Collaborative Practice Agreement · NP
North Carolina Collaborative Practice Arrangement for Nurse Practitioners
Required. The Collaborative Practice Arrangement is the written instrument North Carolina law names for a Nurse Practitioner working with a physician. Below: the board that governs it, what it must contain, and the terms it has to carry.
North Carolina remains a restricted/reduced-practice state for NPs. The SAVE Act has not passed despite repeated filings; there is no experience- or hours-based pathway to independent practice for NPs in NC.
What a North Carolina Collaborative Practice Arrangement must contain
Governed by the North Carolina Board of Nursing and the Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.
The Nurse Practitioner will practice pursuant to a collaborative practice arrangement with a primary supervising Physician, as defined by regulations of the North Carolina Medical Board and Board of Nursing. The Physician shall be available to the Nurse Practitioner for consultation. (See Title 21, Chapter 32M of the North Carolina Administrative Code.)
Source: 21 NCAC 32M
The Physician and the Nurse Practitioner shall hold documented joint meetings monthly for the first six (6) months of a new collaborative practice arrangement, and at least every six (6) months thereafter, sufficient to address practice-relevant clinical problems, quality improvement measures, and compliance with applicable regulations, as required by 21 NCAC 36 .0809 and .0810. The Physician and the Nurse Practitioner shall also establish a process for the ongoing review of the care provided in each practice site, including a written plan for evaluating the quality of care for one or more frequently encountered clinical problems. This plan shall include a description of the identified clinical problems, an evaluation of current treatment interventions, and, where appropriate, a plan for improving outcomes within a specified timeframe. A written record of all required meetings shall be dated and signed by the Physician and the participating Nurse Practitioner and maintained for a period of five (5) years. Such records shall be available for inspection upon request by the North Carolina Medical Board, the North Carolina Board of Nursing, or their authorized agents. Both the Nurse Practitioner and the Physician shall retain copies of these records.
Source: 21 NCAC 36 .0809, .0810
- The Collaborative Practice Arrangement on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.
Statutes and rules cited
- 21 NCAC 32Mregulation
North Carolina Medical Board rules governing nurse practitioner approval to practice and the collaborative practice arrangement with a primary supervising physician.
- 21 NCAC 36 .0809, .0810regulation
Board of Nursing rules requiring documented joint meetings between the primary supervising physician and the nurse practitioner: monthly for the first 6 months of a new collaborative practice arrangement, then at least every 6 months thereafter.
- 21 NCAC 32S .0213regulation
North Carolina Medical Board rule requiring periodic joint meetings, a quality-improvement review process, and 5-year recordkeeping for physician assistant supervision.
- N.C. Gen. Stat. § 90-18.1statute
S.L. 2023-47 team-based practice pathway allowing an experienced physician assistant (4,000+ total hours and 1,000+ specialty hours, approved by the Medical Board) to practice without the traditional cosignature/supervision requirement outside perioperative settings.
- N.C. Gen. Stat. § 90-18.4statute
Clinical Pharmacist Practitioner (CPP) designation, requiring joint Medical Board / Board of Pharmacy approval and a written collaborative practice agreement with a supervising physician.
- 21 NCAC 46 .3101 et seq.regulation
Board of Pharmacy rules on CPP approval, scope (implementing predetermined drug therapy, modifying drug therapy, ordering laboratory tests), and physician countersignature of CPP orders.
- S.L. 2025-37 (Board of Pharmacy CPP guidance, effective October 1, 2025)board guidance
Board of Pharmacy guidance on new CPP authority to order/perform CLIA-waived tests and initiate treatment for influenza under statewide protocols.
- N.C. Gen. Stat. § 90-171 et seq.statute
North Carolina Nursing Practice Act.
- Board of Nursing continuing competence requirementsboard guidance
Board of Nursing guidance on the 30-contact-hour (or alternative) continuing competence requirement for RN license renewal every 2 years.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the agreement has to carry, from the state's supervision rules.
Proximity
Available remotely (no on-site requirement)
Primary (or backup) supervising physician and NP must be continuously available to each other for consultation by direct communication or telecommunication; no on-site or mileage/minute standard is codified (21 NCAC 36 .0810).
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
new collaborative practice agreement, first 6 months: Monthly, in person or via telehealth
Physician and NP must jointly develop a written QI plan / ongoing chart-review process, but no fixed percentage or sampling rate is codified (21 NCAC 36 .0810). Meetings must be signed/dated and records retained 5 years.
ongoing, after first 6 months: Every 6 months, in person or via telehealth
The CPA itself must also be reviewed, signed, and dated at least annually.
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Pain-management practices: consult supervising physician before any controlled-substance prescription expected to exceed 30 days, re-consult at least every 90 days.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation (PC) or PLLC — an NP may wholly own a nursing-services entity alone or jointly with any combination of RN/CNS/CNM/CRNA, or jointly with a physician (N.C. Gen. Stat. § 55B-14); non-licensees may not hold equity.
Ownership and clinical collaboration are legally distinct: the physician an NP collaborates with under a Collaborative Practice Agreement does not need to own the entity the NP practices through.
Legal sources for these rules (5)
- N.C. Gen. Stat. § 90-18.2
- 21 N.C. Admin. Code 36 .0810 — Quality Assurance Standards for a Collaborative Practice Agreementsecondary
- 21 N.C. Admin. Code 32M .0109 — Prescribing Authoritysecondary
- NCBON — Nurse Practitioner Scope of Practice / FAQsecondary
- NC Nurses Association — SAVE Act statussecondary
About North Carolina's rules
The NP 'SAVE Act' (full practice authority) has failed every session since 2021, most recently as S.B. 966 (2026) — NC NPs have no independent-practice pathway. PA 'team-based practice' (S.L. 2025-37/H.B. 67) is now LIVE: its June 30, 2026 trigger has passed, regardless of whether NCMB's conforming rules were finished by then. Several categories below (CRNA proximity/ratio/chart-review, CNM proximity) have no codified numeric standard — treat as open items to verify with the board, not an absence of one.
Other clinicians in North Carolina: see the state overview.