North Carolina 2025-2026 Regular Session

North Carolina House Bill H514 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		GENERAL ASSEMBLY OF NORTH CAROLINA
2	2		SESSION 2025
3		-	H 1
4		-	HOUSE BILL 514
	3	+	H D
	4	+	HOUSE BILL DRH50020-NBf-55C
	5	+
5	6
6	7
7	8		Short Title: APRN Definitions. (Public)
8		-	Sponsors: Representatives White, Lambeth, Setzer, and Cunningham (Primary Sponsors).
9		-	For a complete list of sponsors, refer to the North Carolina General Assembly web site.
10		-	Referred to: Health, if favorable, Judiciary 1, if favorable, Finance, if favorable, Rules,
11		-	Calendar, and Operations of the House
12		-	March 26, 2025
13		-	H514 -v-1
	9	+	Sponsors: Representative White.
	10	+	Referred to:
	11	+
	12	+	DRH50020 -NBf-55C
14	13		A BILL TO BE ENTITLED 1
15	14		AN ACT TO DEFINE THE PRACTICE OF NURSING FOR ADVANCED PRACTICE 2
16	15		REGISTERED NURSES: NURSE PRACTITIONERS (NP), CERTIFIED N URSE 3
17	16		MIDWIVES (CNM), CERTIFIED REGISTERED NURSE ANESTHETISTS (CRNA), 4
18	17		AND CLINICAL NURSE SPECIALISTS (CNS). 5
19	18		Whereas, North Carolina is expected to be the seventh largest state in the nation by 6
20	19		2035 and demand for health care will continue to increase; and 7
21	20		Whereas, North Carolina has provided over 628,000 North Carolinians access to 8
22	21		insurance through Medicaid expansion but lacks the health care providers to ensure their access 9
23	22		to care; and 10
24	23		Whereas, APRNs are registered nurses with master's or doctorate degrees and 11
25	24		advanced education and training; and 12
26	25		Whereas, North Carolina has over 20,000 advanced practice registered nurses 13
27	26		(APRNs) who have been educated and licensed to practice to their full scope; and 14
28	27		Whereas, more than three decades of research demonstrates that APRNs improve 15
29	28		access to safe, high-quality, cost-effective, patient-centered health care; and 16
30	29		Whereas, the Institute of Medicine (IOM) has called for states to allow APRNs to 17
31	30		practice to the full extent of their licensure and education since the 2010 release of the IOM 18
32	31		Report on the Future of Nursing; and 19
33	32		Whereas, health care costs in North Carolina are among the highest in the nation; and 20
34	33		Whereas, a recent report by a Ph.D. health care economist at Duke University 21
35	34		estimates savings of at least $700 million annually for North Carolina patients, employers, and 22
36	35		taxpayers by removing unnecessary and antiquated government regulations; and 23
37	36		Whereas, 36 other states have rolled back these costly and burdensome government 24
38	37		regulations on advanced practice registered nurses over the past 31 years with no evidence of 25
39	38		negative effects on patient safety, and indeed positive impact on patient care, according to 26
40	39		numerous studies; and 27
41	40		Whereas, no state has enacted these reforms and later reversed course to reinstate 28
42	41		these government regulations; and 29
43	42		Whereas, the APRN role has existed for over a half century but remains undefined in 30
44	43		North Carolina statute; and 31
45	44		Whereas, North Carolina's courts and executive branch have called on the legislature, 32
46	45		the body of the people, to remove the ambiguity surrounding APRN practice by clearly defining 33
47		-	it in statute; Now, therefore, 34 General Assembly Of North Carolina Session 2025
48		-	Page 2 House Bill 514-First Edition
49		-	The General Assembly of North Carolina enacts: 1
50		-	SECTION 1. G.S. 90-171.20 reads as rewritten: 2
51		-	"§ 90-171.20. Definitions. 3
52		-	As used in this Article, unless the context requires otherwise: 4
53		-	(1) Advanced assessment. – The taking by an advanced practice registered nurse 5
54		-	of the history, physical, and psychological assessment of a patient's signs, 6
55		-	symptoms, pathophysiologic status, and psychosocial variations in the 7
56		-	determination of differential diagnoses and treatment. 8
57		-	(1a) Advanced practice registered nurse or APRN. – An individual licensed by the 9
58		-	Board as an advanced practice registered nurse within one of the following 10
59		-	four roles: 11
60		-	a. Certified nurse practitioner or CNP. 12
61		-	b. Certified nurse midwife or CNM. 13
62		-	c. Clinical nurse specialist or CNS. 14
63		-	d. Certified registered nurse anesthetist or CRNA. 15
64		-	(1b) "Board" means the Board. – The North Carolina Board of Nursing. 16
65		-	(2) "Health care provider" means any Health care provider. – Any licensed health 17
66		-	care professional and any agent or employee of any health care institution, 18
67		-	health care insurer, health care professional school, or a member of any allied 19
68		-	health profession. For purposes of this Article, a person enrolled in a program 20
69		-	that prepares the person to be a licensed health care professional or an allied 21
70		-	health professional shall be deemed a health care provider. 22
71		-	(3) "License" means a License. – A permit issued by the Board to practice nursing 23
72		-	as an advanced practice registered nurse, as a registered nurse nurse, or as a 24
73		-	licensed practical nurse, including a renewal or reinstatement thereof. 25
74		-	(3a) "Licensee" means any Licensee. – Any person issued a license by the Board, 26
75		-	whether the license is active or inactive, including an inactive license by 27
76		-	means of surrender. 28
77		-	(4) "Nursing" is a Nursing. – A dynamic discipline which includes the assessing, 29
78		-	caring, counseling, teaching, referring and implementing of prescribed 30
79		-	treatment in the maintenance of health, prevention and management of illness, 31
80		-	injury, disability or the achievement of a dignified death. It is ministering to; 32
81		-	assisting; and sustained, vigilant, and continuous care of those acutely or 33
82		-	chronically ill; supervising patients during convalescence and rehabilitation; 34
83		-	the supportive and restorative care given to maintain the optimum health level 35
84		-	of individuals, groups, and communities; the supervision, teaching, and 36
85		-	evaluation of those who perform or are preparing to perform these functions; 37
86		-	and the administration of nursing programs and nursing services. For purposes 38
87		-	of this Article, the administration of required lethal substances or any 39
88		-	assistance whatsoever rendered with an execution under Article 19 of Chapter 40
89		-	15 of the General Statutes does not constitute nursing. 41
90		-	(5) "Nursing program" means any Nursing program. – Any educational program 42
91		-	in North Carolina offering to prepare persons to meet the educational 43
92		-	requirements for licensure under this Article.Article as a registered nurse or a 44
93		-	licensed practical nurse. 45
94		-	(6) "Person" means an Person. – An individual, corporation, partnership, 46
95		-	association, unit of government, or other legal entity. 47
96		-	(6a) Population focus. – With respect to APRN practice, includes one of the 48
97		-	following areas of focus: 49
98		-	a. The family or the individual across the life span. 50
99		-	b. Adult/gerontology. 51 General Assembly Of North Carolina Session 2025
100		-	House Bill 514-First Edition Page 3
