the Nurse Practitioner approval to practice?

    To maintain an active approval to practice, you must maintain sufficient clinical practice hours sufficient to maintain your national certification and maintain your Continuing Education Requirements; otherwise you would need to go through the process outlined in the Nurse Practitioner Refresher Course Packet  (if you have not engaged in clinical practice for > 2 years) to qualify for Nurse Practitioner approval to practice.

  40. [Supervision / Scope of Practice] What are the regulatory requirements for a Nurse Practitioner to provide psychiatric-mental health care for patients?

    The Nurse Practitioner population-focused scope of practice (SOP) is defined by the Nurse Practitioner's formal academic, graduate educational preparation, national certification and maintained competence as defined by the Nurse Practitioner rules (21 NCAC 36 .0801 (9) and 21 NCAC 36 .0802) & operationalized by the Collaborative Practice Agreement (CPA).

    As long as the Collaborative Practice Agreement includes, psychiatric management as part of the scope of care for the Nurse Practitioner, there is documentation of education, and maintained competence for this activity AND this is not in violation of institutional policy; it is within the scope of practice for the Nurse Practitioner to provide basic, uncomplicated psychiatric/mental health issues for clients.  

    Neither specialty nor acute care PMH management is part of  Generalist Nurse Practitioner educational preparation/certification (i.e. AGNP, FNP , PNP, WHNP, etc.), so if a Nurse Practitioner wishes to work in specialty PMH settings it is vital to document how his skill competency was obtained and maintained through formal academic education, post-graduate fellowship or specialty certification such as PMHNP-BC

  41. [Prescriptive Authority] May a Nurse Practitioner prescribe controlled substances?

    Yes. A Nurse Practitioner 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 Nurse Practitioner that he or she supervises.

  42. [Prescriptive Authority] May a Nurse Practitioner prescribe refills for Schedule controlled substances?

    Yes. Prescriptive authority is part of the Nurse Practitioner approval to practice as stipulated in 21 NCAC 36 .0809. Controlled substances may be prescribed and refilled consistent with controlled substance laws and regulations.

  43. [Prescriptive Authority] What is a NPI number?

    A National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI is a payer/reimbursement requirement. The North Carolina Board of Nursing does not have jurisdiction in payer issues.  Licensees are advised to contact the payer directly for questions about NPI issues. 

  44. [Prescriptive Authority] What is the Board’s position on treating family members.

  45. [Prescriptive Authority] May Women’s Health Nurse Practitioners (WHNP) and Certified Nurse Midwives (CNM) treat men?

    The WHNP and the CNM’s scope of practice for men is limited to expedited partner treatment for sexually transmitted infections and for reproductive health issues.

  46. [Prescriptive Authority] Where can I find information about the new controlled substance prescribing rules?

  47. [Prescriptive Authority] Is a pharmacy permit to dispense required for a Nurse Practitioner to distribute sample medications to patients?

    No. The Board of Pharmacy has indicated that the registration, permitting, and oversight requirements of Pharmacy Rule .1703 do not apply to a Nurse Practitioner 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.

  48. [Practice] Do North Carolina rules for Nurse Practitioners apply to those employed by the federal government and working in a federal facility?

    Federally employed Nurse Practitioners are governed by federal rules and regulations in regard to how they practice while working within federal facilities. However, a federally employed Nurse Practitioner who holds a North Carolina approval to practice and wants to maintain the approval to practice must comply with North Carolina rules that pertain to maintaining an active approval to practice (i.e. annual renewal, continuing education and payment of fees). Also, any Nurse Practitioner 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.

  49. [Practice] What information must be on the Nurse Practitioner's name badge when the Nurse Practitioner is involved in the direct provision of health care to patients?

    The North Carolina 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 Nurse Practitioner may choose to include academic or certification designations on the name badge, but these must be in addition to the Nurse Practitioner’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.

  50. [Practice] What does the Medical Board’s Position Statement on Referral Fees and Fee Splitting mean?

    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 Nurse Practitioner employees from receiving a percentage of revenue they have generated (often referred to as a productivity bonus).

