Steps to Becoming an APRN in North Carolina

north carolina nursing

Get your Graduate Degree in North Carolina
Earn your National Certification in North Carolina
Apply for your License in North Carolina
Renewing your License in North Carolina

 

The North Carolina Board of Nursing (phone: 919-782-3211, practice@ncbon.com) regulates the practice of advanced practice registered nurses (APRN) in the following roles:


  • Certified Registered Nurse Anesthetist (CRNA)
  • Clinical Nurse Specialist (CNS)

The Subcommittee of the Medical Board and the Board of Nursing regulates the practice of the APRN in the following role:

North Carolina Statistics

  • 2011 base salary for NPs in NC: $87,653
  • April 2011, North Carolina Board of Nursing allows NPs to prescribe up to 5 refills on Schedule III and IIIN drugs
  • NPs cannot prescribe refills of Schedule II drugs in North Carolina
  • Total number of APRNs licensed in North Carolina as of 2011: 7,149
  • Total number of NPs licensed in North Carolina as of 2011: 3,904
  • Total number of CNSs licensed in North Carolina as of 2011: 82
  • Total number of CNMs licensed in North Carolina as of 2011: 237
  • Nurse Practitioner (NP)

The Midwifery Joint Committee regulates the practice of the APRN in the following role:

  • Certified Nurse Midwife (CNM)

To be approved to work as an APRN in North Carolina, you must hold a valid, unencumbered North Carolina (or Compact state*) RN license. If you do not hold an active RN license in North Carolina, you can obtain one by completing one of the following steps:

  • If you are a graduate of a Board-approved nursing program, you may apply using the Licensure by Examination online application.
  • If you are a graduate of a nursing program outside of the United States and your education preparation is comparable to that of a Board-approved nursing program, and you can submit evidence from a Board-approved evaluation agency of your educational qualifications and English proficiency, you may apply using the Licensure by Examination online application.
  • If you hold an active license in another jurisdiction, you may apply using the Licensure by Endorsement online application. *
  • If your North Carolina RN license has not been current within the past five years, you must complete a Board-approved refresher course and then contact the Board of Nursing Endorsement Department to begin the online application process.

*Nurse Licensure Compact

Rhode Island is part of the Nurse Licensure Compact. The Compact offers practice privileges for registered nurses in all compact states (which includes: Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia and Wisconsin).


 

Step 1. Get Your Graduate Degree

Certified Registered Nurse Anesthetist

To work toward CRNA licensure in North Carolina, you must complete a program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. As such, a master’s of science in nursing or another appropriate master’s degree is required.

Clinical Nurse Specialist

To work toward CNS licensure in North Carolina, you must complete a master’s program or higher in nursing resulting in a minimum of 500 hours of clinical experience for an expanded role in such areas as: mental health, neonatology, gerontology, cardiology, oncology, and community.

Nurse Practitioner

To work toward NP licensure in North Carolina, you must hold a master’s degree or higher in nursing or in a related field with a primary focus on nursing.

If you completed your NP education program before December 31, 1999, you must provide evidence of the completion of a core curriculum that includes at least 400 contact hours of didactic education and at least 400 hours of preceptorship or supervised clinical experience. The core curriculum must contain:

  • Health assessment and diagnostic reasoning
  • Pharmacology
  • Clinical management of common health problems and diseases
  • Clinical preventative services, including health promotion and the prevention of disease
  • Client education
  • Role development, including legal, ethical, economical, health policy and interdisciplinary collaboration issues

If you were approved to practice as an NP in North Carolina before January 18, 1981, you are permanently exempt from the core curriculum requirement. If you were certified as an NP by a national credentialing body before January 1, 1998, you may be exempt from the core curriculum requirements.

Certified Nurse Midwife

To work toward CNM licensure in North Carolina, you must complete a nurse midwifery education program that meets the criteria of the American College of Nurse-Midwives for certification. As such, a post-graduate certificate from a midwifery program or a master’s in nursing is required.


 

Step 2. Earn Your National Certification

After the successful completion of an education program in your APRN specialty, you must become certified through a national credentialing body in your advanced practice nursing specialty:

  • Certified Registered Nurse Anesthetist (CRNA)
  • Clinical Nurse Specialist (CNS)
  • Nurse Practitioner (NP)
  • Certified Nurse Midwife (CNM)

The North Carolina Board of Nursing recognizes the following certifying bodies for APRNs:

  • National Board of Certification and Recertification of Nurse Anesthetists
    • Certified Registered Nurse Anesthetists
  • American Nurses Credentialing Center
    • Adult Nurse Practitioner
    • Family Nurse Practitioner
    • Pediatric Nurse Practitioner
    • Gerontological Nurse Practitioner
    • Acute Care Nurse Practitioner
    • Clinical Specialist in Medical-Surgical Nursing
    • Clinical Specialist in Gerontological Nursing
    • Clinical Specialist in Adult Psychiatric and Mental Health Nursing
    • Clinical Specialist in Child and Adolescent Psychiatric and Mental Health Nursing
    • Psychiatric and Mental Health Nurse Practitioner (Adult and Family)

The North Carolina Midwifery Joint Committee recognizes the following certifying body for APRNs:

Note: If you graduated as an NP before January 1, 2000, you are exempt from the national certification requirement.

Note: Recognition as a CNS is voluntary in the state, but national certification is mandatory if you choose to be recognized as a CNS by the North Carolina Board of Nursing.


 

Step 3. Apply for your License

Applications for NP approval to practice and CRNA recognition must be completed using the online application portal. Applications for CNM approval to practice and CNS recognition can be downloaded and printed from the Board’s website.

