H.B. 277
GENERAL ASSEMBLY OF NORTH CAROLINA
Mar 11, 2021
SESSION 2021 HOUSE PRINCIPAL CLERK
H D
HOUSE BILL DRH10110-NBf-50
Short Title: The SAVE Act. (Public)
Sponsors: Representatives White, Adcock, Cunningham, and Wheatley (Primary Sponsors).
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO DELIVER SAFE, ACCESSIBLE, VALUE-DIRECTED, AND EXCELLENT
3 (SAVE) HEALTH CARE THROUGHOUT NORTH CAROLINA BY MODERNIZING
4 NURSING REGULATIONS.
5 The General Assembly of North Carolina enacts:
6 SECTION 1. G.S. 90-171.20 reads as rewritten:
7 "§ 90-171.20. Definitions.
8 As used in this Article, unless the context requires otherwise:
9 (1) Advanced assessment. – The taking by an advanced practice registered nurse
10 of the history, physical, and psychological assessment of a patient's signs,
11 symptoms, pathophysiologic status, and psychosocial variations in the
12 determination of differential diagnoses and treatment.
13 (1a) Advanced practice registered nurse or APRN. – An individual licensed by the
14 Board as an advanced practice registered nurse within one of the following
15 four roles:
16 a. Nurse practitioner or NP.
17 b. Certified nurse midwife or CNM.
18 c. Clinical nurse specialist or CNS.
19 d. Certified registered nurse anesthetist or CRNA.
20 (1b) "Board" means the Board. – The North Carolina Board of Nursing.
21 (2) "Health care provider" means any Health care provider. – Any licensed health
22 care professional and any agent or employee of any health care institution,
23 health care insurer, health care professional school, or a member of any allied
24 health profession. For purposes of this Article, a person enrolled in a program
25 that prepares the person to be a licensed health care professional or an allied
26 health professional shall be deemed a health care provider.
27 (3) "License" means a License. – A permit issued by the Board to practice nursing
28 as an advanced practice registered nurse, as a registered nurse nurse, or as a
29 licensed practical nurse, including a renewal or reinstatement thereof.
30 (3a) "Licensee" means any Licensee. – Any person issued a license by the Board,
31 whether the license is active or inactive, including an inactive license by
32 means of surrender.
33 (4) "Nursing" is a Nursing. – A dynamic discipline which includes the assessing,
34 caring, counseling, teaching, referring and implementing of prescribed
35 treatment in the maintenance of health, prevention and management of illness,
36 injury, disability or the achievement of a dignified death. It is ministering to;
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1 assisting; and sustained, vigilant, and continuous care of those acutely or
2 chronically ill; supervising patients during convalescence and rehabilitation;
3 the supportive and restorative care given to maintain the optimum health level
4 of individuals, groups, and communities; the supervision, teaching, and
5 evaluation of those who perform or are preparing to perform these functions;
6 and the administration of nursing programs and nursing services. For purposes
7 of this Article, the administration of required lethal substances or any
8 assistance whatsoever rendered with an execution under Article 19 of Chapter
9 15 of the General Statutes does not constitute nursing.
10 (5) "Nursing program" means any Nursing program. – Any educational program
11 in North Carolina offering to prepare persons to meet the educational
12 requirements for licensure under this Article.Article as a registered nurse or a
13 licensed practical nurse.
14 (6) "Person" means an Person. – An individual, corporation, partnership,
15 association, unit of government, or other legal entity.
16 (6a) Population focus. – With respect to APRN practice, includes one of the
17 following areas of focus:
18 a. The family or the individual across the life span.
19 b. Adult/gerontology.
20 c. Neonatal.
21 d. Pediatrics.
22 e. Women's health or gender-related issues.
23 f. Psychiatric mental health.
24 (6b) Practice of nursing as an advanced practice registered nurse or APRN. – In
25 addition to the RN scope of practice and within the APRN role and population
26 foci, also consists of the following six components:
27 a. Conducting an advanced assessment.
28 b. Delegating and assigning therapeutic measures to assistive personnel.
