CHAPTER 36 ‑ BOARD OF NURSING
SECTION .0100 ‑ GENERAL PROVISIONS
21 NCAC 36 .0101 LOCATION
History Note: Authority G.S. 90‑171.23(b)(3);
Eff. February 1, 1976;
Amended Eff. January 1, 1984;
Repealed Eff. January 1, 1986.
21 NCAC 36 .0102 FUNCTIONS
History Note: Authority G.S. 90‑171.23(b)
Eff. February 1, 1976;
Amended Eff. January 1, 1983;
Repealed Eff. April 1, 1989.
21 NCAC 36 .0103 ORGANIZATION
History Note: Authority G.S. 90‑159(2); 90‑162;
Eff. February 1, 1976;
Repealed Eff. January 1, 1983.
21 NCAC 36 .0104 OFFICERS
21 NCAC 36 .0105 COMMITTEES
21 NCAC 36 .0106 EXECUTIVE DIRECTOR
21 NCAC 36 .0107 SEAL
History Note: Authority G.S. 90‑171.22; 90‑171.23(b)(3),(4),(14);
90‑171.24;
Eff. February 1, 1976;
Amended Eff. November 1, 1984; January 1, 1984; January
1, 1983;
Repealed Eff. January 1, 1986.
21 NCAC 36 .0108 PROCEDURE FOR ADOPTION OF RULES
History Note: Authority G.S. 90‑162;
Eff. February 1, 1976;
Repealed Eff. January 1, 1983.
21 ncac 36 .0109 SELECTION AND QUALIFICATIONS OF
NURSE MEMBERS
(a) Vacancies in nurse member positions on the Board that
are scheduled to occur during the next year shall be announced in the last
issue of the North Carolina Board of Nursing "Bulletin" for the
calendar year, which shall be mailed to the address on record for each North
Carolina licensed nurse and posted on the Board's website at www.ncbon.com.
The "Bulletin" and website shall include a petition form for
nominating a nurse to the Board and information on filing the petition with the
Board.
(b) Each petition shall be checked with the records of the
Board to validate that the nominee and each petitioner holds a current North Carolina license to practice nursing. If the nominee is not currently licensed, the
petition shall be declared invalid. If any petitioners are not currently
licensed and this decreases the number of petitioners to less than 10, the
petition shall be declared invalid.
(c) On forms provided by the Board, each nominee shall:
(1) indicate the category for which the nominee
is seeking election;
(2) attest to meeting the qualifications specified
in G.S. 90-171.21(d);
(3) provide written permission to be listed on
the ballot; and
(4) complete the Application for Boards and Commissions
in accordance with Governor Perdue's Executive Order 55.
The forms must be received by the Board or postmarked on or
before April 15.
(d) Minimum on-going employment requirements for the
registered nurse or licensed practical nurse member shall include continuous
employment equal to or greater than 50% of a full-time position that meets the
criteria for the specified Board member position.
(e) This Paragraph applies in determining qualifications
for registered nurse categories of membership:
(1) Nurse Educator includes any nurse who
teaches in or directs a Board approved nursing program in the specific category
as outlined in G.S. 90-171.21(d).
(2) Hospital is defined as any facility which
has an organized medical staff and which is designed, used, and primarily
operated to provide health care, diagnostic and therapeutic services, and
continuous nursing services to inpatients, but excludes nursing homes and adult
care homes.
(3) A hospital system is defined as a
multihospital system, or a single diversified hospital system that includes a
hospital as defined in Subparagraph (e)(2) of this Rule plus non-hospital
preacute and postacute client services.
(4) A nurse accountable for the administration
of nursing services shall be the chief nurse executive of a hospital, hospital
system, or the director of nursing services for a service division that
includes inpatient care within a hospital or hospital system.
(5) A nurse practitioner, nurse anesthetist,
nurse midwife or clinical nurse specialist includes any advanced practice
registered nurse who meets the criteria specified in G.S. 90-171.21(d)(4).
(f) The term "nursing practice" when used in
determining qualifications for registered or practical nurse categories of
membership, means any position for which the holder of the position is required
to hold a current license to practice nursing at the appropriate licensure
level for each category.
(g) A nominee shall be listed in only one category on the
ballot.
(h) Separate slates shall be prepared for election of
registered nurse nominees and for election of licensed practical nurse
nominees. Nominees shall be listed in random order on the slate for licensed
practical nurse nominees and within the categories for registered nurse
nominees. Slates shall be published in the "Bulletin" and posted to
the Board website following the Spring Board meeting and shall be accompanied
by biographical data on nominees and a passport-type photograph.
(i) The procedure for voting shall be identified in the
"Bulletin" following the Spring Board meeting.
(j) The Board of Nursing may contract with a computer or
other service to receive the votes and tabulate the results.
(k) The tabulation and verification of the tabulation of
votes shall include the following:
(1) The certificate number shall be provided
for each individual voting; and
(2) The certificate number shall be matched
with the database from the Board.
(l) A plurality vote shall elect. If more than one person
is to be elected in a category, the plurality vote shall be in descending order
until the required number has been elected. In any election, if there is a tie
vote between nominees, the tie shall be resolved by a draw from the names of
nominees who have tied.
(m) The results of an election shall be recorded in the
minutes of the next regular meeting of the Board of Nursing following the
election and shall include at least the following:
(1) the number of nurses eligible to vote;
(2) the number of votes cast; and
(3) the number of votes cast for each person on
the slate.
(n) The results of the election shall be forwarded to the
Governor and the Governor shall commission those elected to the Board of
Nursing.
(o) All petitions to nominate a nurse, signed consents to
appear on the slate, verifications of qualifications, and copies of the
computerized validation and tabulation shall be retained for a period of three
months following the close of an election.
History Note: Authority G.S. 90-171.21; 90-171.23(b);
Eff. May 1, 1982;
Amended Eff. August 1, 1998; January 1, 1996; June 1,
1992; March 1, 1990; April 1, 1989;
Temporary Amendment Eff. July 2, 2001;
Amended Eff. December 1, 2010; November 1, 2008; January
1, 2004; August 1, 2002.
21 NCAC 36 .0110 OPEN MEETINGS
(a) All
meetings of the Board, including Board committee meetings, are open to the
public.
(b) The agenda
for the meeting will be available upon request and will be posted at the
meeting site. Copies of the agenda are available approximately ten days prior
to a meeting.
(c) Any agency
or individual, directly affected by any item to be considered by the Board, may
request an opportunity to speak in relation to the specific item. Such request
must be in writing and received in the Board office at least five business days
prior to the scheduled meeting.
(d) No more
than two individuals representing a specific agency shall speak to any single
item on the agenda. Presentations shall be limited to no more than five
minutes each. The presentation shall be written and a copy of it shall be made
available to the Board for use in decision‑making and in compiling the
record of the meeting.
(e) Persons
wishing to request that an item be placed on the Board agenda shall submit the
request in writing no less than 30 days prior to the scheduled regular
meeting. Such request shall specify the nature of the matter to be discussed
and suggest the amount of time needed for the discussion.
(f) The Board
may vote to hold an executive session as provided in G.S. 143‑318.11.
Actions shall be taken in open session and so recorded.
History Note: Authority G.S. 90‑171.23(a); 143‑318.10;
Eff. January 1, 1983;
Amended Eff. May 1, 1988; July 1, 1984.
21 NCAC 36 .0111 REMOVAL OF BOARD MEMBERS
History Note: Authority G.S. 90‑171.21(f);
Eff. January 1, 1983;
Repealed Eff. January 1, 1986.
21 NCAC 36 .0112 DETERMINATION OF VACANCY
(a) Except for the RN At-Large Member, should a licensed
nurse member of the Board cease to meet the employment criteria as defined in
G.S. 90-171.21(d) and Rule .0109 Paragraphs (d) and (e)of this Section, the member
shall have 60 days to resume employment in the designated area. If employment
criteria for the specified area are not met within 60 days, the seat shall be
declared vacant. Provided, however, that if such a change in employment for
the specified category of Board member occurs within 18 months of the end of
the member's term, such member may continue to serve until the end of the term.
(b) If at any time a registered nurse member no longer
meets the eligibility requirements listed in G.S. 90-171.21(d)(1)(a) and (a1),
such member shall no longer continue to serve and the position shall be
declared vacant.
(c) If at any time a licensed practical nurse member no
longer meets the eligibility requirements listed in G.S. 90-171.21(d)(2)(a) and
(a1), such member shall no longer continue to serve and the position shall be
declared vacant.
(d) Any vacancy of an unexpired term shall be filled
according to G.S. 90-171.21(c).
History Note: Authority G.S. 90‑171.21(c); 90‑171.23(b);
Eff. May 1, 1988;
Amended Eff. November 1, 2008; January 1, 2004; August 1,
2002; March 1, 1990; May 1, 1989.
21 NCAC 36 .0113 DETERMINATION OF QUALIFICATIONS
For purposes of G.S. 90‑171.21 and Rule .0109(d) and
(e) of this Section, the Board shall determine whether a person meets the
employment requirements by examining the following factors:
(1) whether the licensee is presently employed equal to
or greater than 50% of a full-time position;
(2) the number of days during the preceding three years
devoted to practice in the specified activity that would qualify the licensee
for election in that category;
(3) the duration of any periods of interruption of
engaging in the specified activity during the preceding three years and the
reasons for any such interruptions;
(4) job descriptions, contracts, and any other relevant
evidence concerning the time, effort, and education devoted to the specified
activity; and
(5) whether engagement in the specified activity is or
has been for compensation, and whether income from the specified activity meets
the eligibility requirements for the specified nurse member category.
History Note Authority G.S. 90‑171.21(d); 90‑171.23(b)(2);
Eff. May 1, 1988;
Amended Eff. January 1, 2004; August 1, 2002; May 1,
1989.
21 NCAC 36 .0114 reserved for future codification
21 NCAC 36 .0115 Reserved for future codification
21 NCAC 36 .0116 Reserved for future codification
21 NCAC 36 .0117 reserved for future codification
21 NCAC 36 .0118 reserved for future codification
21 NCAC 36 .0119 reserved for future codification
21 NCAC 36 .0119 SUSPENSION OF AUTHORITY TO EXPEND
FUNDS
In the event the Board's authority to expend funds is
suspended pursuant to G.S. 93B-2(d) the board shall continue to issue and renew
licenses and all fees tendered shall be placed in an escrow account maintained
by the Board for this purpose. Once the Board's authority is restored, the
funds shall be moved from the escrow account into the general operating
account.
History Note: Authority G.S. 93B-2;
Eff. December 1, 2010.
21 NCAC 36 .0120 DEFINITIONS
The following definitions apply throughout this chapter
unless the context indicates otherwise:
(1) "Academic term" means one semester of a
school year.
(2) "Accountability/Responsibility" means
being answerable for action or inaction of self, and of others in the context
of delegation or assignment.
(3) "Accredited institution" means an
institution accredited by a United States Department of Education approved institutional
accrediting body.
(4) "Active Practice" means activities that
are performed, either for compensation or without compensation, consistent with
the scope of practice for each level of licensee as defined in G.S.
90-171.20(4), (7) and (8).
(5) "Advanced Practice Registered Nurse
(APRN)" means a nurse practitioner, nurse anesthetist, nurse-midwife or
clinical nurse specialist.
(6) "Assigning" means designating
responsibility for implementation of a specific activity or set of activities
to a person licensed and competent to perform such activities.
(7) "Clinical experience" means application
of nursing knowledge in demonstrating clinical judgment.
(8) "Clinical judgment" means the application
of the nursing student's knowledge, skills, abilities and experience in making
decisions about client care.
(9) "Competent" means having the knowledge,
skills and ability to safely perform an activity or role.
(10) "Continuing Competence" means the on-going
acquisition and application of knowledge and the decision-making, psychomotor,
and interpersonal skills expected of the licensed nurse resulting in nursing
care that contributes to the health and welfare of clients served.
(11) "Contact Hour" means 60 minutes of an
organized learning experience.
(12) "Continuing Education Activity" means a
planned, organized learning experience that is related to the practice of
nursing or contributes to the competency of the nurse as defined in 21 NCAC 36
.0223 Subparagraph (a)(2).
(13) "Controlling institution" means the degree-granting
organization or hospital under which the nursing education program is
operating.
(14) "Curriculum" means an organized system of
teaching and learning activities directed toward the achievement of specified
learning objectives/outcomes.
(15) "Delegation" means transferring to a
competent individual the authority to perform a selected nursing activity in a
selected situation. The nurse retains accountability for the delegation.
(16) "Dimensions of Practice" means those
aspects of nursing practice that include professional responsibility,
knowledge-based practice, legal/ethical practice and collaborating with others,
consistent with G.S. 90-171.20(4), (7) and (8).
(17) "Distance education" means the teaching
and learning strategies used to meet the learning needs of students, when the
students and faculty are separate from each other.
(18) "Faculty directed clinical practice" means
the responsibility of nursing program faculty in overseeing student clinical
learning including the utilization of preceptors.
(19) "Focused client care experience" means a
clinical experience that simulates an entry-level work experience. The intent
is to assist the student to transition to an entry-level practice. There is no
specific setting requirement. Supervision may be by faculty and preceptor dyad
or direct faculty supervision.
(20) "Interdisciplinary faculty" means faculty
from professions other than nursing.
(21) "Interdisciplinary team" means all
individuals involved in providing a client's care who cooperate, collaborate,
communicate and integrate care to ensure that care is continuous and reliable.
(22) "Level of Licensure" means practice of
nursing by either a Licensed Practice Nurse or a Registered Nurse as defined in
G.S. 90-171.20(7) and (8).
(23) "Level of student" means the point in the
program to which the student has progressed.
(24) "Maximum enrollment" means the total
number of pre-licensure students that can be enrolled in the nursing program at
any one time. The number reflects the capacity of the nursing program based on
demonstrated resources sufficient to implement the curriculum.
(25) "Methods of Instruction" means the planned
process through which teacher and student interact with selected environment
and content so that the response of the student gives evidence that learning
has taken place. It is based upon stated course objectives and outcomes for
learning experiences in classroom, laboratory and clinical settings.
(26) "National Credentialing Body" means a
credentialing body that offers certification or re-certification in the
licensed nurse's or Advanced Practice Registered Nurse's specialty area of
practice.
(27) "NCLEX-PN™" means the National Council
Licensure Examinations for Practical Nurses.
(28) "NCLEX-RN™" means the National Council
Licensure Examinations for Registered Nurses.
(29) "Nursing Accreditation body" means a
national nursing accrediting body, recognized by the United States Department
of Education.
(30) "Nursing program faculty" means
individuals employed full or part time by academic institution responsible for
developing, implementing, evaluation and updating nursing curricula.
(31) "Nursing project" means a project or
research study of a topic related to nursing practice that includes a problem
statement, objectives, methodology and summary of findings.
(32) "Participating in" means to have a part in
or contribute to the elements of the nursing process.
(33) "Pattern of noncompliance" means episodes
of recurring non-compliance with one or more Rules in Section .0300.
(34) "Preceptor" means a registered nurse at or
above the level of licensure that an assigned student is seeking, who may serve
as a teacher, mentor, role model and supervisor for a faculty directed clinical
experience.
(35) "Prescribing Authority" means the legal
permission granted by the Board of Nursing and Medical Board for the nurse
practitioner and nurse midwife to procure and prescribe legend and controlled
pharmacological agents and devices to a client in compliance with Board of
Nursing rules and other applicable federal and state law and regulations.
(36) "Program Closure" means to cease operation
of a nursing program.
(37) "Program Type" means a course of study
that prepares an individual to function as an entry-level practitioner of
nursing. The three program types are:
(a) BSN - Curriculum components for Bachelor of
Science in Nursing provides for the attainment of knowledge and skill sets in
the current practice in nursing, nursing theory, nursing research, community
and public health, health care policy, health care delivery and finance,
communications, therapeutic interventions and current trends in health care.
For this program type, the client is the individual, family, group, and
community.
(b) Associate Degree in Nursing (ADN)/Diploma in
Registered Nursing - Curriculum components for the ADN/Diploma in Registered
Nursing provides for the attainment of knowledge and skill sets in the current
practice in nursing, community concepts, health care delivery, communications,
therapeutic interventions and current trends in health care. For this program
type, client is the individual, group of individuals, and family.
(c) Practical Nurse Diploma - Curriculum
prepares for functioning in a dependent role in providing direct nursing care
under the direction of a registered nurse or other health care provider as
defined by the Nursing Practice Act. Curriculum components provide for the
attainment of knowledge and skill sets in the current practice of practical
nursing, communications, therapeutic interventions, including pharmacology,
growth and development and current trends in health care. For this program
type client is the individual, or group of individuals.
(38) "Review" means collecting and analyzing
information to assess compliance with Section .0300 of this Chapter.
Information may be collected by multiple methods including review of written
reports and materials, on-site observations and review of documents or in
person or telephone interview(s) and conference(s).
(39) "Rescind Approval" means a Board action
that removes the approval status previously granted.
(40) "Self Assessment" means the process
whereby the individual reviews her or his own nursing practice and identifies
the knowledge and skills possessed, as well as those skills to be strengthened.
(41) "Specialty" means a broad,
population-based focus of study encompassing the common health-related problems
of that group of patients and the likely co-morbidities, interventions and
responses to those problems.
(42) "Supervision" means the provision of
guidance or direction, evaluation and follow-up by the licensed nurse for
accomplishment of an assigned or delegated nursing activity or set of
activities.
(43) "Survey" means an on-site visit for the
purpose of gathering data in relation to reviewing nursing programs compliance
with Section .0300 of this Chapter.
History Note: Authority G.S. 90-171.23; 90-171.38;
Eff. April 1, 2003;
Amended Eff. July 1, 2012; November 1, 2008; May 1, 2006;
December 1, 2005; August 1, 2005.
section .0200 – licensure
21 NCAC 36 .0201 REGULAR RENEWAL
(a) Renewal notices shall be sent no less than 60 days
prior to expiration date of a license to all registrants whose licenses are due
for biennial renewal. The notices will be mailed to each eligible registrant's
address as it appears in the records of the Board. A license is issued for the
following biennium when:
(1) all required information is submitted as
requested on the application form; and
(2) all payment of required fees are received.
(b) It shall be the duty of each registrant to keep the
Board informed of a current mailing address.
(c) Renewal applications must be postmarked on or before
the date the current license expires.
(d) A member of the United States Armed Services is exempt
from compliance if on active duty and to whom G.S. 105-249.2 grants an
extension of time to file a tax return.
History Note: Authority G.S. 90-171.29; 90-171.23(b);
90‑171.34; 90‑171.37; 93B-15; 105-249.2;
Eff. February 1, 1976;
Amended Eff. January 1, 2011; December 1, 2008; April 1,
1989; May 1, 1982.
21 NCAC 36 .0202 INACTIVE and retired STATUS
(a) A registrant whose licensure status is inactive and who
desires to resume the practice of nursing in North Carolina shall be removed
from inactive status and shall obtain a current license. To this end the
registrant shall:
(1) submit evidence of unencumbered license in
all jurisdictions in which a license is or has ever been held;
(2) submit evidence of completion of all court
conditions resulting from any misdemeanor or felony conviction(s);
(3) submit evidence showing that the nurse is
safe and competent to re-enter the practice of nursing;
(4) submit the current fee for renewal; and
(5) attest to having completed Continuing
Competence requirements and be prepared to submit evidence of completion if
requested by the Board as specified in Rule .0232(b) of this Section.
(b) The registrant whose license has been inactive for a
period of five years or more shall also submit:
(1) self-certification that the registrant is
of mental and physical health necessary to competently practice nursing;
(2) evidence of competency to resume the
practice of nursing through:
(A) satisfactory completion of a Board‑approved
course; or
(B) an active license in another jurisdiction within the
last five years.
(c) If a refresher course is required, the registrant shall
apply for reactivation of license within one year of completing the refresher
course in order to receive a current license. The application for reactivation
shall include verification from the provider of the refresher course that the
registrant has satisfactorily met both theory and clinical objectives.
(d) The Board shall decline to reactivate a license if it
is not satisfied as to the applicant's competency to practice nursing.
(e) A registrant who has retired from the practice of
nursing may request and be granted by the Board retired nurse status, provided
the registrant:
(1) holds a current unencumbered license issued
by the North Carolina Board of Nursing;
(2) is not currently the subject of an
investigation by this Board for possible violation of the Nursing Practice Act;
and
(3) pay the application fee pursuant to G.S.
90-171.27(b).
(f) While remaining on retired status, the registrant shall
not practice nursing in North Carolina and shall not be subject to payment of
the license renewal fee.
(g) The registrant may use the title Retired Registered
Nurse or Retired Licensed Practical Nurse once issued retired status.
(h) The registrant whose licensure status is retired shall
not be eligible to vote in Board elections.
(i) A registrant whose licensure status is retired and who
desires to resume the practice of nursing shall apply for reinstatement of a
license to practice nursing and meet the same reinstatement requirements for a
nurse on inactive status as set forth in Paragraphs (b)–(e) of this Rule.
History Note: Authority G.S. 90-171.21; 90‑171.23(b)
90-171.27(b);90‑171.36; 90-171.36A; 90‑171.37; 90-171.43;
Eff. February 1, 1976;
Legislative Objection [(g)] Lodged Eff. June 16, 1980;
Legislative Objection [(g)] Removed Eff. July 1, 1981;
Amended Eff. November 1, 2008; January 1, 2004; January
1, 1996; January 1, 1990; May 1, 1982; January 1, 1980.
21 NCAC 36 .0203 REINSTATEMENT OF LAPSED LICENSE
(a) The registrant whose license has lapsed and who desires
reinstatement of that license shall:
(1) furnish information required by these rules
on forms provided by the Board;
(2) submit evidence of unencumbered license in
all jurisdictions in which a license is or has ever been held;
(3) attest to having completed Continuing
Competence requirements and be prepared to submit evidence of completion if
requested by the Board as specified in 21 NCAC 36 .0232(b).
(4) submit evidence of completion of all court
conditions resulting from any misdemeanor or felony conviction(s);
(5) submit such other evidence that the Board
may require according to these rules to determine whether the license should be
reinstated;
(6) provide a statement of the reason for
failure to apply for renewal prior to the deadline; and
(7) submit payment of reinstatement and renewal
fee.
(b) A member of the United States Armed Services is exempt
from payment of reinstatement fee if on active duty and to whom G.S. 105-249.2
grants an extension of time to file a tax return.
(c) The registrant whose license has lapsed for a period of
five years or more shall also submit:
(1) evidence of mental and physical health
necessary to competently practice nursing; and
(2) evidence of satisfactory completion of a
Board-approved refresher course or proof of active licensure within the past
five years in another jurisdiction.
(d) If a refresher course is required, the registrant shall
apply for reinstatement of the license within one year of completing the
refresher course in order to receive a current license. The application for
reinstatement shall include verification from the provider of the refresher
course that the registrant has satisfactorily met both theory and clinical
objectives and is deemed competent to practice nursing at the appropriate level
of licensure.
(e) The Board shall not reinstate a license if it is not
satisfied as to the applicant's ability to practice nursing based on these
rules.
