North Carolina 2025-2026 Regular Session

North Carolina Senate Bill S537 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		GENERAL ASSEMBLY OF NORTH CAROLINA
2	2		SESSION 2025
3		-	S 1
4		-	SENATE BILL 537
	3	+	S D
	4	+	SENATE BILL DRS45266-NBf-55B
	5	+
5	6
6	7
7	8		Short Title: APRN Definitions. (Public)
8	9		Sponsors: Senators Hise, Adcock, and Corbin (Primary Sponsors).
9		-	Referred to: ~~Rules and Operations of the Senate~~
10		-	~~March 26, 2025~~
11		-	~~S537 -v-1~~
	10	+	Referred to:
	11	+
	12	+	DRS45266 -NBf-55B
12	13		A BILL TO BE ENTITLED 1
13	14		AN ACT TO DEFINE THE PRACTICE OF NURSING FOR ADVANCED PRACTICE 2
14	15		REGISTERED NURSES: NURSE PRACTITIONERS (NP), CERTIFIED N URSE 3
15	16		MIDWIVES (CNM), CERTIFIED REGISTERED NURSE ANESTHETISTS (CRNA), 4
16	17		AND CLINICAL NURSE SPECIALISTS (CNS). 5
17	18		Whereas, North Carolina is expected to be the seventh largest state in the nation by 6
18	19		2035 and demand for health care will continue to increase; and 7
19	20		Whereas, North Carolina has provided over 628,000 North Carolinians access to 8
20	21		insurance through Medicaid expansion but lacks the health care providers to ensure their access 9
21	22		to care; and 10
22	23		Whereas, APRNs are registered nurses with master's or doctorate degrees and 11
23	24		advanced education and training; and 12
24	25		Whereas, North Carolina has over 20,000 advanced practice registered nurses 13
25	26		(APRNs) who have been educated and licensed to practice to their full scope; and 14
26	27		Whereas, more than three decades of research demonstrates that APRNs improve 15
27	28		access to safe, high-quality, cost-effective, patient-centered health care; and 16
28	29		Whereas, the Institute of Medicine (IOM) has called for states to allow APRNs to 17
29	30		practice to the full extent of their licensure and education since the 2010 release of the IOM 18
30	31		Report on the Future of Nursing; and 19
31	32		Whereas, health care costs in North Carolina are among the highest in the nation; and 20
32	33		Whereas, a recent report by a Ph.D. health care economist at Duke University 21
33	34		estimates savings of at least $700 million annually for North Carolina patients, employers, and 22
34	35		taxpayers by removing unnecessary and antiquated government regulations; and 23
35	36		Whereas, 36 other states have rolled back these costly and burdensome government 24
36	37		regulations on advanced practice registered nurses over the past 31 years with no evidence of 25
37	38		negative effects on patient safety, and indeed positive impact on patient care, according to 26
38	39		numerous studies; and 27
39	40		Whereas, no state has enacted these reforms and later reversed course to reinstate 28
40	41		these government regulations; and 29
41	42		Whereas, the APRN role has existed for over a half century but remains undefined in 30
42	43		North Carolina statute; and 31
43	44		Whereas, North Carolina's courts and executive branch have called on the legislature, 32
44	45		the body of the people, to remove the ambiguity surrounding APRN practice by clearly defining 33
45	46		it in statute; Now, therefore, 34
46	47		The General Assembly of North Carolina enacts: 35
47		-	SECTION 1. G.S. 90-171.20 reads as rewritten: 36 General Assembly Of North Carolina Session 2025
48		-	Page 2 Senate Bill 537-First Edition
	48	+	SECTION 1. G.S. 90-171.20 reads as rewritten: 36
	49	+	FILED SENATE
	50	+	Mar 25, 2025
	51	+	S.B. 537
	52	+	PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
	53	+	Page 2 DRS45266-NBf-55B
49	54		"§ 90-171.20. Definitions. 1
50	55		As used in this Article, unless the context requires otherwise: 2
51	56		(1) Advanced assessment. – The taking by an advanced practice registered nurse 3
52	57		of the history, physical, and psychological assessment of a patient's signs, 4
53	58		symptoms, pathophysiologic status, and psychosocial variations in the 5
54	59		determination of differential diagnoses and treatment. 6
55	60		(1a) Advanced practice registered nurse or APRN. – An individual licensed by the 7
56	61		Board as an advanced practice registered nurse within one of the following 8
57	62		four roles: 9
58	63		a. Certified nurse practitioner or CNP. 10
59	64		b. Certified nurse midwife or CNM. 11
60	65		c. Clinical nurse specialist or CNS. 12
61	66		d. Certified registered nurse anesthetist or CRNA. 13
62	67		(1b) "Board" means the Board. – The North Carolina Board of Nursing. 14
63	68		(2) "Health care provider" means any Health care provider. – Any licensed health 15
