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North Carolina’s master’s prepared nurses serve as advanced clinicians, nationally certified as nurse anesthetists, clinical nurse specialists, nurse midwives, or nurse practitioners. In addition to work in clinical settings, MSN-prepared nurses in North Carolina are also found working in nonclinical roles as patient advocates, informaticists, educators, administrators, public health nurses and more.
MSN-prepared advanced practice registered nurses (APRN) are increasingly being seen as key to reducing healthcare costs and serving the needs of patients in North Carolina’s medically underserved rural areas. According to a 2015 Duke University Study, less restrictive laws regarding APRN practice in North Carolina could lead to health system savings of between $433 million and over $4 billion annually over the next ten years. Additionally, increasing the APRN scope of practice by allowing them to practice independently to the full extent of their education and training would decrease the state’s projected physician shortages by 92%.
In a step to implement these new laws, a Senate Bill entitled “An Act to Modernize the Nursing Practice Act” was proposed to the North Carolina General Assembly in 2015. The North Carolina Nursing Association (NCNA) says that less restrictive APRN laws would lead to:
- Increased access to lower cost care
- The elimination of costly physician supervision requirements
- Assistance in reforming North Carolina’s Medicaid program
Licensing Requirements for the APRN Roles Recognized by the North Carolina Board of Nursing
The North Carolina Board of Nursing and its subcommittees set forth the following requirements for APRN licensure:
- Nurses must complete a nationally accredited graduate level advanced practice nursing program
- Nurses must earn and maintain national certification in of the state’s four recognized advanced practice nursing roles:
- Clinical Nurse Specialist (CNS)
- Nurse Anesthetist (NA)
- Nurse-Midwife (NM)
- Nurse Practitioner (NP)
NPs and CNSs also focus their studies and become nationally certified in a specific patient population focus such as women’s health; family-individual across the lifespan; psychiatric-mental health; adult-gerontology primary or acute care; or neonatal.
The North Carolina Board of Nursing recognizes the following national certifying bodies as granting the credentials necessary for APRN licensure in each of the four roles:
Clinical Nurse Specialist (CNS)
- AACN Certification Corporation
- Adult acute and critical care CNS
- American Nurses Credentialing Center
- Adult psychiatric-mental health CNS
- Family psychiatric-mental health CNS
- Gerontology CNS
- Adult health CNS
- Public/Community Health CNS
Certified Registered Nurse Anesthetist (CRNA)
Certified Nurse-Midwife (CNM)
Registered Nurse Practitioner (RNP)
- AACN Certification Corporation
- Acute Care Nurse Practitioner Adult-Gerontology (ACNPC-AG)
- American Academy of Nurse Practitioners
- Adult nurse practitioner
- Family nurse practitioner
- Gerontologic nurse practitioner
- American Nurses Credentialing Center
- Acute care nurse practitioner (adult/gerontology)
- Adult nurse practitioner
- Family nurse practitioner
- Gerontological nurse practitioner
- Pediatric nurse practitioner
- Adult psychiatric and mental health nurse practitioner
- Family psychiatric and mental health nurse practitioner
- Pediatric Nursing Certification Board
- Pediatric nurse practitioner primary care
- Pediatric nurse practitioner acute care
- National Certification Corporation
- Women’s health nurse practitioner
- Neonatal nurse practitioner
Earning a Master of Science in Nursing (MSN) in North Carolina
North Carolina’s RNs may enroll in any number of accredited online MSN programs available through nursing schools throughout the US. Online programs, offered in both part-time and full-time learning formats, give nurses the flexibility to further their education without sacrificing current work obligations by arranging to place students in local facilities so as to complete clinical hours without the need to travel.