29 c. Performing other acts that require education and training consistent
30 with professional standards and commensurate with the APRN's
31 education, certification, demonstrated competencies, and experience.
32 d. Complying with the requirements of this Article and rendering quality
33 advanced nursing care.
34 e. Recognizing limits of knowledge and experience.
35 f. Planning for the management of situations beyond the APRN's
36 expertise.
37 (6c) Practice of nursing as a certified nurse midwife or CNM. – In addition to the
38 RN scope of practice and APRN role and population foci, also consists of the
39 following four components:
40 a. The management, diagnosis, and treatment of primary sexual and
41 reproductive health care, including primary, preconception,
42 gynecologic/reproductive/sexual health, antepartum, intrapartum,
43 neonatal, and post-pregnancy care.
44 b. Ordering, performing, supervising, and interpreting diagnostic studies.
45 c. Prescribing pharmacologic and nonpharmacologic therapies.
46 d. Consulting with or referring to other health care providers as
47 warranted by the needs of the patient.
48 (6d) Practice of nursing as a certified registered nurse anesthetist or CRNA. – In
49 addition to the RN scope of practice and within the APRN role and population
50 foci, also consists of the following:
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1 a. Selecting, ordering, procuring, prescribing, and administering drugs
2 and therapeutic devices to facilitate diagnostic, therapeutic, and
3 surgical procedures.
4 b. Ordering, prescribing, performing, supervising, and interpreting
5 diagnostic studies, procedures, and interventions.
6 c. Consulting with or referring to other health care providers as
7 warranted by the needs of the patient.
8 (6e) Practice of nursing as a clinical nurse specialist or CNS. – In addition to the
9 RN scope of practice and APRN role and population foci, also consists of the
10 following eight components:
11 a. The diagnosis and treatment of health and illness states.
12 b. Disease management.
13 c. Prescribing pharmacologic and nonpharmacologic therapies.
14 d. Ordering, performing, supervising, and interpreting diagnostic studies.
15 e. Preventing of illness and risk behaviors.
16 f. Nursing care for individuals, families, and communities.
17 g. Integrating care across the continuum to improve patient outcomes.
18 h. Consulting with or referring to other health care providers as
19 warranted by the needs of the patient.
20 (6f) Practice of nursing as a nurse practitioner or NP. – In addition to the RN scope
21 of practice and APRN role and population foci, also consists of the following
22 six components:
23 a. Health promotion, disease prevention, health education, and
24 counseling.
25 b. Providing health assessment and screening activities.
26 c. Diagnosing, treating, and facilitating patients' management of their
27 acute and chronic illnesses and diseases.
28 d. Ordering, performing, supervising, and interpreting diagnostic studies.
29 e. Prescribing pharmacologic and nonpharmacologic therapies.
30 f. Consulting with or referring to other health care providers as
31 warranted by the needs of the patient.
32 (7) The "practice of nursing by a registered nurse" consists Practice of nursing by
33 a registered nurse. – Consists of the following 10 components:
34 a. Assessing the patient's physical and mental health, including the
35 patient's reaction to illnesses and treatment regimens.
36 b. Recording and reporting the results of the nursing assessment.
37 c. Planning, initiating, delivering, and evaluating appropriate nursing
38 acts.
39 d. Teaching, assigning, delegating to or supervising other personnel in
40 implementing the treatment regimen.
41 e. Collaborating with other health care providers in determining the
42 appropriate health care for a patient but, subject to the provisions of
43 G.S. 90-18.2, not prescribing a medical treatment regimen or making
44 a medical diagnosis, except under supervision of a licensed
45 physician.patient.
46 f. Implementing the treatment and pharmaceutical regimen prescribed or
47 ordered by any person authorized by State law to prescribe or order
48 the regimen.
49 g. Providing teaching and counseling about the patient's health.
50 h. Reporting and recording the plan for care, nursing care given, and the
51 patient's response to that care.
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1 i. Supervising, teaching, and evaluating those who perform or are
2 preparing to perform nursing functions and administering nursing
3 programs and nursing services.
4 j. Providing for the maintenance of safe and effective nursing care,
5 whether rendered directly or indirectly.
