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Practice Agreement · NP

Nurse Practitioner Practice Agreement in North Dakota

North Dakota law does not require a Nurse Practitioner 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.

Practice authorityIndependent practice
Written agreementNo agreement required
What North Dakota calls itNo instrument required
Governing boardNorth Dakota Board of Nursing and the North Dakota State Board of Pharmacy
Research date2026-09-03 · clauses 2026-09-03

No physician-collaboration requirement exists at all — the former rule provision on changing physician collaboration for prescriptive authority (NDAC § 54-05-03.1-12) was repealed effective October 1, 2011. Full authority attaches upon APRN licensure and separate prescriptive-authority approval.

What a Nurse Practitioner practice agreement covers in North Dakota

Governed by the North Dakota Board of Nursing and the North Dakota State Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.

  1. North Dakota does not require the Nurse Practitioner to enter into a collaboration or supervision agreement with a physician. The Nurse Practitioner practices and prescribes independently under the Nurse Practitioner's own license, consistent with N.D.C.C. ch. 43-12.1.

    Source: N.D.C.C. ch. 43-12.1

  2. This Agreement's terms regarding the Nurse Practitioner accordingly serve to define the working relationship, referral pathways, and any Medical Director oversight between the Parties, and are not themselves required by North Dakota law as a condition of the Nurse Practitioner's authority to practice.

  3. The agreement on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.

Statutes and rules cited

  1. N.D.C.C. ch. 43-12.1statute

    North Dakota Nurse Practice Act, governing Nurse Practitioner and Registered Nurse licensure and practice.

  2. N.D.C.C. ch. 43-17statute

    North Dakota Physician Assistant practice act.

  3. N.D.C.C. § 43-15-31.4statute

    Authorizes a pharmacist to initiate or modify a patient's drug therapy under a collaborative practice agreement with a practitioner.

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 · controlled substances permitted

Initial prescriptive authority requires transcript evidence of advanced pharmacotherapy/assessment/pathophysiology coursework plus 30 contact hours of pharmacotherapy CE within the preceding 3 years (NDAC § 54-05-03.1-09); renewal requires 15 contact hours over 2 years (§ 54-05-03.1-11). Individual DEA registration required (§ 54-05-03.1-10(3)) — no collaboration agreement gates this. PDMP query required for new/unestablished patients, every 6 months during ongoing controlled-substance treatment, or on suspected diversion (§ 54-05-03.1-10(4)). May not prescribe controlled substances to oneself, a spouse, or a child (§ 54-05-03.1-10(7)).

Written agreement

Not required

Unconditional — no collaboration agreement of any kind is required for NP practice or prescribing in North Dakota.

Practice ownership (corporate practice of medicine)

Licensee-only ownership required — Professional corporation under N.D. Cent. Code ch. 10-31 (Professional Organizations Act) — shareholders must be licensed to render the same professional service as the corporation; no NP-specific ownership statute exists beyond this general framework.

Legal sources for these rules (3)
  • N.D. Admin. Code ch. 54-05-03.1 — Advanced Practice Registered Nurse
  • N.D. Admin. Code §§ 54-05-03.1-09 to -11 — Prescriptive authority (initial/renewal CE, DEA)
  • N.D. Admin. Code § 54-05-03.1-12 (repealed eff. Oct. 1, 2011) — former physician-collaboration rule
How the relationship works day to day
Who has to be where, how often you meet, and what the physician costs: Nurse Practitioner in North Dakota on collaborativeagreement.com.

About North Dakota's rules

H.B. 1175 (2019, eff. 2020) and a 2022 rule amendment repealed ND's old PA supervision-contract/ratio/countersignature model — PAs are now CONDITIONAL only below 4,000 practice hours or outside a qualifying facility. All four APRN roles (NP, CRNA, CNM, CNS) are FULL independent practice with no collaboration agreement of any kind.

Other clinicians in North Dakota: see the state overview.