March 24, 2020

In the midst of this challenging time with COVID-19, I want to reach out and reassure all of you that the North Carolina Board of Nursing (NCBON) is doing everything possible to ensure that nursing regulation does not present an unnecessary barrier to nursing education programs, graduate nurses entering the workforce and reinstatement or movement of nurses into North Carolina, either physically or through telehealth. We know it is critically important to get nurses in the pipeline as soon as possible.

I know many of you have heard by now that Pearson Vue (testing centers for NCLEX) temporarily closed testing centers in the U.S. and Canada. The National Council of State Boards of Nursing (NCSBN) has worked with Pearson to arrange alternate testing for nursing graduates. On Wednesday, March 25, a limited number (60) of Pearson test sites will resume testing those candidates who have already been authorized to test. As soon as we know the location of the North Carolina site(s), we will let you know. The test centers must follow CDC guidelines, which will limit the number of test takers at any given time. Due to the scarcity of testing sites and the expected delay in testing, NCBON will re-institute the “Graduate Nurse” status for new North Carolina graduates. We will defer to Program Directors of Schools of Nursing to determine whether individual students have mastered the required competencies (didactic and clinical) for program completion.

Once the Program Director deems a student “eligible for graduation”, the individual can apply to NCBON for a “graduate” temporary permit. The temporary permit will allow the graduate nurse (RN and LPN) to practice to their full scope, provided they have RN supervision. This temporary approval is for North Carolina only (a single state license) and is time limited until the graduate can take the NCLEX and complete the fingerprint background check for full licensure. This should ensure that our graduate nurses can readily enter the workforce without delay.

I am also keenly aware of the need for retired or inactive nurses to be able to re-join the workforce. As I write to you, NCBON staff are working on internal processes to make this happen. We will promulgate emergency rules within the week to codify both the process for temporary permits for reinstatement and new graduates.

NCBON is committed to our citizens, our nursing education programs, our health care systems and our graduate nurses. Our purpose is public protection for North Carolinians, and we are committed to work collaboratively with you as we all move through this crisis.

Thank you for all that you do and for your extraordinary efforts at this time. Please let us know how we may be of assistance.

Sincerely,

Julia George, RN, MSN, FRE

Chief Executive Office

Guidance for Advanced Practice Registered Nurses and Licensed Nurses Practicing in North Carolina During COVID-19

On March 10^th, 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

Issue:

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.

Definition:

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.  

General Information:

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:

1. 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.
2. 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.
3. 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.

RN Role:

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.

LPN Role:

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:

1. Report and record pertinent information and communications in relation to all aspects of nursing care provided.
2. 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.
3. 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.

APRN Role:

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?

• NC Response Management System (NC TERMS)
• American Red Cross – check your local areas

This memo is intended to provide the latest information to all North Carolina clinicians and laboratory staff regarding the 2019 Novel Coronavirus (2019-nCoV).

Clinicians caring for patients with suspected or confirmed COVID-19 should immediately contact their local health department or the state Communicable Disease Branch at (919) 733-3419 (available 24/7) to review the risk assessment and discuss laboratory testing and control measures.

The most up-to-date information and guidance can be found at Centers for Disease (CDC) and North Carolina Public Health [Epidemiology] .

Initial testing for COVID-19 is taking place at State Laboratory of Public Health (SLPH).

Temporary order of the North Carolina State Health Director
Novel Coronavirus (nCoV) Infection.

• COVID-19 Outpatient Triage and Assessment Guidance
• Interim Guidance for Use of Personal Protective Equipment (PPE) While Caring for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19)
• Interim Guidance for Discontinuation of Home Isolation for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19)
• Guidance for Advanced Practice Registered Nurses and Licensed Nurses Practicing in North Carolina During COVID-19

NCLEX Exams to Resume in Limited Capacity March 25, 2020

NCLEX-RN and NCLEX-PN Examinations testing will resume on a limited basis at 60 Pearson VUE Testing Centers on March 25, 2020, ramping up to additional sites by March 28. These sites were selected to be close to large metropolitan areas in the U.S. and Canada.

Prescriptions for hydroxychloroquine, chloroquine, azithromycin, Kaletra, and potentially other medications.

On behalf of Department of Health and Human Services (DHHS) Secretary Mandy Cohen, the Board of Nursing is providing the following information regarding volunteering as a Health Care Worker.

CDC interim guidance for evaluating patients, reporting patients under investigation (PUIs), testing specimens, and infection control.

Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected.

Dear NCBON licensee,

The North Carolina Board of Nursing (NCBON) is sending you the following public health alert on behalf of the NC Department of Health and Human Services (NCDHHS). NCBON will continue to send periodic updates regarding COVID-19 as long as North Carolina remains in a state of emergency:

PUBLIC HEALTH ALERT

As you are aware, there has been a rapid increase in COVID-19 infections across the country and we have begun to see cases in North Carolina over the past two weeks. In partnership with our providers and our local health departments, we have been doing intensive containment strategies for the first phase of our response. This includes proactive identification of cases, isolation of sick patients, and contact tracing and quarantine of exposed people. 

We expect that community transmission is occurring in our state and so North Carolina has implemented several proactive community mitigation measures to complement our containment strategies and reduce opportunities for transmission and “flatten the curve”. Increasing access to testing for individuals in important in this stage to help with our containment strategies, to understand better the spread of infection in North Carolina, and inform our mitigation strategies.

The NCBON is sending you this email and the attachments from the NCDHHS as a public health alert.  We will send periodic updates via email regarding COVID-19 as long as North Carolina remains in a state of emergency, however the NCBON website provides a quick reference to the latest information from our trusted public health experts. 

The documents below were developed for clinicians:

1. Guidance for COVID-19 assessment in outpatient settings;
2. Interim guidance for use of personal protective equipment; and
3. Interim guidance for discontinuation of home isolation for persons with COVID-19

Additional guidance for health care providers and other groups is available at NCDHHS. This is a rapidly evolving situation and guidance will change as we continue to learn more. We will continue to disseminate guidance, but we encourage you to check the website for the latest guidance.

As the largest cadre of healthcare professionals, Nurses have a significant role in the response to this pandemic. The NCBON commends your efforts in caring for your patients, your colleagues, yourselves and your families during this unprecedented period in our history. 

Sincerely,

Julia George, RN, MSN, FRE

Chief Executive Office