64	69		care professional and any agent or employee of any health care institution, 16
65	70		health care insurer, health care professional school, or a member of any allied 17
66	71		health profession. For purposes of this Article, a person enrolled in a program 18
67	72		that prepares the person to be a licensed health care professional or an allied 19
68	73		health professional shall be deemed a health care provider. 20
69	74		(3) "License" means a License. – A permit issued by the Board to practice nursing 21
70	75		as an advanced practice registered nurse, as a registered nurse nurse, or as a 22
71	76		licensed practical nurse, including a renewal or reinstatement thereof. 23
72	77		(3a) "Licensee" means any Licensee. – Any person issued a license by the Board, 24
73	78		whether the license is active or inactive, including an inactive license by 25
74	79		means of surrender. 26
75	80		(4) "Nursing" is a Nursing. – A dynamic discipline which includes the assessing, 27
76	81		caring, counseling, teaching, referring and implementing of prescribed 28
77	82		treatment in the maintenance of health, prevention and management of illness, 29
78	83		injury, disability or the achievement of a dignified death. It is ministering to; 30
79	84		assisting; and sustained, vigilant, and continuous care of those acutely or 31
80	85		chronically ill; supervising patients during convalescence and rehabilitation; 32
81	86		the supportive and restorative care given to maintain the optimum health level 33
82	87		of individuals, groups, and communities; the supervision, teaching, and 34
83	88		evaluation of those who perform or are preparing to perform these functions; 35
84	89		and the administration of nursing programs and nursing services. For purposes 36
85	90		of this Article, the administration of required lethal substances or any 37
86	91		assistance whatsoever rendered with an execution under Article 19 of Chapter 38
87	92		15 of the General Statutes does not constitute nursing. 39
88	93		(5) "Nursing program" means any Nursing program. – Any educational program 40
89	94		in North Carolina offering to prepare persons to meet the educational 41
90	95		requirements for licensure under this Article.Article as a registered nurse or a 42
91	96		licensed practical nurse. 43
92	97		(6) "Person" means an Person. – An individual, corporation, partnership, 44
93	98		association, unit of government, or other legal entity. 45
94	99		(6a) Population focus. – With respect to APRN practice, includes one of the 46
95	100		following areas of focus: 47
96	101		a. The family or the individual across the life span. 48
97	102		b. Adult/gerontology. 49
98	103		c. Neonatal. 50
99	104		d. Pediatrics. 51 General Assembly Of North Carolina Session 2025
100		-	~~Senate Bill 537-First Edition~~ Page 3
	105	+	DRS45266-NBf-55B Page 3
101	106		e. Women's health or gender-related issues. 1
102	107		f. Psychiatric mental health. 2
103	108		(6b) Practice of nursing as a certified nurse midwife or CNM. – In addition to the 3
104	109		RN scope of practice and APRN role and population foci, also consists of the 4
105	110		following four components: 5
106	111		a. The management, diagnosis, and treatment of primary sexual and 6
107	112		reproductive health care, including primary, preconception, 7
108	113		gynecologic/reproductive/sexual health, antepartum, intrapartum, 8
109	114		neonatal, and post-pregnancy care. 9
110	115		b. Ordering, performing, supervising, and interpreting diagnostic studies. 10
111	116		c. Prescribing pharmacologic and nonpharmacologic therapies. 11
112	117		d. Consulting with or referring to other health care providers as 12
113	118		warranted by the needs of the patient. 13
114	119		(6c) Practice of nursing as a certified nurse practitioner or CNP. – In addition to 14
115	120		the RN scope of practice and APRN role and population foci, also consists of 15
116	121		the following six components: 16
117	122		a. Health promotion, disease prevention, health education, and 17
118	123		counseling. 18
119	124		b. Providing health assessment and screening activities. 19
120	125		c. Diagnosing, treating, and facilitating patients' management of their 20
121	126		acute and chronic illnesses and diseases. 21
122	127		d. Ordering, performing, supervising, and interpreting diagnostic studies. 22
123	128		e. Prescribing pharmacologic and nonpharmacologic therapies. 23
124	129		f. Consulting with or referring to other health care providers as 24
