Practicing as an Advanced Practice Nurse in North Carolina means a commitment to honor the rules, regulations, and practice scope established by the North Carolina Board of Nursing (NCBON). The NCBON operates similarly to other nursing boards nationwide. This paper reviews the scope of practice, prescriptive privileges and attainment, and other advanced practice nurses following the same guidelines in the state of North Carolina.
The North Carolina Board of Nursing regulates licensed practical nurses (LPNs), registered nurses (RNs), and advance practice nurses (APNs) in the states of North Carolina, South Carolina, Tennessee, and Virginia (Nursinglicensure.org, 2013). The organization is a member of the nurse licensure compact and grants nurses the ability to practice under a multistate license issues by the NCBON in the state identified above. After completing an approved and/or accredited North Carolina RN nursing program, a person can complete the RN application process, which includes completing an application and passing a background check, as well as the completion of a licensing exam with a passing score and payment of fees (Nursinglicensure.org, 2013). Authorization by the board must be granted prior to the applicant taking the state licensing exam. RNs with an active, permanent, and unencumbered RN license issued in North Carolina practices compact states, can choose at this point to apply for approval to become an APRN, advanced practice registered nurse or APN, advanced practice nurse, which is a category of RNs that leads to one of four specialties.
The four categories are a Certified Nurse Midwife (CNM), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), and a Nurse Practitioner (NP) (Logic, 2015). These categories of RNs are regulated by several organizations including the NC Board of Nursing, Midwifery Joint Committee, and the Joint Subcommittee of the Medical Board (Logic, 2015). The CNM nurse is required to have a Master’s in Nursing, as well as the completion of a graduate level midwifery program, along with certification granted by the American Midwifery Certification Board; additionally a national certification examination is required and continuing education courses, and re-certification as required (Logic, 2015). The CRNA designation requires the completion of a Master’s of Science in Nursing or an equivalent Master’s degree program, as well as a graduate level anesthesia program; certification and/or re-certification are required by the National Board of Certification for Nurse Anesthetists and regulation is performed by the North Carolina Board of Nursing (Logic, 2015).
The CNS compels the completion of a Master’s degree or higher degree in a nursing program or the completion of a Post-Master’s certificate in nursing, with clinical specialty along with training for higher level themes of gerontology, mental health, oncology, or cardiology to name a few; the NCBON must recognize the CNS, as well as the CNS must acquire and maintain certification as a CNS by a national credentialing association (Logic, 2015). As of January 1, 2005, all new NP graduates must have a Masters Degree in the state of North Carolina (Logic, 2015). NPs have a wide scope of practice opportunity. NPs can practice in “rural primary care, specialty practices, hospitals, managed care, long-term care, and public health, including providing preventive services, counseling individuals and families, conducting physical examinations, performing diagnostic evaluations of illnesses and injuries, and prescribing therapeutics including medications” (LOGIC, 2015, p. 1). NPs are regulated by both the NCBON and the Medical Board Joint Subcommittee and require certification, as well as re-certification by the “American Nurses Credentialing Center, the American Academy of Nurse Practitioners, the Pediatric Nursing Certification Board, the American Association of Critical Care Nurses Certification Corporation, and the National Certification Corporation of the Obstetric Gynecological and Neonatal Nursing Specialties” (Logic, 2015, p. 1).
In the state of North Carolina, a NP prescribing “includes prescriptive authority for legend drugs and Controlled Substance Schedules II – V” (Logic, 2015, p. 1). Approvals are granted based upon education preparation and national certification. Specific guidelines exist for the NP regarding how they prescribe and dispense any drugs, devices, medical treatments, tests, and procedures associated with their practices. In order to dispense any drugs or devices, the NP must apply for dispensing privileges with the North Carolina Board of Pharmacy, which includes a statement of how the dispensing will be done to comply with regulation 21 NCAC 36.1700 of the Board of Pharmacy (Logic, 2015). Other rules and regulation are mandatory. NPs must get a DEA number that is issued by the U.S. Department of Justice prior to prescribing and dispensing any controlled drug prescription medications (Logic, 2015). Practice guidelines must adhere to “Medical Board rule 21 NCAC32M.0109 and Board of Nursing rule 21 NCAC36.0809, which is outlined under the ‘Prescribing Authority’ in these sections (Logic, 2015).
The practice of any of these nurse specialties requires a supervising physician and a Collaborative Practice Agreement signed by both parties (Logic, 2015). If there is more than one physician or satellite operating site, approval and agreements are required from each physician and office. Collaborative Practice Agreements will vary by the types of patients served, the types of diagnoses defined, the practicing time period of the advanced practice nurse, and the proximity of emergency services and diagnostic centers; the agreement needs to also include types of supervision whether full time or part time by the physician, guidelines for when consultation and/or collaboration are required, when referrals are necessary, and how they will practice together; address of where duties will take place is included as well (Logic, 2015).
In 2010, the Commission on Advanced Practice Nursing, which is a unit of the North Carolina Nurses Association, submitted and got approval of a reference proposal named The Role of an APRN in North Carolina, which provides best practice guidelines, specifically what constitutes an APRN, definitions for the state of North Carolina (NCNurses.org, 2015).
- Logic, S. (2015). APRN Requirements | North Carolina Board of Nursing. Logic. Retrieved July 2015, from http://www.Logic/dcp/i/licensurelisting-advanced-practice-registered-nurse-aprn-requirements
- Ncnurses.org,. (2015). Commission on Advanced Practice Nursing. Retrieved July 2015, from http://www.ncnurses.org/practice/commission-on-advanced-practice-nursing.dot
- Nursinglicensure.org,. (2013). North Carolina Nursing License Requirements: Become A Nurse in NC. Retrieved July 2015, from http://www.nursinglicensure.og/state/nusing-license-north-carolina.html#rn