The North Carolina Board of Nursing requires all APRN candidates to graduate from a nationally accredited program related to their APRN role:
Clinical Nurse Specialist/Nurse Practitioner Programs – The Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) are the two recognized national certifying bodies for CNS and NP graduate-level nursing programs. There are three ACEN-accredited graduate programs in North Carolina, located in the following cities:
- Boiling Springs
- Chapel Hill
- Greensboro
The CCNE accredits 11 graduate programs in North Carolina, located in the following cities:
- Durham
- Greenville
- Hickory
- Charlotte
- Chapel Hill
- Greensboro
- Pembroke
- Wilmington
- Cullowhee
- Winston-Salem
Certified Registered Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the nationally recognized certifying body for CRNAs. The COA accredits six schools in North Carolina, located in the following cities:
- Ashville
- Charlotte
- Durham
- Greenville
- Raleigh
- Winston-Salem
Certified Nurse-Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) is the national accrediting body nurse-midwives programs. The one ACME-accredited program in North Carolina is located in Greenville.
Rules Regarding Out-of-State Programs and Clinical Practice
All out-of-state graduate programs that provide clinical experience opportunities in North Carolina must be licensed by the University of North Carolina (UNC) System General Administration/Board of Governors. A list of these programs can be found on the UNC website.
Additionally, graduate-level nurses who do not hold a North Carolina or multi-state nursing license must contact the North Carolina Board of Nursing to obtain instructions for completing their program’s clinical experience requirements in the state.
Selecting the Right Type of Program Based on Current Education
MSN programs are structured in a number of different ways to accommodate the current education of RNs:
- RNs with an Associate’s Degree in Nursing: Associate’s-prepared RNs must complete both a bachelor’s and master’s nursing program to be eligible for APRN licensure. RN-MSN programs allow nurses to earn both degrees at the same time through accelerated coursework.
- RNs with a Bachelor of Science in Nursing (BSN): Nurses who have earned their BSN would pursue a conventional terminal MSN, allowing them to prepare for their chosen APRN role and patient population focus.
- RNs with a Master of Science in Nursing (MSN): Nurses who have already earned as MSN may continue their education through graduate certificate programs dedicated to APRN roles and patient population foci.
- Professionals with a Bachelor’s Degree in a Subject Other Than Nursing: Professionals with a bachelor’s degree in an area other than nursing would pursue direct-entry (sometimes referred to as entry-level) MSN programs, allowing them to earn a BSN, RN licensure and a master’s degree on one accelerated program. These programs typically take between four and five years to complete.
Scope of Practice and North Carolina State Laws Governing Advanced Practice Registered Nursing
The North Carolina Nursing Practice Act outlines many of the rules regarding the legal scope of practice for APRNs in the state:
Nurse Practitioner Scope of Practice
Nurse practitioners may perform services related to their education under physician supervision and collaboration including, but not limited to:
- Diagnosing and treating various illnesses
- Promoting and maintaining health
- Preventing illness and disability
- Providing guidance and counseling services for individuals and families
- Evaluating health outcomes
Clinical Nurse Specialist Scope of Practice
Clinical Nurse Specialists may perform acts including, but not limited to:
- Assessing the health status of clients through approved methods
- Managing clients’ health problems within an advanced practice framework
- Strategizing to prevent illness and promote wellness
- Analyzing health care outcomes
- Conducting research related to health care outcomes and implementing research findings as appropriate
Nurse-Midwife Scope of Practice
Under the supervision of a qualified physician, nurse midwives may provide services authorized by the Midwifery Practice Act.
Registered Nurse Anesthetist Scope of Practice
Nurse anesthetists in North Carolina may perform anesthesia services in collaboration with one of the following professionals:
- Physician
- Podiatrist
- Dentist
- Another health care provider who meets qualifications set forth by the Board
Under this collaboration, a nurse anesthetist may provide services including, but not limited to:
- Conducting pre-operative health assessments
- Participating in aspects of diagnostic studies
- Choosing and administering preanesthetic medications
- Overseeing aspects of nurse anesthesia equipment
- Conducting general anesthesia, monitored anesthesia care, and regional anesthesia modalities
- Performing tracheal intubation, extubation and providing mechanical ventilation
- Overseeing approved aspects of perianesthetic invasive and non-invasive monitoring
- Overseeing elements of client blood levels
- Documenting client information
- Using appropriate measures to ensure client recovery from anesthesia
- Releasing clients from care following anesthesia
- Providing follow-up care to clients after anesthesia
In addition to anesthesia services, a CRNA may perform clinical acts including, but not limited to:
- Inserting epidural catheters and central vascular access catheters
- Providing care in emergency situations
- Providing patients with respiratory and ventilatory care
- Providing pain relief therapy through approved methods
CRNAs may prescribe a medical regimen or make a medical diagnosis only under the supervision of a physician.