History Note: Authority G.S. 90-171.23(b); 90-171.35;
90-171.37; 93B-15; 105-249.2;
Eff. February 1, 1976;
Amended Eff. December 1, 2010; December 1, 2008; January
1, 1996; February 1, 1994; August 3, 1992; January 1, 1990.
21 NCAC 36 .0204 ENDORSEMENT INTO STATE: REGISTERED
NURSE
21 NCAC 36 .0205 ENDORSEMENT INTO STATE: LICENSED
PRACTICAL NURSE
21 NCAC 36 .0206 LICENSE BY ENDORSEMENT: APPLICATION
History Note: Authority G.S. 90‑171;
Eff. February 1, 1976;
Repealed Eff. May 1, 1982.
21 NCAC 36 .0207 VERIFICATION TO ANOTHER STATE
The North Carolina Board of Nursing will
verify a registrant to another state upon receipt of a request from the
registrant or another Board of nursing which is accompanied by information
properly identifying the registrant and by the appropriate fee.
History Note: Authority G.S. 90‑171.23(b)(3); 90‑171.27(b);
Eff. February 1, 1976;
Amended Eff. April 1, 1989.
21 NCAC 36 .0208 CHANGE OF NAME
In the event of a name or address change, the registrant
must submit a written, signed request and provide identifying data, including
certificate number and social security number.
History Note: Authority G.S. 90‑171.23(b)(3); 90‑171.27(b);
Eff. February 1, 1976;
Amended Eff. December 1, 2006; May 1, 1989; May 1, 1988;
May 1, 1982.
21 NCAC 36 .0209 DUPLICATE CERTIFICATE
(a) A duplicate certificate, so stamped, may
be issued in the event of loss of the original certificate upon receipt of a
written, signed request which provides:
(1) identifying data, including
certificate number and social security number;
(2) statement of circumstances
surrounding loss; and
(3) payment of a duplication
fee.
(b) In the event that the original
certificate never reached the registrant, a duplicate shall be furnished
without fee upon receipt of a notarized statement to that effect.
History Note: Authority G.S. 90‑171.23(b)(3); 90‑171.27(b);
Eff. February 1, 1976;
Amended Eff. January 1, 1996; October 1, 1989; May 1,
1982.
21 NCAC 36 .0210 RESUMPTION OF PREVIOUS NAME
History Note: Authority G.S. 90‑162;
Eff. February 1, 1976;
Repealed Eff. May 1, 1982.
21 NCAC 36 .0211 LICENSURE BY EXAMINATION
(a) An applicant shall meet the educational qualifications
to take the examination for licensure to practice as a registered nurse by:
(1) graduating from a Board approved nursing
program (21 NCAC 36 .0300) designed to prepare a person for registered nurse
licensure; or
(2) graduating from a nursing program outside
the United States that is designed to provide graduates with comparable
education preparation as required in 21 NCAC 36 .0321(b) through (d) for licensure
as a registered nurse, and submitting evidence from an evaluation agency of the
required educational qualifications and evidence of English proficiency. The
evaluation agency(s) for educational qualifications shall be selected from a
list of evaluation agencies published by the National Council of State Boards
of Nursing Inc., which is hereby incorporated by Reference, including
subsequent amendments of the referenced materials. The list of such agencies is
available, at no cost, from the North Carolina Board of Nursing. The evidence
of English proficiency shall be the Test of English as a Foreign Language or a
test determined by the Board to be equivalent to the Test of English as a
Foreign Language;
(b) An applicant shall meet the educational qualifications
to take the examination for licensure to practice as a licensed practical nurse
by:
(1) graduating from a Board approved nursing
program (21 NCAC 36 .0300) designed to prepare a person for practical nurse
licensure;
(2) graduating from a nursing program outside
the United States that is designed to provide graduates with comparable
preparation for licensure as a licensed practical nurse, and submitting
evidence from an evaluation agency of the required educational qualifications
and evidence of English proficiency. The evaluation agency(s) for educational
qualifications shall be selected from a list of evaluation agencies published
by the National Council of State Boards of Nursing, Inc., which is hereby
incorporated by Reference, including subsequent amendments of the referenced
materials. The list of such agencies is available, at no cost, from the North
Carolina Board of Nursing. The evidence of English proficiency shall be
passing the Test of English as a Foreign Language or a test determined by the
Board to be equivalent to the Test of English as a Foreign Language;
(3) graduating from a Board approved nursing
program designed to prepare graduates for registered nurse licensure, and
failing to pass the examination for registered nurse licensure; or
(4) graduating from a nursing program outside
the United States that is designed to prepare graduates with comparable
preparation for licensure as a registered nurse, and submitting the evidence as
described in Subparagraph (a)(2) of this Rule of the required educational
qualifications, and failing to pass the examination for registered nurse
licensure in any jurisdiction.
(c) An application shall be submitted to the Board of
Nursing and a registration form to the testing service. The applicant shall
meet all requirements of the National Council of State Boards of Nursing, Inc.
(d) The initial application shall be held active until the
applicant passes the examination or one year, whichever occurs first. The time
begins on the date the applicant is determined to be eligible for the licensure
examination.
(e) The examinations for licensure developed by the
National Council of State Boards of Nursing, Inc. shall be the examinations for
licensure as a registered nurse or as a licensed practical nurse in North Carolina.
(1) These examinations shall be administered in
accordance with the contract between the Board of Nursing and the National
Council of State Boards of Nursing, Inc.
(2) The examinations for licensure shall be
administered at least twice a year.
(3) Results for the examination shall be
reported to the individual applicant and to the director of the program from
which the applicant was graduated. Aggregate results from the examination(s)
may be published by the Board.
(4) The passing standard score for each of the
five tests comprising the examination for registered nurse licensure, up to and
including the February 1982 examination was 350. For the examination offered
in July 1982 and through July 1988, the passing score was 1600. Beginning
February 1989, the results for registered nurse licensure is reported as
"PASS" or "FAIL".
(5) The passing score for the examination for
practical nurse licensure, up to and including the April 1988 was 350.
Beginning October 1988, the results for practical nurse licensure is reported
as "PASS" or "FAIL".
(f) Applicants who meet the qualifications for licensure by
examination shall be issued a certificate of registration and a license to
practice nursing for the remainder of the biennial period. The qualifications
include:
(1) a "PASS" result on the licensure
examination;
(2) evidence of unencumbered license in all
jurisdictions in which a license is or has ever been held;
(3) evidence of completion of all court
conditions resulting from any misdemeanor or felony convictions; and
(4) a written explanation and all related
documents if the nurse has ever been listed as a Nurse Aide and if there have
ever been any substantiated findings pursuant to G.S. 131E-255. The Board may
take these findings into consideration when determining if a license should be
denied pursuant to G.S. 90-171.37. In the event findings are pending, the Board
may withhold taking any action until the investigation is completed.
(g) Applicants for a North Carolina license may take the
examination for licensure developed by the National Council of State Boards of
Nursing, Inc. in any National Council approved testing site.
History Note: Authority G.S. 90-171.23(15); 90‑171.29;
90‑171.30; 90-171.37(1); 90-171.48;
Eff. February 1, 1976;
Amended Eff. December 1, 2004; April 1, 2003; January 1,
1996; July 1, 1994; February 1, 1994; August 3, 1992.
21 NCAC 36 .0212 SPECIFIC REQUIREMENTS
History Note: Authority G.S. 90‑168 through 90‑170;
Eff. February 1, 1976;
Repealed Eff. May 1, 1982.
21 NCAC 36 .0213 REEXAMINATION
An applicant who fails an examination and is eligible to
retake a subsequent examination must submit a completed Board of Nursing
application, a completed testing service registration form, and related fees.
The applicant is eligible to retake the examination in accordance with the
timeframe specified by the National Council of State Boards of Nursing, Inc.
History Note: Filed as a Temporary Amendment Eff. June
26, 1985, for a period of 120 days to expire on October 23, 1985;
Authority G.S. 90‑171.31; 90‑171.33; 90‑171.38;
Eff. February 1, 1976;
Amended Eff. August 1, 2000; July 1, 1994; February 1,
1994; October 1, 1989; May 1, 1989.
21 NCAC 36 .0214 PROCTORING OF EXAMINATION
21 NCAC 36 .0215 FOREIGN EDUCATED NURSES
History Note: Authority G.S. 90‑162; 90‑170;
90‑171;
Eff. February 1, 1976;
Repealed Eff. May 1, 1982.
21 NCAC 36 .0216 CENSUS OF NURSING PERSONNEL
(a) Employers shall maintain a current list
of persons employed for the practice of nursing as of January 1 of each year
which provides the following:
(1) name;
(2) level of licensure;
(3) certificate number; and
(4) expiration date of license.
(b) Upon request of the Board, this list shall be submitted
for review.
History Note: Authority G.S. 90‑171.23(b); 90‑171.43;
90‑171.44(3)(5);
Eff. February 1, 1976;
Amended Eff. January 1, 1996; April 1, 1989; January 1,
1984.
21 NCAC 36 .0217 REVOCATION, SUSPENSION, OR DENIAL OF
LICENSE
(a) The definitions contained in G.S. 90‑171.20 and
G.S. 150B‑2 (01), (2), (2b), (3), (4), (5), (8), (8a), and (8b) apply.
In addition, the following definitions apply:
(1) "Investigation" means an
exploration of the events and circumstances related to reported information in
an effort to determine if there is a violation of any provisions of this Act or
any rule promulgated by the Board.
(2) "Administrative Law Counsel"
means an attorney whom the Board of Nursing has retained to serve as procedural
officer for contested cases.
(3) "Prosecuting Attorney" means the
attorney retained by the Board of Nursing to prepare and prosecute contested
cases.
(b) A nursing license which has been forfeited under G.S.
15A-1331A may not be reinstated until the licensee has successfully complied
with the court's requirements, has petitioned the Board for reinstatement, has
appeared before the Licensure Committee, and has had reinstatement approved.
The license may initially be reinstated with restrictions.
(c) Behaviors and activities which may result in
disciplinary action by the Board include the following:
(1) drug or alcohol abuse;
(2) illegally obtaining, possessing or
distributing drugs or alcohol for personal or other use, or other violations of
G.S. 90‑86 to 90‑113.8;
(3) commission of any crime which bears on a
licensee's fitness to practice nursing as set out in G.S. 90-171.48(a)(2);
(4) failure to make available to another health
care professional any client information crucial to the safety of the client's
health care;
(5) delegating responsibilities to a person
when the licensee delegating knows or has reason to know that the competency of
that person is impaired by physical or psychological ailments, or by alcohol or
other pharmacological agents, prescribed or not;
(6) practicing or offering to practice beyond
the scope permitted by law;
(7) accepting and performing professional
responsibilities which the licensee knows or has reason to know that he or she
is not competent to perform;
(8) performing, without adequate supervision,
professional services which the licensee is authorized to perform only under
the supervision of a licensed professional, except in an emergency situation
where a person's life or health is in danger;
(9) abandoning or neglecting a client who is in
need of nursing care, without making reasonable arrangements for the
continuation of such care;
(10) harassing, abusing, or intimidating a client
either physically or verbally;
(11) failure to maintain an accurate record for
each client which records all pertinent health care information as defined in
Rule .0224(f)(2) or .0225(f)(2);
(12) failure to exercise supervision over persons
who are authorized to practice only under the supervision of the licensed
professional;
(13) exercising undue influence on the client,
including the promotion of the sale of services, appliances, or drugs for the
financial gain of the practitioner or of a third party;
(14) directly or indirectly offering, giving,
soliciting, or receiving or agreeing to receive, any fee or other consideration
to or from a third party for the referral of a client, or other violations of
G.S. 90‑401;
(15) failure to file a report, or filing a false
report, required by law or by the Board, or impeding or obstructing such filing
or inducing another person to do so;
(16) revealing identifiable data, or information
obtained in a professional capacity, without prior consent of the client,
except as authorized or required by law;
(17) guaranteeing that a cure will result from
the performance of professional services;
(18) altering a license, using a license that has
been altered or permitting or allowing another person to use his or her license
for the purpose of nursing. Altering is defined to include changing the
expiration date, certification number, or any other information appearing on
the license;
(19) delegating professional responsibilities to
a person when the licensee delegating such responsibilities knows or has reason
to know that such a person is not qualified by training, by experience, or by
licensure;
(20) violating any term of probation, condition,
or limitation imposed on the licensee by the Board;
(21) accepting responsibility for client care
while impaired by alcohol or other pharmacological agents;
(22) falsifying a client's record or the
controlled substance records of the agency; or
(23) engaging in any activities of a sexual
nature with a client including kissing, fondling or touching while responsible
for the care of that individual.
(d) When a person licensed to practice nursing as a
licensed practical nurse or as a registered nurse is also licensed in another
jurisdiction and that other jurisdiction takes disciplinary action against the
licensee, the North Carolina Board of Nursing may summarily impose the same or
lesser disciplinary action upon receipt of the other jurisdiction's action.
The licensee may request a hearing. At the hearing the issues will be limited
to:
(1) whether the person against whom action was
taken by the other jurisdiction and the North Carolina licensee are the same
person;
(2) whether the conduct found by the other
jurisdiction also violates the North Carolina Nursing Practice Act; and
(3) whether the sanction imposed by the other jurisdiction
is lawful under North Carolina law.
(e) Before the North Carolina Board of Nursing makes a
final decision in any contested case, the person, applicant or licensee
affected by such decision shall be afforded an administrative hearing pursuant to
the provisions of G.S.150B, Article 3A.
(1) The Paragraphs contained in this Rule shall
apply to conduct of all contested cases heard before or for the North Carolina
Board of Nursing.
(2) The following general statutes, rules, and
procedures apply unless another specific statute or rule of the North Carolina
Board of Nursing provides otherwise: Rules of Civil Procedure as contained in
G.S. 1A‑1 and Rules of Evidence pursuant to G.S. Chapter 8C; G.S. 90‑86
through 90‑113.8; 21 NCAC 36 .0224 ‑ .0225; Article 3A, Chapter
150B; and Rule 6 of the General Rules of Practice for Superior and District
Court.
(3) Every document filed with the Board of
Nursing shall be signed by the person, applicant, licensee, or his attorney who
prepares the document and shall contain his name, title/position, address, and
telephone number. If the individual involved is a licensed nurse the nursing
license certificate number shall appear on all correspondence with the Board of
Nursing.
(f) In accordance with G.S. 150B‑3(c) a license may
be summarily suspended if the public health, safety, or welfare requires
emergency action. This determination is delegated to the Chairman or Executive
Director of the Board pursuant to G.S. 90‑171.23(b)(3). Such a finding
shall be incorporated with the order of the Board of Nursing and the order is
effective on the date specified in the order or on service of the certified
copy of the order at the last known address of the licensee, whichever is
later, and continues to be effective during the proceedings. Failure to
receive the order because of refusal of service or unknown address does not
invalidate the order. Proceedings shall be commenced in a timely manner.
(g) Board staff shall issue a Letter of Charges only upon
completion of an investigation, by authorized Board staff, of a written or
verbal complaint and review with legal counsel or prosecuting attorney or
Executive Director.
(1) Subsequent to an investigation and
validation of a complaint, a Letter of Charges shall be sent on behalf of the
Board of Nursing to the person who is the subject of the complaint.
(A) The Letter of Charges shall be served in accordance
with G.S. 1A‑1, Rule 4, Rules of Civil Procedure.
(B) The Letter of Charges serves as the Board's formal
notification to the person that an allegation of possible violation(s) of the
Nursing Practice Act has been initiated.
(C) The Letter of Charges does not in and of itself
constitute a contested case.
(2) The Letter of Charges shall include the
following:
(A) a short and plain statement of the factual
allegations;
(B) a citation of the relevant sections of the statutes
or rules involved;
(C) notification that a settlement conference will be
scheduled upon request;
(D) explanation of the procedure used to govern the
settlement conference;
(E) notification that if a settlement conference is not
requested, or if held, does not result in resolution of the case, an
administrative hearing shall be scheduled; and
(F) if applicable, any sanction or remediation in
accordance with Board‑adopted policy may be included.
(3) A case becomes a contested case after the
person disputes the allegations contained in the Letter of Charges, requests an
administrative hearing, or refuses to accept a settlement offer extended by the
Board of Nursing.
(h) No Board member shall discuss with any person the
merits of any case pending before the Board of Nursing. Any Board member who
has direct knowledge about a case prior to the commencement of the proceeding
shall disqualify himself from any participation with the majority of the Board
of Nursing hearing the case.
(i) A settlement conference, if requested by the person,
shall be held for the purpose of attempting to resolve a dispute through
informal procedures prior to the commencement of formal administrative
proceedings.
(1) The conference shall be held in the offices
of the Board of Nursing, unless another site is designated by mutual agreement
of all involved parties.
(2) All parties shall attend or be represented
at the settlement conference. The parties shall be prepared to discuss the
alleged violations and the incidents on which these are based.
(3) Prior to the commencement of the settlement
conference, a form shall be signed by the person which invalidates all previous
offers made to the person by the Board.
(4) At the conclusion of the day during which
the settlement conference is held, a form shall be signed by all parties which
indicates whether the settlement offer is accepted or rejected. Subsequent to
this decision:
(A) if a settlement is reached, the Board of Nursing
shall forward a written settlement agreement containing all conditions of the
settlement to the other party(ies); or
(B) if a settlement cannot be reached, the case shall
proceed to a formal administrative hearing.
(j) Disposition may be made of any contested case or an
issue in a contested case by stipulation, agreement, or consent order at any
time prior to or during the hearing of a contested case.
(k) The Board of Nursing shall give the parties in a
contested case a Notice of Hearing not less than 15 calendar days before the
hearing. The Notice shall be given in accordance with G.S. 1A‑1, Rule 4,
Rules of Civil Procedure. The notice shall include:
(1) Acknowledgment of service, or attempted
service, of the Letter of Charges in compliance with Part (g)(1)(A) of this
Rule;
(2) Date, time, and place of the hearing;
(3) Notification of the right of a party to
represent himself or to be represented by an attorney;
(4) A statement that, pursuant to Paragraph (n)
of this Rule, subpoenas may be requested by the licensee to compel the
attendance of witnesses or the production of documents;
(5) A statement advising the licensee that a
notice of representation, containing the name of licensee's counsel, if any,
shall be filed with the Board of Nursing not less than 10 calendar days prior
to the scheduled date of the hearing;
(6) A statement advising the licensee that a
list of all witnesses for the licensee shall be filed with the Board of Nursing
not less than 10 calendar days prior to the scheduled date of the hearing; and
(7) A statement advising the licensee that
failure to appear at the hearing may result in the allegations of the Letter of
Charges being taken as true and that the Board may proceed on that assumption.
(l) Pre-hearing conferences may be held to simplify the
issues to be determined, to obtain stipulations in regards to testimony or
exhibits, to obtain stipulations of agreement on nondisputed facts or the
application of particular laws, to consider the proposed witnesses for each
party, to identify and exchange documentary evidence intended to be introduced
at the hearing, and to consider such other matters that may be necessary or
advisable for the efficient and expeditious conduct of the hearing.
(1) The pre-hearing conference shall be
conducted in the offices of the Board of Nursing, unless another site is
designated by mutual agreement of all parties.
(2) The pre-hearing conference shall be an
informal proceeding and shall be conducted by a Board‑designated administrative
law counsel.
(3) All agreements, stipulations, amendments,
or other matters resulting from the pre-hearing conference shall be in writing,
signed by all parties, and introduced into the record at the beginning of the
formal administrative hearing.
(m) Administrative hearings conducted before a majority of
Board members shall be held in Wake County or, by mutual consent in another
location when a majority of the Board has convened in that location for the
purpose of conducting business. For those proceedings conducted by an
Administrative Law Judge the venue shall be determined in accordance with G. S.
150B‑38(e). All hearings conducted by the Board of Nursing shall be open
to the public.
(n) The Board of Nursing, through its Executive Director, may
issue subpoenas for the Board or a licensee, in preparation for, or in the
conduct of, a contested case.
(1) Subpoenas may be issued for the appearance
of witnesses or the production of documents or information, either at the
hearing or for the purposes of discovery.
(2) Requests by a licensee for subpoenas shall
be made in writing to the Executive Director and shall include the following:
(A) the full name and home or business address of all
persons to be subpoenaed; and
(B) the identification, with specificity, of any
documents or information being sought.
(3) Subpoenas shall include the date, time, and
place of the hearing and the name and address of the party requesting the
subpoena. In the case of subpoenas for the purpose of discovery, the subpoena
shall include the date, time, and place for responding to the subpoena.
(4) Subpoenas shall be served as provided by
the Rules of Civil Procedure, G.S. 1A‑1. The cost of service, fees, and
expenses of any witnesses or documents subpoenaed shall be paid by the party
requesting the witnesses.
(o) All motions related to a contested case, except motions
for continuance and those made during the hearing, shall be in writing and
submitted to the Board of Nursing at least 10 calendar days before the
hearing. Pre-hearing motions shall be heard at a pre-hearing conference or at
the contested case hearing prior to the commencement of testimony. The
designated administrative law counsel shall hear the motions and the response
from the non‑moving party pursuant to Rule 6 of the General Rules of
Practice for the Superior and District Courts and rule on such motions. If the
pre‑hearing motions are heard by an Administrative Law Judge from Office
of Administrative Hearings the provisions of G.S. 150B‑40(e) shall govern
the proceedings.
(p) Motions for a continuance of a hearing may be granted
upon a showing of good cause. Motions for a continuance must be in writing and
received in the office of the Board of Nursing no less than seven calendar days
before the hearing date. In determining whether good cause exists,
consideration will be given to the ability of the party requesting a
continuance to proceed effectively without a continuance. A motion for a
continuance filed less than seven calendar days from the date of the hearing
shall be denied unless the reason for the motion could not have been
ascertained earlier. Motions for continuance filed prior to the date of the
hearing shall be ruled on by the Administrative Law Counsel of the Board. All
other motions for continuance shall be ruled on by the majority of the Board
members or Administrative Law Counsel sitting at hearing.
(q) All hearings by the Board of Nursing shall be conducted
by a majority of members of the Board of Nursing, except as provided in Subparagraph
(1) of this Paragraph. The Board of Nursing shall designate one of its members
to preside at the hearing. The Board of Nursing shall designate an
administrative law counsel who shall advise the presiding officer. The seated
members of the Board of Nursing shall hear all evidence, make findings of fact
and conclusions of law, and issue an order reflecting a majority decision of
the Board.
(1) When a majority of the members of the Board
of Nursing is unable or elects not to hear a contested case, the Board of
Nursing shall request the designation of an administrative law judge from the
Office of Administrative Hearings to preside at the hearing. The provisions of
G.S. 150B, Article 3A and 21 NCAC 36 .0217 shall govern a contested case in
which an administrative law judge is designated as the Hearing Officer.
(2) In the event that any party or attorney or
other representative of a party engages in conduct which obstructs the
proceedings or would constitute contempt if done in the General Court of Justice,
the Board may apply to the applicable superior court for an order to show cause
why the person(s) should not be held in contempt of the Board and its
processes.
(3) During a hearing, if it appears in the
interest of justice that further testimony should be received and sufficient
time does not remain to conclude the testimony, the Board of Nursing may
continue the hearing to a future date to allow for the additional testimony to
be taken by deposition or to be presented orally. In such situations and to
such extent as possible, the seated members of the Board of Nursing and the
designated administrative law counsel shall receive the additional testimony.
