What Nurse Practitioners Do
While historically the Nurse Practitioner role began in rural primary care, Nurse Practitioners practice in many settings such as specialty practices, hospitals, managed care, long-term care, and public health. Nurse Practitioners manage a broad range of health issues, emphasizing primary care and health promotion. Nurse Practitioners diagnose and treat health conditions with a focus on preventative services, counseling individuals and families, and monitoring health status over time.
Nurse Practitioner Laws & Rules
The Nurse Practitioner is jointly regulated by the North Carolina Board of Nursing (NCBON) and the North Carolina Medical Board (NCMB). The dual regulation is carried out via the Nurse Practitioner Joint Subcommittee which is composed of members of the Board of Nursing and members of the Medical Board to whom responsibility is given by § 90-8.2 and § 90-171.23(b)(14) to develop rules to govern the practice of Nurse Practitioners in North Carolina. Although the rule codification is maintained separately by the North Carolina Board of Nursing and North Carolina Medical Board, the Nurse Practitioner practice requirements and scope are exactly the same in each set of rules.
- § 90-18.2. - Limitations on Nurse Practitioners (North Carolina Medical Board Nurse Practitioner Law)
21 NCAC 32M .0100 - Approval of Nurse Practitioners (North Carolina Medical Board Nurse Practitioner Rules)
21 NCAC 36 .0800 - Approval & Practice Parameters for Nurse Practitioners
- 21 NCAC 36 .0801 - Definitions
- 21 NCAC 36 .0802 - Scope of Practice
- 21 NCAC 36 .0803 - Nurse Practitioner Registration
- 21 NCAC 36 .0804 - Process for Approval to Practice
- 21 NCAC 36 .0805 - Education and Certification Requirements for Registration as a Nurse Practitioner
- 21 NCAC 36 .0806 - Annual Renewal
- 21 NCAC 36 .0807 - Continuing Education (CE)
- 21 NCAC 36 .0808 - Inactive Status
- 21 NCAC 36 .0809 - Prescribing Authority
- 21 NCAC 36 .0810 - Quality Assurance Standards for a Collaborative Practice Agreement
- 21 NCAC 36 .0811 - Method of Identification
- 21 NCAC 36 .0812 - Disciplinary Action
- 21 NCAC 36 .0813 - Fees
- 21 NCAC 36 .0814 - Practicing During a Disaster
- 21 NCAC 36 .0815 - Reporting Criteria
- 21 NCAC 36 .0816 - Definition of Consultation for Prescribing Targeted Controlled Substances
Collaborative Practice Guidelines
Collaborative Practice Agreement – A Guide for Implementation
North Carolina Board of Nursing 21 NCAC 36 .0800 “Approval and Practice Parameters for Nurse Practitioners,” and similar Medical Board Rule 21 NCAC 32M .0100 “Approval of Nurse Practitioners,” were effective August 1, 2004.
What should be in the “Collaborative Practice Agreement?” The CPA is an agreement between the nurse practitioner (NP) and primary supervising physician addressing how they will operationalize the NP administrative code/rules in their practice. The collaborative practice agreement is not an employer contract (CPA). Since practices differ, CPAs will differ according to: types of patients served; most common diagnoses and therapies; complexity of the client population; ready availability of emergency services, diagnostic centers and specialists. No specific format is required.
Required components of the CPA are:
- The drugs, devices, medical treatments, tests, and procedures that may be prescribed, ordered, and performed by the nurse practitioner.
- A pre-determined plan for emergency services.
PRESCRIBING AUTHORITY:
What drugs, devices, medical treatments, tests and procedures may be prescribed, ordered and performed, or would be appropriate for the diagnosis and treatment of the common medical problems seen in the practice?
The CPA may contain a list by specific drugs or a broad description of categories of drugs and devices for treating the common health problems seen in the practice. For example: categories of drugs, such as antiseizure, anti-diabetic drugs-oral/insulin, hormones, oral contraceptives, cephalosporins, aminoglycosides, antivirals, antiasthmatics, diuretics, antihypertensive etc. . Prescribing exceptions could be by classes of drugs or specific drugs in a class or routes for administration.