101		-	c. Neonatal. 1
102		-	d. Pediatrics. 2
103		-	e. Women's health or gender-related issues. 3
104		-	f. Psychiatric mental health. 4
105		-	(6b) Practice of nursing as a certified nurse midwife or CNM. – In addition to the 5
106		-	RN scope of practice and APRN role and population foci, also consists of the 6
107		-	following four components: 7
108		-	a. The management, diagnosis, and treatment of primary sexual and 8
109		-	reproductive health care, including primary, preconception, 9
110		-	gynecologic/reproductive/sexual health, antepartum, intrapartum, 10
111		-	neonatal, and post-pregnancy care. 11
112		-	b. Ordering, performing, supervising, and interpreting diagnostic studies. 12
113		-	c. Prescribing pharmacologic and nonpharmacologic therapies. 13
114		-	d. Consulting with or referring to other health care providers as 14
115		-	warranted by the needs of the patient. 15
116		-	(6c) Practice of nursing as a certified nurse practitioner or CNP. – In addition to 16
117		-	the RN scope of practice and APRN role and population foci, also consists of 17
118		-	the following six components: 18
119		-	a. Health promotion, disease prevention, health education, and 19
120		-	counseling. 20
121		-	b. Providing health assessment and screening activities. 21
122		-	c. Diagnosing, treating, and facilitating patients' management of their 22
123		-	acute and chronic illnesses and diseases. 23
124		-	d. Ordering, performing, supervising, and interpreting diagnostic studies. 24
125		-	e. Prescribing pharmacologic and nonpharmacologic therapies. 25
126		-	f. Consulting with or referring to other health care providers as 26
127		-	warranted by the needs of the patient. 27
128		-	(6d) Practice of nursing as a certified registered nurse anesthetist or CRNA. – In 28
129		-	addition to the RN scope of practice and within the APRN role and population 29
130		-	foci, also consists of the following: 30
131		-	a. Selecting, ordering, procuring, prescribing, and administering drugs 31
132		-	and therapeutic devices to facilitate diagnostic, therapeutic, and 32
133		-	surgical procedures. 33
134		-	b. Ordering, prescribing, performing, supervising, and interpreting 34
135		-	diagnostic studies, procedures, and interventions. 35
136		-	c. Consulting with or referring to other health care providers as 36
137		-	warranted by the needs of the patient. 37
138		-	(6e) Practice of nursing as a clinical nurse specialist or CNS. – In addition to the 38
139		-	RN scope of practice and APRN role and population foci, also consists of the 39
140		-	following eight components: 40
141		-	a. The diagnosis and treatment of health and illness states. 41
142		-	b. Disease management. 42
143		-	c. Prescribing pharmacologic and nonpharmacologic therapies. 43
144		-	d. Ordering, performing, supervising, and interpreting diagnostic studies. 44
145		-	e. Preventing of illness and risk behaviors. 45
146		-	f. Nursing care for individuals, families, and communities. 46
147		-	g. Integrating care across the continuum to improve patient outcomes. 47
148		-	h. Consulting with or referring to other health care providers as 48
149		-	warranted by the needs of the patient. 49 General Assembly Of North Carolina Session 2025
150		-	Page 4 House Bill 514-First Edition
151		-	(6f) Practice of nursing as an advanced practice registered nurse or APRN. – In 1
152		-	addition to the RN scope of practice and within the APRN role and population 2
153		-	foci, also consists of the following six components: 3
154		-	a. Conducting an advanced assessment. 4
155		-	b. Delegating and assigning therapeutic measures to assistive personnel. 5
156		-	c. Performing other acts that require education and training consistent 6
157		-	with professional standards and commensurate with the APRN's 7
158		-	education, certification, demonstrated competencies, and experience. 8
159		-	d. Complying with the requirements of this Article and rendering quality 9
160		-	advanced nursing care. 10
161		-	e. Recognizing limits of knowledge and experience. 11
162		-	f. Planning for the management of situations beyond the APRN's 12
163		-	expertise. 13
164		-	(7) The "practice of nursing by a registered nurse" consists Practice of nursing by 14
165		-	a registered nurse. – Consists of the following 10 components: 15
166		-	a. Assessing the patient's physical and mental health, including the 16
167		-	patient's reaction to illnesses and treatment regimens. 17
168		-	b. Recording and reporting the results of the nursing assessment. 18
169		-	c. Planning, initiating, delivering, and evaluating appropriate nursing 19
170		-	acts. 20
171		-	d. Teaching, assigning, delegating to or supervising other personnel in 21
172		-	implementing the treatment regimen. 22
173		-	e. Collaborating with other health care providers in determining the 23
174		-	appropriate health care for a patient but, subject to the provisions of 24
175		-	G.S. 90-18.2, not prescribing a medical treatment regimen or making 25
176		-	a medical diagnosis, except under supervision of a licensed 26
177		-	physician.patient. 27
178		-	f. Implementing the treatment and pharmaceutical regimen prescribed or 28
179		-	ordered by any person authorized by State law to prescribe or order 29
180		-	the regimen. 30
181		-	g. Providing teaching and counseling about the patient's health. 31
182		-	h. Reporting and recording the plan for care, nursing care given, and the 32
183		-	patient's response to that care. 33
184		-	i. Supervising, teaching, and evaluating those who perform or are 34
185		-	preparing to perform nursing functions and administering nursing 35
186		-	programs and nursing services. 36
187		-	j. Providing for the maintenance of safe and effective nursing care, 37
188		-	whether rendered directly or indirectly. 38
189		-	(8) The "practice of nursing by a licensed practical nurse" consists of the 39
190		-	following seven components: 40
191		-	a. Participating in the assessment of the patient's physical and mental 41
192		-	health, including the patient's reaction to illnesses and treatment 42
193		-	regimens. 43
194		-	b. Recording and reporting the results of the nursing assessment. 44
195		-	c. Participating in implementing the health care plan developed by the 45
196		-	registered nurse and/or prescribed by any person authorized by State 46
197		-	law to prescribe such a plan, by performing tasks assigned or delegated 47
198		-	by and performed under the supervision or under orders or directions 48
199		-	of a registered nurse, physician licensed to practice medicine, dentist, 49
200		-	or other person authorized by State law to provide the supervision. 50 General Assembly Of North Carolina Session 2025
201		-	House Bill 514-First Edition Page 5
202		-	c1. Assigning or delegating nursing interventions to other qualified 1
203		-	personnel under the supervision of the registered nurse. 2
204		-	d. Participating in the teaching and counseling of patients as assigned by 3
205		-	a registered nurse, physician, or other qualified professional licensed 4
206		-	to practice in North Carolina. 5
207		-	e. Reporting and recording the nursing care rendered and the patient's 6
208		-	response to that care. 7
209		-	f. Maintaining safe and effective nursing care, whether rendered directly 8