In the event that new members of the Board or a different administrative law
counsel must participate, a copy of the transcript of the hearing shall be
provided to them prior to the receipt of the additional testimony.
(r) All parties have the right to present evidence,
rebuttal testimony, and argument with respect to the issues of law, and to
cross‑examine witnesses. The North Carolina Rules of Evidence in G.S. 8C
shall apply to contested case proceedings, except as provided otherwise in this
Rule and G.S. 150B‑41.
(1) Sworn affidavits may be introduced by
mutual agreement from all parties.
(2) All oral testimony shall be under oath or
affirmation and shall be recorded. Unless otherwise stipulated by all parties,
witnesses are excluded from the hearing room until such time that they have
completed their testimony and have been released.
(s) Any form or Board‑approved policy or procedure
referenced in this Rule, or any rules applicable to a case, are available upon
request from the Board of Nursing and shall be supplied at cost.
History Note: Authority G.S. 14‑208.5; 15A‑1331A;
90‑171.23(b)(3)(7); 90‑171.37; 90‑171.47; 90‑401; 150B‑3(c);
150B‑11; 150B‑14; 150B‑38 through 150B‑42;
Eff. February 1, 1976;
Amended Eff. October 1, 1989; November 1, 1988; July 1,
1986; July 1, 1984;
Temporary Amendment Eff. December 7, 1990 for a period of
180 days to expire on June 5, 1991;
ARRC Objection Lodged December 20, 1990;
Amended Eff. January 1, 1991;
ARRC Objection Removed February 25, 1991;
Temporary Amendment Eff. February 26, 1991 for a period
of 35 days to expire on April 1, 1991;
Amended Eff. January 1, 1996; February 1, 1995; April 1,
1991;
Temporary Amendment Eff. March 5, 2001;
Amended Eff. January 1, 2007; August 2, 2002.
21 NCAC 36 .0218 LICENSURE WITHOUT EXAMINATION (BY
ENDORSEMENT)
(a) The Board shall provide an application form which the
applicant who wishes to apply for licensure without examination (by
endorsement) shall complete in its entirety.
(b) The applicant for licensure by endorsement as a
registered nurse shall show evidence of:
(1) completion of a program of nursing
education for registered nurse licensure which was approved by the jurisdiction
of original licensure;
(2) attainment of the standard score on the
examination which was required by the jurisdiction issuing the original
certificate of registration;
(3) self-certification that the applicant is of
mental and physical health necessary to competently practice nursing;
(4) unencumbered license in all jurisdictions
in which a license is or has ever been held. A license that has had all
encumbrances resolved in the jurisdictions in which the reasons for the
encumbrances occurred shall be considered an unencumbered license for purposes
of this provision;
(5) current license in a jurisdiction; if the
license has been inactive or lapsed for five or more years, the applicant shall
be subject to requirements for a refresher course as indicated in G.S.
90-171.35 and G.S. 90-171.36;
(6) completion of all court conditions
resulting from any misdemeanor or felony convictions; and
(7) a written explanation and all related
documents if the nurse has been listed as a Nurse Aide and there has been a
substantiated finding(s) pursuant to G.S. 131E-255. The Board may take the
finding(s) into consideration when determining if a license should be denied
pursuant to G.S. 90-171.37. In the event a finding(s) is pending, the Board
may withhold taking any action until the investigation is completed.
(c) The applicant for licensure by endorsement as a
licensed practical nurse shall show evidence of:
(1) completion of:
(A) a program in practical nursing approved by the
jurisdiction of original licensure; or
(B) course(s) of study within a program(s) which shall
be comparable to that required of practical nurse graduates in North Carolina; or
(C) course of study for military hospital corpsman which
shall be comparable to that required of practical nurse graduates in North Carolina.
The applicant who was graduated
prior to July 1956 shall be considered on an individual basis in light of
licensure requirements in North Carolina at the time of original licensure;
(2) attainment of the standard score on the
examination which was required by the jurisdiction issuing the original certificate
of registration;
(3) self-certification that the applicant is of
mental and physical health necessary to competently practice nursing;
(4) unencumbered license in all jurisdictions
in which a license is or has ever been held. A license that has had all
encumbrances resolved in the jurisdictions in which the reasons for the
encumbrances occurred shall be considered an unencumbered license for purposes
of this provision;
(5) current license in a jurisdiction; if the
license has been inactive or lapsed for five or more years, the applicant shall
be subject to requirements for a refresher course as indicated in G.S.
90-171.35 and G.S. 90-171.36;
(6) completion of all court conditions
resulting from any misdemeanor or felony convictions; and
(7) a written explanation and all related
documents if the nurse has been listed as a Nurse Aide and there has been a
substantiated finding(s) pursuant to G.S. 131E-255. The Board may take the
finding(s) into consideration when determining if a license should be denied
pursuant to G.S. 90-171.37. In the event a finding(s) is pending, the Board
may withhold taking any action until the investigation is completed.)
(d) A nurse educated in a foreign country (including Canada) shall be eligible for North Carolina licensure by endorsement if the nurse has:
(1) proof of education as required by the
jurisdiction issuing the original certificate;
(2) prior to January 1, 2004 proof of passing
either the:
(A) Canadian Nurses Association Test Service Examination
(CNATS) in the English language; or
(B) Canadian Registered Nurse Examination (CRNE) in the
English language; or
(C) the licensing examination developed by the National
Council of State Board of Nursing (NCLEX).
(3) beginning January 1, 2004, the applicant
educated in a foreign country including Canada shall show evidence of
Subparagraph (d)(1) and Part (2)(C) of this Paragraph; Parts (d)(2)(A) and (B)
shall no longer apply;
(4) self-certification that the applicant is of
mental and physical health necessary to competently practice nursing;
(5) unencumbered license in all jurisdictions
which a license is or has ever been held. A license that has had all
encumbrances resolved in the jurisdictions in which the reasons for the
encumbrances occurred shall be considered an unencumbered license for purposes
of this provision;
(6) current license in another jurisdiction or
foreign country. If the license has been inactive or lapsed for five or more
years, the applicant shall be subject to requirements for a refresher course as
indicated in G.S. 90-171.35 and G.S. 90-171.36;
(7) completed all court conditions resulting
from any misdemeanor or felony conviction(s); and
(8) a written explanation and all related
documents if the nurse has been listed as a Nurse Aide and if there has been a
substantiated finding(s) pursuant to G.S. 131E-255. The Board may take the
finding(s) into consideration when determining if a license should be denied
pursuant to G.S. 90-171.37. In the event a finding(s) is pending, the Board
may withhold taking any action until the investigation is completed.
(e) When an applicant is eligible for licensure consistent
with Part (d)(2)(A) or (d)(2)(B) of this Rule the license issued by the Board
will not permit the individual to practice in other states party to the Nurse
Licensure Compact.
(f) Facts provided by the applicant and the Board of
Nursing of original licensure shall be compared to confirm the identity and
validity of the applicant's credentials. Status in other states of current
licensure may be verified. When eligibility is determined, a certificate of
registration and a current license for the remainder of the biennial period
shall be issued.
History Note: Authority G.S. 90‑171.23(b); 90‑171.32;
90‑171.33; 90‑171.37; 90-171.48;
Eff. May 1, 1982;
Amended Eff. December 1, 2005; April 1, 2003; January 1,
1996; July 1, 1994;
February 1, 1994; August 3, 1992.
21 NCAC 36 .0219 TEMPORARY LICENSE
(a) The Board may issue a Status P nonrenewable temporary
license to persons who have filed a completed application for licensure without
examination with correct fee and provided validation of an active license in another
jurisdiction. If an applicant indicates prior court conviction(s) or
disciplinary action(s) in another jurisdiction, eligibility for a temporary
license shall be determined after review of relevant documents.
(b) The following applies to Status P temporary licenses:
(1) The Status P nonrenewable temporary license
shall expire on the lesser of six months or the date a full license is issued
or when it is determined the applicant is not qualified to practice nursing in
North Carolina.
(2) Status P temporary license shall authorize
the holder to practice nursing in the same manner as a fully licensed R.N. or
L.P.N., whichever the case may be.
(3) Holders of valid Status P temporary license
shall identify themselves as R.N. Petitioner (R.N.P.) or L.P.N. petitioner
(L.P.N.P.), as the case may be, after signatures on records.
(4) Upon expiration or revocation of the Status
P temporary license, the individual is ineligible to practice nursing as
described in Subparagraph (b)(2) of this Rule.
History Note: Authority G.S. 90‑171.33;
Eff. May 1, 1982;
Temporary Amendment Eff. June 29, 1988 for a period of 180 days to expire on December 25, 1988;
Amended Eff. December 1, 2006; January 1, 1996; July 1,
1994; August 3, 1992; January 1, 1989.
21 NCAC 36 .0220 REFRESHER COURSE
(a) A refresher course shall be designed for those persons,
previously licensed, who are not eligible for re-entry into nursing practice
because their license has lapsed for five or more years.
(b) Satisfactory completion of a Board-approved refresher
course is required of the person who:
(1) requests reactivation of an inactive
license and who has not held an active license for five or more years;
(2) requests reinstatement of a lapsed license
and who has not held an active license for five or more years;
(3) requests endorsement to North Carolina who
has not held an active license for five or more years;
(4) is directed by the Board to complete such a
course when the Board takes action as authorized in G.S. 90-171.37; or
(5) needs a refresher course as a result of the
license being inactive for disciplinary action and has met all eligibility
requirements for reinstatement of the license.
Those persons identified in Subparagraph (4) or (5) of this
Paragraph may be subject to Board-stipulated restrictions in the clinical
component of the refresher course.
(c) Application for approval of a refresher course shall be
completed and submitted by the provider at least 90 days prior to the expected
date of enrollment and shall include evidence of complying with the rules for
refresher courses. Board approval shall be secured prior to the enrollment of
students. Provider approval will be granted for a period of time not to exceed
five years. However, any changes in faculty, curriculum, or clinical
facilities shall be approved by the Board prior to implementation as set out in
the Rules of this Chapter.
(d) The Board will make site visits if necessary. A
decision on an application to offer a refresher course will be given within 30
days following receipt of the application.
(e) The provider of a refresher course shall be approved by
the Board as set out in these Rules. A provider may be a post-secondary
educational institution, a health care institution, or other agency.
(f) Administrative responsibility for developing and
implementing the course shall be vested in a registered nurse director.
(g) Instructors in the course shall be directly accountable
to the nurse director. The director shall have had at least one year prior
teaching experience preparing individuals for LPN or RN licensure at the
post-secondary level or in a nursing staff development position. The director
and each instructor shall:
(1) be licensed to practice nursing as a
registered nurse in North Carolina;
(2) hold a baccalaureate or higher degree; and
(3) have had at least two years experience in
direct patient nursing practice as an RN.
(h) Proximity of the instructor to students is the major
factor in determining faculty-student ratio for clinical learning experiences.
In no case shall this ratio exceed 1:10.
(i) Course objectives shall be stated which:
(1) show relationships between theory and
practice; and
(2) indicate behaviors consistent with the
ability to safely practice nursing.
(j) The curriculum for the R.N. Refresher Course shall
incorporate:
(1) common medical-surgical conditions and
management of common nursing problems associated with these conditions,
including mental health principles associated with management of nursing
problems;
(2) functions of the registered nurse as
defined in G.S. 90-171.20 and 21 NCAC 36 .0221, .0224, .0225 and .0401; and
(3) instruction in and opportunities to
demonstrate ability to safely practice nursing and knowledge in caring for
clients with common medical-surgical problems.
(k) The curriculum for the L.P.N. Refresher Course shall
incorporate:
(1) common medical-surgical conditions and
common nursing approaches to their management, including mental health
principles;
(2) functions of the licensed practical nurse
as defined in G.S. 90-171.20(8) and 21 NCAC 36 .0221, .0225 and .0401; and
(3) instruction in and opportunity to
demonstrate ability to safely practice nursing and knowledge in caring for
clients with common medical-surgical problems.
(l) The course shall include both theory and clinical
instruction:
(1) The R.N. Refresher Course shall include at
least 240 hours of instruction, at least 120 of which shall consist of clinical
learning experiences.
(2) The L.P.N. Refresher Course shall include
at least 180 hours of instruction, at least 90 of which shall consist of
clinical learning experiences.
(m) Evaluation processes shall be implemented which
effectively measure the refresher student's:
(1) knowledge and understanding of curriculum
content; and
(2) ability to provide safe nursing care to
clients with common medical-surgical conditions.
(n) Clinical resources shall indicate in written contract
their support and availability to provide the necessary clinical experiences.
(o) The application for approval of a refresher course
shall include:
(1) course objectives, content outline and time
allocation;
(2) didactic and clinical learning experiences
including teaching methodologies, for measuring the registrant's abilities to
practice nursing;
(3) plan for evaluation of student competencies
and ability to practice safe nursing;
(4) a faculty list which includes the director
and all instructors and identifies their qualifications and their functions in
teaching roles; and
(5) the projected clinical schedule.
(p) A course or combination of courses within a basic
nursing curriculum may be considered a refresher course for re-entry into
practice if:
(1) such course or combination of courses
equals or exceeds requirements for refresher courses;
(2) such course or combination of courses is
taught on a level commensurate with level of relicensure sought; and
(3) the Board designee approves such course or
combination of courses as a substitute for a refresher course.
(q) Individuals, previously licensed in North Carolina,
presently residing outside of North Carolina, may meet these requirements by
successfully completing a North Carolina approved refresher course completed in
another state or country. Agencies desiring approval for conducting refresher
courses shall submit applications per Paragraphs (c) through (p) of this Rule.
Clinical experiences shall be in agencies approved by the comparable
state/country agency to the Board of Nursing. The agency applying for
refresher course approval shall submit evidence of the agency approval.
(r) Individuals enrolled in refresher courses shall
identify themselves as R.N. Refresher Student (RN RS) or LPN Refresher Student
(LPN RS) consistent with the course level, after signatures on records or on
name pins.
(s) Upon completion of a Board-approved refresher course,
the course provider shall furnish the Board with the names and North Carolina certificate numbers of those persons who have satisfactorily completed the
course and are deemed safe to practice nursing at the appropriate level of
licensure on the Board supplied form.
(t) Upon request, the Board shall provide:
(1) a list of approved providers;
(2) forms for applications for program
approval; and
(3) forms for verification of successful
completion to all approved programs.
History Note: Authority G.S. 90‑171.23(b)(3); 90‑171.35;
90‑171.36; 90‑171.37; 90-171.38; 90-171.83;
Eff. May 1, 1982;
Amended Eff. January 1, 2007; July 1, 2000; June 1, 1993;
April 1, 1989.
21 NCAC 36 .0221 LICENSE REQUIRED
(a) No cap, pin, uniform, insignia or title shall be used
to represent to the public, that an unlicensed person is a registered nurse or
a licensed practical nurse as defined in G.S. 90-171.43.
(b) The repetitive performance of a common task or
procedure which does not require the professional judgment of a registered
nurse or licensed practical nurse shall not be considered the practice of
nursing for which a license is required. Tasks that may be delegated to the
Nurse Aide I and Nurse Aide II shall be established by the Board of Nursing
pursuant to 21 NCAC 36 .0403. Tasks may be delegated to an unlicensed person
which:
(1) frequently recur in the daily care of a
client or group of clients;
(2) are performed according to an established
sequence of steps;
(3) involve little or no modification from one
client-care situation to another;
(4) may be performed with a predictable
outcome; and
(5) do not inherently involve ongoing
assessment, interpretation, or decision-making which cannot be logically
separated from the procedure(s) itself.
Client-care services which do not meet all of these criteria
shall be performed by a licensed nurse
(c) The registered nurse or licensed practical nurse shall
not delegate the professional judgment required to implement any treatment or
pharmaceutical regimen which is likely to produce side effects, toxic effects,
allergic reactions, or other unusual effects; or which may rapidly endanger a
client's life or well-being and which is prescribed by a person authorized by
state law to prescribe such a regimen. The nurse who assumes responsibility
for implementing a treatment or pharmaceutical regimen shall be accountable
for:
(1) recognizing side effects;
(2) recognizing toxic effects;
(3) recognizing allergic reactions;
(4) recognizing immediate desired effects;
(5) recognizing unusual and unexpected effects;
(6) recognizing changes in client's condition
that contraindicates continued administration of the pharmaceutical or
treatment regimen;
(7) anticipating those effects which may
rapidly endanger a client's life or well-being; and
(8) making judgments and decisions concerning
actions to take in the event such effects occur.
(d) When health care needs of an individual are incidental
to the personal care needs of the individual, nurses shall not be accountable
for care performed by clients themselves, their families or significant others,
or by caretakers who provide personal care to the individual.
(e) Pharmacists may administer drugs in accordance with 21
NCAC 46 .2507.
History Note: Authority G.S. 90-85.3; 90-171.23(b);
90-171.43; 90-171.83;
Eff. May 1, 1982;
Amended Eff. July 1, 2004; April 1, 2002; December 1,
2000; July 1, 2000; January 1, 1996; February 1, 1994; April 1, 1989; January
1, 1984;
Emergency Amendment Eff. September 10, 2004;
Amended Eff. April 1, 2008; December 1, 2004.
21 NCAC 36 .0222 COMPONENTS OF NURSING PRACTICE
History Note: Authority G.S. 90‑171.20(7),(8); 90‑171.23(b);
Eff. January 1, 1984;
Amended Eff. June 1, 1989; July 1, 1984;
Repealed Eff. January 1, 1991.
21 NCAC 36 .0223 CONTINUING EDUCATION PROGRAMS
(a) Definitions.
(1) Continuing education in
nursing is a planned, organized learning experience taken after completion of a
basic nursing program which prepares a nurse to perform advanced skills. Types
of learning experiences that may be considered continuing education as defined
in Subparagraph (a)(3) of this Rule include:
(A) a non‑degree oriented program;
(B) a course(s) or component(s) of a
course(s) within an academic degree‑oriented program; or
(C) an advanced academic degree‑granting
program which prepares the registered nurse for advanced practice as a clinical
nurse specialist, nurse anesthetist, nurse midwife or nurse practitioner.
(2) Programs offering an
educational experience designed to enhance the practice of nursing are those
which include one or more of the following:
(A) enrichment of knowledge;
(B) development or change of attitudes;
or
(C) acquisition or improvement of skills.
(3) Programs are considered to
teach nurses advanced skills when:
(A) the skill taught is not generally
included in the basic educational preparation of the nurse; and
(B) the period of instruction is
sufficient to assess or provide necessary knowledge from the physical,
biological, behavioral and social sciences, and includes supervised clinical
practice to ensure that the nurse is able to practice the skill safely and
properly.
(4) Student status may be
granted to an individual who does not hold a North Carolina nursing license but
who participates in a clinical component of a continuing education programs in
North Carolina when:
(A) the individual possesses a current
unencumbered license to practice nursing in a jurisdiction other than North
Carolina;
(B) the course offering meets one of the
following criteria:
(i) is part of an academic degree‑granting
nursing program which has approval in a jurisdiction other than North Carolina
or national accreditation; or
(ii) is offered through an in‑state
academic institution which has Board approval for basic nursing education
program(s) or national accreditation for advanced nursing education program(s);
or
(iii) is approved by the Board as a
continuing education offering, thereby meeting the criteria as defined in
Paragraph (b) of this Rule;
(C) the individual receives supervision
by a qualified preceptor or member of the faculty who has a valid license to
practice as a registered nurse in North Carolina;
(D) the course of instruction has a
specified period of time not exceeding twelve months;
(E) the individual is not employed in
nursing practice in North Carolina during participation in the program; and
(F) the Board has been given advance
notice of the name of each student, the jurisdiction in which the student is
licensed, the license number, and the expiration date.
(b) Criteria for voluntary approval of
continuing education programs in nursing.
(1) Planning the educational
program shall include:
(A) definition of learner population; for
example, registered nurse, licensed practical nurse, or both;
(B) identification of characteristics of
the learner; for example, clinical area of practice, place of employment, and
position; and
(C) assessment of needs of the learner;
for example, specific requests from individuals or employers, pre‑tests,
or audits of patient records.
(2) Objectives shall:
(A) be measurable and stated in
behavioral terms;
(B) reflect the needs of the learners;
(C) state desired outcomes;
(D) serve as criteria for the selection
of content, learning experiences and evaluation of achievement;
(E) be achievable within the time
allotted; and
(F) be applicable to nursing.
(3) Content shall:
(A) relate to objectives;
(B) reflect input by qualified faculty;
and
(C) contain learning experiences
appropriate to objectives.
(4) Teaching methodologies
shall:
(A) utilize pertinent educational
principles;
(B) provide adequate time for each
learning activity; and
(C) include sharing objectives with
participants.
(5) Resources shall include:
(A) faculty who have knowledge and
experience necessary to assist the learner to meet the program objectives and
are in sufficient number not to exceed a faculty‑learner ratio in a
clinical practicum of 1:10. If higher ratios are desired, sufficient
justification must be provided; and
(B) physical facilities which ensure that
adequate and appropriate equipment and space are available and appropriate
clinical resources are available.
(6) Evaluation must be
conducted:
(A) by the provider to assess the
participant's achievement of program objectives and content and will be
documented; and
(B) by the learner in order to assess the
program and resources.
(7) Records shall be maintained
by the provider for a period of three years and shall include a summary of
program evaluations, roster of participants, and course outline. The provider
shall award a certificate to each participant who successfully completes the
program.
(c) Approval process.
(1) The provider shall:
(A) make application on forms provided by
the Board no less than 60 days prior to the proposed enrollment date;
(B) present written documentation as
specified in (b)(1) through (b)(7) of this Rule; and
(C) notify the Board of any significant
changes relative to (b)(1) through (b)(7) of this Rule; for example, changes in
faculty or total program hours.
(2) Approval is granted for a two
year period. Any request to offer an approved program by anyone other than the
original provider must be made to the North Carolina Board of Nursing.
(3) If a course is not approved,
the provider may appeal in writing for reconsideration within 30 days after
notification of the disapproval. If the course is not approved upon
reconsideration, the provider may request, within 10 days, a hearing at the
next regularly scheduled meeting of the Board, or no later than 90 days from
the date of request, whichever shall come first.
(4) Site visits may be made by
the Board as deemed appropriate to determine compliance with the criteria as
specified in Paragraph (b) of this Rule.
(5) The Board shall withdraw
approval from a provider if the provider does not maintain the quality of the
offering to the satisfaction of the Board or if there is misrepresentation of
facts within the application for approval.
(6) Approval of continuing
education programs will be included in published reports of Board actions. A
list of approved programs will be maintained in the Board's file.
History Note: Authority G.S. 90‑171.23(b); 90‑171.42;
Eff. January 1, 1984;
Amended Eff. October 1, 1992; October 1, 1991; October 1,
1989; January 1, 1989.