Prescriptive Authority for APRNs in North Carolina
NPs and CNMs in North Carolina may earn prescriptive authority upon obtaining a DEA number. The authority includes legend drugs and Controlled Substance Schedules II – V consistent with the nurse’s scope of practice (details would be outlined in the nurse’s collaborative practice agreement).
CNSs and CRNAs are not eligible for prescriptive authority in North Carolina
Collaborative Practice in North Carolina
APRNs in North Carolina must meet collaborative practice requirements based on their role.
CNMs – Nurse midwives must work under the supervision of a physician who is actively engaged in the practice of obstetrics in North Carolina. The agreement must outline the clinical responsibilities of the CNM as well as define communication and consultation methods between the CNM and the supervising physician.
NPs – Nurse practitioners must enter into a collaborative agreement with a physician that details the NP and physician’s continuous availability to each other for consultation and collaboration. Collaborative agreements vary based on the NP’s practice location, factoring in details such as:
- Types of patients treated
- Complexity of care offered
- Common patient diagnoses
- Availability of practice’s emergency services, diagnostic centers, and specialists
Additional details that may influence the NP’s scope of practice may include the NP’s professional experience and the duration of the NP’s past agreement with the collaborating physician, if applicable.
CRNAs – Nurse anesthetists must collaborate with a physician, dentist, podiatrist, or other qualified health care professional to perform anesthesia services, although no written agreement is required.
CNSs – Clinical nurse specialists may practice with no collaborative restrictions.
North Carolina and the APRN Consensus Model
The 2015 Senate Bill “An Act to Modernize the Nursing Practice Act” would align North Carolina’s nursing laws with the national APRN consensus model, a uniform set of rules designed to allow nurses to practice to the full extent of their education without significant restrictions.
As of January 2016, North Carolina had adopted the following major components of the model:
- Roles
- Education
- Certification
- CRNA independent practice
- CNS independent practice
Continuing Education Requirements for APRNs in North Carolina
CNMs, CNSs, and CRNAs must develop a continued learning plan and complete a self practice assessment during each two-year license cycle. Additionally, they must complete one of the following learning activities related to their area of practice:
- Thirty contact hours of CE
- 640 hours of active practice
- National certification or recertification from a recognized national certifying body
- Two semester hours of post-licensure academic education
- Fifteen contact hours of a CE activity, along with one of the following:
- Serving as an investigator or co-investigator in the completion of a nursing project (nurses must include a statement based on project details)
- Authoring or co-authoring a published nursing article, paper, book, or book chapter
- Creating and conducting an educational presentation or presentations for other nurses or health professionals (presentations must total a minimum of five contact hours)
NPs must complete 50 contact hours of CE every year. A minimum of 20 hours must meet the following requirements:
- Hours must be approved by the ANCC, the ACCME, or another national credentialing body
- Hours must consist of courses from an institution of higher learning relevant to the NP’s practice
Additional CE options for NPs include:
- Clinical presentations (up to five hours)
- Board-approved professional volunteer service (up to 5 hours)
- Completing research related to area of specialty approved by the Institutional Review Board (IRB) (up to 10 hours)
- Authoring or serving as a secondary author on a journal article or book chapter (up to five hours)
- Authoring or serving as a secondary author on a book (up to 30 hours)
- Preceptor hours, subject to approval from an educational program (up to 30 hours)