Practice Agreement · RN
Registered Nurse Practice Agreement in North Carolina
North Carolina law does not require a Registered Nurse to hold a named agreement with a physician. Practices still use one to define the working relationship; here is what it covers and what the state does require.
RNs (general licensure, not an APRN) aren't subject to physician-supervision or collaborative-practice-agreement requirements in NC. Per NCBON's 'RN Scope of Practice Clarification' (March 2024), RN practice in all steps of the nursing process 'is independent and comprehensive' and 'does not require assignment or supervision by a higher level health care provider.' RNs work within physician orders, standing orders, and facility protocols — categorically different from an APRN's collaborative practice agreement.
What a Registered Nurse practice agreement covers in North Carolina
Governed by the North Carolina Board of Nursing. Each numbered item is a statutory requirement the agreement must satisfy.
The Registered Nurse ("RN") will practice under the direction and supervision of the Physician in accordance with the requirements of the North Carolina Board of Nursing. This Agreement is established pursuant to the North Carolina Nurse Practice Act (NCGS § 90-171, et seq.) and any applicable regulations governing the Registered Nurse. The Physician shall be available to the Registered Nurse for consultation regarding clinical and patient care issues.
Source: N.C. Gen. Stat. § 90-171 et seq.
- The agreement on file also carries 2 scope, 2 education, 2 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
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · no controlled-substance authority
RNs do not have independent prescriptive authority in NC; they may administer medications only as prescribed by a provider authorized by law to prescribe.
Written agreement
Not required
Unconditional — general RN licensure is never subject to physician supervision or a collaborative-practice agreement, unlike the APRN/PA categories above.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation (PC) or PLLC for nursing services — an RN may co-own with any combination of NP/CNS/CNM/CRNA, or with a physician (N.C. Gen. Stat. § 55B-14). Non-clinical businesses an RN might own (home health agency, staffing agency, general wellness business) fall outside § 55B-14 entirely and carry no ownership restriction.
For medical-aesthetics (med-spa) businesses performing medical procedures (e.g. Botox, laser), an RN may NOT own the clinical entity — that still requires physician (or physician+PA/NP) ownership under § 55B-14. Common workaround: the RN owns the MSO/business side while a physician-owned PC holds the clinical entity, with a physician medical director overseeing the procedures. This is secondary-sourced (law-firm guidance applying § 55B-14, not a med-spa-specific primary rule) — flag for confirmation before relying on it.
Legal sources for these rules (4)
- N.C. Gen. Stat. § 90-171.20(7) — Nursing Practice Act, Article 9A
- NCBON — RN Scope of Practice Clarification (Position Statement, March 2024)secondary
- 21 N.C. Admin. Code 36 .0224 — Components of Registered Nursing Practice
- N.C. Gen. Stat. § 55B-14 — Professional Corporation Act (ownership eligibility)
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.