21 ncac 36 .0224 COMPONENTS OF NURSING PRACTICE FOR
THE REGISTERED NURSE
(a) The responsibilities which any registered nurse can
safely accept are determined by the variables in each nursing practice
setting. These variables include:
(1) the nurse's own qualifications including:
(A) basic educational preparation; and
(B) knowledge and skills subsequently acquired through
continuing education and practice;
(2) the complexity and frequency of nursing
care needed by a given client population;
(3) the proximity of clients to personnel;
(4) the qualifications and number of staff;
(5) the accessible resources; and
(6) established policies, procedures,
practices, and channels of communication which lend support to the types of
nursing services offered.
(b) Assessment is an on-going process and consists of the
determination of nursing care needs based upon collection and interpretation of
data relevant to the health status of a client, group or community.
(1) Collection of data includes:
(A) obtaining data from relevant sources regarding the
biophysical, psychological, social and cultural factors of the client's life
and the influence these factors have on health status, including:
(i) subjective reporting;
(ii) observations of appearance and behavior;
(iii) measurements of physical structure and
physiological functions;
(iv) information regarding available resources; and
(B) verifying data collected.
(2) Interpretation of data includes:
(A) analyzing the nature and inter‑relationships
of collected data; and
(B) determining the significance of data to client's
health status, ability to care for self, and treatment regimen.
(3) Formulation of a nursing diagnosis
includes:
(A) describing actual or potential responses to health
conditions. Such responses are those for which nursing care is indicated, or
for which referral to medical or community resources is appropriate; and
(B) developing a statement of a client problem
identified through interpretation of collected data.
(c) Planning nursing care activities includes identifying
the client's needs and selecting or modifying nursing interventions related to
the findings of the nursing assessment. Components of planning include:
(1) prioritizing nursing diagnoses and needs;
(2) setting realistic, measurable goals and outcome
criteria;
(3) initiating or participating in
multidisciplinary planning;
(4) developing a plan of care which includes
determining and prioritizing nursing interventions; and
(5) identifying resources based on necessity
and availability.
(d) Implementation of nursing activities is the initiating
and delivering of nursing care according to an established plan, which
includes, but is not limited to:
(1) procuring resources;
(2) implementing nursing interventions and
medical orders consistent with 21 NCAC 36 .0221(c) and within an environment
conducive to client safety;
(3) prioritizing and performing nursing
interventions;
(4) analyzing responses to nursing
interventions;
(5) modifying nursing interventions; and
(6) assigning, delegating and supervising
nursing activities of other licensed and unlicensed personnel consistent with
Paragraphs (a) and (i) of this Rule, G.S. 90‑171.20(7)d and (7)i, and 21
NCAC 36 .0401.
(e) Evaluation consists of determining the extent to which
desired outcomes of nursing care are met and planning for subsequent care.
Components of evaluation include:
(1) collecting evaluative data from relevant
sources;
(2) analyzing the effectiveness of nursing
interventions; and
(3) modifying the plan of care based upon newly
collected data, new problem identification, change in the client's status and
expected outcomes.
(f) Reporting and Recording by the registered nurse are
those communications required in relation to all aspects of nursing care.
(1) Reporting means the communication of
information to other persons responsible for, or involved in, the care of the
client. The registered nurse is accountable for:
(A) directing the communication to the appropriate
person(s) and consistent with established policies, procedures, practices and
channels of communication which lend support to types of nursing services
offered;
(B) communicating within a time period which is
consistent with the client's need for care;
(C) evaluating the responses to information reported;
and
(D) determining whether further communication is
indicated.
(2) Recording means the documentation of
information on the appropriate client record, nursing care plan or other
documents. This documentation must:
(A) be pertinent to the client's health care;
(B) accurately describe all aspects of nursing care
including assessment, planning, implementation and evaluation;
(C) be completed within a time period consistent with
the client's need for care;
(D) reflect the communication of information to other
persons; and
(E) verify the proper administration and disposal of
controlled substances.
(g) Collaborating involves communicating and working
cooperatively with individuals whose services may have a direct or indirect
effect upon the client's health care and includes:
(1) initiating, coordinating, planning and
implementing nursing or multidisciplinary approaches for the client's care;
(2) participating in decision‑making and
in cooperative goal‑directed efforts;
(3) seeking and utilizing appropriate resources
in the referral process; and
(4) safeguarding confidentiality.
(h) Teaching and Counseling clients is the responsibility
of the registered nurse, consistent with G.S. 90‑171.20(7)g.
(1) Teaching and counseling consist of
providing accurate and consistent information, demonstrations and guidance to
clients, their families or significant others regarding the client's health
status and health care for the purpose of:
(A) increasing knowledge;
(B) assisting the client to reach an optimum level of
health functioning and participation in self care; and
(C) promoting the client's ability to make informed
decisions.
(2) Teaching and counseling include, but are
not limited to:
(A) assessing the client's needs, abilities and
knowledge level;
(B) adapting teaching content and methods to the
identified needs, abilities of the client(s) and knowledge level;
(C) evaluating effectiveness of teaching and counseling;
and
(D) making referrals to appropriate resources.
(i) Managing the delivery of nursing care through the on‑going
supervision, teaching and evaluation of nursing personnel is the responsibility
of the registered nurse as specified in the legal definition of the practice of
nursing and includes, but is not limited to:
(1) continuous availability for direct
participation in nursing care, onsite when necessary, as indicated by client's
status and by the variables cited in Paragraph (a) of this Rule;
(2) assessing capabilities of personnel in
relation to client status and plan of nursing care;
(3) delegating responsibility or assigning
nursing care functions to personnel qualified to assume such responsibility and
to perform such functions;
(4) accountability for nursing care given by
all personnel to whom that care is assigned and delegated; and
(5) direct observation of clients and
evaluation of nursing care given.
(j) Administering nursing services is the responsibility of
the registered nurse as specified in the legal definition of the practice of
nursing in G.S. 90‑171.20 (7)i, and includes, but is not limited to:
(1) identification, development and updating of
standards, policies and procedures related to the delivery of nursing care;
(2) implementation of the identified standards,
policies and procedures to promote safe and effective nursing care for clients;
(3) planning for and evaluation of the nursing
care delivery system; and
(4) management of licensed and unlicensed
personnel who provide nursing care consistent with Paragraphs (a) and (i) of
this Rule and which includes:
(A) appropriate allocation of human resources to promote
safe and effective nursing care;
(B) defined levels of accountability and responsibility
within the nursing organization;
(C) a mechanism to validate qualifications, knowledge
and skills of nursing personnel;
(D) provision of educational opportunities related to
expected nursing performance; and
(E) validation of the implementation of a system for
periodic performance evaluation.
(k) Accepting responsibility for self for individual
nursing actions, competence and behavior is the responsibility of the
registered nurse, which includes:
(1) having knowledge and understanding of the
statutes and rules governing nursing;
(2) functioning within the legal boundaries of
registered nurse practice; and
(3) respecting client rights and property, and
the rights and property of others.
History Note: Authority G.S. 90‑171.20(7); 90‑171.23(b);
90‑171.43(4);
Eff. January 1, 1991;
Temporary Amendment Eff. October 24, 2001;
Amended Eff. August 1, 2002.
21 NCAC 36 .0225 COMPONENTS OF NURSING PRACTICE FOR
THE LICENSED PRACTICAL NURSE
(a) The licensed practical nurse shall accept only those
assigned nursing activities and responsibilities, as defined in Paragraphs (b)
through (i) of this Rule, which the licensee can safely perform. That
acceptance shall be based upon the variables in each practice setting which
include:
(1) the nurse's own qualifications in relation
to client need and plan of nursing care, including:
(A) basic educational preparation; and
(B) knowledge and skills subsequently acquired through
continuing education and practice;
(2) the degree of supervision by the registered
nurse consistent with Paragraph (d)(3) of this Rule;
(3) the stability of each client's clinical
condition;
(4) the complexity and frequency of nursing
care needed by each client or client group;
(5) the accessible resources; and
(6) established policies, procedures,
practices, and channels of communication which lend support to the types of
nursing services offered.
(b) Assessment is an on-going process and consists of
participation in the determination of nursing care needs based upon collection
and interpretation of data relevant to the health status of a client.
(1) collection of data consists of obtaining
data from relevant sources regarding the biophysical, psychological, social and
cultural factors of the client's life and the influence these factors have on
health status, according to structured written guidelines, policies and forms,
and includes:
(A) subjective reporting;
(B) observations of appearance and behavior;
(C) measurements of physical structure and physiologic
function; and
(D) information regarding available resources.
(2) interpretation of data is limited to:
(A) participation in the analysis of collected data by
recognizing existing relationships between data gathered and a client's health
status and treatment regimen; and
(B) determining a client's need for immediate nursing
interventions based upon data gathered regarding the client's health status,
ability to care for self, and treatment regimen consistent with Paragraph
(a)(6) of this Rule.
(c) Planning nursing care activities includes participation
in the identification of client's needs related to the findings of the nursing
assessment. Components of planning include:
(1) participation in making decisions regarding
implementation of nursing intervention and medical orders and plan of care
through the utilization of assessment data;
(2) participation in multidisciplinary planning
by providing resource data; and
(3) identification of nursing interventions and
goals for review by the registered nurse.
(d) Implementation of nursing activities consists of
delivering nursing care according to an established health care plan and as
assigned by the registered nurse or other person(s) authorized by law as
specified in G.S. 90‑171.20 (8)(c).
(1) Nursing activities and responsibilities
which may be assigned to the licensed practical nurse include:
(A) procuring resources;
(B) implementing nursing interventions and medical
orders consistent with Paragraph (b) of this Rule and Paragraph (c) of 21 NCAC
36 .0221 and within an environment conducive to client safety;
(C) prioritizing and performing nursing interventions;
(D) recognizing responses to nursing interventions;
(E) modifying immediate nursing interventions based on
changes in a client's status; and
(F) delegating specific nursing tasks as outlined in
the plan of care and consistent with Paragraph (d)(2) of this Rule, and 21 NCAC
36 .0401.
(2) The licensed practical nurse may
participate, consistent with 21 NCAC 36 .0224(d)(6), in implementing the health
care plan by assigning nursing care activities to other licensed practical
nurses and delegating nursing care activities to unlicensed personnel qualified
and competent to perform such activities and providing all of the following
criteria are met:
(A) validation of qualifications of personnel to whom
nursing activities may be assigned or delegated;
(B) continuous availability of a registered nurse for
supervision consistent with 21 NCAC 36 .0224(i) and Paragraph (d)(3) of this
Rule;
(C) accountability maintained by the licensed practical
nurse for responsibilities accepted, including nursing care given by self and
by all other personnel to whom such care is assigned or delegated;
(D) participation by the licensed practical nurse in on‑going
observations of clients and evaluation of clients' responses to nursing
actions; and
(E) provision of supervision limited to the validation
that tasks have been performed as assigned or delegated and according to
established standards of practice.
(3) The degree of supervision required for the
performance of any assigned or delegated nursing activity by the licensed
practical nurse when implementing nursing care is determined by variables which
include, but are not limited to:
(A) educational preparation of the licensed practical
nurse, including both the basic educational program and the knowledge and
skills subsequently acquired by the nurse through continuing education and
practice;
(B) stability of the client's clinical condition, which
involves both the predictability and rate of change. When a client's condition
is one in which change is highly predictable and would be expected to occur
over a period of days or weeks rather than minutes or hours, the licensed
practical nurse participates in care with minimal supervision. When the
client's condition is unpredictable or unstable, the licensed practical nurse
participates in the performance of the task under close supervision of the
registered nurse or other person(s) authorized by law to provide such
supervision;
(C) complexity of the nursing task which is determined
by depth of scientific body of knowledge upon which the action is based and by
the task's potential threat to the client's well‑being. When a task is
complex, the licensed practical nurse participates in the performance of the
task under close supervision of the registered nurse or other person(s)
authorized by law to provide such supervision;
(D) the complexity and frequency of nursing care needed
by a given client population;
(E) the proximity of clients to personnel;
(F) the qualifications and number of staff;
(G) the accessible resources; and
(H) established policies, procedures, practices and
channels of communication which lend support to the types of nursing services
offered.
(e) Evaluation, a component of implementing the health care
plan, consists of participation in determining the extent to which desired
outcomes of nursing care are met and in planning for subsequent care.
Components of evaluation by the licensed practical nurse include:
(1) collecting evaluative data from relevant
sources according to written guidelines, policies and forms;
(2) recognizing the effectiveness of nursing
interventions; and
(3) proposing modifications to the plan of care
for review by the registered nurse or other person(s) authorized by law to
prescribe such a plan.
(f) Reporting and recording are those communications
required in relation to the aspects of nursing care for which the licensed
practical nurse has been assigned responsibility.
(1) Reporting means the communication of
information to other persons responsible for or involved in the care of the
client. The licensed practical nurse is accountable for:
(A) directing the communication to the appropriate
person(s) and consistent with established policies, procedures, practices and
channels of communication which lend support to types of nursing services
offered;
(B) communicating within a time period which is
consistent with the client's need for care;
(C) evaluating the nature of responses to information
reported; and
(D) determining whether further communication is
indicated.
(2) Recording means the documentation of
information on the appropriate client record, nursing care plan or other
documents. This documentation must:
(A) be pertinent to the client's health care including
client's response to care provided;
(B) accurately describe all aspects of nursing care
provided by the licensed practical nurse;
(C) be completed within a time period consistent with
the client's need for care;
(D) reflect the communication of information to other
persons; and
(E) verify the proper administration and disposal of
controlled substances.
(g) Collaborating involves communicating and working
cooperatively in implementing the health care plan with individuals whose
services may have a direct or indirect effect upon the client's health care.
As delegated by the registered nurse or other person(s) authorized by law, the
licensed practical nurse's role in collaborating in client care includes:
(1) participating in planning and implementing
nursing or multidisciplinary approaches for the client's care;
(2) seeking and utilizing appropriate resources
in the referral process; and
(3) safeguarding confidentiality.
(h) "Participating in the teaching and
counseling" of clients as assigned by the registered nurse, physician or
other qualified professional licensed to practice in North Carolina is the
responsibility of the licensed practical nurse. Participation includes:
(1) providing accurate and consistent
information, demonstrations, and guidance to clients, their families or
significant others regarding the client's health status and health care for the
purpose of:
(A) increasing knowledge;
(B) assisting the client to reach an optimum level of
health functioning and participation in self care; and
(C) promoting the client's ability to make informed
decisions.
(2) collecting evaluative data consistent with
Paragraph (e) of this Rule.
(i) Accepting responsibility for self for individual
nursing actions, competence and behavior which includes:
(1) having knowledge and understanding of the
statutes and rules governing nursing;
(2) functioning within the legal boundaries of
licensed practical nurse practice; and
(3) respecting client rights and property, and
the rights and property of others.
History Note: Authority G.S. 90‑171.20(7),(8); 90‑171.23(b);
90‑171.43(4);
Eff. January 1, 1991;
Amended Eff. January 1, 1996;
Temporary Amendment Eff. October 24, 2001;
Amended Eff. August 1, 2002.
21 NCAC 36 .0226 NURSE ANESTHESIA PRACTICE
(a) Only those registered nurses who meet the
qualifications as outlined in Paragraph (b) of this Rule may perform nurse
anesthesia activities outlined in Paragraph (c) of this Rule.
(b) Qualifications and Definitions:
(1) The registered nurse who completes a
program accredited by the Council on Accreditation of Nurse Anesthesia
Educational Programs, is credentialed as a certified registered nurse
anesthetist by the Council on Certification of Nurse Anesthetists, and who
maintains recertification through the Council on Recertification of Nurse
Anesthetists, may perform nurse anesthesia activities in collaboration with a
physician, dentist, podiatrist, or other lawfully qualified health care
provider, but may not prescribe a medical treatment regimen or make a medical
diagnosis except under the supervision of a licensed physician; and
(2) Collaboration is a process by which the
certified registered nurse anesthetist works with one or more qualified health
care providers, each contributing his or her respective area of expertise
consistent with the appropriate occupational licensure laws of the State and
according to the established policies, procedures, practices and channels of
communication which lend support to nurse anesthesia services and which define
the role(s) and responsibilities of the qualified nurse anesthetist within the
practice setting. The individual nurse anesthetist maintains accountability
for the outcome of his or her actions.
(c) Nurse Anesthesia activities and responsibilities which
the appropriately qualified registered nurse anesthetist may safely accept are
dependent upon the individual's knowledge and skills and other variables in
each practice setting as outlined in 21 NCAC 36 .0224(a). These activities
include:
(1) Preanesthesia preparation and evaluation of
the client to include:
(A) performing a pre-operative health assessment;
(B) recommending, requesting and evaluating pertinent
diagnostic studies; and
(C) selecting and administering preanesthetic
medications.
(2) Anesthesia induction, maintenance and emergence
of the client to include:
(A) securing, preparing and providing safety checks on
all equipment, monitors, supplies and pharmaceutical agents used for the
administration of anesthesia;
(B) selecting, implementing, and managing general
anesthesia; monitored anesthesia care; and regional anesthesia modalities,
including administering anesthetic and related pharmaceutical agents,
consistent with the client's needs and procedural requirements;
(C) performing tracheal intubation, extubation and
providing mechanical ventilation;
(D) providing perianesthetic invasive and non-invasive
monitoring, recognizing abnormal findings, implementing corrective action, and
requesting consultation with appropriately qualified health care providers as
necessary;
(E) managing the client's fluid, blood, electrolyte and
acid-base balance; and
(F) evaluating the client's response during emergency
from anesthesia and implementing pharmaceutical and supportive treatment to
ensure the adequacy of client recovery from anesthesia.
(3) Postanesthesia Care of the client to
include:
(A) providing postanesthesia follow-up care, including
evaluating the client's response to anesthesia, recognizing potential anesthetic
complications, implementing corrective actions, and requesting consultation
with appropriately qualified health care professionals as necessary;
(B) initiating and administering respiratory support to
ensure adequate ventilation and oxygenation in the immediate postanesthesia
period;
(C) initiating and administering pharmacological or
fluid support of the cardiovascular system during the immediate postanesthesia
period;
(D) documenting all aspects of nurse anesthesia care and
reporting the client's status, perianesthetic course, and anticipated problems
to an appropriately qualified postanesthetic health care provider who assumes
the client's care following anesthesia consistent with 21 NCAC 36 .0224(f); and
(E) releasing clients from the postanesthesia care or
surgical setting as per established agency policy.
(d) Other clinical activities for which the qualified
registered nurse anesthetist may accept responsibility include, but are not
limited to:
(1) inserting central vascular access catheters
and epidural catheters;
(2) identifying, responding to and managing
emergency situations, including initiating and participating in cardiopulmonary
resuscitation;
(3) providing consultation related to
respiratory and ventilatory care and implementing such care according to
established policies within the practice setting; and
(4) initiating and managing pain relief therapy
utilizing pharmaceutical agents, regional anesthetic techniques and other
accepted pain relief modalities according to established policies and protocols
within the practice setting.
History Note: Authority G.S. 90-171.20(4); 90-171.20(7);
90-171.21; 90-171.23; 90-171.42(b);
Eff. July 1, 1993;
Temporary Amendment Eff. July 25, 1994 for a period of
180 days or until the permanent rule becomes effective, whichever is sooner;
Amended Eff. December 1, 2010; December 1, 1994.
21 NCAC 36 .0227 APPROVAL AND PRACTICE PARAMETERS FOR
NURSE PRACTITIONERS
History Note: Authority G.S. 90-6; 90-18(c)(13), (14);
90-18.2; 90-171.20(4); 90-171.20(7); 90-171.23(b); 90-171.36; 90-171.37;
90-171.42; 90-171.83;
Eff. January 1, 1996;
Amended Eff. August 1, 2002; July 1, 2000; May 1, 1999;
Recodified to Rules .0801-.0814 Eff. August 1, 2004.
21 NCAC 36 .0228 CLINICAL NURSE SPECIALIST PRACTICE
(a) Effective July 1, 2015, only a registered nurse who
meets the qualifications as outlined in Paragraph (b) of this Rule shall be recognized
by the Board as a clinical nurse specialist to perform advanced practice
registered nursing activities as outlined in Paragraph (f) of this Rule.
(b) The Board of Nursing shall recognize an applicant who:
(1) has an unrestricted license to practice as
a registered nurse in North Carolina or a state that has adopted the Nurse
Licensure Compact;
(2) has an unrestricted previous approval,
registration or license as a clinical nurse specialist if previously approved,
registered, or licensed as a clinical nurse specialist in another state,
territory, or possession of the United States;
(3) has successfully completed a master's or
higher degree program accredited by a nursing accrediting body approved by the
United States Secretary of Education or the Council for Higher Education
Accreditation and meets the qualifications for clinical nurse specialist
certification by an approved national credentialing body under Part (b)(4)(A)
of this Rule; and
(4) either:
(A) has current certification as a clinical nurse
specialist from a national credentialing body approved by the Board of Nursing,
as defined in Paragraph (h) of this Rule and 21 NCAC 36 .0120(26); or
(B) if no clinical nurse specialist certification is
available in the specialty, meets requirements determined by the Board to be
equivalent to national certification. The Board shall determine equivalence
based on consideration of an official transcript and course descriptions
validating Subparagraph (b)(3) of this Rule, current curriculum vitae, work history,
and professional recommendations indicating evidence of at least 1,000 hours of
clinical nurse specialist practice, and documentation of certificates
indicating 75 contact hours of continuing education applicable to clinical
nurse specialist practice during the previous five years.
(c) An applicant certified as a clinical nurse specialist
by a national credentialing body prior to January 1, 2007 and who has
maintained that certification and active clinical nurse specialist practice,
and holds a master’s or higher degree in nursing or a related field shall be
recognized by the Board as a clinical nurse specialist.
(d) New graduates seeking first-time clinical nurse
specialist recognition in North Carolina shall hold a Master's, post-master’s
or higher degree from a clinical nurse specialist program accredited by a
nursing accrediting body approved by the U.S. Secretary of Education or the
Council for Higher Education Accreditation as acceptable by the Board, and
meets all requirements in Subparagraph (b)(1) and Part (g)(5)(A) of this Rule.
(e) A clinical nurse specialist seeking Board of Nursing
recognition who has not practiced as a clinical nurse specialist in more than
two years shall complete a clinical nurse specialist refresher course approved by
the Board of Nursing in accordance with 21 NCAC 36 .0220(o) and (p) and
consisting of common conditions and their management related to the clinical
nurse specialist’s area of education and certification. A clinical nurse
specialist refresher course participant shall be granted clinical nurse
specialist recognition that is limited to clinical activities required by the
refresher course.
(f) The scope of practice of a clinical nurse specialist
incorporates the basic components of nursing practice as defined in Rule .0224
of this Section as well as the understanding and application of nursing
principles at an advanced practice registered nurse level in the area of
clinical nursing specialization in which the clinical nurse specialist is
educationally prepared and for which competency has been maintained that
includes the following:
(1) assessing clients' health status,
synthesizing and analyzing multiple sources of data, and identifying
alternative possibilities as to the nature of a healthcare problem;
(2) diagnosing and managing clients' acute and
chronic health problems within an advanced practice nursing framework;
(3) assessing for and monitoring the usage and
effect of pharmacologic agents within an advanced practice nursing framework;
(4) formulating strategies to promote wellness
and prevent illness;
(5) prescribing and implementing therapeutic
and corrective non-pharmacologic nursing interventions;
(6) planning for situations beyond the clinical
nurse specialist's expertise, and consulting with or referring clients to other
health care providers as appropriate;
(7) promoting and practicing in collegial and
collaborative relationships with clients, families, other health care
professionals and individuals whose decisions influence the health of individual
clients, families and communities;
(8) initiating, establishing and utilizing
measures to evaluate health care outcomes and modify nursing practice
decisions;
(9) assuming leadership for the application of
research findings for the improvement of health care outcomes; and
(10) integrating education, consultation,
management, leadership, and research into the clinical nurse specialist role.