125	130		warranted by the needs of the patient. 25
126	131		(6d) Practice of nursing as a certified registered nurse anesthetist or CRNA. – In 26
127	132		addition to the RN scope of practice and within the APRN role and population 27
128	133		foci, also consists of the following: 28
129	134		a. Selecting, ordering, procuring, prescribing, and administering drugs 29
130	135		and therapeutic devices to facilitate diagnostic, therapeutic, and 30
131	136		surgical procedures. 31
132	137		b. Ordering, prescribing, performing, supervising, and interpreting 32
133	138		diagnostic studies, procedures, and interventions. 33
134	139		c. Consulting with or referring to other health care providers as 34
135	140		warranted by the needs of the patient. 35
136	141		(6e) Practice of nursing as a clinical nurse specialist or CNS. – In addition to the 36
137	142		RN scope of practice and APRN role and population foci, also consists of the 37
138	143		following eight components: 38
139	144		a. The diagnosis and treatment of health and illness states. 39
140	145		b. Disease management. 40
141	146		c. Prescribing pharmacologic and nonpharmacologic therapies. 41
142	147		d. Ordering, performing, supervising, and interpreting diagnostic studies. 42
143	148		e. Preventing of illness and risk behaviors. 43
144	149		f. Nursing care for individuals, families, and communities. 44
145	150		g. Integrating care across the continuum to improve patient outcomes. 45
146	151		h. Consulting with or referring to other health care providers as 46
147	152		warranted by the needs of the patient. 47
148	153		(6f) Practice of nursing as an advanced practice registered nurse or APRN. – In 48
149	154		addition to the RN scope of practice and within the APRN role and population 49
150	155		foci, also consists of the following six components: 50
151	156		a. Conducting an advanced assessment. 51 General Assembly Of North Carolina Session 2025
152		-	Page 4 ~~Senate Bill 537-First Edition~~
	157	+	Page 4 DRS45266-NBf-55B
153	158		b. Delegating and assigning therapeutic measures to assistive personnel. 1
154	159		c. Performing other acts that require education and training consistent 2
155	160		with professional standards and commensurate with the APRN's 3
156	161		education, certification, demonstrated competencies, and experience. 4
157	162		d. Complying with the requirements of this Article and rendering quality 5
158	163		advanced nursing care. 6
159	164		e. Recognizing limits of knowledge and experience. 7
160	165		f. Planning for the management of situations beyond the APRN's 8
161	166		expertise. 9
162	167		(7) The "practice of nursing by a registered nurse" consists Practice of nursing by 10
163	168		a registered nurse. – Consists of the following 10 components: 11
164	169		a. Assessing the patient's physical and mental health, including the 12
165	170		patient's reaction to illnesses and treatment regimens. 13
166	171		b. Recording and reporting the results of the nursing assessment. 14
167	172		c. Planning, initiating, delivering, and evaluating appropriate nursing 15
168	173		acts. 16
169	174		d. Teaching, assigning, delegating to or supervising other personnel in 17
170	175		implementing the treatment regimen. 18
171	176		e. Collaborating with other health care providers in determining the 19
172	177		appropriate health care for a patient but, subject to the provisions of 20
173	178		G.S. 90-18.2, not prescribing a medical treatment regimen or making 21
174	179		a medical diagnosis, except under supervision of a licensed 22
175	180		physician.patient. 23
176	181		f. Implementing the treatment and pharmaceutical regimen prescribed or 24
177	182		ordered by any person authorized by State law to prescribe or order 25
178	183		the regimen. 26
179	184		g. Providing teaching and counseling about the patient's health. 27
180	185		h. Reporting and recording the plan for care, nursing care given, and the 28
181	186		patient's response to that care. 29
182	187		i. Supervising, teaching, and evaluating those who perform or are 30
183	188		preparing to perform nursing functions and administering nursing 31
184	189		programs and nursing services. 32
185	190		j. Providing for the maintenance of safe and effective nursing care, 33
186	191		whether rendered directly or indirectly. 34
187	192		(8) The "practice of nursing by a licensed practical nurse" consists of the 35
188	193		following seven components: 36
189	194		a. Participating in the assessment of the patient's physical and mental 37