Will the NP dispense drugs and devices? If so, apply for dispensing privileges through the Board of Pharmacy. If dispensing, state how this will be done to comply with the Board of Pharmacy, and in accordance with 21 NCAC 36 .1700.
How will the NP address prescribing and dispensing drugs and devices not included in the collaborative practice agreement as stated in rule 21 NCAC 36 .0809 (b)(3)(A)(B) and 21 NCAC 32M .0109 (b)(3)(A)(B).
Will the NP prescribe any controlled drugs? If so, the NP must have a DEA number.
A Nurse Practitioner could do a combination of the above or use a different approach to describe in the CPA the prescribing authority for the Nurse Practitioner. It is required to describe in the CPA, the drugs and devices that may be prescribed by the NP as outlined in Medical Board rule 21 NCAC 32M .0109 “Prescribing Authority” and, in the Board of Nursing rule 21 NCAC 36 .0809 “Prescribing Authority.”
If I prescribe, what needs to be included in my CPA?
In keeping with all regulatory requirements, the CPA is a good place to describe the arrangement for NP – physician continuous availability for the ongoing supervision, consultation, collaboration, referral, and evaluation of care provided by the NP. The CPA may be more structured than required by NP rules but may not be less. The CPA must be onsite for inspection by members or agents of either Board.
PATIENT POPULATION:
What patients will the NP typically see? Depending on the NP scope of practice (area of academic preparation and national certification), i.e. Family Nurse Practitioner, Women’s Health etc., what diagnoses/problems are most common in the practice? For example, are High Risk Maternity patients seen?
Describe any patients or disease management situations that only the primary or back up supervising physician will see or see in consultation with the NP.
QUALITY IMPROVEMENT PROCESS:
What will be the process for the ongoing review of care provided, including a written plan for evaluating the quality of care provided for one or more frequently encountered clinical problems?
What will be the process for consultation, meetings, and documentation of the quality improvement process meetings?
REQUIREMENTS FOR DOCUMENTATION:
In the Rules, 21 NCAC 36 .0810(b)(1)(2) and 21 NCAC 32M .0110(b)(1)(2) “Quality Assurance Standards for a Collaborative Practice Agreement,” the CPA shall be agreed upon and signed by both the primary supervising physician and the NP, and maintained in each practice site (electronic signature software may be used).
The review of the CPA shall be done at least yearly, and acknowledged with a dated signature sheet, signed by both primary supervising Physician and the Nurse Practitioner, appended to the Collaborative Practice Agreement and available for inspection by members or agents of either Board (electronic signature software may be used).
This is not an all-inclusive list of questions or statements to be considered, but is meant to guide the development of the Collaborative Practice Agreement.
No CPA can effectively cover every clinical situation. Therefore, the CPA is not intended to be, nor should it be, a substitute for the exercise of professional judgment by the Nurse Practitioner. There are situations involving patient care, both common and unusual that require the individualized exercise of clinical judgment.
In creating your “Collaborative Practice Agreement” utilize the current Nurse Practitioner rules. If you have further questions, email aprnpractice@ncbon.com.
Continuing Education Requirements
Policy Statement/Procedure:
Nurse Practitioner Rule 21 NCAC 36.0807 states to maintain Nurse Practitioner approval to practice, the NP shall maintain national certification or earn 50 contact hours of continuing education every two years. Your renewal will always be due on your birth month after the initial approval to practice has been granted. At least 20 hours of the required 50 hours must be those hours for which approval has been granted by the American Nurses Credentialing Center (ANCC) or Accreditation Council on Continuing Medical Education (ACCME) or other national credentialing bodies or **practice relevant courses in an institution of higher learning. The remaining 30 hours must be CEs at the advanced practice level Included as a part of the total 50 contact hours (for those who have not maintained national certification) 1 contact hour of CE is required for those NPs who prescribe controlled substances.
This CE shall address controlled substance prescribing practices, signs of the abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management.
**Note: By a national accredited provider of nursing continuing professional development, or nurse practice-relevant courses in an institution of higher learning. A nurse practitioner who possesses a current national certification by a national credentialing body shall be deemed in compliance with the requirement of Paragraph (a) of this Rule.