(g) A registered nurse seeking recognition by the Board as
a clinical nurse specialist shall:
(1) complete the appropriate application that
shall include the following:
(A) evidence of a masters, post-master's certificate or
doctoral degree as set out in Subparagraph (b)(3) or Paragraph (d) of this
Rule; and, either
(B) evidence of current certification in a clinical
nursing specialty from a national credentialing body as set out in Part
(b)(4)(A) of this Rule; or
(C) meet requirements as set out in Part (b)(4)(B) of
this Rule;
(2) renew the recognition every two years at
the time of registered nurse renewal; and
(3) either:
(A) submit evidence of initial certification and
re-certification by a national credentialing body at the time such occurs in
order to maintain Board of Nursing recognition consistent with Paragraphs (b)
and (h) of this Rule; or
(B) if subject to Part (b)(4)(B) of this Rule, submit
evidence of at least 1,000 hours of practice and 75 contact hours of continuing
education every five years.
(h) The Board of Nursing may approve those national
credentialing bodies offering certification and recertification in a clinical
nursing specialty that have established the following minimum requirements:
(1) an unrestricted registered nurse license;
and
(2) certification as a clinical nurse
specialist shall be limited to masters, post-master's certificate, or
doctorally prepared applicant.
History Note: Authority G.S. 90-171.20(4);
90-171.20(7); 90-171.21(d)(4); 90-171.23(b); 90-171.27(b); 90-171.42(b);
Eff. April 1, 1996;
Amended Eff. January 1, 2015; April 1, 2008; January 1,
2007; November 1, 2005; August 1, 2005; April 1, 2003.
21 NCAC 36 .0229 reserved for future codification
21 NCAC 36 .0230 reserved for future codification
21 NCAC 36 .0231 EXCEPTIONS TO HEALTH CARE
PRACTITIONERS IDENTIFICATION REQUIREMENTS:
(a) The licensed nurse or nurse aide II is not required to
wear a readily visible badge or other form of identification in the following
direct patient care situations:
(1) procedures requiring full sterile dress; or
(2) procedures requiring other protective
clothing or covering.
(b) Identification of the licensed nurse or nurse aide may
be limited to first name only and level of licensure or listing status when the
full name identification may:
(1) place the personal safety of the nurse or
nurse aide II in jeopardy; or
(2) interfere with the therapeutic relationship
between the nurse or nurse aide and client(s).
(c) In all other situations involving the direct provision
of health care to clients, the licensed nurse or nurse aide II shall wear or
display a readily visible form of identification to include:
(1) the individual's first and last name; and
(2) the license, approval to practice title or
listing title as required by law, or standard abbreviations for such title.
(d) There shall be written agency policy outlining any
exceptions to the requirements consistent with Paragraph (b) of this Rule.
History Note: Authority G.S. 90-171.43;
90-171.83(a),(c); 90-178.3; 90-640(a)-(d);
Temporary Adoption Eff. April 15, 2001;
Eff. August 1, 2002.
21 NCAC 36 .0232 CONTINUING COMPETENCE
(a) Effective July 1, 2006, upon application for license
renewal or reinstatement, each licensee shall:
(1) Complete a self-assessment of practice
including the dimensions of: professional responsibility, knowledge based
practice, legal/ethical practice and collaborating with others;
(2) Develop a plan for continued learning; and
(3) Select and implement a learning activity
option from those outlined in Paragraph (b) of this Rule.
(b) Effective July 1, 2008, upon application for license
renewal or reinstatement, each licensee shall attest to having completed one of
the following learning activity options during the preceding renewal cycle and
be prepared to submit evidence of completion if requested by the Board:
(1) National Certification or re-certification
related to the nurse's practice role by a national credentialing body
recognized by the Board, consistent with 21 NCAC 36 .0120 and 21 NCAC 36 .0801;
(2) Thirty contact hours of continuing
education activities related to the nurse's practice;
(3) Completion of a Board approved refresher
course, consistent with 21 NCAC 36 .0220 and 21 NCAC 36 .0808(d);
(4) Completion of a minimum of two semester
hours of post-licensure academic education related to nursing practice;
(5) Fifteen contact hours of a continuing
education activity related to the nurse's practice and completion of a nursing
project as principal or co-principal investigator to include a statement of the
problem, project objectives, methods and summary of findings;
(6) Fifteen contact hours of a continuing
education activity related to the nurse's practice and authoring or
co-authoring a published nursing-related article, paper, book or book chapter;
(7) Fifteen contact hours of a continuing
education activity related to the nurse's practice and designing, developing,
and conducting an educational presentation or presentations totaling a minimum
of five contact hours for nurses or other health professionals; or
(8) Fifteen contact hours of a continuing education
activity related to the nurse's practice and 640 hours of active practice
within the previous two years.
(c) The following documentation shall be accepted as
evidence of completion of learning activity options outlined in Paragraph (b)
of this Rule:
(1) Evidence of national certification shall
include a copy of a certificate which includes name of licensee, name of
certifying body, date of certification, date of certification expiration.
Certification shall be initially attained during the licensure period, or have
been in effect during the entire licensure period, or have been re-certified
during the licensure period.
(2) Evidence of contact hours of continuing
education shall include the name of the licensee; title of educational
activity, name of the provider, number of contact hours and date of activity.
(3) Evidence of completion of a Board approved
refresher course shall include written correspondence from the provider with
the name of the licensee, name of the provider, and verification of successful
completion of the course.
(4) Evidence of post-licensure academic
education shall include a copy of transcript with the name of the licensee,
name of educational institution, date of attendance, name of course with grade
and number of credit hours received.
(5) Evidence of completion of a nursing project
shall include an abstract or summary of the project, the name of the licensee,
role of the licensee as principal or co-principal investigator, date of project
completion, statement of the problem, project objectives, methods used and
summary of findings.
(6) Evidence of authoring or co-authoring a
published nursing-related article, paper, book or book chapter which shall
include a copy of the publication to include the name of the licensee and
publication date.
(7) Evidence of developing and conducting an
educational presentation or presentations totaling at least five contact hours
for nurses or other health professionals shall include a copy of program
brochure or course syllabi, objectives, content and teaching methods, and date
and location of presentation.
(8) Evidence of 640 hours of active practice in
nursing shall include documentation of the name of the licensee, number of
hours worked in calendar or fiscal year, name and address of employer and
signature of supervisor. If self-employed, hours worked may be validated
through other methods such as tax records or other business records. If active
practice is of a volunteer or gratuitous nature, hours worked may be validated
by the recipient agency.
(d) A licensee shall retain supporting documentation to
provide proof of completion of the option chosen in Paragraph (b) of this Rule
throughout the renewal cycle.
(e) Effective July 1, 2008, at the time of license renewal
or reinstatement, licensees may be subject to audit for proof of compliance
with the Board's requirements for continuing competence.
(f) The Board shall inform licensees of their selection for
audit upon notice of license renewal or request for reinstatement.
Documentation of acceptable evidence shall be consistent with Paragraph (c) of
this Rule and shall be submitted to the Board no later than the last day of the
renewal month.
(g) Failure of a licensee to meet the requirements of this
Rule shall result in disciplinary action pursuant to G.S. 90-171.37 and 21 NCAC
36 .0217.
History Note: Authority G.S. 90-171.23(b); 90-171.37(1)
and (8);
Eff. May 1, 2006;
Amended Eff. November 1, 2008
21 NCAC 36 .0233 OUT OF STATE STUDENTS
(a) Unlicensed nursing students enrolled in out of state
nursing education programs who are requesting utilization of North Carolina
clinical facilities shall be allowed such experiences following approval by the
Board of Nursing. Upon receiving such a request, the chief nursing
administrator of a North Carolina clinical facility shall provide the Board
with the following at least 30 days prior to the start of the requested
experience:
(1) Letter of request for approval to provide
the clinical offering including proposed starting and completion dates;
(2) Documentation that the nursing program is
currently approved by the Board of Nursing in the state in which the parent
institution is located;
(3) Name, qualifications and evidence of
current RN licensure of the faculty responsible for coordinating the student's
experience; and
(4) Name, qualifications and evidence of
current license to practice as an RN in NC for preceptor or on-site faculty.
(b) Copies of the following shall be distributed by the
chief nursing administrator of the clinical facility to all students and
faculty involved in the clinical experiences:
(1) North Carolina Nursing Practice Act;
(2) North Carolina administrative rules and
related interpretations regarding the role of the RN, LPN, and unlicensed
nursing personnel; and
(3) North Carolina Board of Nursing developed
Suggestions for Utilization of Preceptors.
(c) Failure to continue in compliance with the requirements
in Paragraph (a) of this Rule shall result in the immediate withdrawal of the
Board's approval of the clinical offering and student status consistent with G.S.
90-171.43(2).
History Note: Authority G.S. 90-85.3; 90-171.23(b)
90-171.43; 90-171.83;
Eff. April 1, 2008.
SECTION
.0300 ‑ APPROVAL OF NURSING PROGRAMS
21 NCAC 36 .0301 APPROVAL BODY
History Note: Authority G.S. 90‑171.23(b)(8); 90‑171.23(b)(9);
90‑171.23(b)(10); 90‑171.38; 90‑171.39; 90‑171.40;
Eff. February 1, 1976;
Amended Eff. June 1, 1992; January 1, 1989; January 1,
1984;
Temporary Amendment Eff. October 11, 2001;
Repealed Eff. August 1, 2002.
21 NCAC 36 .0302 ESTABLISHMENT OF A NURSING PROGRAM ‑
INITIAL APPROVAL
(a) At least six months prior to the proposed enrollment of
students in a nursing program, an institution seeking approval to operate a
nursing program shall employ a program director qualified pursuant to 21 NCAC
36 .0317(c) to develop the application documenting the following:
(1) a narrative description of the
organizational structure of the program and its relationship to the controlling
institution, including accreditation status. The controlling institution must
be an accredited institution;
(2) a general overview of the proposed total
curriculum that includes:
(A) program philosophy, purposes, and objectives;
(B) master plan of the curriculum, indicating the
sequence for both nursing and non-nursing courses, as well as prerequisites and
corequisites;
(C) course descriptions and course objectives for all
courses; and
(D) course syllabi pursuant to 21 NCAC 36.0321(i) for
all first-year nursing courses;
(3) proposed student population;
(4) projected student enrollment;
(5) evidence of learning resources to implement
and maintain the program;
(6) financial resources adequate to begin and
maintain program;
(7) physical facilities adequate to house the
program;
(8) support services available to the program
from the institution;
(9) approval of the program by the governing
body of the parent institution; and
(10) a plan with a specified time frame for:
(A) availability of qualified faculty as specified in 21
NCAC 36 .0318;
(B) course syllabi as specified in 21 NCAC 36. 0321(h)
of this Section for all nursing courses;
(C) student policies pursuant to 21 NCAC 36 .0320 of
this Section for admission, progression, and graduation of students; and
(D) total program evaluation pursuant to 21 NCAC 36
.0317(e).
(b) The application to establish a nursing program must be
on a Board form, contain current and accurate information, be complete, and be
signed by the program director and the chief executive officer of the
controlling institution.
(c) The completed application shall be received by the
Board not less than 90 days prior to a regular meeting of the Board to be
considered on the agenda of that meeting.
(d) The Board shall conduct an on-site survey of the
proposed program and agencies and afford the petitioning institution an
opportunity to respond to the survey.
(e) The Board shall consider all evidence, including the
application, the survey report, and any testimony from representatives of the
petitioning institution in determining approval status.
(f) If the Board finds, from the evidence presented, that
the resources and plans meet all rules for establishing a new nursing program,
the Board shall grant Initial Approval including a maximum enrollment and
implementation date.
(g) If the Board determines that a proposed program does
not comply with all rules, initial approval shall be denied.
(h) Failure of the controlling institution to submit
documentation consistent with the time specified in the plan of Subparagraph
(a)(10) of this Rule shall result in Initial Approval being rescinded.
(i) Following the Initial Approval, if the first class of
students are not enrolled in the program within one year, the approval shall be
rescinded.
(j) For 12 months following rescinded approval, the
controlling institution shall not submit an application for establishing a
nursing program.
(k) A program may retain Initial Approval Status for the
time necessary for full implementation of the curriculum.
(l) Programs with Initial Approval shall be surveyed:
(1) during the final term of curriculum
implementation of the program; and
(2) when there is information that the program
may not be complying with Section .0300.
(m) If at any time it comes to the attention of the Board
that a program on initial approval is not complying with Section .0300 of this
Chapter, the program, upon written notification, shall:
(1) correct the area of noncompliance and
submit written evidence of correction to the Board; or
(2) submit and implement a plan for correction
to the Board.
(n) If the Board determines that the program does not
comply with Paragraph (m) of this Rule, Initial Approval shall be rescinded.
(o) If, following the survey during the final term for
curriculum implementation, the Boards finds that the program is complying with
Section .0300 of this Chapter, the Board shall place the program on Full
Approval status.
(p) If, following the survey during the final term for
curriculum implementation the Board finds that the program does not comply with
the Section .0300 of this Chapter, the Board shall rescind Initial Approval and
provide the program with written notice of the Board's decision.
(q) Upon written request from the program submitted within
10 business days of the Board's written notice, the Board shall schedule a
hearing within 30 business days from the date on which the request was
received.
(r) Following the hearing and consideration of all evidence
provided, the Board shall assign the program Full Approval status or shall
enter an Order rescinding the Initial Approval status, which shall constitute
closure of the program pursuant to 21 NCAC 36 .0309.
History Note: Authority G.S. 90‑171.23(b)(8); 90‑171.38;
Eff. February 1, 1976;
Amended Eff. June 1, 1992; January 1, 1989; November 1,
1984; May 1, 1982;
Temporary Amendment Eff. October 11, 2001;
Amended Eff. January 1, 2009; December 1, 2005; August 1,
2002.
21 NCAC 36 .0303 EXISTING NURSING PROGRAM
(a) All nursing programs under the authority of the Board may
obtain national program accreditation by a nursing accreditation body as
defined in 21 NCAC 36 .0120(29).
(b) Full Approval
(1) The Board shall review approved programs at
least every eight years as specified in G.S. 90-171.40. Reviews of individual
programs shall be conducted at shorter intervals upon request from the
individual institution or as considered necessary by the Board. National accreditation
self study reports shall provide basis for review for accredited programs.
(2) The Board shall send a written report of
the review no more than 20 business days following the completion of the review
process. Responses from a nursing education program regarding a review report
or Board Warning Status as referenced in Paragraph (c) of this Rule shall be
received in the Board office by the deadline date specified in the letter
accompanying the report or notification of Warning Status. If no materials or
documents are received by the specified deadline date, the Board shall act upon
the findings in the review report and testimony of the Board staff.
(3) If the Board determines that a program has
complied with the rules in this Section, the program shall be continued on Full
Approval status.
(4) If the Board determines a pattern of
noncompliance with one or more rules in this Section, a review shall be
conducted. The program shall submit to the Board a plan of compliance to
correct the identified pattern. Failure to comply with the correction plan
shall result in withdrawal of approval, constituting closure, consistent with
21 NCAC 36 .0309.
(c) Warning Status
(1) If the Board determines that a program is
not complying with the rules in this Section, the Board shall assign the
program Warning Status, and shall give written notice by certified mail to the
program specifying:
(A) the areas in which there is noncompliance;
(B) the date of notice by which the program must
comply. The maximum timeframe for compliance is two years; and
(C) the opportunity to schedule a hearing.
(2) On or before the required date of
compliance identified in this Paragraph, if the Board determines that the program
is complying with the rules in this Section, the Board shall assign the program
Full Approval Status.
(3) If the Board finds the program is not in
compliance with the rules in this Section by the date specified in Part
(c)(1)(B) of this Rule, the Board shall withdraw approval constituting closure
consistent with 21 NCAC 36 .0309.
(4) Upon written request from the program,
submitted within 10 business days of the Board's written notice of Warning
Status, the Board shall schedule a hearing within 30 business days from the
date on which the request was received.
(5) When a hearing is held at the request of
the program and the Board determines that:
(A) the program is in compliance with the rules in this
Section, the Board shall assign the program Full Approval status; or
(B) the program is not in compliance with the rules in
this Section, the program shall remain on Warning Status. A review by the
Board shall be conducted during that time.
NOTE: The Board recommends but does not require that all
nursing programs under the authority of the Board pursue and maintain national
nursing accreditation.
History Note: Authority G.S. 90-171.23(b); 90-171.38;
90-171.39; 90-171.40;
Eff. February 1, 1976;
Amended Eff. August 1, 2011; July 3, 2008; March 1, 2006;
January 1, 2004; June 1, 1992; January 1, 1989.
21 NCAC 36 .0304 ADMINISTRATION
History Note: Authority G.S. 90‑171.23(b)(8); 90‑171.38;
Eff. February 1, 1976;
Amended Eff. January 1, 1989; January 1, 1984;
Repealed Eff. June 1, 1992.
21 NCAC 36 .0305 ADMISSION
21 NCAC 36 .0306 PROGRESSION
21 NCAC 36 .0307 GRADUATION
21 NCAC 36 .0308 TRANSFER AND ADVANCED STANDING
History Note: Authority G.S. 90‑171.7;
Eff. February 1, 1976;
Repealed Eff. January 1, 1984.
21 NCAC 36 .0309 PROCESS FOR CLOSURE OF A PROGRAM
(a) When the controlling institution makes the decision to
close a nursing program, the Administration of the institution shall submit a
written plan for the discontinuation of the program to the Board.
(b) When the Board closes a nursing program, the program
director shall develop and submit to the Board a plan, for discontinuation of
the program including the transfer of students to approved programs. Closure
shall take place after the transfer of students to approved programs.
(c) The controlling institution shall notify the Board of
the arrangement for storage of permanent records.
History Note: Authority G.S. 90-171.38; 90-171.39;
90-171.40;
Eff. June 1, 1992;
Amended Eff. December 1, 2005.
21 NCAC 36 .0310 AGENCY APPROVAL PROCESS – INITIAL
SURVEY
History Note: Authority G.S. 90-171.39;
Eff. June 1, 1992;
Temporary Repeal Eff. October 11, 2001;
Repealed Eff. August 1, 2002.
21 NCAC 36 .0311 LIBRARY
21 NCAC 36 .0312 HOSPITALS AND OTHER AGENCIES
21 NCAC 36 .0313 CLINICAL
21 NCAC 36 .0314 INPATIENT FACILITIES
History Note: Authority G.S. 90‑171.7(2),(4),(5)a.,b.;
Eff. February 1, 1976;
Repealed Eff. January 1, 1984.
21 NCAC 36 .0315 FULL APPROVAL/APPROVAL WITH
STIPULATIONS
History Note: Authority G.S. 90-171.39;
Eff. June 1, 1992;
Temporary Repeal Eff. October 11, 2001;
Repealed Eff. August 1, 2002.
21 NCAC 36 .0316 SURVEYS: REPORTS: ACTIONS
History Note: Authority G.S. 90‑171.23(b)(9); 90 ‑171.40;
Eff. February 1, 1976;
Amended Eff. January 1, 1984;
Repealed Eff. January 1, 1989.
21 NCAC 36 .0317 ADMINISTRATION
(a) The controlling institution of a nursing program shall
provide those human, physical, technical, and financial resources and services
essential to support program processes, outcomes, and maintain compliance with
Section .0300 of this Chapter.
(b) A full time registered nurse qualified pursuant to
Paragraph (c) of this Rule shall have the authority for the direction of the
nursing program. This authority shall encompass responsibilities for
maintaining compliance with rules and other legal requirements in all areas of
the program. The program director shall have non-teaching time sufficient to
allow for program organization, administration, continuous review, planning, and
development.
(c) Program director in a program preparing for initial
nurse licensure shall satisfy the following requirements:
(1) hold a current unrestriced license or
multistate licensure privilege to practice as a registered nurse in North
Carolina;
(2) have two years of full-time experience as a
faculty member in a board approved nursing program;
(3) be experientially qualified to lead the
program to accomplish the mission, goals, and expected program outcomes;
(4) hold either a baccalaureate in nursing or a
graduate degree in nursing from an accredited institution. If newly employed
on or after January 1, 2016, hold a graduate degree from an accredited
institution. If newly employed on or after January 1, 2021, hold a graduate
degree in nursing from an accredited institution;
(5) prior to or within the first three years of
employment, have preparation in teaching and learning principles for adult
education, including curriculum development, implementation, and evaluation,
appropriate to assignment. This preparation may be demonstrated by one of the
following:
(A) completion of 45 contact hours of continuing
education courses;
(B) completion of a certificate program in nursing
education;
(C) nine semester hours of graduate course work;
(D) national certification in nursing education; or
(E) documentation of successful completion of
structured, individualized development activities of at least 45 contact hours
approved by the Board. Criteria for approval include content in the faculty
role within the curriculum implementation, objectives to be met and evaluated,
review of strategies for identified student population and expectations of
student and faculty performance;
(6) maintain competence in the areas of
assigned responsibility; and
(7) have current knowledge of nursing practice
for the registered nurse and the licensed practical nurse.
(d) The nursing education program shall implement, for
quality improvement, a comprehensive program evaluation that shall include the
following:
(1) students' achievement of program outcomes;
(2) evidence of program resources including
fiscal, physical, human, clinical, and technical learning resources; student
support services, and the availability of clinical sites and the viability of
those sites adequate to meet the objectives of the program;
(3) measures of program outcomes for graduates;
(4) evidence that accurate program information
for consumers is available;
(5) evidence that the head of the academic
institution and the administration support program outcomes;
(6) evidence that program director and program
faculty meet board qualifications and are sufficient in number to achieve
program outcomes;
(7) evidence that the academic institution
assures security of student information;
(8) evidence that collected evaluative data is
utilized in implementing quality improvement activities; and
(9) evidence of student participation in
program planning, implementation, evaluation, and continuous improvement.
(e) The controlling institution and the nursing education
program shall communicate information describing the nursing education program
that is accurate, complete, consistent across mediums, and accessible by the
public. The following shall be accessible to all applicants and students:
(1) admission policies and practices;
(2) policy on advanced placement, transfer of
credits;
(3) number of credits required for completion
of the program;
(4) tuition, fees, and other program costs;
(5) policies and procedures for withdrawal,
including refund of tuition or fees;
(6) grievance procedure;
(7) criteria for successful progression in the
program including graduation requirements; and
(8) policies for clinical performance.
History Note: Authority G.S. 90‑171.23(b)(8); 90‑171.38;
Eff. June 1, 1992;
Amended Eff. January 1, 2015; April 1, 2008; March 1,
2006.