210		-	or indirectly." 9
211		-	SECTION 2. G.S. 90-18(c) reads as rewritten: 10
212		-	"(c) The following shall not constitute practicing medicine or surgery as defined in this 11
213		-	Article: 12
214		-	… 13
215		-	(7) The practice of midwifery as defined in G.S. 90-178.2. 14
216		-	… 15
217		-	(14) The practice of nursing by a an advanced practice registered nurse engaged in 16
218		-	the practice of nursing and the performance of acts otherwise constituting 17
219		-	medical practice by a registered nurse when performed in accordance with 18
220		-	rules and regulations developed by a joint subcommittee of the North Carolina 19
221		-	Medical Board and the Board of Nursing and adopted by both boards.as 20
222		-	defined in Article 9A of this Chapter. 21
223		-	…." 22
224		-	SECTION 3.(a) G.S. 90-18.2 is repealed. 23
225		-	SECTION 3.(b) G.S. 90-2(a) reads as rewritten: 24
226		-	"(a) There is established the North Carolina Medical Board to regulate the practice of 25
227		-	medicine and surgery for the benefit and protection of the people of North Carolina. The Board 26
228		-	shall consist of 13 members: 27
229		-	… 28
230		-	(2) Five members shall all be appointed by the Governor as follows: 29
231		-	… 30
232		-	d. One shall be a certified nurse practitioner as defined in G.S. 90-18.2 31
233		-	as recommended by the Review Panel pursuant to G.S. 90-3. 32
234		-	…." 33
235		-	SECTION 3.(c) G.S. 90-18.3(a) reads as rewritten: 34
236		-	"(a) Whenever a statute or State agency rule requires that a medical or physical 35
237		-	examination shall be conducted by a physician, the examination may be conducted and the form 36
238		-	signed by a certified nurse practitioner or a physician assistant, and a physician need not be 37
239		-	present. Nothing in this section shall otherwise change the scope of practice of a certified nurse 38
240		-	practitioner or a physician assistant, as defined by G.S. 90-18.1 and G.S. 90-18.2, 39
241		-	respectively.assistant." 40
242		-	SECTION 3.(d) G.S. 90-85.24(a) reads as rewritten: 41
243		-	"(a) The Board of Pharmacy shall be entitled to charge and collect not more than the 42
244		-	following fees: 43
245		-	… 44
246		-	(13) For annual registration as a dispensing nurse practitioner under G.S. 90-18.2, 45
247		-	practitioner, seventy-five dollars ($75.00); 46
248		-	…." 47
249		-	SECTION 3.(e) G.S. 90-85.34A reads as rewritten: 48
250		-	"§ 90-85.34A. Public health pharmacy practice. 49
251		-	… 50 General Assembly Of North Carolina Session 2025
252		-	Page 6 House Bill 514-First Edition
253		-	(c) This section does not affect the practice of certified nurse practitioners pursuant to 1
254		-	G.S. 90-18.2 or of physician assistants pursuant to G.S. 90-18.1." 2
255		-	SECTION 4. G.S. 90-29(b) reads as rewritten: 3
256		-	"(b) A person shall be deemed to be practicing dentistry in this State who does, undertakes 4
257		-	or attempts to do, or claims the ability to do any one or more of the following acts or things 5
258		-	which, for the purposes of this Article, constitute the practice of dentistry: 6
259		-	… 7
260		-	(6) Administers an anesthetic of any kind in the treatment of dental or oral 8
261		-	diseases or physical conditions, or in preparation for or incident to any 9
262		-	operation within the oral cavity; provided, however, that this subsection shall 10
263		-	not apply to a lawfully qualified certified registered nurse anesthetist who 11
264		-	administers such anesthetic under the supervision and direction of a licensed 12
265		-	dentist or physician, anesthetic, or to a registered dental hygienist qualified to 13
266		-	administer local anesthetics. 14
267		-	…." 15
268		-	SECTION 5. G.S. 90-171.23(b) reads as rewritten: 16
269		-	"(b) Duties, powers. The Board is empowered to: 17
270		-	… 18
271		-	(14) Appoint and maintain a subcommittee of the Board to work jointly with the 19
272		-	subcommittee of the North Carolina Medical Board to develop rules and 20
273		-	regulations to govern the performance of medical acts by registered nurses 21
274		-	and to determine reasonable fees to accompany an application for approval or 22
275		-	renewal of such approval as provided in G.S. 90-8.2. The fees and rules 23
276		-	developed by this subcommittee shall govern the performance of medical acts 24
277		-	by registered nurses and shall become effective when they have been adopted 25
278		-	by both Boards.Grant prescribing, ordering, dispensing, and furnishing 26
279		-	authority to holders of the advanced practice registered nurse license pursuant 27
280		-	to G.S. 90-171.20. 28
281		-	…." 29
282		-	SECTION 6. G.S. 90-171.27(b) reads as rewritten: 30
283		-	"§ 90-171.27. Expenses payable from fees collected by Board. 31
284		-	… 32
285		-	(b) The schedule of fees shall not exceed the following rates: 33
286		-	Application for license as advanced practice registered nurse ............................... $100.00 34
287		-	Renewal of license to practice as advanced practice registered nurse 35
288		-	(two-year period)............................................................................................. 100.00 36
289		-	Reinstatement of lapsed license to practice as advanced practice 37
290		-	registered nurse and renewal fee ..................................................................... 180.00 38
	46	+	it in statute; Now, therefore, 34
	47	+	The General Assembly of North Carolina enacts: 35
	48	+	SECTION 1. G.S. 90-171.20 reads as rewritten: 36
	49	+	H.B. 514
	50	+	Mar 25, 2025
	51	+	HOUSE PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
	52	+	Page 2 DRH50020-NBf-55C
	53	+	"§ 90-171.20. Definitions. 1
	54	+	As used in this Article, unless the context requires otherwise: 2
	55	+	(1) Advanced assessment. – The taking by an advanced practice registered nurse 3
	56	+	of the history, physical, and psychological assessment of a patient's signs, 4
	57	+	symptoms, pathophysiologic status, and psychosocial variations in the 5
	58	+	determination of differential diagnoses and treatment. 6
	59	+	(1a) Advanced practice registered nurse or APRN. – An individual licensed by the 7
	60	+	Board as an advanced practice registered nurse within one of the following 8
	61	+	four roles: 9
	62	+	a. Certified nurse practitioner or CNP. 10
	63	+	b. Certified nurse midwife or CNM. 11
	64	+	c. Clinical nurse specialist or CNS. 12
	65	+	d. Certified registered nurse anesthetist or CRNA. 13
	66	+	(1b) "Board" means the Board. – The North Carolina Board of Nursing. 14
	67	+	(2) "Health care provider" means any Health care provider. – Any licensed health 15
	68	+	care professional and any agent or employee of any health care institution, 16
	69	+	health care insurer, health care professional school, or a member of any allied 17
	70	+	health profession. For purposes of this Article, a person enrolled in a program 18
	71	+	that prepares the person to be a licensed health care professional or an allied 19
	72	+	health professional shall be deemed a health care provider. 20
	73	+	(3) "License" means a License. – A permit issued by the Board to practice nursing 21
	74	+	as an advanced practice registered nurse, as a registered nurse nurse, or as a 22
	75	+	licensed practical nurse, including a renewal or reinstatement thereof. 23
