Frequently Asked Questions
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Nurse Practitioner

The Nurse Practitioner (NP) Survival Guide to North Carolina Board of Nursing Compliance Review Audits will answer many of your questions regarding Nurse Practitioner practice in North Carolina.

  1. Is a current Registered Nurse license needed to practice as a Nurse Practitioner in North Carolina?

  2. Is physician supervision required for Nurse Practitioner practice in North Carolina?

  3. What is Initial Approval to Practice?

  4. What is an Approval Number?

  5. What should be done when the relationship with a supervising physician is discontinued?

  6. What are the required credentials for a supervising physician?

  7. How is the Nurse Practitioners scope of practice defined in North Carolina?

  8. What is Nurse Practitioner Registration? Is it required?

  9. What materials must be provided for an audit by the Board?

  10. Do Nurse Practitioners have hospital admission privileges in North Carolina?

  11. What happens if a job or supervising physician is changed?

  12. What are the minimum number of hours required to maintain the Nurse Practitioner approval to practice?

  13. What is a Collaborative Practice Agreement (CPA)?

  14. Is current national certification required for Nurse Practitioner approval to practice in North Carolina?

  15. Can Nurse Practitioners prescribe refills for Schedule controlled substances?

  16. What information must be on the Nurse Practitioner's name badge?

  17. Does the North Carolina Board of Nursing approve graduate programs?

  18. Does the Quality Improvement Process (QIP) process start again each time supervising physicians are changed?

  19. Is the supervising physician required to be physically present at all times while the Nurse Practitioner is practicing?

  20. Can Nurse Practitioners prescribe controlled substances?

  21. Are supervising physicians and back-up supervising physicians responsible for the medical acts of Nurse Practitioners?

  22. Are Nurse Practitioners required to have an NPI number?

  23. What are the usual age ranges for the Nurse Practitioner roles?

  1. Is a current Registered Nurse license needed to practice as a Nurse Practitioner in North Carolina?

    Yes, an active, permanent, unencumbered Registered Nurse license issued by North Carolina or a multistate privilege to practice issued by another compact state is required for approval to practice as a Nurse Practitioner in North Carolina. Individuals holding a temporary Registered Nurse license are not eligible for Nurse Practitioner approval to practice.

  2. Is physician supervision required for Nurse Practitioner practice in North Carolina?

    Yes. a collaborative practice agreement (CPA) with a supervising physician licensed by the North Carolina Medical Board is required for Nurse Practitioner approval to practice in North Carolina.

  3. 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 prior to beginning employment as a Nurse Practitioner.

  4. What is an Approval Number?

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

  5. What should be done when the relationship with a supervising physician is discontinued?

    Visit request inactive status. There is no fee associated with requesting inactive status with a supervising physician. 

  6. What are the required credentials for a supervising physician?

    The supervising physician must be licensed with the North Carolina Medical Board with a population focus, certification, and maintained competence that mirrors or exceeds that of the Nurse Practitioner population focus.

  7. 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 Practitioners formal academic, graduate educational preparation, national certification, and maintained competence. The scope of practice is operationalized by the Collaborative Practice Agreement (CPA).

  8. What is Nurse Practitioner Registration? Is it required?

    Yes, Registration is required for use of the title Nurse Practitioner in North Carolina. Registration is a one-time occurrence that can be completed with first initial approval to practice or at any time if not seeking approval to practice.

  9. What materials must be provided for an audit by the Board?

    Either electronic or paper documentation regarding registration and approval to practice, collaborative practice agreements, quality improvement process meetings, and continuing education must be provided for the previous two years.

  10. 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 Nurse Practitioners provided that these functions are included in the CPA between the Nurse Practitioner and supervising physician and the hospital has policies and procedures allowing Nurse Practitioners to perform these functions.

  11. What happens if a job or supervising physician is changed?

    Visit add a physician. The Nurse Practitioner must receive the final approval letter with the new supervising physician before starting a new practice.

  12. What are the minimum number of hours required to maintain the Nurse Practitioner approval to practice?

    Nurse Practitioners must maintain sufficient clinical practice hours to maintain national certification and maintain Continuing Education Requirements of 50 hours per year. If a Nurse Practitioner has not engaged in clinical practice for two years or greater, then the Nurse Practitioner will be required to complete a Nurse Practitioner Refresher Course.

  13. What is a Collaborative Practice Agreement (CPA)?

    The CPA identifies the drugs, devices, medical treatments, tests, and procedures that may be prescribed, ordered, and performed, as would be appropriate for the diagnosis and treatment of the common medical problems seen in the Nurse Practitioner’s practice. The CPA must state how the continuous availability of the supervising physician will be provided for ongoing supervision, consultation, collaboration, referral, and evaluation of care provided by the Nurse Practitioner. The CPA must be reviewed, signed, and dated annually by the Nurse Practitioner and supervising physician.

  14. Is current national certification required for Nurse Practitioner approval to practice in North Carolina?

    Yes, Nurse Practitioners must have and maintain national certification for approval to practice in North Carolina.

  15. Can Nurse Practitioners prescribe refills for Schedule controlled substances?

    Yes, prescriptive authority is part of the Nurse Practitioner approval to practice. Controlled substances may be prescribed and refilled consistent with controlled substance laws and rules.

    • Schedule II controlled substances cannot be refilled
    • Schedules III and IV controlled substances may be refilled up to five times in six months
    • Schedule V controlled substances may be refilled as authorized by the practitioner
  16. What information must be on the Nurse Practitioner's name badge?

    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 type of license or listing title when providing patient care.

    For example, one might use Mary Smith, RN, NP, MSN or Mary Smith, RN, NP, DNP.

  17. Does the North Carolina Board of Nursing approve graduate programs?

    No, the Board only has authority over pre-licensure nursing programs, and not graduate level programs.

  18. Does the Quality Improvement Process (QIP) process start again each time supervising physicians are changed?

    Yes, the QIP must be initiated again each time supervising physicians change. Monthly meetings are required for 6 months to discuss practice relevant clinical issues and quality improvement measures; then the QIPs are conducted every 6 months thereafter.

  19. Is the supervising physician required to be physically present at all times while the Nurse Practitioner is practicing?

    No onsite physical presence is not required; however, the supervising physician must be continuously available to the Nurse Practitioner for consultation by direct communication or telecommunication.

  20. Can Nurse Practitioners prescribe controlled substances?

    Yes, a Nurse Practitioner may prescribe controlled substances. The supervising physician must have a DEA registration equal to or greater than the DEA registration of a Nurse Practitioner that he or she supervises.

  21. Are supervising physicians and back-up supervising physicians responsible for the medical acts of Nurse Practitioners?

    Yes, supervising physicians are responsible at all times for the medical acts of the Nurse Practitioner they supervise. Back-up supervising physicians are only responsible for the medical acts of the Nurse Practitioner when they are actively supervising the Nurse Practitioner. A Nurse Practitioner is only required to have one supervising physician.

  22. Are Nurse Practitioners required to have an NPI number?

    No, a National Provider Identifier (NPI) number is not a requirement for approval as an Nurse Practitioner in North Carolina. An NPI is a unique 10-digit identification number issued to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). The Board has no authority in payer issues.

  23. What are the usual age ranges for the Nurse Practitioner roles?

    National professional specialty and advanced practice registered nursing organizations provide practice guidelines for each APRN role. These documents address role, function, population served, and practice setting. They offer advanced practice registered nurses the broadest parameters for practice within the limits established by formal academic education and national certification. Therefore, professional practice parameters are recommended as the initial resource in defining an individual APRN’s role, population foci, and specialty practice.

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