Guidance for Advanced Practice Registered Nurses and Licensed Nurses Practicing in North Carolina During COVID-19
On March 10th, Governor Cooper issued an executive order declaring a state of emergency for North Carolina (NC) related to the coronavirus COVID-19. For all COVID-19 related questions please refer to the NC Health and Human Services or the Center for Disease Control and Prevention . Information related to nursing practice in NC in an emergency is found below.
I am an out-of-state RN/LPN and would like to work in NC. What are the requirements for licensed nurses during the state of emergency?
Licensed nurses outside of NC are authorized to practice in NC under the following guidelines:
- Nurses must hold an active, unrestricted multi-state license in any Nurse Licensure Compact state can practice in NC at any time.
- Nurses holding an active, unrestricted single state license in a non-compact state can practice in NC during periods of official disaster designation.
- Prior to allowing practice, employing system/facility must verify active, unrestricted licensure of all nurses (RN and LPN), from all states (compact or non-compact). Licensure information can be verified easily through NURSYS available at: www.nursys.com
- Employing system/facility must maintain a record of the names and verified license number for a period of 1 year and provide this information to the Board if requested.
I am an out-of-state NP and would like to work in NC. What are the requirements for NPs during the state of emergency?
- An NP approved to practice in NC, or another state may perform medical acts, as an NP under the supervision of a physician licensed to practice medicine in NC during a state emergency-COVID-19;
- the NP shall notify the NCBON in writing of the names, practice location and telephone number for the NP and each primary supervising physician within 15 days of the first performance of medical acts, as an NP during the state emergency, and the NCBON shall notify the NC Medical Board; and
- teams of MDs and NPs practicing shall not be required to maintain on-site documentation describing supervisory arrangements and plans for prescriptive authority as otherwise required.
What is the general guidance for using telehealth/telenursing?
Please refer to the Telehealth/Telenursing Position Statement for further guidance
TELEHEALTH/TELENURSING POSITION STATEMENT for RN, LPN, and APRN Practice
The practice of nursing using telehealth/telenursing modalities is within the legal scope of practice for licensed nurses - registered nurse (RN), licensed practical nurse (LPN), and advanced practice registered nurse (APRN), provided all licensure criteria within this position statement are met.
Telehealth/telenursing (alternatively 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 Nurse Licensure Compact (NLC) member states, which include North Carolina, have determined that nursing practice occurs at the location of the client at the time services are being provided.
Licensed nurses practicing via telehealth/telenursing modalities are required to be licensed or hold the privilege to practice in the state(s) where the client(s) is/are located. Licensed nurses are responsible and accountable for knowing, understanding, and practicing in compliance with the laws, rules, and standards of practice of the state(s) where the client(s) is/are located. The practice of nursing is not limited to client care but includes all nursing practice as defined by each state’s practice law and rules. The following conditions apply:
- Nurses holding an active, unencumbered multistate license in any NLC member state or jurisdiction, including NC, are legally authorized to practice to the extent of the RN or LPN scope in any and all NLC member states and jurisdictions. APRN practice is not included in the NLC.
- Nurses holding an active, unencumbered single state license in any state or jurisdiction, including NC, are legally authorized to practice only in the single state(s) or jurisdiction(s) for which individual license(s) is/are held.
- Licensed nurses seeking to practice via telehealth/telenursing or other care modalities outside of the United States, must contact the country or territories where the client resides to know, understand, and adhere to the law and rules of that country or territory before providing any telehealth/telemedicine services to clients.
Telehealth/telenursing includes all elements of RN scope of practice as delineated in law and rules [(G.S. 90-171.20 (7) and 21 NCAC 36.0224)]. These include assessing (including triaging) clients; planning, implementing, and evaluating client care; teaching and counseling clients; managing and supervising the delivery of care; teaching nursing personnel/students; administering nursing services; collaborating; and consulting with others regarding the client’s care.
Must be supervised by an RN, APRN, physician, physician assistant, or other person authorized by state law to provide the supervision.
Telehealth/telenursing includes all elements of LPN scope of practice as delineated in law and rules [(G.S. 90-171.20 (8) and 21 NCAC 36.0225)]. These include participation in assessing, planning, and evaluating client care; implementing client care according to an established health care plan; teaching and counseling clients as assigned; and collaborating with other healthcare providers. LPN supervision of others is limited by state laws and rules. It is beyond the scope of LPN practice to perform complex, independent decision-making, such as that potentially required to triage client care needs via telehealth/telenursing modalities.
Both RN and LPN Roles:
- Report and record pertinent information and communications in relation to all aspects of nursing care provided.
- Accept responsibility and accountability for client care via telehealth/telenursing modalities only if possess the documented education and validated competence necessary to safely deliver nursing services.
- Accept orders for medical interventions via telehealth/telenursing from nurse practitioners, certified nurse midwives, physicians, and physician assistants authorized to make medical diagnoses and prescribe medical regimens.
An APRN may practice within his/her designated scope of practice set forth in NC law and rules using telehealth/telemedicine methods of healthcare delivery.
Any APRN using telehealth to regularly provide services to clients located in NC need not reside in NC but must hold either a valid, unencumbered multi-state RN license, or a valid, unencumbered NC single-state RN license. Additionally, the APRN must meet the licensure, approval to practice, and listing requirements for their particular APRN role in concert with NC law and rules. Likewise, any APRN who is approved or recognized to practice in NC and wishes to provide telehealth services outside of NC, must meet the licensure laws of the jurisdiction where the client is located before providing any telehealth services to clients outside of NC.
Are there opportunities to volunteer as a nurse in NC?