	76	+	(3a) "Licensee" means any Licensee. – Any person issued a license by the Board, 24
	77	+	whether the license is active or inactive, including an inactive license by 25
	78	+	means of surrender. 26
	79	+	(4) "Nursing" is a Nursing. – A dynamic discipline which includes the assessing, 27
	80	+	caring, counseling, teaching, referring and implementing of prescribed 28
	81	+	treatment in the maintenance of health, prevention and management of illness, 29
	82	+	injury, disability or the achievement of a dignified death. It is ministering to; 30
	83	+	assisting; and sustained, vigilant, and continuous care of those acutely or 31
	84	+	chronically ill; supervising patients during convalescence and rehabilitation; 32
	85	+	the supportive and restorative care given to maintain the optimum health level 33
	86	+	of individuals, groups, and communities; the supervision, teaching, and 34
	87	+	evaluation of those who perform or are preparing to perform these functions; 35
	88	+	and the administration of nursing programs and nursing services. For purposes 36
	89	+	of this Article, the administration of required lethal substances or any 37
	90	+	assistance whatsoever rendered with an execution under Article 19 of Chapter 38
	91	+	15 of the General Statutes does not constitute nursing. 39
	92	+	(5) "Nursing program" means any Nursing program. – Any educational program 40
	93	+	in North Carolina offering to prepare persons to meet the educational 41
	94	+	requirements for licensure under this Article.Article as a registered nurse or a 42
	95	+	licensed practical nurse. 43
	96	+	(6) "Person" means an Person. – An individual, corporation, partnership, 44
	97	+	association, unit of government, or other legal entity. 45
	98	+	(6a) Population focus. – With respect to APRN practice, includes one of the 46
	99	+	following areas of focus: 47
	100	+	a. The family or the individual across the life span. 48
	101	+	b. Adult/gerontology. 49
	102	+	c. Neonatal. 50
	103	+	d. Pediatrics. 51 General Assembly Of North Carolina Session 2025
	104	+	DRH50020-NBf-55C Page 3
	105	+	e. Women's health or gender-related issues. 1
	106	+	f. Psychiatric mental health. 2
	107	+	(6b) Practice of nursing as a certified nurse midwife or CNM. – In addition to the 3
	108	+	RN scope of practice and APRN role and population foci, also consists of the 4
	109	+	following four components: 5
	110	+	a. The management, diagnosis, and treatment of primary sexual and 6
	111	+	reproductive health care, including primary, preconception, 7
	112	+	gynecologic/reproductive/sexual health, antepartum, intrapartum, 8
	113	+	neonatal, and post-pregnancy care. 9
	114	+	b. Ordering, performing, supervising, and interpreting diagnostic studies. 10
	115	+	c. Prescribing pharmacologic and nonpharmacologic therapies. 11
	116	+	d. Consulting with or referring to other health care providers as 12
	117	+	warranted by the needs of the patient. 13
	118	+	(6c) Practice of nursing as a certified nurse practitioner or CNP. – In addition to 14
	119	+	the RN scope of practice and APRN role and population foci, also consists of 15
	120	+	the following six components: 16
	121	+	a. Health promotion, disease prevention, health education, and 17
	122	+	counseling. 18
	123	+	b. Providing health assessment and screening activities. 19
	124	+	c. Diagnosing, treating, and facilitating patients' management of their 20
	125	+	acute and chronic illnesses and diseases. 21
	126	+	d. Ordering, performing, supervising, and interpreting diagnostic studies. 22
	127	+	e. Prescribing pharmacologic and nonpharmacologic therapies. 23
	128	+	f. Consulting with or referring to other health care providers as 24
	129	+	warranted by the needs of the patient. 25
	130	+	(6d) Practice of nursing as a certified registered nurse anesthetist or CRNA. – In 26
	131	+	addition to the RN scope of practice and within the APRN role and population 27
	132	+	foci, also consists of the following: 28
	133	+	a. Selecting, ordering, procuring, prescribing, and administering drugs 29
	134	+	and therapeutic devices to facilitate diagnostic, therapeutic, and 30
	135	+	surgical procedures. 31
	136	+	b. Ordering, prescribing, performing, supervising, and interpreting 32
	137	+	diagnostic studies, procedures, and interventions. 33
	138	+	c. Consulting with or referring to other health care providers as 34
	139	+	warranted by the needs of the patient. 35
	140	+	(6e) Practice of nursing as a clinical nurse specialist or CNS. – In addition to the 36
	141	+	RN scope of practice and APRN role and population foci, also consists of the 37
	142	+	following eight components: 38
	143	+	a. The diagnosis and treatment of health and illness states. 39
	144	+	b. Disease management. 40
	145	+	c. Prescribing pharmacologic and nonpharmacologic therapies. 41
	146	+	d. Ordering, performing, supervising, and interpreting diagnostic studies. 42
	147	+	e. Preventing of illness and risk behaviors. 43
	148	+	f. Nursing care for individuals, families, and communities. 44
	149	+	g. Integrating care across the continuum to improve patient outcomes. 45
	150	+	h. Consulting with or referring to other health care providers as 46
	151	+	warranted by the needs of the patient. 47
	152	+	(6f) Practice of nursing as an advanced practice registered nurse or APRN. – In 48
	153	+	addition to the RN scope of practice and within the APRN role and population 49
	154	+	foci, also consists of the following six components: 50
	155	+	a. Conducting an advanced assessment. 51 General Assembly Of North Carolina Session 2025
	156	+	Page 4 DRH50020-NBf-55C
	157	+	b. Delegating and assigning therapeutic measures to assistive personnel. 1
	158	+	c. Performing other acts that require education and training consistent 2
	159	+	with professional standards and commensurate with the APRN's 3
	160	+	education, certification, demonstrated competencies, and experience. 4
	161	+	d. Complying with the requirements of this Article and rendering quality 5
	162	+	advanced nursing care. 6
	163	+	e. Recognizing limits of knowledge and experience. 7
	164	+	f. Planning for the management of situations beyond the APRN's 8
	165	+	expertise. 9
	166	+	(7) The "practice of nursing by a registered nurse" consists Practice of nursing by 10
	167	+	a registered nurse. – Consists of the following 10 components: 11
	168	+	a. Assessing the patient's physical and mental health, including the 12
	169	+	patient's reaction to illnesses and treatment regimens. 13
	170	+	b. Recording and reporting the results of the nursing assessment. 14
	171	+	c. Planning, initiating, delivering, and evaluating appropriate nursing 15
	172	+	acts. 16
	173	+	d. Teaching, assigning, delegating to or supervising other personnel in 17
	174	+	implementing the treatment regimen. 18
	175	+	e. Collaborating with other health care providers in determining the 19
	176	+	appropriate health care for a patient but, subject to the provisions of 20
	177	+	G.S. 90-18.2, not prescribing a medical treatment regimen or making 21
	178	+	a medical diagnosis, except under supervision of a licensed 22
	179	+	physician.patient. 23
	180	+	f. Implementing the treatment and pharmaceutical regimen prescribed or 24
	181	+	ordered by any person authorized by State law to prescribe or order 25
