Last spring, my husband and I took a romantic getaway to Asheville, North Carolina which was the first chance I had to spend much time in the state. I have to say, I was quite impressed. The North Carolina “mountains” (being from the West Coast they are look more like hills) are beautiful, and quaint Asheville was packed with good
people and great eats. I can’t wait to go back. But, does North Carolina make the grade when it comes to laws regulating the nurse practitioner scope of practice in the Tar Heel State? Unfortunately, North Carolina ranks rather poorly compared to other states when it comes to giving nurse practitioners autonomy in their practice. Let’s look at the specifics of these laws. North Carolina’s Nurse Practitioner Supervision Laws Nurse practitioners
in North Carolina must work under physician supervision as outlined in a collaborative practice agreement. This written agreement must include a description of the arrangement between the nurse practitioner and physician. The physician must be “continuously available for consultation, collaboration, referral and evaluation of care by the nurse practitioner”.
A supervising physician is not required to be present on site with the nurse practitioner in the clinic or hospital but must be continuously available for consultation by phone. The primary supervising physician may also name back-up supervising physicians in the case that he/she is not available. The collaborative practice agreement must be reviewed each year and resigned by both the NP and supervising physician. Nurse practitioners are required to meet at least
once every six moths with their supervising physician. During the first six months of practice, new nurse practitioners must meet with their supervising physician at least monthly. While these periodic meetings are required, North Carolina law does not require the collaborating physician to sign a certain number of the nurse practitioner’s charts. There is not a restriction on the number of nurse practitioners one physician may supervise. North Carolina’s Nurse
Practitioner Prescribing Laws Nurse practitioners practicing in North Carolina are allowed to prescribe medications including controlled substances II-V. In April, 2011, laws regulating nurse practitioner’s ability to prescribe were changed. NPs are now allowed to prescribe up to 5 refills for Schedule III controlled substances. Dosage units
must be limited to a 30 day supply for each refill. For example, nurse practitioners may write a prescription for a 30 day supply of hydrocodone, a Schedule III drug, and refill this prescription five times. The nurse practitioner’s ability to prescribe should also be outlined in the collaborative practice agreement. All prescriptions written by a nurse practitioner in North Carolina must contain the name of the supervising physician. It is prohibited for NPs to prescribe controlled substances for their own use or for the use of their supervising physician. Nurse practitioners in North Carolina also may not prescribe controlled substances for immediate family, anyone living in their residence or with whom they are in a relationship or have a significant emotional tie. Other Scope of Practice Laws in North Carolina Nurse practitioners in North Carolina who have not practiced as an NP in more than two years must take a nurse practitioner refresher course before returning to practice. The course is individually planned, self-directed and requires varying numbers of hours of continuing education in pharmacology, medical education and precepted clinical hours depending on how long the NP has been out of practice. NPs practicing in North Carolina are also required to earn 50 contact hours of continuing medical education each year. They are allowed to sign death certificates but are not allowed to authorize handicap parking permits. You Might Also Like: How Much Will Your NP Salary Change with Experience?  Starting your own practice as a nurse practitioner is a thrilling, monumental life event. It’s entrepreneurial and puts you in the front seat of patient care. However, if you practice as an NP in one of the 28 states that don’t confer full autonomy to NPs, you’ll need to create a collaborative practice agreement (CPA) with a physician to practice to the full extent of your license. A well-structured CPA can make the business side of your professional life easier, so you can focus on what you do best: Providing your patients with exceptional care. Here’s why and how to create a collaborative agreement so you can start out on the right foot. If you're starting your own practice as an NP, chances are good that you'll need to create a collaborative practice agreement with a physician. We'll walk you through how to do this and give you some CPA templates to get you started. What Is a Collaborative Practice Agreement? Why Do You Need One?A CPA is a legal document that formalizes the relationship between an NP and a supervising physician. CPA requirements vary by state and are governed by the respective Board of Nursing, but in general, they all require an NP to have some level of oversight by a physician. Julie Nyhus, FNP-BC, explains that the purpose of a CPA is to “allow the two parties involved to be clear about the functions of the NP.” They also allow both parties to define the requirements for a supervising physician’s oversight. It’s possible that your collaborating physician has a document that you can use as a starting point. If not, check with a lawyer or another nurse entrepreneur to see if they have any sample documents you can tailor for your own use. (Links to examples below.) And, as with any legally binding agreement, you should have the contract reviewed by a lawyer before signing it. How to Outline the Terms of Your AgreementHere are the typical sections to include in a collaborating physician contract. Section #1: Scope of PracticeName who this agreement covers. Is it between you, an individual, and the physician, or is it larger in scope (i.e., covering all the NPs in a practice, for example)? You’ll also want to use this section to list what each profession within your group will be practicing and the actual locations where the work will be done. Section #2: Practice ProtocolsOutline the guidelines your team will follow for contacting the physician: When, how, and for what purpose. This will most likely be based on your state’s nurse practice act and the type of practice you’re engaged in. Section #3: Physician ConsultationState the type (e.g., in-person, telephone, etc.) and frequency of consultation expected by your collaborating physician. Section #4: Record ReviewInclude the frequency and manner of chart review your physician collaborator will perform. Section #5: Resolution of DisagreementsOutline how you and your collaborating physician will resolve any differences of clinical opinion. Section #6: Alteration of AgreementDefine the term (i.e., length) of the agreement and under what circumstances it may be altered or terminated. Section #7: CompensationDefine payment terms for the physician collaborator. Most collaborating physicians expect to be paid for their services, aside perhaps from a doctor working in a group practice with NPs. Typically, both parties agree on an hourly rate, but annual fees, per-chart-reviewed fees, and profit percentages are common arrangements, as well. You and the collaborating physician can design the compensation structure in any way you find mutually agreeable. Section #8: SignaturesProvide a space in the document where you and the collaborating physician can both sign and date it. 3 Tips for Creating a Collaborative Practice Agreement That WorksOnce the CPA is drafted, Nyhus recommends that both parties review and revise the document together. Prior to signing, it’d be ideal to have your own attorneys review the agreement, too; this can help ensure that you didn’t miss anything, and it’ll give you a chance to have your attorney explain any parts of the document that you didn’t understand. Each person involved in the CPA should consider having their own attorney to help avoid any conflicts of interest. Here are three additional tips to keep in mind as you go through the process of creating and implementing your collaborative practice agreement. 1) Explicitly detail each person’s responsibilities.For example, “Physician will visit the NP’s practice site one day in every calendar month.” 2) Make sure to check in regularly with your collaborating physician.As a professional courtesy, and to maintain the integrity of your CPA, be sure to regularly check in with your collaborating physician. 3) Familiarize yourself with the terms of your agreement.In addition to ensuring that the document itself is in order and meets the needs of both parties, it’s important to understand and abide by the terms set in the agreement. Place visuals around your practice to remind yourself and your team of proper CPA protocol, and add reminders in your calendar for regular check-ins. Do All NPs Need to Have a Collaborative Agreement With a Physician?The short answer is no. You’re only required to create a collaborative practice agreement with a physician if you work in a state that reduces or restricts your practice authority. (Learn more about NP scope by state.) Each state is responsible for defining and articulating the practice requirements that NPs and their collaborating physicians are expected to adhere to. Because each state’s requirements are unique, you should thoroughly familiarize yourself with your state’s applicable laws. And while your state might not legally require this contractual agreement, you may feel the need to create a contract in order to formalize your relationship with any physician you work with. You might do this in order to outline different responsibilities and further protect yourself and your business. 3 Examples of Nurse Practitioner Collaborative Agreement TemplatesNyhus says the best resource for developing collaborative agreements is the Nurse Practitioner's Business Practice and Legal Guide by Carolyn Buppert. However, you also can find many downloadable templates on the web, including the following examples:
Final ThoughtsAs you head out on your own, remember that your experience, sharp skills, risk management strategy, and strong team are positioning you for success. And lean on your collaborating physicians whenever you want — that’s why they’re there! Image courtesy of iStock.com/PeopleImages How do you write a collaborative practice agreement?According to the CDC, a collaborative practice agreement should include these parts:. Explanation of the purpose of the agreement.. A list of the parties to the agreement.. The patients who are included in the agreement (either a specific list of patients or a group of patients). Care functions authorized by the agreement.. What is a collaborative agreement for nurse practitioners?A collaborative practice agreement is a written contract that establishes a working relationship between the nurse practitioner and the physician. Often this means that the physician will provide supervision and guidance, and be available for consultations with the NP.
Can nurse practitioners practice independently in North Carolina?Is physician supervision required for Nurse Practitioner practice in North Carolina? Yes. a collaborative practice agreement (CPA) with a supervising physician licensed by the North Carolina Medical Board is required for Nurse Practitioner approval to practice in North Carolina.
Can a DNP be called doctor in North Carolina?The Scope of The Term “Doctor”
The answer to the question of if a DNP-prepared nurse can be referred to as doctor is yes – however, there are different schools of thought on the matter, and restrictions of whenand wherethe nurse may be referred to as a doctor.
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Sample collaborative practice agreement nurse practitioner north carolina
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