190	195		health, including the patient's reaction to illnesses and treatment 38
191	196		regimens. 39
192	197		b. Recording and reporting the results of the nursing assessment. 40
193	198		c. Participating in implementing the health care plan developed by the 41
194	199		registered nurse and/or prescribed by any person authorized by State 42
195	200		law to prescribe such a plan, by performing tasks assigned or delegated 43
196	201		by and performed under the supervision or under orders or directions 44
197	202		of a registered nurse, physician licensed to practice medicine, dentist, 45
198	203		or other person authorized by State law to provide the supervision. 46
199	204		c1. Assigning or delegating nursing interventions to other qualified 47
200	205		personnel under the supervision of the registered nurse. 48
201	206		d. Participating in the teaching and counseling of patients as assigned by 49
202	207		a registered nurse, physician, or other qualified professional licensed 50
203	208		to practice in North Carolina. 51 General Assembly Of North Carolina Session 2025
204		-	~~Senate Bill 537-First Edition~~ Page 5
	209	+	DRS45266-NBf-55B Page 5
205	210		e. Reporting and recording the nursing care rendered and the patient's 1
206	211		response to that care. 2
207	212		f. Maintaining safe and effective nursing care, whether rendered directly 3
208	213		or indirectly." 4
209	214		SECTION 2. G.S. 90-18(c) reads as rewritten: 5
210	215		"(c) The following shall not constitute practicing medicine or surgery as defined in this 6
211	216		Article: 7
212	217		… 8
213	218		(7) The practice of midwifery as defined in G.S. 90-178.2. 9
214	219		… 10
215	220		(14) The practice of nursing by a an advanced practice registered nurse engaged in 11
216	221		the practice of nursing and the performance of acts otherwise constituting 12
217	222		medical practice by a registered nurse when performed in accordance with 13
218	223		rules and regulations developed by a joint subcommittee of the North Carolina 14
219	224		Medical Board and the Board of Nursing and adopted by both boards.as 15
220	225		defined in Article 9A of this Chapter. 16
221	226		…." 17
222	227		SECTION 3.(a) G.S. 90-18.2 is repealed. 18
223	228		SECTION 3.(b) G.S. 90-2(a) reads as rewritten: 19
224	229		"(a) There is established the North Carolina Medical Board to regulate the practice of 20
225	230		medicine and surgery for the benefit and protection of the people of North Carolina. The Board 21
226	231		shall consist of 13 members: 22
227	232		… 23
228	233		(2) Five members shall all be appointed by the Governor as follows: 24
229	234		… 25
230	235		d. One shall be a certified nurse practitioner as defined in G.S. 90-18.2 26
231	236		as recommended by the Review Panel pursuant to G.S. 90-3. 27
232	237		…." 28
233	238		SECTION 3.(c) G.S. 90-18.3(a) reads as rewritten: 29
234	239		"(a) Whenever a statute or State agency rule requires that a medical or physical 30
235	240		examination shall be conducted by a physician, the examination may be conducted and the form 31
236	241		signed by a certified nurse practitioner or a physician assistant, and a physician need not be 32
237	242		present. Nothing in this section shall otherwise change the scope of practice of a certified nurse 33
238	243		practitioner or a physician assistant, as defined by G.S. 90-18.1 and G.S. 90-18.2, 34
239	244		respectively.assistant." 35
240	245		SECTION 3.(d) G.S. 90-85.24(a) reads as rewritten: 36
241	246		"(a) The Board of Pharmacy shall be entitled to charge and collect not more than the 37
242	247		following fees: 38
243	248		… 39
244	249		(13) For annual registration as a dispensing nurse practitioner under G.S. 90-18.2, 40
245	250		practitioner, seventy-five dollars ($75.00); 41
246	251		…." 42
247	252		SECTION 3.(e) G.S. 90-85.34A reads as rewritten: 43
248	253		"§ 90-85.34A. Public health pharmacy practice. 44
249	254		… 45
250	255		(c) This section does not affect the practice of certified nurse practitioners pursuant to 46
251	256		G.S. 90-18.2 or of physician assistants pursuant to G.S. 90-18.1." 47
252	257		SECTION 4. G.S. 90-29(b) reads as rewritten: 48
253	258		"(b) A person shall be deemed to be practicing dentistry in this State who does, undertakes 49
254	259		or attempts to do, or claims the ability to do any one or more of the following acts or things 50
255	260		which, for the purposes of this Article, constitute the practice of dentistry: 51 General Assembly Of North Carolina Session 2025
256		-	Page 6 ~~Senate Bill 537-First Edition~~