  51. [Practice] Can Nurse Practitioners engage in telehealth/telemedicine?

    Yes. A Nurse Practitioner (NP) may practice within his/her designated scope of practice set forth in North Carolina Laws and Rules using telehealth/telemedicine methods of healthcare delivery. Telehealth (interchangeably termed telemedicine) is the practice of healthcare within a professionally designated scope of practice using electronic communication, information technology, or other means between a licensee in one location and a client in another location with or without an intervening healthcare provider. The North Carolina Medical Board has a position statement on Telemedicine that can be used for guidance on training of staff utilizing telehealth, evaluations and examinations, licensee-client relationship, prescribing, health records, and licensure.

    Any Nurse Practitioner using telehealth to regularly provide services to clients located in North Carolina need not reside in North Carolina but must hold either a valid, unencumbered multi-state Registered Nurse license, or a valid, unencumbered North Carolina single-state Registered Nurse license. Additionally, a Nurse Practitioner must be both registered and approved to practice in North Carolina. Approval to practice requires that a Nurse Practitioner have a supervising physician and a Collaborative Practice Agreement (CPA). The Nurse Practitioner Scope of Practice is set forth and defined by the North Carolina Administrative Code (NCAC) Nurse Practitioner Rules (21 NCAC 36 .0802 SCOPE OF PRACTICE) and operationalized through the Collaborative Practice Agreement. Telemedicine activities should be clearly defined within the Collaborative Practice Agreement. Please see the position statement on Telehealth/Telenursing

    In North Carolina, Nurse Practitioners are jointly regulated by both the North Carolina Board of Nursing and the North Carolina Medical Board. Please note that supervising physicians must hold a valid, unencumbered North Carolina license. The North Carolina Board of Nursing recommends that the Nurse Practitioner contact the North Carolina Medical Boardto assure full understanding of physician duties and responsibilities when entering into a Collaborative Practice Agreement.

  52. [Practice] Can Nurse Practitioners practice in roles that are outside of their area of certification?

    The population focused Nurse Practitioner scope of Practice is defined by the Nurse Practitioner’s formal academic, graduate educational preparation, national certification and maintained competence as defined by the Nurse Practitioner rules (21 NCAC 36 .0801 (9) and 21 NCAC 36 .0802) & operationalized by the Collaborative Practice Agreement (CPA). Additional areas of competence can be obtained and validated through additional education, certification (when available) and competence validation. A Nurse Practitioner may expand their areas of competence within their population focus through additional education and competence validation if this is permitted by their employer policy and procedures and is not in violation of any other laws or rules.

    To expand the scope of practice beyond the population focus for which the Nurse Practitioner has formal academic, graduate educational preparation, national certification and maintained competence must be approved by the Joint Subcommittee as stipulated in 21 NCAC 36 .0804 (f).

    Applications for approval of changes in practice arrangements for a nurse practitioner currently approved to practice in North Carolina shall be submitted by the applicant as follows:

    (1) Addition or change of primary supervising physician shall be submitted to the Board of Nursing and processed pursuant to protocols developed by both Boards; and

    (2) Request for change(s) in the scope of practice shall be submitted to the Joint Subcommittee

  53. [Practice] Can a Nurse Practitioner practice below his/her highest level of licensure and education?

    Yes. While it is legal for any licensed nurse, including advanced practice nurses (CNM, CNP, CNS, or CRNA) to accept a role that is below their highest level of licensure, it does potentially place the licensee and the institution in a precarious situation where a higher standard of care than is required by the entry-level RN license. A high level of caution is warranted along with review of institutional policies to ensure adherence, not only the regulatory requirements, but the institutional policy requirements as well. Guidance on this topic is addressed in the FAQ-Nursing Practice link “Can a LPN or RN work in a position that is below his/her level of licensure?”  This information would apply to any Advanced Practice Registered Nurse (APRN)

  54. [Education] Does the North Carolina Board of Nursing approve post-licensure and graduate-level nursing education programs in North Carolina and in other states?