	182	+	the regimen. 26
	183	+	g. Providing teaching and counseling about the patient's health. 27
	184	+	h. Reporting and recording the plan for care, nursing care given, and the 28
	185	+	patient's response to that care. 29
	186	+	i. Supervising, teaching, and evaluating those who perform or are 30
	187	+	preparing to perform nursing functions and administering nursing 31
	188	+	programs and nursing services. 32
	189	+	j. Providing for the maintenance of safe and effective nursing care, 33
	190	+	whether rendered directly or indirectly. 34
	191	+	(8) The "practice of nursing by a licensed practical nurse" consists of the 35
	192	+	following seven components: 36
	193	+	a. Participating in the assessment of the patient's physical and mental 37
	194	+	health, including the patient's reaction to illnesses and treatment 38
	195	+	regimens. 39
	196	+	b. Recording and reporting the results of the nursing assessment. 40
	197	+	c. Participating in implementing the health care plan developed by the 41
	198	+	registered nurse and/or prescribed by any person authorized by State 42
	199	+	law to prescribe such a plan, by performing tasks assigned or delegated 43
	200	+	by and performed under the supervision or under orders or directions 44
	201	+	of a registered nurse, physician licensed to practice medicine, dentist, 45
	202	+	or other person authorized by State law to provide the supervision. 46
	203	+	c1. Assigning or delegating nursing interventions to other qualified 47
	204	+	personnel under the supervision of the registered nurse. 48
	205	+	d. Participating in the teaching and counseling of patients as assigned by 49
	206	+	a registered nurse, physician, or other qualified professional licensed 50
	207	+	to practice in North Carolina. 51 General Assembly Of North Carolina Session 2025
	208	+	DRH50020-NBf-55C Page 5
	209	+	e. Reporting and recording the nursing care rendered and the patient's 1
	210	+	response to that care. 2
	211	+	f. Maintaining safe and effective nursing care, whether rendered directly 3
	212	+	or indirectly." 4
	213	+	SECTION 2. G.S. 90-18(c) reads as rewritten: 5
	214	+	"(c) The following shall not constitute practicing medicine or surgery as defined in this 6
	215	+	Article: 7
	216	+	… 8
	217	+	(7) The practice of midwifery as defined in G.S. 90-178.2. 9
	218	+	… 10
	219	+	(14) The practice of nursing by a an advanced practice registered nurse engaged in 11
	220	+	the practice of nursing and the performance of acts otherwise constituting 12
	221	+	medical practice by a registered nurse when performed in accordance with 13
	222	+	rules and regulations developed by a joint subcommittee of the North Carolina 14
	223	+	Medical Board and the Board of Nursing and adopted by both boards.as 15
	224	+	defined in Article 9A of this Chapter. 16
	225	+	…." 17
	226	+	SECTION 3.(a) G.S. 90-18.2 is repealed. 18
	227	+	SECTION 3.(b) G.S. 90-2(a) reads as rewritten: 19
	228	+	"(a) There is established the North Carolina Medical Board to regulate the practice of 20
	229	+	medicine and surgery for the benefit and protection of the people of North Carolina. The Board 21
	230	+	shall consist of 13 members: 22
	231	+	… 23
	232	+	(2) Five members shall all be appointed by the Governor as follows: 24
	233	+	… 25
	234	+	d. One shall be a certified nurse practitioner as defined in G.S. 90-18.2 26
	235	+	as recommended by the Review Panel pursuant to G.S. 90-3. 27
	236	+	…." 28
	237	+	SECTION 3.(c) G.S. 90-18.3(a) reads as rewritten: 29
	238	+	"(a) Whenever a statute or State agency rule requires that a medical or physical 30
	239	+	examination shall be conducted by a physician, the examination may be conducted and the form 31
	240	+	signed by a certified nurse practitioner or a physician assistant, and a physician need not be 32
	241	+	present. Nothing in this section shall otherwise change the scope of practice of a certified nurse 33
	242	+	practitioner or a physician assistant, as defined by G.S. 90-18.1 and G.S. 90-18.2, 34
	243	+	respectively.assistant." 35
	244	+	SECTION 3.(d) G.S. 90-85.24(a) reads as rewritten: 36
	245	+	"(a) The Board of Pharmacy shall be entitled to charge and collect not more than the 37
	246	+	following fees: 38
291	247		… 39
292		-	Reasonable charge for duplication services and materials. 40
293		-	A fee for an item listed in this schedule shall not increase from one year to the next by more 41
294		-	than twenty percent (20%)." 42
295		-	SECTION 7.(a) Article 9A of Chapter 90 of the General Statutes is amended by 43
296		-	adding the following new sections to read: 44
297		-	"§ 90-171.36B. Advanced practice registered nurse licensure. 45
298		-	(a) No advanced practice registered nurse shall practice as an advanced practice 46
299		-	registered nurse unless the nurse is licensed by the Board under this section. 47
300		-	(b) An applicant for a license to practice as an APRN shall apply to the Board in a format 48
301		-	prescribed by the Board and pay a fee in an amount determined under G.S. 90-171.27. 49
302		-	(c) The Board shall adopt rules, not inconsistent with this Article, which identify the 50
303		-	criteria which must be met by an applicant in order to be issued a license. 51 General Assembly Of North Carolina Session 2025
304		-	House Bill 514-First Edition Page 7
305		-	"§ 90-171.36C. Advanced practice registered nurse licensure; grandfathering exceptions. 1
306		-	(a) The Board shall issue an APRN license to any person recognized by the Board as an 2
307		-	APRN or approved to practice as an APRN in this State on or before the date that this section 3
308		-	becomes law. 4
309		-	(b) An advanced practice registered nurse licensed under this section shall maintain all 5
310		-	practice privileges provided to licensed advanced practice registered nurses under this Chapter. 6
311		-	"§ 90-171.36D. Advanced practice registered nurse licensure renewal; reinstatement. 7
312		-	(a) An applicant for renewal of an APRN license issued under this Article shall apply for 8
313		-	licensure renewal according to the frequency and schedule established by the Board and pay the 9
314		-	required fee. 10
315		-	(b) Failure to renew the APRN license before the expiration date shall result in automatic 11
316		-	forfeiture of the right to practice nursing as an APRN in North Carolina until such time as the 12
317		-	license has been reinstated. 13
318		-	(c) An APRN licensee who has allowed his or her license to lapse by failure to renew 14
319		-	may apply for reinstatement in a manner prescribed by the Board and pay the required fee. 15
320		-	(d) The Board shall adopt rules, not inconsistent with this Article, which identify the 16
321		-	criteria which must be met by an applicant for APRN license renewal or reinstatement." 17
322		-	SECTION 7.(b) G.S. 90-171.37(b) is repealed. 18
323		-	SECTION 8. G.S. 90-171.43 reads as rewritten: 19
324		-	"§ 90-171.43. License required. 20
325		-	(a) No person shall practice or offer to practice as a an advanced practice registered nurse, 21
326		-	registered nurse nurse, or licensed practical nurse, or use the word "nurse" as a title for herself or 22
327		-	himself, or use an abbreviation to indicate that the person is a an advanced practice registered 23