21 NCAC 36 .0318 FACULTY
(a) Nursing program faculty shall include full-time and
part-time faculty members. Part-time faculty shall participate in curriculum
implementation and evaluation.
(b) Policies for nursing program faculty members shall be
consistent with those for other faculty of the institution. Variations in
these policies may be necessary due to the nature of the nursing curriculum.
(c) Fifty percent or more of the nursing faculty shall hold
a graduate degree.
(d) As of January 1, 2021, at least 80 percent of the full
time faculty shall hold a graduate degree in nursing.
(e) As of January 1, 2021, at least 50 percent of the part
time faculty shall hold a graduate degree in nursing.
(f) Hold a current unrestricted license or multistate
licensure privilege to practice as a registered nurse in North Carolina.
(g) Full-time and part-time nurse faculty who teach in a
program leading to initial licensure as a nurse shall:
(1) hold either a baccalaureate in nursing or a
graduate degree in nursing from an accredited institution;
(2) have two calendar years or the equivalent
of full time clinical experience as a registered nurse;
(3) if newly employed in a full time faculty
position on or after January 1, 2016, hold a graduate degree from an accredited
institution, or obtain a graduate degree in nursing from an accredited
institution within five years of initial full time employment;
(4) prior to or within the first three years of
employment, have preparation in teaching and learning principles for adult
education, including curriculum development, implementation, and evaluation,
appropriate to assignment. This preparation may be demonstrated by one of the
following:
(A) completion of 45 contact hours of continuing
education courses;
(B) completion of a certificate program in nursing
education;
(C) nine semester hours of graduate course work;
(D) national certification in nursing education; or
(E) documentation of successful completion of
structured, individualized development activities of at least 45 contact hours
approved by the Board. Criteria for approval include content in the faculty
role within the curriculum implementation, objectives to be met and evaluated,
review of strategies for identified student population and expectations of
student and faculty performance;
(5) maintain competence in the areas of
assigned responsibility; and
(6) have current knowledge of nursing practice
for the registered nurse and the licensed practical nurse.
(h) Interdisciplinary faculty who teach in nursing program
courses shall have academic preparation in the content area they are teaching.
(i) Clinical preceptors shall have competencies, assessed
by the nursing program, related to the area of assigned clinical teaching
responsibilities and serve as role models to the student. Clinical preceptors
may be used to enhance faculty-directed clinical learning experiences after a
student has received basic instruction for that specific learning experience.
Clinical preceptors shall hold a current, unrestricted license to practice as a
registered nurse in North Carolina.
(j) Nurse faculty members shall have the authority and
responsibility for:
(1) student admission, progression, and graduation
requirements; and
(2) the development, implementation, and
evaluation of the curriculum.
(k) Nurse faculty members shall be academically qualified
and sufficient in number to implement the curriculum as demanded by the course
objectives, the levels of the students, the nature of the learning environment,
and to provide for teaching, supervision and evaluation.
(l) The faculty-student ratio for faculty directed
preceptor clinical experiences shall be no larger than 1:15. The
faculty-student ratio for all other clinical experiences shall be no larger
than 1:10.
History Note: Authority G.S. 90-171.23(b)(8);
90-171.38; 90-171.83;
Eff. February 1, 1976;
Amended Eff. January 1, 2015; August 1, 2011; November 1,
2008; July 1, 2006; July 1, 2000; January 1, 1996; June 1, 1992; January 1,
1989; January 1, 1984.
21 NCAC 36 .0319 NURSING PROGRAMS IN NON‑COMPLIANCE
History Note: Authority G.S. 90‑171.40;
Eff. May 1, 1982;
Amended Eff. November 1, 1984;
Repealed Eff. November 1, 1989.
21 NCAC 36 .0320 STUDENTS
(a) Students in nursing programs shall meet requirements
established by the controlling institution. Additional requirements may be
stipulated by the nursing program for students because of the nature and legal
responsibilities of nursing education and nursing practice.
(b) Admission requirements and practices shall be stated
and published in the controlling institution's publications and shall include
assessment of:
(1) record of high school graduation,
high-school equivalent, or earned credits from a post-secondary institution;
(2) achievement potential through the use of
previous academic records and pre-entrance examination cut-off scores that are
consistent with curriculum demands and scholastic expectations; and
(3) physical and emotional health that would
provide evidence that is indicative of the applicant's ability to provide safe
nursing care to the public.
(c) The number of students enrolled in nursing courses
shall not exceed the maximum number approved by the Board as defined in 21 NCAC
36 .0302(f) and 21 NCAC 36 .0321(k) by more than 10 students.
(d) The nursing program shall publish policies in nursing
student handbook and college catalog that provide for identification and
dismissal of students who:
(1) present physical or emotional problems
which conflict with safety essential to nursing practice and do not respond to
treatment or counseling within a timeframe that enables meeting program
objectives.
(2) demonstrate behavior which conflicts with
safety essential to nursing practice.
(e) The nursing program shall maintain a three year average
at or above 95 percent of the national pass rate for licensure level pass rate
on first writing of the licensure examination for calendar years ending
December 31.
(f) The controlling institution shall publish policies in
nursing student handbook and college catalog for transfer of credits or for
admission to advanced placement and the nursing program shall determine the
total number of nursing courses or credits awarded for advanced placement.
History Note: Authority G.S. 90‑171.23(b)(8); 90‑171.38;
90-171.43;
Eff. February 1, 1976;
Amended Eff. January 1, 2006; August 1, 1998; January 1,
1996; June 1, 1992; January 1, 1989; January 1, 1984.
21 NCAC 36 .0321 CURRICULUM
(a) Nursing program curriculum shall:
(1) be planned by nursing program faculty;
(2) reflect the stated program philosophy,
purposes, and objectives pursuant to 21 NCAC 36 .0302(a)(2);
(3) be consistent with the Statutes and Rules
governing the practice of nursing;
(4) define the level of performance required to
pass each course in the curriculum;
(5) enable the student to develop the nursing
knowledge, skills and competencies necessary for the level, scope and all
applicable Rules as defined in 21 NCAC 36 .0221, .0224, .0225, and .0231
consistent with the level of licensure; and
(6) include content in the biological,
physical, social and behavioral sciences to provide a foundation for safe and
effective nursing practice.
(b) Didactic content and supervised clinical experience
appropriate to program type shall include:
(1) Using informatics to communicate, manage
knowledge, mitigate error and support decision making,
(2) Employing evidence-based practice to
integrate best research with clinical expertise and client values for optimal
care, including skills to identify and apply best practices to nursing care by:
(A) providing client-centered, culturally competent
care;
(B) respecting client differences, values, preferences
and expressed needs;
(C) involving clients in decision-making and care
management;
(D) coordinating and managing continuous client care
consistent with the level of licensure. This includes demonstration of the
ability to supervise others and provide leadership of the profession
appropriate for program type; and
(E) promoting healthy lifestyles for clients and
populations.
(3) Working in interdisciplinary teams to
cooperate, collaborate, communicate and integrate client care and health
promotion.
(4) Participating in quality improvement
processes to measure client outcomes, identify hazards and errors, and develop
changes in processes of client care.
(c) Clinical experience shall be comprised of sufficient
hours to accomplish the curriculum, shall be supervised by qualified faculty
pursuant to 21 NCAC 36 .0318 and shall ensure students' ability to practice at
an entry level.
(d) All student clinical experiences, including those with
preceptors, shall be directed by nursing faculty.
(e) By January 1, 2008, a focused client care experience
with a minimum of 120 hours shall be provided in the final year of curriculum
implementation for programs preparing registered nurses.
(f) Beginning January 1, 2008, a focused client care
experience with a minimum of 90 hours shall be provided in the final semester
of curriculum implementation for programs preparing practical nurses.
(g) Learning experiences and methods of instruction,
including distance education methods, shall be consistent with the written
curriculum plan and demonstrate logical progression.
(h) Objectives for each course shall indicate the knowledge
and skills expected of the students. These objectives shall be stated to:
(1) indicate the relationship between the
classroom learning and the application of this learning in the clinical
laboratory experience;
(2) serve as criteria for the selection of the
types of and settings for learning experiences; and
(3) serve as the basis for evaluating student
performance.
(i) Student course syllabi shall include a description and
outline of content, learning environments and activities, course placement,
allocation of time, and methods of evaluation of student performance, including
clinical evaluation tools.
(j) Each course shall be implemented in accordance with the
student course syllabus.
(k) Requests for approval of changes in, or expansion of,
the program accompanied by all required documentation shall be submitted on the
form provided by the Board at least 30 days prior to implementation for
approval by the Board. Criteria for approval include the availability of
classrooms, laboratories, clinical placements, equipment and supplies and
faculty sufficient to implement the curriculum to an increased number of
students. Approval is required: for any increase in enrollment that exceeds,
by more than 10 students, the maximum number approved by the Board. Requests
for expansion are considered only for programs with Full Approval status that
demonstrate at least a three-year average student retention rate equal to or
higher than the state average retention rate for program type.
(l) The nursing education program shall notify the Board
of:
(1) alternative or additional program
schedules; and
(2) planned decrease in the Board-approved
student enrollment number to accurately reflect program capacity.
History Note: Authority G.S. 90‑171.23(b)(8); 90‑171.38;
Eff. February 1, 1976;
Amended Eff. June 1, 1992; January 1, 1989; January 1,
1984;
Temporary Amendment Eff. October 11, 2001;
Amended Eff. December 1, 2005; August 1, 2002.
21 NCAC 36 .0322 FACILITIES
(a) Campus facilities shall be appropriate in
type, number, and accessibility for the total needs of the program.
(b) Classrooms,
laboratories, and conference rooms shall be sufficient in size, number, and
types for the number of students and purposes for which the rooms are to be
used. Lighting, ventilation, location, and equipment must be suitable for the
number of students and purposes for which the rooms are to be used.
(c) Office and conference space for nursing
program faculty members shall be appropriate and available for uninterrupted
work and privacy including conferences with students.
(d) Learning resources, including clinical
experiences, shall be comprehensive, current, developed with nursing faculty
input, accessible to students and faculty and support the implementation of the
curriculum.
History Note: Authority G.S. 90‑171.23(b)(8); 90‑171.38;
Eff. February 1, 1976;
Amended Eff. January 1, 1996; June 1, 1992; January 1,
1989; May 1, 1988;
Temporary Amendment Eff. October 11, 2001;
Amended Eff. April 1, 2006; August 1, 2002.
21 NCAC 36 .0323 RECORDS AND REPORTS
(a) The controlling institution's publications describing
the nursing program shall be accurate.
(b) There shall be a system for maintaining official
records. Current and permanent student records shall be stored in a secure
manner that prevents physical damage and unauthorized access.
(c) Both permanent and current records shall be available
for review by Board staff.
(d) The official permanent record for each graduate shall
include documentation of graduation from the program and a transcript of the
individual's achievement in the program.
(e) The record for each enrolled student shall contain up‑to‑date
and complete information, including the following:
(1) documentation of admission criteria met by
the student;
(2) high school graduation, high school
equivalent, or earned credits from post‑secondary institution approved
pursuant to G.S. 90-171.38(a); and
(3) transcript of credit hours achieved in the
classroom, laboratory, and clinical instruction for each course that reflects
progression consistent with program policies.
(f) The nursing program shall file with the Board records,
data, and reports in order to furnish information concerning operation of the
program as prescribed in the rules in this Section including:
(1) an Annual Report to be filed with the Board
by November 1 of each year;
(2) a Program Description Report for
non-accredited programs filed with the Board at least 30 days prior to a
scheduled review; and
(3) notification by institution administration
of any change of the registered nurse responsible for the nursing program.
This notification shall include a vitae for the new individual and shall be
submitted within 20 business days of the effective date of the change.
(g) All communications relevant to accreditation shall be
submitted to the North Carolina Board of Nursing at the same time the
communications are submitted to the accrediting body.
(h) The Board may require additional records and reports
for review at any time to provide evidence and substantiate compliance with the
rules in this Section by a program and its associated agencies.
(i) The part of the application for licensure by
examination to be submitted by the nursing program shall include a statement
verifying satisfactory completion of all requirements for graduation and the
date of completion. The nursing program director shall submit the verification
form to the Board within one month following completion of the program.
History Note: Authority G.S. 90‑171.23(b)(8); 90‑171.38;
Eff. February 1, 1976;
Amended Eff. January 1, 2015; December 1, 2005; January
1, 2004; June 1, 1992; January 1, 1989; January 1, 1984.
21 NCAC 36 .0324 EXPERIMENTAL APPROACHES
History Note: Authority G.S. 90‑171.23(b)(8); 90‑171.38;
Eff. January 1, 1984;
Amended Eff. June 1, 1992; January 1, 1989;
Repealed Eff. December 1, 2005.
21 NCAC 36 .0325 REMOVAL OF APPROVAL
History Note: Authority G.S. 90-171.23(b); 90-171.38;
90-171.39; 90-171.40; 90-171.42(b);
Eff. October 1, 1992;
Temporary Repeal Eff. October 11, 2001;
Repealed Eff. August 1, 2002.
SECTION .0400 ‑ UNLICENSED PERSONNEL: NURSE AIDES
21 NCAC 36 .0401 ROLES OF UNLICENSED PERSONNEL
(a)
Definitions. As used in Section .0400:
(1) "Nursing
care activities" means activities performed by unlicensed personnel which
are delegated by licensed nurses in accordance with paragraphs (b) and (c) of
this Rule.
(2) "Patient
care activities" means activities performed by unlicensed personnel when
health care needs are incidental to the personal care required.
(b) The Board
of Nursing, as authorized by G.S. 90-171.23(b)(1)(2)(3), shall be the
determining authority to identify those nursing care activities which may be
delegated to unlicensed personnel. The licensed nurse, registered and
practical, in accordance with 21 NCAC 36 .0224 and .0225 and G.S.
90-171.20(7)(8), may delegate nursing care activities to unlicensed personnel,
regardless of title, that are appropriate to the level of knowledge and skill
of the unlicensed personnel and are within the legal scope of practice as
defined by the Board of Nursing for unlicensed personnel.
(c) Those
activities which may be delegated to unlicensed personnel are determined by the
following variables:
(1) knowledge
and skills of the unlicensed personnel;
(2) verification
of clinical competence of the unlicensed personnel by the employing agency;
(3) stability
of the client's condition which involves predictability, absence of risk of
complication, and rate of change, which thereby excludes delegation of nursing
care activities which do not meet the requirements defined in 21 NCAC 36
.0221(b);
(4) the
variables in each service setting which include but are not limited to:
(A) the
complexity and frequency of nursing care needed by a given client population;
(B) the
proximity of clients to staff;
(C) the number
and qualifications of staff;
(D) the
accessible resources; and
(E) established
policies, procedures, practices, and channels of communication which lend
support to the types of nursing activities being delegated, or not delegated,
to unlicensed personnel.
History Note: Authority G.S. 90‑171.20(2)(4)(7)d.,e.,g.;
90‑171.43(4); 90‑171.55;
42 U.S.C.S. 1395i‑3 (1987);
Eff. March 1, 1989;
Amended Eff. December 1, 1995; October 1, 1991.
21 NCAC 36 .0402 COORDINATION WITH DIVISION OF HEALTH
SERVICE REGULATION (dhsr)
(a) The Board of Nursing shall accept Level I nurse aides
listed on the Division of Health Service Regulation (DHSR) maintained Nurse
Aide Registry as meeting the requirements of 21 NCAC 36 .0403(a).
(b) The Board of Nursing shall acquire information from the
Division of Health Service Regulation (DHSR) regarding all qualified Level I
nurse aides.
History Note: Authority G.S. 90‑171.20(2)(4)(7)d.,e.,g.;
90‑171.43(4); 90‑171.55;
42 U.S.C.S. 1395i‑3 (1987);
Eff. March 1, 1989;
Amended Eff. November 1, 2008; December 1, 1995.
21 NCAC 36 .0403 QUALIFICATIONS
(a) The nurse aide I shall perform basic nursing skills and
personal care activities after successfully completing an approved nurse aide I
training and competency evaluation or competency evaluation program. The
licensed nurse shall delegate these activities only after considering the
variables defined in Rule .0401(b) and (c) of this Section. Pursuant to G.S.
90-171.55, as of April 1, 1992 no individual may function as a nurse aide I,
regardless of title, to provide nursing care activities, as identified in Rule
.0401(a) of this Section, to clients or residents until:
(1) the individual has successfully completed,
in addition to an orientation program specific to the employing facility, a
State approved nurse aide I training and competency evaluation program or its
equivalent; or a State approved competency evaluation program and the employing
facility or agency has verified listing on the Division of Health Service
Regulation Nurse Aide Registry (DHSRNAR); or
(2) the employing agency or facility has
assured that the individual is enrolled in a State approved nurse aide I
training and competency evaluation program which the individual shall
successfully complete within four months of employment date. During the four
month period, the individual shall be assigned only tasks for which he has
demonstrated competence and performs under supervision.
(b) The nurse aide II shall perform more complex nursing
skills with emphasis on sterile technique in elimination, oxygenation, and
nutrition after successful completion of an approved nurse aide II training and
competency evaluation program. The licensed nurse shall delegate these
activities to the nurse aide II only after consideration of the variables
described in Rule .0401(b) and (c) of this Section. Pursuant to G.S.
90-171.55, as of January 1, 1991 no individual may function as a nurse aide II
unless:
(1) the individual has successfully completed,
in addition to an orientation program specific to the employing agency, a nurse
aide II program approved by the Board of Nursing according to these Rules or
its equivalent as identified by the Board of Nursing;
(2) the individual is listed as a nurse aide I
on the DFS Nurse Aide I Registry with no substantiated findings of abuse, neglect,
or misappropriation of property; and
(3) the employing facility or agency has
inquired of the Board of Nursing as to information in the Board of Nursing
Nurse Aide II Registry concerning the individual and confirms with the Board of
Nursing that the individual is listed on the Board of Nursing Nurse Aide II
Registry (BONNAR) as a nurse aide Level II.
(c) Listing on a Nurse Aide Registry is not required if the
care is performed by clients themselves, their families or significant others,
or by caretakers who provide personal care to individuals whose health care
needs are incidental to the personal care required.
(d) Pursuant to G.S. 131E-114.2 and G.S. 131E-270, the
medication aide shall be limited to performing technical aspects of medication
administration consistent with Rule .0401(b) and (c) of this Section, Rule
.0221 of this Chapter, and only after:
(1) successful completion of a medication aide
training program approved by the Board of Nursing;
(2) successful completion of a state-approved
competency evaluation program; and
(3) listing on the Medication Aide Registry.
History Note: Authority G.S. 90‑171.20(2)(4)(7)d.,e.,g.;
90‑171.43(4); 90‑171.55; 90-171.56; 131E-114.2; 131E-270; 42U.S.C.S.
1395i-3 (1987);
Eff. March 1, 1989;
Temporary Amendment Eff. October 11, 1989 For a Period of
180 Days to Expire on April 6, 1990;
Amended Eff. September 1, 2006; December 1, 1995; March
1, 1990.
21 ncac 36 .0404 LISTING AND RENEWAL
(a) All nurse aide IIs, as defined in Rule .0403(b) of this
Section, regardless of working title, employed or assigned in a service agency
or facility for the purpose of providing nursing care activities shall be listed
on the Board of Nursing Nurse Aide II Registry and shall meet the following
requirements:
(1) successful completion of a nurse aide II
program or its Board approved equivalent;
(2) GED or high school diploma;
(3) listed as a Level I nurse aide on the DHSR
Nurse Aide Registry with no substantiated findings of abuse, neglect, or
misappropriation of property; and
(4) submission of an application to the Board
of Nursing for placement on the Board of Nursing Nurse Aide II Registry prior
to working as a nurse aide II.
The application shall be submitted with the required fee
within 30 business days of completion of the nurse aide II program.
Application for initial listing received in the Board office shall show an
expiration day of the last day of the birth month of the following year.
(b) Nursing students currently enrolled in Board of Nursing
approved nursing programs desiring listing as a nurse aide II shall submit:
(1) An application fee; and
(2) A listing form completed by the nursing
program director indicating successful completion of course work equivalent in
content and clinical hours to that required for a nurse aide II.
(c) Registered nurses and licensed practical nurses who
hold current, unrestricted licenses to practice in North Carolina, and registered
nurses and licensed practical nurses in the discipline process by the Board of
Nursing who do not have any findings as cited in G.S. 131E-256(a)(1) may make
application as a nurse aide II.
(d) An individual previously enrolled in a Board approved
nursing program leading to licensure as RN or LPN may list with no additional
testing provided the student withdrew from school in good standing within the
last 24 months and completed the equivalent content and clinical hours. Such
individual shall submit listing form as described in Paragraph (b)(2) of this
Rule. If the student was in good standing upon withdrawal from the school and
withdrew from the school in excess of 24 months, the student must complete an
entire nurse aide II program.
(e) Individuals who have completed a training course
equivalent in content and clinical hours to the nurse aide II program, may
submit documentation of same to the Board of Nursing for review. If training
is equivalent, the individual may submit the application with required fee and
be listed on the Board of Nursing Nurse Aide Registry as a nurse aide II.
(f) An employing agency or facility may choose up to four
nurse aide II tasks to be performed by nurse aide I personnel without the nurse
aide I completing the entire nurse aide II program. These tasks are individual
activities which may be performed after the nurse aide has received the
approved training and competency evaluation as defined in Rule .0403(b) of this
Section.
(1) The agency may obtain the selected tasks
curriculum model from the nearest Community College or the Board of Nursing.
(2) The Board of Nursing must be notified of
the nurse aide II task(s) that will be performed by nurse aide I personnel in
the agency and for which all Board stipulations have been met. The
notification of nurse aide II task(s) form which may be requested from the
Board office shall be used. Each agency shall receive a verification letter
once the Board has been appropriately notified.
(3) Documentation of the training and
competency evaluation must be maintained for each nurse aide I who is approved
to perform nurse aide II task(s) within the agency.
(g) Each nurse aide II shall renew listing with the Board
of Nursing biennially on forms provided by the Board. The renewal application
shall be accompanied by the required fee.
(1) To be eligible for renewal, the nurse aide
II must have worked at least eight hours for compensation during the past 24
months performing nursing care activities under the supervision of a Registered
Nurse.
(2) Any nurse aide II who has had a continuous
period of 24 months during which no nursing care activities were performed for
monetary compensation but who has performed patient care activities for
monetary compensation shall successfully complete the competency evaluation
portion of the nurse aide II program and submit application in order to be
placed on the Board of Nursing Nurse Aide II Registry.
(3) A nurse aide II who has performed no
nursing care or patient care activities for monetary compensation within the
past 24 months must successfully complete a nurse aide II program prior to
submitting the application for renewal.
(4) A nurse aide II who has substantiated
findings of abuse, neglect, or misappropriation of funds on the DHSR Nurse Aide
Registry shall not be eligible for renewal as a nurse aide II.
History Note: Authority G.S. 90-171.19;
90-171.20(2)(4)(7)d,e,g; 90-171.37; 90-171.43(4); 90-171.55; 90-171.83; 42
U.S.C.S. 1395i-3 (1987);
Eff. March 1, 1989;
Amended Eff. July 1, 2010; November 1, 2008; August 1,
2005; August 1, 2002; July 1, 2000; December 1, 1995; April 1, 1990.