	261	+	Page 6 DRS45266-NBf-55B
257	262		… 1
258	263		(6) Administers an anesthetic of any kind in the treatment of dental or oral 2
259	264		diseases or physical conditions, or in preparation for or incident to any 3
260	265		operation within the oral cavity; provided, however, that this subsection shall 4
261	266		not apply to a lawfully qualified certified registered nurse anesthetist who 5
262	267		administers such anesthetic under the supervision and direction of a licensed 6
263	268		dentist or physician, anesthetic, or to a registered dental hygienist qualified to 7
264	269		administer local anesthetics. 8
265	270		…." 9
266	271		SECTION 5. G.S. 90-171.23(b) reads as rewritten: 10
267	272		"(b) Duties, powers. The Board is empowered to: 11
268	273		… 12
269	274		(14) Appoint and maintain a subcommittee of the Board to work jointly with the 13
270	275		subcommittee of the North Carolina Medical Board to develop rules and 14
271	276		regulations to govern the performance of medical acts by registered nurses 15
272	277		and to determine reasonable fees to accompany an application for approval or 16
273	278		renewal of such approval as provided in G.S. 90-8.2. The fees and rules 17
274	279		developed by this subcommittee shall govern the performance of medical acts 18
275	280		by registered nurses and shall become effective when they have been adopted 19
276	281		by both Boards.Grant prescribing, ordering, dispensing, and furnishing 20
277	282		authority to holders of the advanced practice registered nurse license pursuant 21
278	283		to G.S. 90-171.20. 22
279	284		…." 23
280	285		SECTION 6. G.S. 90-171.27(b) reads as rewritten: 24
281	286		"§ 90-171.27. Expenses payable from fees collected by Board. 25
282	287		… 26
283	288		(b) The schedule of fees shall not exceed the following rates: 27
284	289		Application for license as advanced practice registered nurse ............................... $100.00 28
285	290		Renewal of license to practice as advanced practice registered nurse 29
286	291		(two-year period)............................................................................................. 100.00 30
287	292		Reinstatement of lapsed license to practice as advanced practice 31
288	293		registered nurse and renewal fee ..................................................................... 180.00 32
289	294		… 33
290	295		Reasonable charge for duplication services and materials. 34
291	296		A fee for an item listed in this schedule shall not increase from one year to the next by more 35
292	297		than twenty percent (20%)." 36
293	298		SECTION 7.(a) Article 9A of Chapter 90 of the General Statutes is amended by 37
294	299		adding the following new sections to read: 38
295	300		"§ 90-171.36B. Advanced practice registered nurse licensure. 39
296	301		(a) No advanced practice registered nurse shall practice as an advanced practice 40
297	302		registered nurse unless the nurse is licensed by the Board under this section. 41
298	303		(b) An applicant for a license to practice as an APRN shall apply to the Board in a format 42
299	304		prescribed by the Board and pay a fee in an amount determined under G.S. 90-171.27. 43
300	305		(c) The Board shall adopt rules, not inconsistent with this Article, which identify the 44
301	306		criteria which must be met by an applicant in order to be issued a license. 45
302	307		"§ 90-171.36C. Advanced practice registered nurse licensure; grandfathering exceptions. 46
303	308		(a) The Board shall issue an APRN license to any person recognized by the Board as an 47
304	309		APRN or approved to practice as an APRN in this State on or before the date that this section 48
305	310		becomes law. 49
306	311		(b) An advanced practice registered nurse licensed under this section shall maintain all 50
307	312		practice privileges provided to licensed advanced practice registered nurses under this Chapter. 51 General Assembly Of North Carolina Session 2025
308		-	~~Senate Bill 537-First Edition~~ Page 7
	313	+	DRS45266-NBf-55B Page 7
309	314		"§ 90-171.36D. Advanced practice registered nurse licensure renewal; reinstatement. 1
310	315		(a) An applicant for renewal of an APRN license issued under this Article shall apply for 2
311	316		licensure renewal according to the frequency and schedule established by the Board and pay the 3
312	317		required fee. 4
313	318		(b) Failure to renew the APRN license before the expiration date shall result in automatic 5