328		-	nurse, registered nurse nurse, or licensed practical nurse, unless the person is currently licensed 24
329		-	as a an advanced practice registered nurse, registered nurse nurse, or licensed practical nurse as 25
330		-	provided by this Article. If the word "nurse" is part of a longer title, such as "nurse's aide", a 26
331		-	person who is entitled to use that title shall use the entire title and may not abbreviate the title to 27
332		-	"nurse". This Article shall not, however, be construed to prohibit or limit the following: 28
333		-	(1) The performance by any person of any act for which that person holds a 29
334		-	license issued pursuant to North Carolina law;law. 30
335		-	(2) The clinical practice by students enrolled in approved nursing programs, 31
336		-	continuing education programs, or refresher courses under the supervision of 32
337		-	qualified faculty;faculty. 33
338		-	(3) The performance of nursing performed by persons who hold a temporary 34
339		-	license issued pursuant to G.S. 90-171.33;G.S. 90-171.33. 35
340		-	(4) The delegation to any person, including a member of the patient's family, by 36
341		-	a physician licensed to practice medicine in North Carolina, a licensed dentist 37
342		-	or registered nurse of those patient-care services which are routine, repetitive, 38
343		-	limited in scope that do not require the professional judgment of a registered 39
344		-	nurse or licensed practical nurse;nurse. 40
345		-	(5) Assistance by any person in the case of emergency. 41
346		-	Any person permitted to practice nursing without a license as provided in subdivision (2) 42
347		-	(a)(2) or (3) (a)(3) of this section shall be held to the same standard of care as any licensed nurse. 43
348		-	(a1) The abbreviations for the APRN designation of a certified nurse midwife, a clinical 44
349		-	nurse specialist, a certified registered nurse anesthetist, and a certified nurse practitioner shall be 45
350		-	APRN, plus the role title, i.e., CNM, CNS, CRNA, and CNP. 46
351		-	(a2) It shall be unlawful for any person to use the title "APRN" or "APRN" plus their 47
352		-	respective role titles, the role title alone, authorized abbreviations, or any other title that would 48
353		-	lead a person to believe the individual is an APRN, unless permitted by this act. 49
354		-	…." 50
355		-	SECTION 9. G.S. 90-171.43A reads as rewritten: 51 General Assembly Of North Carolina Session 2025
356		-	Page 8 House Bill 514-First Edition
357		-	"§ 90-171.43A. Mandatory employer verification of licensure status. 1
358		-	(a) Before hiring an advanced practice registered nurse, a registered nurse nurse, or a 2
359		-	licensed practical nurse in North Carolina, a health care facility shall verify that the applicant has 3
360		-	a current, valid license to practice nursing pursuant to G.S. 90-171.43. 4
361		-	(b) For purposes of this section, "health care facility" means: 5
362		-	(1) Facilities described in G.S. 131E-256(b). 6
363		-	(2) Public health departments, physicians' offices, ambulatory care facilities, and 7
364		-	rural health clinics." 8
365		-	SECTION 10. G.S. 90-171.44 reads as rewritten: 9
366		-	"§ 90-171.44. Prohibited acts. 10
367		-	It shall be a violation of this Article, and subject to action under G.S. 90-171.37, for any 11
368		-	person to: 12
369		-	(1) Sell, fraudulently obtain, or fraudulently furnish any nursing diploma or aid 13
370		-	or abet therein. 14
371		-	(2) Practice nursing under cover of any fraudulently obtained license. 15
372		-	(3) Practice nursing without a license. This subdivision shall not be construed to 16
373		-	prohibit any licensed registered nurse who has successfully completed a 17
374		-	program established under G.S. 90-171.38(b) from conducting medical 18
375		-	examinations or performing procedures to collect evidence from the victims 19
376		-	of offenses described in that subsection. 20
377		-	(3a) Refer to himself or herself as an advanced practice registered nurse; or refer 21
378		-	to himself or herself as any of the four roles of advanced practice registered 22
379		-	nurses, a registered nurse, or a licensed practical nurse; or use the 23
380		-	abbreviations "APRN," "CNM," "CNS," "CRNA," "CNP," "RN," and "LPN." 24
381		-	(4) Conduct a nursing program or a refresher course for activation of a license, 25
382		-	that is not approved by the Board. 26
383		-	(5) Employ unlicensed persons to practice nursing." 27
384		-	SECTION 11.(a) Article 10A of Chapter 90 of the General Statutes is repealed. 28
385		-	SECTION 11.(b) G.S. 90-21.11 reads as rewritten: 29
386		-	"§ 90-21.11. Definitions. 30
387		-	The following definitions apply in this Article: 31
388		-	(1) Health care provider. – Without limitation, any of the following: 32
389		-	a. A person who pursuant to the provisions of Chapter 90 of the General 33
390		-	Statutes is licensed, or is otherwise registered or certified to engage in 34
391		-	the practice of or otherwise performs duties associated with any of the 35
392		-	following: medicine, surgery, dentistry, pharmacy, optometry, 36
393		-	midwifery, osteopathy, podiatry, chiropractic, radiology, nursing, 37
394		-	physiotherapy, pathology, anesthesiology, anesthesia, laboratory 38
395		-	analysis, rendering assistance to a physician, dental hygiene, 39
396		-	psychiatry, or psychology. 40
397		-	…." 41
398		-	SECTION 11.(c) G.S. 115C-407.57(b)(2) reads as rewritten: 42
399		-	"(2) If a student participating in an interscholastic athletic activity exhibits signs 43
400		-	or symptoms consistent with a concussion, the student shall be removed from 44
401		-	the activity at that time and shall not be allowed to return to play or practice 45
402		-	that day. The student shall not return to play or practice on a subsequent day 46
403		-	until the student is evaluated by and receives written clearance for such 47
404		-	participation from one of the following: 48
405		-	… 49 General Assembly Of North Carolina Session 2025
406		-	House Bill 514-First Edition Page 9
407		-	e. A certified nurse practitioner, consistent with the limitations of 1
408		-	G.S. 90-18.2.provisions of Article 9A of Chapter 90 of the General 2
409		-	Statutes." 3
410		-	SECTION 12.(a) No later than 30 calendar days after this act becomes law, the 4
411		-	Governor shall submit to the Centers for Medicare and Medicaid Services an "opt-out" letter 5
412		-	requesting an exemption under 42 C.F.R. § 482.52(c) that allows hospitals, ambulatory surgical 6
413		-	centers, critical access hospitals, and rural hospitals in this State the maximum flexibility to 7
414		-	obtain Medicare reimbursement for anesthesia services in a manner that best serves each facility 8
415		-	and the patients and communities the facility serves. 9
416		-	SECTION 12.(b) This section is effective when it becomes law. 10
417		-	SECTION 13.(a) The North Carolina Board of Nursing, the North Carolina Medical 11
418		-	Board, and the North Carolina State Board of Dental Examiners shall adopt rules to implement 12
419		-	the provisions of this act. 13
420		-	SECTION 13.(b) This section is effective when it becomes law. 14
421		-	SECTION 14. The Revisor of Statutes shall change all references to nurse 15