6 (8) The "practice of nursing by a licensed practical nurse" consists Practice of
7 nursing by a licensed practical nurse. – Consists of the following seven
8 components:
9 a. Participating in the assessment of the patient's physical and mental
10 health, including the patient's reaction to illnesses and treatment
11 regimens.
12 b. Recording and reporting the results of the nursing assessment.
13 c. Participating in implementing the health care plan developed by the
14 registered nurse and/or prescribed by any person authorized by State
15 law to prescribe such a plan, by performing tasks assigned or delegated
16 by and performed under the supervision or under orders or directions
17 of a registered nurse, physician licensed to practice medicine, dentist,
18 or other person authorized by State law to provide the supervision.
19 c1. Assigning or delegating nursing interventions to other qualified
20 personnel under the supervision of the registered nurse.
21 d. Participating in the teaching and counseling of patients as assigned by
22 a registered nurse, physician, or other qualified professional licensed
23 to practice in North Carolina.
24 e. Reporting and recording the nursing care rendered and the patient's
25 response to that care.
26 f. Maintaining safe and effective nursing care, whether rendered directly
27 or indirectly."
28 SECTION 2. G.S. 90-18(c) reads as rewritten:
29 "(c) The following shall not constitute practicing medicine or surgery as defined in this
30 Article:
31 …
32 (7) The practice of midwifery as defined in G.S. 90-178.2.
33 …
34 (14) The practice of nursing by a an advanced practice registered nurse engaged in
35 the practice of nursing and the performance of acts otherwise constituting
36 medical practice by a registered nurse when performed in accordance with
37 rules and regulations developed by a joint subcommittee of the North Carolina
38 Medical Board and the Board of Nursing and adopted by both boards.as
39 defined in Article 9A of this Chapter.
40 …."
41 SECTION 3.(a) G.S. 90-18.2 is repealed.
42 SECTION 3.(b) G.S. 90-2(a) reads as rewritten:
43 "(a) There is established the North Carolina Medical Board to regulate the practice of
44 medicine and surgery for the benefit and protection of the people of North Carolina. The Board
45 shall consist of 13 members:
46 …
47 (2) Five members shall all be appointed by the Governor as follows:
48 …
49 d. One shall be a nurse practitioner as defined in G.S. 90-18.2 as
50 recommended by the Review Panel pursuant to G.S. 90-3.
51 …."
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1 SECTION 3.(c) G.S. 90-18.3(a) reads as rewritten:
2 "(a) Whenever a statute or State agency rule requires that a medical or physical
3 examination shall be conducted by a physician, the examination may be conducted and the form
4 signed by a nurse practitioner or a physician assistant, and a physician need not be present.
5 Nothing in this section shall otherwise change the scope of practice of a nurse practitioner or a
6 physician assistant, as defined by G.S. 90-18.1 and G.S. 90-18.2, respectively.assistant."
7 SECTION 3.(d) G.S. 90-85.24(a) reads as rewritten:
8 "(a) The Board of Pharmacy shall be entitled to charge and collect not more than the
9 following fees:
10 …
11 (13) For annual registration as a dispensing nurse practitioner under G.S. 90-18.2,
12 practitioner, seventy-five dollars ($75.00);
13 …."
14 SECTION 3.(e) G.S. 90-85.34A reads as rewritten:
15 "§ 90-85.34A. Public health pharmacy practice.
16 …
17 (c) This section does not affect the practice of nurse practitioners pursuant to G.S. 90-18.2
18 or of physician assistants pursuant to G.S. 90-18.1."
19 SECTION 4. G.S. 90-29(b) reads as rewritten:
20 "(b) A person shall be deemed to be practicing dentistry in this State who does, undertakes
21 or attempts to do, or claims the ability to do any one or more of the following acts or things
22 which, for the purposes of this Article, constitute the practice of dentistry:
23 …
24 (6) Administers an anesthetic of any kind in the treatment of dental or oral
25 diseases or physical conditions, or in preparation for or incident to any
26 operation within the oral cavity; provided,