The conversion for credit to contact hours are:
- 1 semester credit = 15 contact hours
- 1 quarter credit = 7.5 contact hours
For the activities below to count toward the CE requirement, they must be completed every two consecutive years.
| Activity | Example | Acceptable Evidence |
|---|---|---|
Five (5) hours - Clinical Presentations Note: Licensees may not earn contact hours for their own presentations in conferences or in the performance of their normal employment obligations. | Designing, developing and conducting an educational presentation or presentations for health professionals totaling a minimum of 5 contact hours | Dated copy of presentation(s) |
| Up to 30 Preceptor hours |
| Original letter from the program director stating the following:
|
| Five (5) hours - author on a journal article or book chapter published during renewal year |
|
|
| Five (15) hours - primary or secondary author of a book published during renewal year |
|
|
| Ten (10) hours - Completion of an Institutional Review Board (IRB) approved research project related to your certification specialty | Completion of an IRB-approved research project for which you were the primary investigator | IRB close-out letter |
| Five (5) hours - Professional volunteer service | Local, state, national or international health care related organization in which your NP or certification specialty expertise is required
| Signed/dated attestation from manager or committee chair |
Initial or recertification in Basic Life Support (BLS) does not count toward Nurse Practitioner continuing education credit.
Only initial certification in Advanced Cardiovascular Life Support (ACLS), Pediatric Advanced Life Support (PALS), Neonatal Resuscitation Program (NRP) and instructor certification will count toward Nurse Practitioner continuing education credit if one has obtained a certificate with the date completed and number of contact hours provided.
Prescribing Authority
Nurse Practitioner approval includes prescriptive authority for legend drugs and Controlled Substance Schedules II – V consistent with the scope of practice as determined by educational preparation and national certification.
Controlled Substance Reporting System (CSRS)
The North Carolina Board of Nursing (NCBON) is providing a streamlined registration process to the NC Controlled Substances Reporting System (CSRS) through collaboration with NC Department of Health and Human Services (NCDHHS).
Apply
Frequently Asked Questions (CSRS)
DEA Numbers
If an NP is going to prescribe or order controlled substances, the NP must obtain a DEA number.
Website: www.deadiversion.usdoj.gov
Phone: 1 (800) 882-9539 (8:30 a.m. – 6:00 p.m. EST)
Email: dea.registration.help@usdoj.gov
Dispensing of Drugs
Information regarding dispensing of drugs other than samples may be obtained from:
North Carolina Board of Pharmacy
P.O. Box 4560
Chapel Hill, NC 27514
Phone: (919) 246-1050
Website: www.ncbop.org
Compliance Review Materials
Beginning January 1, 2008, the North Carolina Board of Nursing and the North Carolina Medical Board began a standardized approach to Nurse Practitioner Compliance Reviews. The purpose of the reviews is to ensure that the nurse practitioner is meeting the requirements of the Boards’ rules and regulations.
- Rules Regulating Nurse Practitioner Practice (21 NCAC 32M .0100 and 21 NCAC 36 .0800)
- North Carolina General Statues governing Nurse Practitioner § 90-8.2; § 90-18(c)(14); § 90-18.2, § 90-18.3 – Medical Board, and Nursing Practice Act § 90-171.23(b)(14)
- Correspondence sent to and received from the Boards
NC DHHS Issues FAQ: Gabapentin Reporting Changes
The NC Department of Health and Human Services (NC DHHS) requested the North Carolina Board of Nursing to share information related to changes in Gabapentin reporting. This correspondence is being shared with you to provide you with the final version of the North Carolina Controlled Substance Reporting System (NC CSRS) Gabapentin Frequently Asked Questions (FAQ) document developed by NC DHHS. Per legislative Session 2023-2024, North Carolina GS 90-113.70 requires the dispensers of controlled substances to report these dispensations to the North Carolina Controlled Substances Reporting System. HB 190 Section 11.2 G.S. 90-113.73(c) included the required reporting of Gabapentin as a substance of interest for practitioners and dispensers effective March 1, 2024, and effective for veterinarians March 1, 2025.
The Gabapentin FAQ document has been designed by NC DHHS to provide clear answers to common questions arising from this change. This document and other information can be located on the NC DHHS website