21 NCAC 36 .0405 APPROVAL OF NURSE AIDE EDUCATION
PROGRAMS
(a) The Board of Nursing shall accept those programs
approved by DHSR to prepare the nurse aide I.
(b) The North Carolina Board of Nursing shall approve nurse
aide II programs. Nurse aide II programs may be offered by an individual,
agency, or educational institution after the program is approved by the Board.
(1) Each entity desiring to offer a nurse aide
II program shall submit a program approval application at least 60 days prior
to offering the program. It shall include documentation of the following
standards:
(A) students will be supervised by qualified faculty as
defined in Subparagraph (b)(3) of this Rule for clinical experience with
faculty/student ratio not to exceed 1:10;
(B) the selection and utilization of clinical facilities
must support the program curriculum as outlined in Subparagraph (b)(2) of this
Rule;
(C) a written contract shall exist between the program
and clinical facility prior to student clinical experience in the facility;
(D) admission requirements shall include:
(i) successful completion of nurse aide I training
program or Board of Nursing established equivalent and current nurse aide I
listing on DHSR Registry; and
(ii) GED or high school diploma; and
(iii) other admission requirements as identified by
the program; and
(E) a procedure for timely processing and disposition
of program and student complaints shall be established.
(2) Level II nurse aide programs shall include
a minimum of 80 hours of theory and 80 hours of supervised clinical instruction
consistent with the legal scope of practice as defined by the Board of Nursing
in Rule .0403(b) of this Section. Changes made by the Board of Nursing in
content hours or scope of practice in the nurse aide II program shall be
published in the Bulletin. Requests by the programs to modify the nurse aide
II course content shall be directed to the Board office.
(3) Minimum competency and qualifications for
faculty for the nurse aide Level II programs shall include:
(A) a current unrestricted license to practice as a
registered nurse in North Carolina;
(B) have had at least two years of direct patient care
experiences as an R.N.; and
(C) have experience teaching adult learners.
(4) Each nurse aide II program shall furnish the
Board records, data, and reports requested by the Board in order to provide
information concerning operation of the program and any individual who
successfully completes the program.
(5) When an approved nurse aide II program
closes, the Board shall be notified in writing by the program. The Board shall
be informed as to permanent storage of student records.
(c) An annual program report shall be submitted by the
Program Director to the Board of Nursing on a Board form by March 15 of each
year. Failure to submit annual report shall result in administrative action
affecting approval status as described in Paragraphs (d) and (e) of this Rule.
Complaints regarding nurse aide II programs may result in an on site survey by
the North Carolina Board of Nursing.
(d) Approval status shall be determined by the Board of
Nursing using the annual program report, survey report and other data submitted
by the program, agencies, or students. The determination shall result in full
approval or approval with stipulations.
(e) If stipulations have not been met as specified by the
Board of Nursing, a hearing shall be held by the Board of Nursing regarding
program approval status. A program may continue to operate while awaiting the
hearing before the Board. EXCEPTION: In the case of summary suspension of
approval as authorized by G.S. 150B-3(c), the program must immediately cease
operation.
(1) When a hearing is scheduled, the Board
shall cause notice to be served on the program and shall specify a date for the
hearing to be held not less than 20 days from the date on which notice is
given.
(2) If the Board determines from evidence
presented at hearing that the program is complying with all federal and state
law including these Rules, the Board shall assign the program Full Approval
status.
(3) If the Board, following a hearing, finds
that the program is not complying with all federal and state law including
these Rules, the Board shall withdraw approval.
(A) This action constitutes discontinuance of the
program; and
(B) The parent institution shall present a plan to the
Board for transfer of students to approved programs or fully refund tuition
paid by the student. Closure shall take place after the transfer of students
to approved programs within a time frame established by the Board; and
(C) The parent institution shall notify the Board of the
arrangements for storage of permanent records.
History Note: Authority G.S.
90-171.20(2)(4)(7)d.,e.,g.; 90-171.39; 90-171.40; 90-171.43(4); 90-171.55; 90-171.83;
42 U.S.C.S. 1395i-3 (1987);
Eff. March 1, 1989;
Amended Eff. November 1, 2008; April 1, 2003; August 1,
2002; July 1, 2000; December 1, 1995; March 1, 1990;
21 NCAC 36 .0406 MEDICATION AIDE TRAINING
REQUIREMENTS
(a) Faculty for the medication aide training program are
required to:
(1) have a current, unrestricted license to
practice as a registered nurse in North Carolina;
(2) have had at least two years of practice
experience as a registered nurse that includes medication administration;
(3) have successfully completed an instructor
training program approved by the Board according to these Rules; and
(4) maintain Board of Nursing certification as
a medication aide instructor.
(b) The medication aide instructor certification shall be
renewed every two years provided the following requirements are met:
(1) the individual has taught at least one
medication aide training program within the preceding two years; and
(2) the individual successfully completes a
review program approved by the Board according to these Rules.
(c) The applicant for a medication aide training program
approved by the Board must have a high school diploma or GED.
History Note: Authority G.S. 90-171.56; 131E-114.2;
131E-270;
Eff. September 1, 2006;
Amended Eff. April 1, 2008.
SECTION .0500 ‑ PROFESSIONAL CORPORATIONS
21 NCAC 36 .0501 Purpose AND DEFINITIONS
(a) The purpose of the rules in this Section is to adopt
rules supplementing or clarifying Chapter 55B of the General Statutes for
professional corporations whose purpose is the provision of nursing and related
services.
(b) The following definitions shall apply throughout this
Section:
(1) "Board" means the North Carolina
Board of Nursing.
(2) "Nursing and Related Services"
means those activities through which nursing, as defined in G.S. 90‑171.20(4),
is practiced.
(3) "Licensee" means any individual
who is duly licensed to practice nursing in North Carolina as a registered
nurse.
(4) "Professional Corporation" means
professional corporations organized for the purpose of providing
nursing related services in North Carolina.
(5) "Director" means the Executive
Director of the North Carolina Board of Nursing.
History Note: Authority G.S. 55B‑2; 55B‑12;
90-171.20(6); 90-171.23
Eff. March 1, 1991;
Amended Eff. November 1, 2008
21 NCAC 36 .0502 NAME OF PROFESSIONAL CORPORATION
The following requirement, in addition to the provisions of
Chapter 55B, the Professional Corporation Act of North Carolina, must be met
regarding the corporate name:
The name of the professional corporation referred to herein
shall not include any adjectives or words not in accordance with ethical
customs of the nursing profession.
History Note: Authority G.S. 55B‑5; 55B‑12;
90‑171.43;
Eff. March 1, 1991.
21 NCAC 36 .0503 PREREQUISITES FOR INCORPORATION
The following requirements must be met in order to
incorporate:
(1) The incorporator, whether one or more, of a
professional corporation shall be licensed to practice nursing in North Carolina as a registered nurse.
(2) Before the filing of the articles of incorporation
with the Secretary of State, the incorporators shall file, with the Board, the
original articles of incorporation, plus a copy, together with a registration
fee of fifty dollars ($50.00).
(3) The original articles of incorporation and the copy
shall be accompanied by an application to the Board (Corp. Form 1) certified by
all incorporators, setting forth the names, addresses, and certificate numbers
of each shareholder of the corporation who will be practicing nursing for the
corporation.
(4) Included with the above shall be a statement that
all such persons are licensed to practice nursing in North Carolina as
registered nurses, and stating that the corporation will be conducted in
compliance with the Professional Corporation Act and these Rules.
(5) If the articles are changed in any manner before
being filed with the Secretary of State, they shall be re‑submitted to
the Board and shall not be filed with the Secretary of State until approved by
the Board.
History Note: Authority G.S. 55B‑4; 55B‑10;
55B‑12; 90‑171.20(6);
Eff. March 1, 1991;
Amended Eff. April 1, 2009.
21 NCAC 36 .0504 CERTIFICATE OF REGISTRATION
The Certificate of Registration shall be issued as follows:
(1) The Board shall issue a Certificate of Registration
(Corp. Form 2) for the professional corporation to become effective only when
the professional corporation files the articles of incorporation with the
Secretary of State and if:
(a) the Board finds that no disciplinary action
is pending before the Board against any of the licensed incorporators or
persons who will be directors, officers, or shareholders of such corporation;
and
(b) it appears to the Board that such
corporation will be conducted in compliance with the law and rules.
(2) The proposed original articles of incorporation,
and the Certification of Registration, will be returned to the incorporators
for filing with the Secretary of State. A copy of the articles of
incorporation and a copy of the Certificate of Registration will be retained in
the Board office. If the required findings cannot be made, the registration
fee shall be refunded to the incorporators.
(3) The initial Certificate of Registration shall
remain in effect until December 31, of the year in which it was issued unless
suspended or terminated as provided by law. The Certificate of Registration
shall be renewed annually thereafter.
(4) At least 20 days prior to the date of expiration of
the certificate, the corporation shall submit its written application for
renewal on a form provided by the Board (Corp. Form 3), along with a check in
the amount of twenty‑five dollars ($25.00) in payment of the renewal fee.
History Note: Authority G.S. 55B‑12; 90‑171.20(6);90-171.23;
Eff. April 1, 1991;
Amended Eff. November 1, 2008.
21 NCAC 36 .0505 GENERAL AND ADMINISTRATIVE
PROVISIONS
The following general provisions shall apply to all
incorporating professional corporations:
(1) If the Board declines to issue a Certificate of
Registration required by 21 NCAC 36 .0504 (a)(1), or declines to renew the same
when properly requested, or refuses to take any other required action, the
aggrieved party may request, in writing, a review of such action by the Board,
and the Board shall provide a formal hearing for such aggrieved party before a
majority of the Board.
(2) All amendments to charters of professional
corporations, all merger and consolidation agreements to which a professional
corporation is a party, and all dissolution proceedings and similar changes in
the corporate structure of a professional corporation shall be filed with the
Board for approval before being filed with the Secretary of State. A true copy
of the changes filed with the Secretary of State shall be filed with the Board
within ten days after filing with the Secretary of State.
(3) The Board is authorized to issue the certificate
(Corp. Form 4) required by G.S. 55B‑6 when stock is transferred in a
professional corporation, and such certificate shall be permanently attached to
the stub of the transferee's certificate in the stock book of the professional
corporation.
History Note: Authority G.S. 55B‑6; 55B‑12;
90-171.23;
Eff. April 1, 1991;
Amended Eff. November 1, 2008.
21 NCAC 36 .0506 FORMS
The following forms may be obtained from the office of the
Board of Nursing regarding professional corporations:
(1) Rules adopted by the North Carolina Board
of Nursing relating to Professional Corporations whose purpose is providing
nursing related services;
(2) Corp. Form 1 ‑ Certificate of
Incorporator(s) and Application for a Certificate of Registration for a
Professional Corporation;
(3) Corp. Form 2 ‑ Certificate of
Registration of a Professional Corporation for the Purpose of Providing Nursing
Related Services;
(4) Corp. Form 3 ‑ Application for
Renewal of Certificate of Registration; and
(5) Corp. Form 4 ‑ Certificate
Authorizing Transfer of Stock in Professional Corporation Organized to Provide
Nursing Related Services.
History Note: Authority G.S. 55B‑12; 90-171.23;
Eff. March 1, 1991;
Amended Eff. November 1, 2008.
21 NCAC 36 .0507 FEES
(a) Initial registration fee of fifty dollars ($50.00) is
required.
(b) Fee for renewal of Certificate of Registration is
twenty‑five dollars ($25.00).
History Note: Authority G.S. 55B‑10; 55B‑11;
55B‑12;
Eff. April 1, 1991.
SECTION .0600 - ARTICLES OF ORGANIZATION
21 NCAC 36 .0601 NAME OF LIMITED LIABILITY COMPANY
The name of a limited liability company for the purpose of
providing nursing and related services shall not include any adjectives or
other words not in accordance with ethical customs of the nursing profession.
History Note: Authority G.S. 55B-10; 57C-2-30;
Eff. August 1, 1998.
21 NCAC 36 .0602 PREREQUISITES FOR ORGANIZATION
(a) Before filing the articles of organization for a
limited liability company with the Secretary of State, the organizing members
shall submit the following to the Board:
(1) a registration fee as set by Rule .0606 of
this Section; and
(2) a certificate certified by those registered
nurse organizing members, setting forth the names, addresses, and license
numbers of each person who will be employed by the limited liability company to
practice nursing and related services as specified in G.S. 55B14(c)(2), (4) -
(6), and stating that all such persons are duly licensed to practice nursing in
North Carolina, and representing that the company will be conducted in
compliance with law and these Rules.
(b) A certification that each of those organizing members
who may provide nursing and related services as specified in G.S. 55B-14(c)(2),
(4) - (6) is licensed to practice nursing in North Carolina shall be returned
to the limited liability company for filing with the Secretary of State.
History Note: Authority G.S. 55B-4; 55B-10; 55B-12;
55B-14; 57C-2-01; 90-171.23;
Eff. August 1, 1998;
Amended Eff. November 1, 2008.
21 NCAC 36 .0603 CERTIFICATE OF REGISTRATION
(a) A Certificate of Registration for a Limited Liability
Company shall remain effective until December 31 of the year in which it was
issued unless suspended or terminated as provided by law.
(b) A Certificate of Registration shall be renewed annually
on application forms supplied by the Board. The application shall be
accompanied by a renewal fee as set by Rule .0605 of this Section.
History Note: Authority G.S. 55B-10; 55B-11; 57C-2-01;
90-171.23;
Eff. August 1, 1998;
Amended Eff. November 1, 2008.
21 NCAC 36 .0604 GENERAL AND ADMINISTRATIVE
PROVISIONS
The Board shall issue the certificate authorizing transfer
of membership when membership is transferred in the company. This transfer
form shall be permanently retained by the company. The membership books of the
company shall be kept at the principal office of the company and shall be
subject to inspection by authorized agents of the Board.
History Note: Authority G.S. 55B-6; 55B-12; 57C-2-01;
Eff. August 1, 1998.
21 NCAC 36 .0605 FEES
(a) The fee for an initial Certificate of Registration is
fifty dollars ($50.00).
(b) The fee for renewal of a Certificate of Registration is
twenty-five dollars ($25.00).
History Note: Authority G.S. 55B-10; 55B-11; 57C-2-01;
90-171.23;
Eff. August 1, 1998;
Amended Eff. November 1, 2008.
section .0700 – nurse licensure compact
21 NCAC 36 .0701 DEFINITIONS OF TERMS IN THE COMPACT
(a) For the purpose of the Compact enacted into
Law G.S. 90, Article 9G:
(1) "Board" means party state's
regulatory body responsible for issuing nurses licenses.
(2) "Information system" means the
coordinated licensure information system.
(3) "Primary state of residence"
means the state of a person's declared fixed permanent and principal home for
legal purposes; domicile.
(4) "Public" means any individual or
entity other than designated staff or representatives of party state Boards or
the National Council of State Boards of Nursing, Inc.
(b) Other terms used in this Section are as
defined in G.S. 90-171.82.
History Note: Authority G.S. 90-171.82; 90-171.87(4); 90-171.88(d)(e);
Eff. July 1, 2000.
21 NCAC 36 .0702 ISSUANCE OF A LICENSE BY A COMPACT PARTY STATE
For the purpose of the Compact:
(1) A nurse applying for a license in a home state
shall produce evidence of the nurse’s primary state of residence. Such
evidence shall include a declaration signed by the licensee attesting to the
licensee's primary state of residence. Further evidence that may be requested
includes, but is not limited to:
(a) Driver's license with a home address;
(b) Voter registration card displaying a home
address;
(c) Federal income tax return declaring the
primary state of residence;
(d) Military Form No. 2058 – state of legal
residence certificate; or
(e) W2 from US Government or any bureau, division
or agency thereof indicating the declared state of residence.
(2) A nurse changing primary state of residence, from
one party state to another party state, may continue to practice under the
former home state license and multistate licensure privilege during the
processing of the nurse's licensure application in the new home state for a
period not to exceed 90 days.
(3) The licensure application in the new home state of
a nurse under pending investigation by the former home state shall be held in
abeyance. The 90-day period in Item (2) of this Rule shall be stayed until
resolution of the pending investigation.
(4) The former home state license shall no longer be
valid upon the issuance of a new home state license.
(5) If a decision denying licensure is made by the new
home state, the new home state shall notify the former home state within 10
business days and the former home state may take action in accordance with that
state's laws and rules.
(6) No individual shall be issued a multistate
licensure privilege unless the applicant provides evidence of successful
completion of the licensing examination developed by the National Council of
State Boards of Nursing, Inc.
(7) A nurse on a visa from another country applying for
licensure in a party state may declare either the country of origin or the
party state as the primary state of residence. If the foreign country is
declared the primary state of residence, a single state license will be issued
by the party state.
(8) A license issued by a party state is valid for
practice in all other party states unless clearly designated as valid only in
the state which issued the license.
History Note: Authority G.S. 90-171.82(6);
90-171.83(a)(b); 90-171.85(b); 90-171.87(4);
Eff. July 1, 2000;
Amended Eff. November 1, 2013; July 1, 2012; July 1,
2005.
21 NCAC 36 .0703 LIMITATIONS ON MULTISTATE LICENSURE
PRIVILEGE
(a) Home state Boards shall include in all licensure
disciplinary orders or agreements that limit practice or require monitoring the
requirement that the licensee subject to said order or agreement will agree to
limit the licensee's practice to the home state during the pendency of the
disciplinary order or agreement. This requirement may, in the alternative,
allow the nurse to practice in other party states with prior written
authorization from both the home state and such other party state Boards.
(b) An individual who had a license which was surrendered,
revoked, suspended, or an application denied for cause in a prior state of
primary residence, may be issued a single state license in a new primary state
of residence until such time as the individual would be eligible for an
unrestricted license by the prior state(s) or adverse action. Once eligible for
licensure in the prior state(s); a multistate license may be issued.
History Note: Authority G.S. 90-171.37; 90-171.85(f);
90-171.87(4);
Eff. July 1, 2000;
Amended Eff. July1, 2012.
21 NCAC 36 .0704 INFORMATION SYSTEM
(a) Levels of access:
(1) The public shall have access to nurse
licensure information limited to:
(A) the nurse's name;
(B) jurisdiction(s) of licensure;
(C) license expiration date(s);
(D) licensure classification(s) and status(es);
(E) public emergency and final disciplinary actions, as
defined by contributing state authority; and
(F) the status of multistate licensure privileges.
(2) Non-party state Boards shall have access to
all Information System data except current significant investigative
information and other information as limited by contributing party state
authority.
(3) Party state Boards shall have access to all
Information System data contributed by the party states and other information
as limited by the contributing state authority.
(b) The licensee may request in writing to the home state
Board to review the data relating to the Licensee in the Information System.
In the event a licensee asserts that any data relating to him or her is
inaccurate, the burden of proof shall be upon the licensee to provide evidence
that substantiates such claim. The Board shall verify and within 10 business
days correct inaccurate data to the Information System.
(c) The Board shall report to the Information System within
10 business days:
(1) disciplinary action, agreement or order
requiring participation in alternative programs or which limit practice or
require monitoring (except agreements and orders relating to participation in
alternative programs required to remain nonpublic by contributing state authority);
(2) dismissal of complaint; and
(3) changes in status of disciplinary action or
licensure encumbrance.
(d) Current significant investigative information shall be
deleted from the Information System within 10 business days upon report of
disciplinary action, agreement or order requiring participation in alternative
programs or agreements which limit practice or require monitoring or dismissal
of a complaint.
(e) Changes to licensure information in the Information
System shall be completed within 10 business days upon notification by a Board.
History Note: Authority G.S. 90-171.87(4); 90-171.88;
Eff. July 1, 2000.
21 NCAC 36 .0705 PARTY STATE LICENSURE REQUIREMENTS
Party state licensure requirements for registered nurses and
licensed practical nurses shall be considered substantially equivalent by the
North Carolina Board of Nursing when current requirements include:
(1) completion of a nursing education program
approved by the jurisdiction of original licensure; and
(2) successful completion of the licensing
examination developed by the National Council of State Boards of Nursing, Inc.
History Note: Authority G.S. 90-171.32; 90-171.87(4);
90-171.94;
Eff. July 1, 2000.
SECTION .0800 - APPROVAL AND PRACTICE PARAMETERS FOR NURSE
PRACTITIONERS
21 NCAC 36 .0801 DEFINITIONS
The following definitions apply to this Section:
(1) "Approval to Practice" means authorization
by the Medical Board and the Board of Nursing for a nurse practitioner to
perform medical acts within her or his area of educational preparation and
certification under a collaborative practice agreement (CPA) with a licensed
physician in accordance with this Section.
(2) "Back-up Supervising Physician" means the
licensed physician who, by signing an agreement with the nurse practitioner and
the primary supervising physician(s) shall provide supervision, collaboration,
consultation and evaluation of medical acts by the nurse practitioner in
accordance with the collaborative practice agreement when the Primary
Supervising Physician is not available. Back-up supervision shall be in
compliance with the following:
(a) The signed and dated agreements for each
back-up supervising physician(s) shall be maintained at each practice site.
(b) A physician in a graduate medical education
program, whether fully licensed or holding only a resident's training license,
shall not be named as a back-up supervising physician.
(c) A fully licensed physician in a graduate
medical education program who is also practicing in a non-training situation
and has a signed collaborative practice agreement with the nurse practitioner
and the primary supervising physician may be a back-up supervising physician
for a nurse practitioner in the non-training situation.
(3) "Board of Nursing" means the North
Carolina Board of Nursing.
(4) "Collaborative practice agreement" means
the arrangement for nurse practitioner-physician continuous availability to
each other for ongoing supervision, consultation, collaboration, referral and
evaluation of care provided by the nurse practitioner.
(5) "Disaster" means a state of disaster as
defined in G.S. 166A-4(1a) and proclaimed by the Governor, or by the General
Assembly pursuant to G.S. 166A-6.
(6) "Joint Subcommittee" means the
subcommittee composed of members of the Board of Nursing and members of the
Medical Board to whom responsibility is given by G.S. 90-8.2 and G.S.
90-171.23(b)(14) to develop rules to govern the performance of medical acts by
nurse practitioners in North Carolina.
(7) "Medical Board" means the North Carolina
Medical Board.
(8) "National Credentialing Body" means one
of the following credentialing bodies that offers certification and
re-certification in the nurse practitioner's specialty area of practice:
(a) American Nurses Credentialing Center (ANCC);
(b) American Academy of Nurse Practitioners
(AANP);
(c) American Association of Critical Care Nurses
Certification Corporation (AACN);
(d) National Certification Corporation of the
Obstetric Gynecologic and Neonatal Nursing Specialties (NCC); and
(e) the Pediatric Nursing Certification Board
(PNCB).
(9) "Nurse Practitioner" or "NP"
means a currently licensed registered nurse approved to perform medical acts
consistent with the nurse's area of nurse practitioner academic educational
preparation and national certification under an agreement with a licensed
physician for ongoing supervision, consultation, collaboration and evaluation
of the medical acts performed. Such medical acts are in addition to those
nursing acts performed by virtue of registered nurse (RN) licensure. The NP is
held accountable under the RN license for those nursing acts that he or she may
perform.