    No. The North Carolina Board of Nursing neither approves nor disapproves post-licensure and graduate-level nursing education programs in North Carolina and in other states. See the following links:

  55. [Education] Do Nurse Practitioner students need a Registered Nurse license to do clinical rotations in North Carolina?

    Yes. A Registered Nurse license is a requirement for APRN practice. Academic programs are responsible for ensuring that post-licensure students participating in clinical rotations in North Carolina must have a North Carolina license or a multi-state license as defined by the Nurse Licensure Compact. Advanced Practice Registered Nurse student clinical rotations are conducted under the supervision of an appropriately credentialed preceptor as required by individual state regulation. However, the student must have the foundational Registered Nurse license required by the state where the clinical experience occurs. If the student’s license is not a multi-state license as noted in Nurse Licensure Compact, s/he will need Temporary License.

    See the following Frequently Asked Questions which provide interpretation and application of current law and rule:

  56. [Education] Who may precept a nurse practitioner student in clinical settings?

    This is not a regulatory issue and as such there are no Nurse Practitioner Nursing Board Rules addressing who may precept, evaluate or proctor a Nurse Practitioner.  While Nurse Practitioners are educated from a nursing paradigm, and ideally, would be Precepted, evaluated or proctored by other Nurse Practitioners, institutional and professional practice policy is the appropriate point of reference for your question.

    The National Organization of Nurse Practitioner Faculty address this issue in who may precept a Nurse Practitioner student.

    Criterion IV.B.3: Nurse Practitioner faculty may share the clinical teaching of students with qualified preceptors.

    The supervision of students may be shared with other clinicians serving as clinical preceptors. Programs may use a mix of clinicians to provide direct clinical teaching to students appropriate to the range of clinical experiences required to meet the program objectives. This mix of preceptors may enhance the Interprofessional experience for the student. Over the course of the program the student should have a majority of clinical experiences with preceptors from the same

    population-focused area of practice in primary care and/or acute care, as appropriate, such as child, adult, or across the lifespan. In addition, over the course of the program the student must have clinical experiences with an Advanced Practice Registered Nurse preceptor and preferably an Nurse Practitioner with expertise in the population-focused area of practice in primary care and/or acute care, as appropriate.

  57. [Education] Is a Doctorate required for entry into practice as a Nurse Practitioner?

    No. As noted in 21 NCAC 36 .0805 EDUCATION AND CERTIFICATION REQUIREMENTS FOR REGISTRATION AS A NURSE PRACTITIONER, (a) A nurse practitioner with first-time approval to practice after January 1, 2000, shall provide evidence of certification or recertification as a nurse practitioner by a national credentialing body. (b) A nurse practitioner applicant who completed a nurse practitioner education program prior to December 31, 1999 shall provide evidence of successful completion of a course of education that contains a core curriculum including 400 contact hours of didactic education and 400 hours of preceptorship or supervised clinical experience.

    On October 25, 2004, the member schools affiliated with the American Association of Colleges of Nursing (AACN) voted to endorse the Position Statement on the Practice Doctorate in Nursing. This decision called for moving the current level of preparation necessary for advanced nursing practice from the master’s degree to the doctorate-level by the year 2015. This endorsement was preceded by almost three years of research and consensus-building by an AACN task force charged with examining the need for the practice doctorate with a variety of stakeholder groups. While market forces may preferentially choose a Nurse Practitioner with doctoral preparation, the North Carolina Board of Nursing regulations currently require a master's or higher degree for qualification for entry into practice as a Nurse Practitioner.

  58. [Education] Is there a minimum number of pharmacology hours within the required annual 50 continuing education hours AND is there a requirement for continuing education hours that focus on controlled substances/diversion/addiction?

North Carolina Board of Nursing

Protect the public by regulating the practice of nursing.
Sitemap

Copyright © 2018
North Carolina Board of Nursing
All rights reserved

Terms of Service Privacy Policy

Contact Information

(919) 782-3211
(919) 781-9461
8 a.m.-5 p.m., Mon-Fri
North Carolina Board of Nursing