422		-	practitioners to instead be references to certified nurse practitioners and shall change all 16
423		-	references to the abbreviation NP to instead be references to the abbreviation CNP, wherever 17
424		-	those terms appear in the following statutes: G.S. 15-190, 20-37.6(c1), 55B-14(c), 58-3-169, 18
425		-	58-50-30, 58-51-45, 90-1.1, 90-3, 90-21.17, 90-21.81, 90-171.21, 90-724, 108A-77.1, 115C-323, 19
426		-	115C-375.2A, 122C-263.1, 122C-465, 130A-115, 130A-440.1, and 131D-4.8. 20
427		-	SECTION 15. Except as otherwise provided, this act is effective 90 days after it 21
428		-	becomes law. 22
	248	+	(13) For annual registration as a dispensing nurse practitioner under G.S. 90-18.2, 40
	249	+	practitioner, seventy-five dollars ($75.00); 41
	250	+	…." 42
	251	+	SECTION 3.(e) G.S. 90-85.34A reads as rewritten: 43
	252	+	"§ 90-85.34A. Public health pharmacy practice. 44
	253	+	… 45
	254	+	(c) This section does not affect the practice of certified nurse practitioners pursuant to 46
	255	+	G.S. 90-18.2 or of physician assistants pursuant to G.S. 90-18.1." 47
	256	+	SECTION 4. G.S. 90-29(b) reads as rewritten: 48
	257	+	"(b) A person shall be deemed to be practicing dentistry in this State who does, undertakes 49
	258	+	or attempts to do, or claims the ability to do any one or more of the following acts or things 50
	259	+	which, for the purposes of this Article, constitute the practice of dentistry: 51 General Assembly Of North Carolina Session 2025
	260	+	Page 6 DRH50020-NBf-55C
	261	+	… 1
	262	+	(6) Administers an anesthetic of any kind in the treatment of dental or oral 2
	263	+	diseases or physical conditions, or in preparation for or incident to any 3
	264	+	operation within the oral cavity; provided, however, that this subsection shall 4
	265	+	not apply to a lawfully qualified certified registered nurse anesthetist who 5
	266	+	administers such anesthetic under the supervision and direction of a licensed 6
	267	+	dentist or physician, anesthetic, or to a registered dental hygienist qualified to 7
	268	+	administer local anesthetics. 8
	269	+	…." 9
	270	+	SECTION 5. G.S. 90-171.23(b) reads as rewritten: 10
	271	+	"(b) Duties, powers. The Board is empowered to: 11
	272	+	… 12
	273	+	(14) Appoint and maintain a subcommittee of the Board to work jointly with the 13
	274	+	subcommittee of the North Carolina Medical Board to develop rules and 14
	275	+	regulations to govern the performance of medical acts by registered nurses 15
	276	+	and to determine reasonable fees to accompany an application for approval or 16
	277	+	renewal of such approval as provided in G.S. 90-8.2. The fees and rules 17
	278	+	developed by this subcommittee shall govern the performance of medical acts 18
	279	+	by registered nurses and shall become effective when they have been adopted 19
	280	+	by both Boards.Grant prescribing, ordering, dispensing, and furnishing 20
	281	+	authority to holders of the advanced practice registered nurse license pursuant 21
	282	+	to G.S. 90-171.20. 22
	283	+	…." 23
	284	+	SECTION 6. G.S. 90-171.27(b) reads as rewritten: 24
	285	+	"§ 90-171.27. Expenses payable from fees collected by Board. 25
	286	+	… 26
	287	+	(b) The schedule of fees shall not exceed the following rates: 27
	288	+	Application for license as advanced practice registered nurse ............................... $100.00 28
	289	+	Renewal of license to practice as advanced practice registered nurse 29
	290	+	(two-year period)............................................................................................. 100.00 30
	291	+	Reinstatement of lapsed license to practice as advanced practice 31
	292	+	registered nurse and renewal fee ..................................................................... 180.00 32
	293	+	… 33
	294	+	Reasonable charge for duplication services and materials. 34
	295	+	A fee for an item listed in this schedule shall not increase from one year to the next by more 35
	296	+	than twenty percent (20%)." 36
	297	+	SECTION 7.(a) Article 9A of Chapter 90 of the General Statutes is amended by 37
	298	+	adding the following new sections to read: 38
	299	+	"§ 90-171.36B. Advanced practice registered nurse licensure. 39
	300	+	(a) No advanced practice registered nurse shall practice as an advanced practice 40
	301	+	registered nurse unless the nurse is licensed by the Board under this section. 41
	302	+	(b) An applicant for a license to practice as an APRN shall apply to the Board in a format 42
	303	+	prescribed by the Board and pay a fee in an amount determined under G.S. 90-171.27. 43
	304	+	(c) The Board shall adopt rules, not inconsistent with this Article, which identify the 44
	305	+	criteria which must be met by an applicant in order to be issued a license. 45
	306	+	"§ 90-171.36C. Advanced practice registered nurse licensure; grandfathering exceptions. 46
	307	+	(a) The Board shall issue an APRN license to any person recognized by the Board as an 47
	308	+	APRN or approved to practice as an APRN in this State on or before the date that this section 48
	309	+	becomes law. 49
	310	+	(b) An advanced practice registered nurse licensed under this section shall maintain all 50
	311	+	practice privileges provided to licensed advanced practice registered nurses under this Chapter. 51 General Assembly Of North Carolina Session 2025
	312	+	DRH50020-NBf-55C Page 7
	313	+	"§ 90-171.36D. Advanced practice registered nurse licensure renewal; reinstatement. 1
	314	+	(a) An applicant for renewal of an APRN license issued under this Article shall apply for 2
	315	+	licensure renewal according to the frequency and schedule established by the Board and pay the 3
	316	+	required fee. 4
	317	+	(b) Failure to renew the APRN license before the expiration date shall result in automatic 5
	318	+	forfeiture of the right to practice nursing as an APRN in North Carolina until such time as the 6
	319	+	license has been reinstated. 7
	320	+	(c) An APRN licensee who has allowed his or her license to lapse by failure to renew 8
	321	+	may apply for reinstatement in a manner prescribed by the Board and pay the required fee. 9
	322	+	(d) The Board shall adopt rules, not inconsistent with this Article, which identify the 10
	323	+	criteria which must be met by an applicant for APRN license renewal or reinstatement." 11
	324	+	SECTION 7.(b) G.S. 90-171.37(b) is repealed. 12
	325	+	SECTION 8. G.S. 90-171.43 reads as rewritten: 13
	326	+	"§ 90-171.43. License required. 14
	327	+	(a) No person shall practice or offer to practice as a an advanced practice registered nurse, 15
	328	+	registered nurse nurse, or licensed practical nurse, or use the word "nurse" as a title for herself or 16
	329	+	himself, or use an abbreviation to indicate that the person is a an advanced practice registered 17
	330	+	nurse, registered nurse nurse, or licensed practical nurse, unless the person is currently licensed 18
	331	+	as a an advanced practice registered nurse, registered nurse nurse, or licensed practical nurse as 19
	332	+	provided by this Article. If the word "nurse" is part of a longer title, such as "nurse's aide", a 20
	333	+	person who is entitled to use that title shall use the entire title and may not abbreviate the title to 21
	334	+	"nurse". This Article shall not, however, be construed to prohibit or limit the following: 22