314	319		forfeiture of the right to practice nursing as an APRN in North Carolina until such time as the 6
315	320		license has been reinstated. 7
316	321		(c) An APRN licensee who has allowed his or her license to lapse by failure to renew 8
317	322		may apply for reinstatement in a manner prescribed by the Board and pay the required fee. 9
318	323		(d) The Board shall adopt rules, not inconsistent with this Article, which identify the 10
319	324		criteria which must be met by an applicant for APRN license renewal or reinstatement." 11
320	325		SECTION 7.(b) G.S. 90-171.37(b) is repealed. 12
321	326		SECTION 8. G.S. 90-171.43 reads as rewritten: 13
322	327		"§ 90-171.43. License required. 14
323	328		(a) No person shall practice or offer to practice as a an advanced practice registered nurse, 15
324	329		registered nurse nurse, or licensed practical nurse, or use the word "nurse" as a title for herself or 16
325	330		himself, or use an abbreviation to indicate that the person is a an advanced practice registered 17
326	331		nurse, registered nurse nurse, or licensed practical nurse, unless the person is currently licensed 18
327	332		as a an advanced practice registered nurse, registered nurse nurse, or licensed practical nurse as 19
328	333		provided by this Article. If the word "nurse" is part of a longer title, such as "nurse's aide", a 20
329	334		person who is entitled to use that title shall use the entire title and may not abbreviate the title to 21
330	335		"nurse". This Article shall not, however, be construed to prohibit or limit the following: 22
331	336		(1) The performance by any person of any act for which that person holds a 23
332	337		license issued pursuant to North Carolina law;law. 24
333	338		(2) The clinical practice by students enrolled in approved nursing programs, 25
334	339		continuing education programs, or refresher courses under the supervision of 26
335	340		qualified faculty;faculty. 27
336	341		(3) The performance of nursing performed by persons who hold a temporary 28
337	342		license issued pursuant to G.S. 90-171.33;G.S. 90-171.33. 29
338	343		(4) The delegation to any person, including a member of the patient's family, by 30
339	344		a physician licensed to practice medicine in North Carolina, a licensed dentist 31
340	345		or registered nurse of those patient-care services which are routine, repetitive, 32
341	346		limited in scope that do not require the professional judgment of a registered 33
342	347		nurse or licensed practical nurse;nurse. 34
343	348		(5) Assistance by any person in the case of emergency. 35
344	349		Any person permitted to practice nursing without a license as provided in subdivision (2) 36
345	350		(a)(2) or (3) (a)(3) of this section shall be held to the same standard of care as any licensed nurse. 37
346	351		(a1) The abbreviations for the APRN designation of a certified nurse midwife, a clinical 38
347	352		nurse specialist, a certified registered nurse anesthetist, and a certified nurse practitioner shall be 39
348	353		APRN, plus the role title, i.e., CNM, CNS, CRNA, and CNP. 40
349	354		(a2) It shall be unlawful for any person to use the title "APRN" or "APRN" plus their 41
350	355		respective role titles, the role title alone, authorized abbreviations, or any other title that would 42
351	356		lead a person to believe the individual is an APRN, unless permitted by this act. 43
352	357		…." 44
353	358		SECTION 9. G.S. 90-171.43A reads as rewritten: 45
354	359		"§ 90-171.43A. Mandatory employer verification of licensure status. 46
355	360		(a) Before hiring an advanced practice registered nurse, a registered nurse nurse, or a 47
356	361		licensed practical nurse in North Carolina, a health care facility shall verify that the applicant has 48
357	362		a current, valid license to practice nursing pursuant to G.S. 90-171.43. 49
358	363		(b) For purposes of this section, "health care facility" means: 50
359	364		(1) Facilities described in G.S. 131E-256(b). 51 General Assembly Of North Carolina Session 2025
360		-	Page 8 ~~Senate Bill 537-First Edition~~
	365	+	Page 8 DRS45266-NBf-55B
361	366		(2) Public health departments, physicians' offices, ambulatory care facilities, and 1
362	367		rural health clinics." 2
363	368		SECTION 10. G.S. 90-171.44 reads as rewritten: 3
364	369		"§ 90-171.44. Prohibited acts. 4
365	370		It shall be a violation of this Article, and subject to action under G.S. 90-171.37, for any 5
366	371		person to: 6
367	372		(1) Sell, fraudulently obtain, or fraudulently furnish any nursing diploma or aid 7