(10) "Primary Supervising Physician" means the
licensed physician who shall provide ongoing supervision, collaboration,
consultation and evaluation of the medical acts performed by the nurse
practitioner as defined in the collaborative practice agreement. Supervision
shall be in compliance with the following:
(a) The primary supervising physician shall
assure both Boards that the nurse practitioner is qualified to perform those
medical acts described in the collaborative practice agreement.
(b) A physician in a graduate medical education
program, whether fully licensed or holding only a resident's training license,
shall not be named as a primary supervising physician.
(c) A fully licensed physician in a graduate
medical education program who is also practicing in a non-training situation
may supervise a nurse practitioner in the non-training situation.
(11) "Registration" means authorization by the
Medical Board and the Board of Nursing for a registered nurse to use the title
nurse practitioner in accordance with this Section.
(12) "Supervision" means the physician's
function of overseeing medical acts performed by the nurse practitioner.
(13) "Volunteer Approval" means approval to
practice consistent with this rule except without expectation of direct or indirect
compensation or payment (monetary, in kind or otherwise) to the nurse
practitioner.
History Note: Authority G.S. 90-8.1; 90-8.2; 90-18(14);
90-18.2; 90-171.20(4); 90-171.20(7); 90-171.23(b); 90-171.83;
Recodified from 21 NCAC 36 .0227(a) Eff. August 1, 2004;
Amended Eff. September 1, 2012; December 1, 2009;
December 1, 2006; August 1, 2004.
21 NCAC 36 .0802 SCOPE OF PRACTICE
A nurse practitioner shall be held accountable by both
Boards for the continuous and comprehensive management of a broad range of
personal health services for which the nurse practitioner is educationally
prepared and for which competency has been maintained, with physician
supervision and collaboration as described in Rule .0810 of this Section.
These services include but are not restricted to:
(1) promotion and maintenance of health;
(2) prevention of illness and disability;
(3) diagnosing, treating and managing acute and chronic
illnesses;
(4) guidance and counseling for both individuals and
families;
(5) prescribing, administering and dispensing
therapeutic measures, tests, procedures and drugs;
(6) planning for situations beyond the nurse
practitioner's expertise, and consulting with and referring to other health
care providers as appropriate; and
(7) evaluating health outcomes.
History Note: Authority G.S. 90-18(14); 90-171.20(7);
90-171.23(b)(14);
Recodified from 21 NCAC 36 .0227(b) Eff. August 1, 2004;
Amended Eff. August 1, 2004.
21 NCAC 36 .0803 NURSE PRACTITIONER REGISTRATION
(a) The Board of Nursing shall register an applicant as a
nurse practitioner who:
(1) has an unrestricted license to practice as
a registered nurse in North Carolina and, when applicable, an unrestricted
approval, registration or license as a nurse practitioner in another state,
territory, or possession of the United States;
(2) has successfully completed a nurse
practitioner education program as outlined in Rule .0805 of this Section;
(3) is certified as a nurse practitioner by a
national credentialing body consistent with 21 NCAC 36 .0801(8); and
(4) has supplied additional information necessary
to evaluate the application as requested.
(b) Beginning January 1, 2005, new graduates of a nurse
practitioner program, who are seeking first-time nurse practitioner
registration in North Carolina shall:
(1) hold a Master's or higher degree in Nursing
or related field with primary focus on Nursing;
(2) have successfully completed a graduate
level nurse practitioner education program accredited by a national accrediting
body; and
(3) provide documentation of certification by a
national credentialing body.
History Note: Authority G.S. 90-18(c)(13); 90-18.2;
90-171.20(7); 90-171.23(b); 90-171.83;
Eff. August 1, 2004;
Amended Eff. September 1, 2012; November 1, 2008;
December 1, 2006.
21 NCAC 36 .0804 PROCESS FOR APPROVAL TO PRACTICE
(a) Prior to the performance of any medical acts, a nurse
practitioner shall:
(1) meet registration requirements as specified
in 21 NCAC 36 .0803;
(2) submit an application for approval to
practice;
(3) submit any additional information necessary
to evaluate the application as requested; and
(4) have a collaborative practice agreement
with a primary supervising physician.
(b) A nurse practitioner seeking approval to practice who
has not practiced as a nurse practitioner in more than two years shall complete
a nurse practitioner refresher course approved by the Board of Nursing in
accordance with Paragraphs (o) and (p) of 21 NCAC 36 .0220 and consisting of
common conditions and their management directly related to the nurse
practitioner's area of education and certification. A nurse practitioner
refresher course participant shall be granted an approval to practice that is
limited to clinical activities required by the refresher course.
(c) The nurse practitioner shall not practice until
notification of approval to practice is received from the Board of Nursing
after both Boards have approved the application.
(d) The nurse practitioner's approval to practice is
terminated when the nurse practitioner discontinues working within the approved
nurse practitioner collaborative practice agreement, or experiences an
interruption in her or his registered nurse licensure status, and the nurse practitioner
shall so notify the Board of Nursing in writing. The Boards shall extend the
nurse practitioner's approval to practice in cases of emergency such as injury,
sudden illness or death of the primary supervising physician.
(e) Applications for approval to practice in North Carolina
shall be submitted to the Board of Nursing and then approved by both Boards as
follows:
(1) the Board of Nursing shall verify
compliance with Rule .0803 and Paragraph (a) of this Rule; and
(2) the Medical Board shall verify that the
designated primary supervising physician holds a valid license to practice
medicine in North Carolina and compliance with Paragraph (a) of this Rule.
(f) Applications for approval of changes in practice
arrangements for a nurse practitioner currently approved to practice in North Carolina shall be submitted by the applicant as follows:
(1) addition or change of primary supervising
physician shall be submitted to the Board of Nursing and processed pursuant to
protocols developed by both Boards; and
(2) request for change(s) in the scope of
practice shall be submitted to the Joint Subcommittee.
(g) A registered nurse who was previously approved to
practice as a nurse practitioner in this state who reapplies for approval to
practice shall:
(1) meet the nurse practitioner approval
requirements as stipulated in Rule .0808(c) of this Section; and
(2) complete the appropriate application.
(h) Volunteer Approval to Practice. The North Carolina
Board of Nursing shall grant approval to practice in a volunteer capacity to a
nurse practitioner who has met the qualifications to practice as a nurse
practitioner in North Carolina.
(i) The nurse practitioner shall pay the appropriate fee as
outlined in Rule .0813 of this Section.
(j) A Nurse Practitioner approved under this Section shall
keep proof of current licensure, registration and approval available for
inspection at each practice site upon request by agents of either Board.
History Note: Authority G.S. 90-18(13), (14); 90-18.2;
90-171.20(7); 90-171.23(b);
Recodified from 21 NCAC 36 .0227(c) Eff. August 1, 2004;
Amended Eff. November 1, 2013; January 1, 2013; December
1, 2009; November 1, 2008; January 1, 2007; August 1, 2004.
21 NCAC 36 .0805 EDUCATION
AND CERTIFICATION REQUIREMENTS FOR REGISTRATION AS A NURSE PRACTITIONER
(a) A nurse practitioner with first-time approval to
practice after January 1, 2000, shall provide evidence of certification or
recertification as a nurse practitioner by a national credentialing body.
(b) A nurse practitioner applicant who completed a nurse
practitioner education program prior to December 31, 1999 shall provide
evidence of successful completion of a course of education that contains a core
curriculum including 400 contact hours of didactic education and 400 hours of
preceptorship or supervised clinical experience. The core curriculum shall
contain the following components:
(1) health assessment and diagnostic reasoning
including:
(A) historical data;
(B) physical examination data;
(C) organization of data base;
(2) pharmacology;
(3) pathophysiology;
(4) clinical management of common health
problems and diseases such as the following shall be evident in the nurse
practitioner's academic program:
(A) respiratory system;
(B) cardiovascular system;
(C) gastrointestinal system;
(D) genitourinary system;
(E) integumentary system;
(F) hematologic and immune systems;
(G) endocrine system;
(H) musculoskeletal system;
(I) infectious diseases;
(J) nervous system;
(K) behavioral, mental health and substance abuse
problems;
(5) clinical preventative services including
health promotion and prevention of disease;
(6) client education related to Subparagraph
(b)(4)–(5) of this Rule; and
(7) role development including legal, ethical,
economical, health policy and interdisciplinary collaboration issues.
(c) Nurse practitioner applicants exempt from components of
the core curriculum requirements listed in Paragraph (b) of this Rule are:
(1) Any nurse practitioner approved to practice
in North Carolina prior to January 18, 1981, is permanently exempt from the
core curriculum requirement.
(2) A nurse practitioner certified by a
national credentialing body prior to January 1, 1998, who also provides
evidence of satisfying Subparagraph (b)(1)–(3) of this Rule shall be exempt
from core curriculum requirements in Subparagraph (b)(4)–(7) of this Rule.
Evidence of satisfying Subparagraph (b)(1)–(3) of this Rule shall include:
(A) a narrative of course content; and
(B) contact hours.
History Note: Authority G.S. 90-18(14); 90-171.42;
Recodified from 21 NCAC 36.0227(d) Eff. August 1, 2004;
Amended Eff. December 1, 2009; December 1, 2006; August
1, 2004.
21 NCAC 36 .0806 ANNUAL RENEWAL
(a) Each registered nurse who is approved to practice as a
nurse practitioner in this state shall annually renew each approval to practice
with the Board of Nursing no later than the last day of the nurse
practitioner's birth month by:
(1) Maintaining current RN licensure;
(2) Submitting the fee required in Rule .0813
of this Section; and
(3) Completing the renewal application.
(b) If the nurse practitioner has not renewed by the last
day of her or his birth month, the approval to practice as a nurse practitioner
shall lapse.
History Note: Authority G.S. 90-8.1; 90-8-2; 90-18(14)
90-171.23(b); 90-171.83;
Recodified from 21 NCAC 36.0227(e) Eff. August 1, 2004;
Amended Eff. December 1, 2009; November 1, 2008; August
1, 2004.
21 NCAC 36 .0807 CONTINUING EDUCATION (CE)
In order to maintain nurse practitioner approval to
practice, the nurse practitioner shall earn 50 contact hours of continuing
education each year beginning with the first renewal after initial approval to
practice has been granted. At least 20 hours of the required 50 hours must be
those hours for which approval has been granted by the American Nurses
Credentialing Center (ANCC) or Accreditation Council on Continuing Medical
Education (ACCME), other national credentialing bodies or practice relevant
courses in an institution of higher learning. Documentation shall be
maintained by the nurse practitioner and made available upon request to either
Board.
History Note: Authority G.S. 90-8.1; 90-8.2; 90-18(14);
90-171.23(b)(14); 90-171.42;
Recodified from 21 NCAC 36 .0227(f) Eff. August 1, 2004;
Amended Eff. December 1, 2009; April 1, 2008; August 1,
2004.
21 NCAC 36 .0808 INACTIVE STATUS
(a) Any nurse practitioner who wishes to place her or his
approval to practice on an inactive status shall notify the Board of Nursing in
writing.
(b) A nurse practitioner with an inactive approval to
practice status shall not practice as a nurse practitioner.
(c) A nurse practitioner with an inactive approval to
practice status who reapplies for approval to practice shall meet the
qualifications for approval to practice in Rules .0803(a)(1), .0804(a) and (b),
.0807, and .0810 of this Section and receive notification from the Board of
Nursing of approval prior to beginning practice after the application is
approved by both Boards.
(d) A nurse practitioner who has not practiced as a nurse
practitioner in more than two years shall complete a nurse practitioner
refresher course approved by the Board of Nursing in accordance with Paragraphs
(o) and (p) of 21 NCAC 36 .0220 and consisting of common conditions and
management of these conditions directly related to the nurse practitioner's
area of education and certification. A nurse practitioner refresher course
participant shall be granted an approval to practice that is limited to
clinical activities required by the refresher course.
History Note: Authority G.S. 90-18(13); 90-18.2;
90-171.36; 90-171.83;
Recodified from 21 NCAC 36 .0227(g) Eff. August 1, 2004;
Amended Eff. November 1, 2013; January 1, 2013; December
1, 2009; December 1, 2006; August 1, 2004.
21 NCAC 36 .0809 PRESCRIBING AUTHORITY
(a) The prescribing stipulations contained in this Rule
apply to writing prescriptions and ordering the administration of medications.
(b) Prescribing and dispensing stipulations are as follows:
(1) Drugs and devices that may be prescribed by
the nurse practitioner in each practice site shall be included in the
collaborative practice agreement as outlined in Rule .0810(b) of this Section.
(2) Controlled Substances (Schedules II, IIN,
III, IIIN, IV, V) defined by the State and Federal Controlled Substances Acts
may be procured, prescribed or ordered as established in the collaborative
practice agreement, providing all of the following requirements are met:
(A) the nurse practitioner has an assigned DEA number
which is entered on each prescription for a controlled substance;
(B) dosage units for schedules II, IIN, III, and IIIN
are limited to a 30 day supply; and
(C) the supervising physician(s) must possess the same
schedule(s) of controlled substances as the nurse practitioner's DEA
registration.
(3) The nurse practitioner may prescribe a drug
or device not included in the collaborative practice agreement only as follows:
(A) upon a specific written or verbal order obtained
from a primary or back-up supervising physician before the prescription or
order is issued by the nurse practitioner; and
(B) the written or verbal order as described in Part
(b)(3)(A) of this Rule shall be entered into the patient record with a notation
that it is issued on the specific order of a primary or back-up supervising
physician and signed by the nurse practitioner and the physician.
(4) Refills may be issued for a period not to
exceed one year.
(5) Each prescription shall be noted on the
patient's chart and include the following information:
(A) medication and dosage;
(B) amount prescribed;
(C) directions for use;
(D) number of refills; and
(E) signature of nurse practitioner.
(6) Prescription Format:
(A) all prescriptions issued by the nurse practitioner
shall contain the supervising physician(s) name, the name of the patient, and
the nurse practitioner's name, telephone number, and approval number;
(B) the nurse practitioner's assigned DEA number shall
be written on the prescription form when a controlled substance is prescribed
as defined in Subparagraph (b)(2) of this Rule.
(7) A nurse practitioner shall not prescribe
controlled substances, as defined by the State and Federal Controlled
Substances Acts, for the nurse practitioner's own use or that of a nurse
practitioner's supervising physician; or that of a member of the nurse
practitioner's immediate family, which shall mean a spouse, parent, child,
sibling, parent-in-law, son or daughter-in-law, brother or sister-in-law,
step-parent, step-child, step-siblings, or any other person living in the same
residence as the licensee; or anyone with whom the nurse practitioner is having
a sexual relationship or has a significant emotional relationship.
(c) The nurse practitioner may obtain approval to dispense
the drugs and devices other than samples included in the collaborative practice
agreement for each practice site from the Board of Pharmacy, and dispense in
accordance with 21 NCAC 46 .1703 that is hereby incorporated by reference
including subsequent amendments of the referenced materials.
History Note: Authority G.S. 90-8.1; 90-8.2; 90-18(14);
90-18.2; 90-171.23(b)(14);
Recodified from 21 NCAC 36 .0227(h) Eff. August 1, 2004;
Amended Eff. December 1, 2012; April 1, 2011; November 1,
2008; August 1, 2004.
21 NCAC 36 .0810 QUALITY
ASSURANCE STANDARDS FOR A COLLABORATIVE PRACTICE AGREEMENT
The following are the quality assurance standards for a
collaborative practice agreement:
(1) Availability: The primary or back-up supervising
physician(s) and the nurse practitioner shall be continuously available to each
other for consultation by direct communication or telecommunication.
(2) Collaborative Practice Agreement:
(a) shall be agreed upon and signed by both the
primary supervising physician and the nurse practitioner, and maintained in
each practice site;
(b) shall be reviewed at least yearly. This
review shall be acknowledged by a dated signature sheet, signed by both the
primary supervising physician and the nurse practitioner, appended to the
collaborative practice agreement and available for inspection by members or
agents of either Board;
(c) shall include the drugs, devices, medical
treatments, tests and procedures that may be prescribed, ordered and performed
by the nurse practitioner consistent with Rule .0809 of this Section; and
(d) shall include a pre-determined plan for
emergency services.
(3) The nurse practitioner shall demonstrate the
ability to perform medical acts as outlined in the collaborative practice
agreement upon request by members or agents of either Board.
(4) Quality Improvement Process.
(a) The primary supervising physician and the
nurse practitioner shall develop a process for the ongoing review of the care
provided in each practice site including a written plan for evaluating the quality
of care provided for one or more frequently encountered clinical problems.
(b) This plan shall include a description of the
clinical problem(s), an evaluation of the current treatment interventions, and
if needed, a plan for improving outcomes within an identified time-frame.
(c) The quality improvement process shall
include scheduled meetings between the primary supervising physician and the
nurse practitioner at least every six months. Documentation for each meeting
shall:
(i) identify clinical problems discussed,
including progress toward improving outcomes as stated in Sub-item (4)(b) of
this Rule, and recommendations, if any, for changes in treatment plan(s);
(ii) be signed and dated by those who attended;
and
(iii) be available for review by members or
agents of either Board for the previous five calendar years and be retained by
both the nurse practitioner and primary supervising physician.
(5) Nurse Practitioner-Physician Consultation. The
following requirements establish the minimum standards for consultation between
the nurse practitioner and primary supervising physician(s):
(a) During the first six months of a
collaborative practice agreement between a nurse practitioner and the primary
supervising physician, there shall be monthly meetings for the first six months
to discuss practice relevant clinical issues and quality improvement measures.
(b) Documentation of the meetings shall:
(i) identify clinical issues discussed and
actions taken;
(ii) be signed and dated by those who attended;
and
(iii) be available for review by members or
agents of either Board for the previous five calendar years and be retained by
both the nurse practitioner and primary supervising physician.
History Note: Authority G.S 90-8.1; 90-8.2; 90-18(14);
90-18.2; 90-171.23(b)(14);
Recodified from 21 NCAC 36 .0227(i) Eff. August 1, 2004;
Amended Eff. December 1, 2009; August 1, 2004.
21 NCAC 36 .0811 METHOD OF IDENTIFICATION
When providing care to the public, the nurse practitioner
shall identify herself/himself as specified in G.S. 90-640 and 21 NCAC 36
.0231.
History Note: Authority G.S. 90-18(14); 90-640;
Recodified from 21 NCAC 36 .0227(j) Eff. August 1, 2004;
Amended Eff. August 1, 2004.
21 NCAC 36 .0812 DISCIPLINARY ACTION
(a) After notice and hearing in accordance with provisions
of G. S. 150B, Article 3A, disciplinary action may
be taken by the appropriate Board if one or more of the following is found:
(1) violation of G.S. 90-18 and G.S. 90-18.2 or
the joint rules adopted by each Board;
(2) immoral or dishonorable conduct pursuant to
and consistent with G.S. 90-14(a)(1);
(3) any submissions to either Board pursuant to
and consistent with G.S. 90-14(a)(3);
(4) the nurse practitioner is adjudicated
mentally incompetent or the nurse practitioner's mental or physical condition
renders the nurse practitioner unable to safely function as a nurse
practitioner pursuant to and consistent with G.S. 90-14(a)(5) and G.S.
90-171.37(3);
(5) unprofessional conduct by reason of
deliberate or negligent acts or omissions and contrary to the prevailing
standards for nurse practitioners in accordance and consistent with G.S.
90-14(a)(6) and G.S. 90-171.35(5);
(6) conviction in any court of a criminal offense
in accordance and consistent with G.S. 90-14(a)(7) and G.S. 90-171.37 (2) and
G.S. 90-171.48;
(7) payments for the nurse practitioner
practice pursuant to and consistent with G.S. 90-14(a)(8);
(8) lack of professional competence as a nurse
practitioner pursuant to and consistent with G.S. 90-14(a)(11);
(9) exploiting the client pursuant to and
consistent with G.S. 90-14(a)(12) including the promotion of the sale of
services, appliances, or drugs for the financial gain of the practitioner or of
a third party;
(10) failure to respond to inquires which may be
part of a joint protocol between the Board of Nursing and Medical Board for
investigation and discipline pursuant to and consistent with G.S. 90-14(a)(14);
(11) the nurse practitioner has held himself or
herself out or permitted another to represent the nurse practitioner as a
licensed physician; or
(12) the nurse practitioner has engaged or
attempted to engage in the performance of medical acts other than according to
the collaborative practice agreement.
(b) The nurse practitioner is subject to G.S. 90-171.37;
90-171.48 and 21 NCAC 36 .0217 by virtue of the license to practice as a
registered nurse.
(c) After an investigation is completed, the joint
subcommittee of both boards may recommend one of the following:
(1) dismiss the case;
(2) issue a private letter of concern;
(3) enter into negotiation for a Consent Order;
or
(4) a disciplinary hearing in accordance with
G.S. 150B, Article 3A. If a hearing is recommended, the joint subcommittee
shall also recommend whether the matter should be heard by the Board of Nursing
or the Medical Board.
(d) Upon a finding of violation, each Board may utilize the
range of disciplinary options as enumerated in G.S. 90-14(a) or G.S. 90-171.37.
History Note: Authority G.S. 90-18(c)(14); 90-171.37;
90-171.44; 90-171.47; 90-171.48;
Recodified from 21 NCAC 36 .0227(k) Eff. August 1, 2004;
Amended Eff. April 1, 2007; August 1, 2004.
21 NCAC 36 .0813 FEES
(a) An application fee of one hundred dollars ($100.00)
shall be paid at the time of initial application for approval to practice and
each subsequent application for approval to practice. The application fee
shall be twenty dollars ($20.00) for volunteer approval.
(b) The fee for annual renewal of approval shall be fifty
dollars ($50.00).
(c) The fee for annual renewal of volunteer approval shall
be ten dollars ($10.00).
(d) No portion of any fee in this Rule is refundable.
History Note: Authority G.S. 90-6; 90-171.23(b)(14);
Recodified from 21 NCAC 36 .0227(l) Eff. August 1, 2004;
Amended Eff. November 1, 2008; August 1, 2004.
21 NCAC 36 .0814 PRACTICING DURING A DISASTER
(a) A nurse practitioner approved to practice in this State
or another state may perform medical acts, as a nurse practitioner under the
supervision of a physician licensed to practice medicine in North Carolina
during a disaster in a county in which a state of disaster has been declared or
counties contiguous to a county in which a state of disaster has been declared.
(b) The nurse practitioner shall notify the Board of
Nursing in writing of the names, practice locations and telephone numbers for
the nurse practitioner and each primary supervising physician within 15 days of
the first performance of medical acts, as a nurse practitioner during the
disaster, and the Board of Nursing shall notify the Medical Board.
(c) Teams of physician(s) and nurse practitioner(s)
practicing pursuant to this Rule shall not be required to maintain on-site
documentation describing supervisory arrangements and plans for prescriptive
authority as otherwise required pursuant to Rules .0809 and .0810 of this
Section.
History Note: Authority G.S. 90-18(c)(13), (14);
90-18.2; 90-171.23(b);
Recodified from 21 NCAC 36 .0227(m) Eff. August 1, 2004;
Amended Eff. December 1, 2009; August 1, 2004.