	335	+	(1) The performance by any person of any act for which that person holds a 23
	336	+	license issued pursuant to North Carolina law;law. 24
	337	+	(2) The clinical practice by students enrolled in approved nursing programs, 25
	338	+	continuing education programs, or refresher courses under the supervision of 26
	339	+	qualified faculty;faculty. 27
	340	+	(3) The performance of nursing performed by persons who hold a temporary 28
	341	+	license issued pursuant to G.S. 90-171.33;G.S. 90-171.33. 29
	342	+	(4) The delegation to any person, including a member of the patient's family, by 30
	343	+	a physician licensed to practice medicine in North Carolina, a licensed dentist 31
	344	+	or registered nurse of those patient-care services which are routine, repetitive, 32
	345	+	limited in scope that do not require the professional judgment of a registered 33
	346	+	nurse or licensed practical nurse;nurse. 34
	347	+	(5) Assistance by any person in the case of emergency. 35
	348	+	Any person permitted to practice nursing without a license as provided in subdivision (2) 36
	349	+	(a)(2) or (3) (a)(3) of this section shall be held to the same standard of care as any licensed nurse. 37
	350	+	(a1) The abbreviations for the APRN designation of a certified nurse midwife, a clinical 38
	351	+	nurse specialist, a certified registered nurse anesthetist, and a certified nurse practitioner shall be 39
	352	+	APRN, plus the role title, i.e., CNM, CNS, CRNA, and CNP. 40
	353	+	(a2) It shall be unlawful for any person to use the title "APRN" or "APRN" plus their 41
	354	+	respective role titles, the role title alone, authorized abbreviations, or any other title that would 42
	355	+	lead a person to believe the individual is an APRN, unless permitted by this act. 43
	356	+	…." 44
	357	+	SECTION 9. G.S. 90-171.43A reads as rewritten: 45
	358	+	"§ 90-171.43A. Mandatory employer verification of licensure status. 46
	359	+	(a) Before hiring an advanced practice registered nurse, a registered nurse nurse, or a 47
	360	+	licensed practical nurse in North Carolina, a health care facility shall verify that the applicant has 48
	361	+	a current, valid license to practice nursing pursuant to G.S. 90-171.43. 49
	362	+	(b) For purposes of this section, "health care facility" means: 50
	363	+	(1) Facilities described in G.S. 131E-256(b). 51 General Assembly Of North Carolina Session 2025
	364	+	Page 8 DRH50020-NBf-55C
	365	+	(2) Public health departments, physicians' offices, ambulatory care facilities, and 1
	366	+	rural health clinics." 2
	367	+	SECTION 10. G.S. 90-171.44 reads as rewritten: 3
	368	+	"§ 90-171.44. Prohibited acts. 4
	369	+	It shall be a violation of this Article, and subject to action under G.S. 90-171.37, for any 5
	370	+	person to: 6
	371	+	(1) Sell, fraudulently obtain, or fraudulently furnish any nursing diploma or aid 7
	372	+	or abet therein. 8
	373	+	(2) Practice nursing under cover of any fraudulently obtained license. 9
	374	+	(3) Practice nursing without a license. This subdivision shall not be construed to 10
	375	+	prohibit any licensed registered nurse who has successfully completed a 11
	376	+	program established under G.S. 90-171.38(b) from conducting medical 12
	377	+	examinations or performing procedures to collect evidence from the victims 13
	378	+	of offenses described in that subsection. 14
	379	+	(3a) Refer to himself or herself as an advanced practice registered nurse; or refer 15
	380	+	to himself or herself as any of the four roles of advanced practice registered 16
	381	+	nurses, a registered nurse, or a licensed practical nurse; or use the 17
	382	+	abbreviations "APRN," "CNM," "CNS," "CRNA," "CNP," "RN," and "LPN." 18
	383	+	(4) Conduct a nursing program or a refresher course for activation of a license, 19
	384	+	that is not approved by the Board. 20
	385	+	(5) Employ unlicensed persons to practice nursing." 21
	386	+	SECTION 11.(a) Article 10A of Chapter 90 of the General Statutes is repealed. 22
	387	+	SECTION 11.(b) G.S. 90-21.11 reads as rewritten: 23
	388	+	"§ 90-21.11. Definitions. 24
	389	+	The following definitions apply in this Article: 25
	390	+	(1) Health care provider. – Without limitation, any of the following: 26
	391	+	a. A person who pursuant to the provisions of Chapter 90 of the General 27
	392	+	Statutes is licensed, or is otherwise registered or certified to engage in 28
	393	+	the practice of or otherwise performs duties associated with any of the 29
	394	+	following: medicine, surgery, dentistry, pharmacy, optometry, 30
	395	+	midwifery, osteopathy, podiatry, chiropractic, radiology, nursing, 31
	396	+	physiotherapy, pathology, anesthesiology, anesthesia, laboratory 32
	397	+	analysis, rendering assistance to a physician, dental hygiene, 33
	398	+	psychiatry, or psychology. 34
	399	+	…." 35
	400	+	SECTION 11.(c) G.S. 115C-407.57(b)(2) reads as rewritten: 36
	401	+	"(2) If a student participating in an interscholastic athletic activity exhibits signs 37
	402	+	or symptoms consistent with a concussion, the student shall be removed from 38
	403	+	the activity at that time and shall not be allowed to return to play or practice 39
	404	+	that day. The student shall not return to play or practice on a subsequent day 40
	405	+	until the student is evaluated by and receives written clearance for such 41
	406	+	participation from one of the following: 42
	407	+	… 43
	408	+	e. A certified nurse practitioner, consistent with the limitations of 44
	409	+	G.S. 90-18.2.provisions of Article 9A of Chapter 90 of the General 45
	410	+	Statutes." 46
	411	+	SECTION 12.(a) No later than 30 calendar days after this act becomes law, the 47
	412	+	Governor shall submit to the Centers for Medicare and Medicaid Services an "opt-out" letter 48
	413	+	requesting an exemption under 42 C.F.R. § 482.52(c) that allows hospitals, ambulatory surgical 49
	414	+	centers, critical access hospitals, and rural hospitals in this State the maximum flexibility to 50 General Assembly Of North Carolina Session 2025
	415	+	DRH50020-NBf-55C Page 9
	416	+	obtain Medicare reimbursement for anesthesia services in a manner that best serves each facility 1
	417	+	and the patients and communities the facility serves. 2
	418	+	SECTION 12.(b) This section is effective when it becomes law. 3
	419	+	SECTION 13.(a) The North Carolina Board of Nursing, the North Carolina Medical 4
	420	+	Board, and the North Carolina State Board of Dental Examiners shall adopt rules to implement 5
	421	+	the provisions of this act. 6
	422	+	SECTION 13.(b) This section is effective when it becomes law. 7
	423	+	SECTION 14. The Revisor of Statutes shall change all references to nurse 8
	424	+	practitioners to instead be references to certified nurse practitioners and shall change all 9
	425	+	references to the abbreviation NP to instead be references to the abbreviation CNP, wherever 10
	426	+	those terms appear in the following statutes: G.S. 15-190, 20-37.6(c1), 55B-14(c), 58-3-169, 11
	427	+	58-50-30, 58-51-45, 90-1.1, 90-3, 90-21.17, 90-21.81, 90-171.21, 90-724, 108A-77.1, 115C-323, 12
	428	+	115C-375.2A, 122C-263.1, 122C-465, 130A-115, 130A-440.1, and 131D-4.8. 13
	429	+	SECTION 15. Except as otherwise provided, this act is effective 90 days after it 14
	430	+	becomes law. 15