H.B. 218
GENERAL ASSEMBLY OF NORTH CAROLINA
Feb 28, 2023
SESSION 2023 HOUSE PRINCIPAL CLERK
H D
HOUSE BILL DRH10108-NBf-95
Short Title: The SAVE Act. (Public)
Sponsors: Representative White.
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. Certified nurse practitioner or CNP.
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 a certified nurse midwife or CNM. – In addition to the
25 RN scope of practice and APRN role and population foci, also consists of the
26 following four components:
27 a. The management, diagnosis, and treatment of primary sexual and
28 reproductive health care, including primary, preconception,
29 gynecologic/reproductive/sexual health, antepartum, intrapartum,
30 neonatal, and post-pregnancy care.
31 b. Ordering, performing, supervising, and interpreting diagnostic studies.
32 c. Prescribing pharmacologic and nonpharmacologic therapies.
33 d. Consulting with or referring to other health care providers as
34 warranted by the needs of the patient.
35 (6c) Practice of nursing as a certified nurse practitioner or CNP. – In addition to
36 the RN scope of practice and APRN role and population foci, also consists of
37 the following six components:
38 a. Health promotion, disease prevention, health education, and
39 counseling.
40 b. Providing health assessment and screening activities.
41 c. Diagnosing, treating, and facilitating patients' management of their
42 acute and chronic illnesses and diseases.
43 d. Ordering, performing, supervising, and interpreting diagnostic studies.
44 e. Prescribing pharmacologic and nonpharmacologic therapies.
45 f. Consulting with or referring to other health care providers as
46 warranted by the needs of the patient.
47 (6d) Practice of nursing as a certified registered nurse anesthetist or CRNA. – In
48 addition to the RN scope of practice and within the APRN role and population
49 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 an advanced practice registered nurse or APRN. – In
21 addition to the RN scope of practice and within the APRN role and population
22 foci, also consists of the following six components:
23 a. Conducting an advanced assessment.
24 b. Delegating and assigning therapeutic measures to assistive personnel.
25 c. Performing other acts that require education and training consistent
26 with professional standards and commensurate with the APRN's
27 education, certification, demonstrated competencies, and experience.
28 d. Complying with the requirements of this Article and rendering quality
29 advanced nursing care.
30 e. Recognizing limits of knowledge and experience.
31 f. Planning for the management of situations beyond the APRN's
32 expertise.
33 (7) The "practice of nursing by a registered nurse" consists Practice of nursing by
34 a registered nurse. – Consists of the following 10 components:
35 a. Assessing the patient's physical and mental health, including the
36 patient's reaction to illnesses and treatment regimens.
37 b. Recording and reporting the results of the nursing assessment.
38 c. Planning, initiating, delivering, and evaluating appropriate nursing
39 acts.
40 d. Teaching, assigning, delegating to or supervising other personnel in
41 implementing the treatment regimen.
42 e. Collaborating with other health care providers in determining the
43 appropriate health care for a patient but, subject to the provisions of
44 G.S. 90-18.2, not prescribing a medical treatment regimen or making
45 a medical diagnosis, except under supervision of a licensed
46 physician.patient.
47 f. Implementing the treatment and pharmaceutical regimen prescribed or
48 ordered by any person authorized by State law to prescribe or order
49 the regimen.
50 g. Providing teaching and counseling about the patient's health.
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1 h. Reporting and recording the plan for care, nursing care given, and the
2 patient's response to that care.
3 i. Supervising, teaching, and evaluating those who perform or are
4 preparing to perform nursing functions and administering nursing
5 programs and nursing services.
6 j. Providing for the maintenance of safe and effective nursing care,
7 whether rendered directly or indirectly.
8 (8) The "practice of nursing by a licensed practical nurse" consists Practice of
9 nursing by a licensed practical nurse. – Consists of the following seven
10 components:
11 a. Participating in the assessment of the patient's physical and mental
12 health, including the patient's reaction to illnesses and treatment
13 regimens.
14 b. Recording and reporting the results of the nursing assessment.
15 c. Participating in implementing the health care plan developed by the
16 registered nurse and/or prescribed by any person authorized by State
17 law to prescribe such a plan, by performing tasks assigned or delegated
18 by and performed under the supervision or under orders or directions
19 of a registered nurse, physician licensed to practice medicine, dentist,
20 or other person authorized by State law to provide the supervision.
21 c1. Assigning or delegating nursing interventions to other qualified
22 personnel under the supervision of the registered nurse.
23 d. Participating in the teaching and counseling of patients as assigned by
24 a registered nurse, physician, or other qualified professional licensed
25 to practice in North Carolina.
26 e. Reporting and recording the nursing care rendered and the patient's
27 response to that care.
28 f. Maintaining safe and effective nursing care, whether rendered directly
29 or indirectly."
30 SECTION 2. G.S. 90-18(c) reads as rewritten:
31 "(c) The following shall not constitute practicing medicine or surgery as defined in this
32 Article:
33 …
34 (7) The practice of midwifery as defined in G.S. 90-178.2.
35 …
36 (14) The practice of nursing by a an advanced practice registered nurse engaged in
37 the practice of nursing and the performance of acts otherwise constituting
38 medical practice by a registered nurse when performed in accordance with
39 rules and regulations developed by a joint subcommittee of the North Carolina
40 Medical Board and the Board of Nursing and adopted by both boards.as
41 defined in Article 9A of this Chapter.
42 …."
43 SECTION 3.(a) G.S. 90-18.2 is repealed.
44 SECTION 3.(b) G.S. 90-2(a) reads as rewritten:
45 "(a) There is established the North Carolina Medical Board to regulate the practice of
46 medicine and surgery for the benefit and protection of the people of North Carolina. The Board
47 shall consist of 13 members:
48 …
49 (2) Five members shall all be appointed by the Governor as follows:
50 …
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1 d. One shall be a certified nurse practitioner as defined in G.S. 90-18.2
2 as recommended by the Review Panel pursuant to G.S. 90-3.
3 …."
4 SECTION 3.(c) G.S. 90-18.3(a) reads as rewritten:
5 "(a) Whenever a statute or State agency rule requires that a medical or physical
6 examination shall be conducted by a physician, the examination may be conducted and the form
7 signed by a certified nurse practitioner or a physician assistant, and a physician need not be
8 present. Nothing in this section shall otherwise change the scope of practice of a certified nurse
9 practitioner or a physician assistant, as defined by G.S. 90-18.1 and G.S. 90-18.2,
10 respectively.assistant."
11 SECTION 3.(d) G.S. 90-85.24(a) reads as rewritten:
12 "(a) The Board of Pharmacy shall be entitled to charge and collect not more than the
13 following fees:
14 …
15 (13) For annual registration as a dispensing nurse practitioner under G.S. 90-18.2,
16 practitioner, seventy-five dollars ($75.00);
17 …."
18 SECTION 3.(e) G.S. 90-85.34A reads as rewritten:
19 "§ 90-85.34A. Public health pharmacy practice.
20 …
21 (c) This section does not affect the practice of certified nurse practitioners pursuant to
22 G.S. 90-18.2 or of physician assistants pursuant to G.S. 90-18.1."
23 SECTION 4. G.S. 90-29(b) reads as rewritten:
24 "(b) A person shall be deemed to be practicing dentistry in this State who does, undertakes
25 or attempts to do, or claims the ability to do any one or more of the following acts or things
26 which, for the purposes of this Article, constitute the practice of dentistry:
27 …
28 (6) Administers an anesthetic of any kind in the treatment of dental or oral
29 diseases or physical conditions, or in preparation for or incident to any
30 operation within the oral cavity; provided, however, that