Nurse Practitioner Scope of Practice: North Carolina
Last spring, my husband and I took a romantic getaway to Asheville, North Carolina which was the first chance I had to spend much time in the state. I have to say, I was quite impressed. The North Carolina “mountains” (being from the West Coast they are look more like hills) are beautiful, and quaint Asheville was packed with good people and great eats. I can’t wait to go back. But, does North Carolina make the grade when it comes to laws regulating the nurse practitioner scope of practice in the Tar Heel State?
Unfortunately, North Carolina ranks rather poorly compared to other states when it comes to giving nurse practitioners autonomy in their practice. Let’s look at the specifics of these laws.
North Carolina’s Nurse Practitioner Supervision Laws
Nurse practitioners in North Carolina must work under physician supervision as outlined in a collaborative practice agreement. This written agreement must include a description of the arrangement between the nurse practitioner and physician. The physician must be “continuously available for consultation, collaboration, referral and evaluation of care by the nurse practitioner”. A supervising physician is not required to be present on site with the nurse practitioner in the clinic or hospital but must be continuously available for consultation by phone. The primary supervising physician may also name back-up supervising physicians in the case that he/she is not available. The collaborative practice agreement must be reviewed each year and resigned by both the NP and supervising physician.
Nurse practitioners are required to meet at least once every six moths with their supervising physician. During the first six months of practice, new nurse practitioners must meet with their supervising physician at least monthly. While these periodic meetings are required, North Carolina law does not require the collaborating physician to sign a certain number of the nurse practitioner’s charts. There is not a restriction on the number of nurse practitioners one physician may supervise.
North Carolina’s Nurse Practitioner Prescribing Laws
Nurse practitioners practicing in North Carolina are allowed to prescribe medications including controlled substances II-V. In April, 2011, laws regulating nurse practitioner’s ability to prescribe were changed. NPs are now allowed to prescribe up to 5 refills for Schedule III controlled substances. Dosage units must be limited to a 30 day supply for each refill. For example, nurse practitioners may write a prescription for a 30 day supply of hydrocodone, a Schedule III drug, and refill this prescription five times. The nurse practitioner’s ability to prescribe should also be outlined in the collaborative practice agreement.
All prescriptions written by a nurse practitioner in North Carolina must contain the name of the supervising physician. It is prohibited for NPs to prescribe controlled substances for their own use or for the use of their supervising physician. Nurse practitioners in North Carolina also may not prescribe controlled substances for immediate family, anyone living in their residence or with whom they are in a relationship or have a significant emotional tie.
Other Scope of Practice Laws in North Carolina
Nurse practitioners in North Carolina who have not practiced as an NP in more than two years must take a nurse practitioner refresher course before returning to practice. The course is individually planned, self-directed and requires varying numbers of hours of continuing education in pharmacology, medical education and precepted clinical hours depending on how long the NP has been out of practice.
NPs practicing in North Carolina are also required to earn 50 contact hours of continuing medical education each year. They are allowed to sign death certificates but are not allowed to authorize handicap parking permits.
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