368	373		or abet therein. 8
369	374		(2) Practice nursing under cover of any fraudulently obtained license. 9
370	375		(3) Practice nursing without a license. This subdivision shall not be construed to 10
371	376		prohibit any licensed registered nurse who has successfully completed a 11
372	377		program established under G.S. 90-171.38(b) from conducting medical 12
373	378		examinations or performing procedures to collect evidence from the victims 13
374	379		of offenses described in that subsection. 14
375	380		(3a) Refer to himself or herself as an advanced practice registered nurse; or refer 15
376	381		to himself or herself as any of the four roles of advanced practice registered 16
377	382		nurses, a registered nurse, or a licensed practical nurse; or use the 17
378	383		abbreviations "APRN," "CNM," "CNS," "CRNA," "CNP," "RN," and "LPN." 18
379	384		(4) Conduct a nursing program or a refresher course for activation of a license, 19
380	385		that is not approved by the Board. 20
381	386		(5) Employ unlicensed persons to practice nursing." 21
382	387		SECTION 11.(a) Article 10A of Chapter 90 of the General Statutes is repealed. 22
383	388		SECTION 11.(b) G.S. 90-21.11 reads as rewritten: 23
384	389		"§ 90-21.11. Definitions. 24
385	390		The following definitions apply in this Article: 25
386	391		(1) Health care provider. – Without limitation, any of the following: 26
387	392		a. A person who pursuant to the provisions of Chapter 90 of the General 27
388	393		Statutes is licensed, or is otherwise registered or certified to engage in 28
389	394		the practice of or otherwise performs duties associated with any of the 29
390	395		following: medicine, surgery, dentistry, pharmacy, optometry, 30
391	396		midwifery, osteopathy, podiatry, chiropractic, radiology, nursing, 31
392	397		physiotherapy, pathology, anesthesiology, anesthesia, laboratory 32
393	398		analysis, rendering assistance to a physician, dental hygiene, 33
394	399		psychiatry, or psychology. 34
395	400		…." 35
396	401		SECTION 11.(c) G.S. 115C-407.57(b)(2) reads as rewritten: 36
397	402		"(2) If a student participating in an interscholastic athletic activity exhibits signs 37
398	403		or symptoms consistent with a concussion, the student shall be removed from 38
399	404		the activity at that time and shall not be allowed to return to play or practice 39
400	405		that day. The student shall not return to play or practice on a subsequent day 40
401	406		until the student is evaluated by and receives written clearance for such 41
402	407		participation from one of the following: 42
403	408		… 43
404	409		e. A certified nurse practitioner, consistent with the limitations of 44
405	410		G.S. 90-18.2.provisions of Article 9A of Chapter 90 of the General 45
406	411		Statutes." 46
407	412		SECTION 12.(a) No later than 30 calendar days after this act becomes law, the 47
408	413		Governor shall submit to the Centers for Medicare and Medicaid Services an "opt-out" letter 48
409	414		requesting an exemption under 42 C.F.R. § 482.52(c) that allows hospitals, ambulatory surgical 49
410	415		centers, critical access hospitals, and rural hospitals in this State the maximum flexibility to 50 General Assembly Of North Carolina Session 2025
411		-	~~Senate Bill 537-First Edition~~ Page 9
	416	+	DRS45266-NBf-55B Page 9
412	417		obtain Medicare reimbursement for anesthesia services in a manner that best serves each facility 1
413	418		and the patients and communities the facility serves. 2
414	419		SECTION 12.(b) This section is effective when it becomes law. 3
415	420		SECTION 13.(a) The North Carolina Board of Nursing, the North Carolina Medical 4
416	421		Board, and the North Carolina State Board of Dental Examiners shall adopt rules to implement 5
417	422		the provisions of this act. 6
418	423		SECTION 13.(b) This section is effective when it becomes law. 7
419	424		SECTION 14. The Revisor of Statutes shall change all references to nurse 8
420	425		practitioners to instead be references to certified nurse practitioners and shall change all 9
421	426		references to the abbreviation NP to instead be references to the abbreviation CNP, wherever 10
422	427		those terms appear in the following statutes: G.S. 15-190, 20-37.6(c1), 55B-14(c), 58-3-169, 11
423	428		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
424	429		115C-375.2A, 122C-263.1, 122C-465, 130A-115, 130A-440.1, and 131D-4.8. 13
425	430		SECTION 15. Except as otherwise provided, this act is effective 90 days after it 14
426	431		becomes law. 15