NP Approval to Practice

To apply for NP licensure in North Carolina, you must complete the Nurse Practitioner Registration and Initial Approval to Practice form (you may also complete just the Nurse Practitioner Initial Approval to Practice application form if you were previously licensed as an NP in North Carolina).

All new nurse practitioners in North Carolina must first apply for registration. You need only apply for NP registration once, and once you have applied, you will always be registered as an NP in North Carolina and will always be allowed to use the title of “nurse practitioner.” Registration, however, does not allow you to practice as an NP in North Carolina. You must also apply using an initial approval to practice application.

This form combines the NP registration application with the initial approval to practice education. You may complete this form if you are applying for the first time for your NP license in North Carolina. Once you have completed this application, you will be notified, via email, of the receipt of your online application, and then notified, via mail, of your final approval to practice within three weeks after submitting your application.

You may track the status of your application by visiting the Nurse Practitioner Application Status Check page and entering your birth date and social security number.

Once you have received your approval letter in the mail, you must verify your license through the Board’s Licensure Verification Service.  After verification, you will receive a written confirmation of your registration and interim approval.

Before you begin your online application for NP licensure, you will want to assemble the following items, as the system times out after 20 minutes of inactivity:

  • Your social security number
  • Your date of birth
  • Your Compact state RN license number and expiration date if you are not licensed as an RN in North Carolina
  • Your collaborating physician name and his or her license number, practice name, practice address, and practice phone number
  • If your collaborating physician has any malpractice claims, you will need to download the claims form and submit it to the Board of Nursing
  • A list of any additional practice sites, along with their addresses
  • A MasterCard or Visa for the applications fees, which include: $25 registration application fee and $100 approval to practice application fee (per practice)

CRNA Recognition

To apply for CRNA recognition in North Carolina, you must complete an Initial NC CRNA Recognition form.

Beginning July 1, 2003, the North Carolina Board of Nursing initiated a verification process for all nurse anesthetists as to ensure all criteria are met and all qualifications and practice parameters are followed. In short, if you are an RN who completed a program that is accredited by the Council on Accreditation of Nurse Anesthesia Educational Program, you are automatically credentialed as a certified registered nurse anesthetist (CRNA) by the Council on Certification and Recertification of Nurse Anesthetists. You may perform all nurse anesthesia activities in collaboration with a physician, podiatrist, dentist or other healthcare provider, but you may not prescribe medical treatment or make a medical diagnosis unless it is under the supervision of a licensed physician.

You must apply for initial recognition in North Carolina as a CRNA if you are a:

  • CRNA practicing in North Carolina
  • CRNA endorsing as an RN into North Carolina
  • CRNA licensed by another Compact state and who is practicing in North Carolina under the Nurse Licensure Compact

Before you begin completing the initial recognition form, you will want to assemble the following items, as the system times out after 20 minutes of inactivity:

  • Your social security number
  • Your NC Temporary, Permanent or Compact State RN certification number
  • Your birth month
  • A valid MasterCard or Visa, or checking account information for the administrative fee of $25

After the Board has received your recognition application, they will determine if you have met all the conditions before your approval will be granted.

Your initial recognition as a CRNA in North Carolina will be valid for either one or two years, depending on your national certification renewal date. All CRNAs are expected to renew their national certification every two years in July. After your form is submitted to the Board, you can expect to receive a CRNA recognition certificate from the Board in the mail within 4 to 6 weeks.

CNS Recognition

To apply for recognition as a CNS in North Carolina, you must download, print and mail the Application for Recognition as a Clinical Nurse Specialist on the Board of Nursing’s website (click on “Practice,” then “APRN,” and then “CNS”).

Download the PDF document and print it, and remember to keep a copy of the completed application for your records. In addition to a completed and signed application for CNS recognition, you must include:

  • A check or money order in the amount of $25 made payable to the “North Carolina Board of Nursing” (you may also pay by credit card)
  • A copy of your graduate degree
  • A notarized letter from your program director attesting that you have completed a graduate program that included at least 500 hours of clinical experience in a clinical nursing specialty sent directly from the program director to the Board (the form is found at the end of the application)
  • A copy of your current national certification, sent directly from the credentialing body to the Board (must include the certification number and expiration date)

Send the completed application form, the processing fee and any related documentation to the: North Carolina Board of Nursing, Practice Coordinator, P.O. Box 2129, Raleigh, NC 27602. Allow four to six weeks for your application to be received and processed by the Board.

CNM Approval to Practice

To apply for licensure as a CNM in North Carolina, you must download, print and mail the Application for Approval as a Certified Nurse-Midwife on the Board of Nursing’s website (click on “Practice,” then “APRN,” and then “CNM”). You must either type or print using black ink on the application.

All applications for initial approval in North Carolina as a CNM are reviewed and approved by the Midwifery Joint Committee. Download the PDF document and print it, and remember to keep a copy of the completed application for your records. In addition to a completed and signed application for CNM licensure, which must also include all relevant information regarding your collaborative agreement, you must include:

  • An application fee of $100 in a check or money order made payable to the “Midwifery Joint Committee” (must be attached to the application)
  • A copy of your certification from the American College of Nurse-Midwives (you may also apply for licensure if you are awaiting the results from your certification examination)
  • A passport-type photograph taken within the last six months
  • If you were previously verified as a CNM in another state(s), complete the Licensure Biography ANCM Certification From Other States form

Mail the completed and signed application, along with all related documents and application fee to the: Midwifery Joint Committee, P.O. Box 2129, Raleigh, NC 27602-2129.

Prescriptive Privileges

The North Carolina Board of Nursing and the Medical Board grants legal permission for NPs and CNMs to procure and prescribe legend and controlled pharmacological agents and devices under the Board of Nursing rules and federal and state laws and regulations.

All drugs and devices prescribed by the NP must be included in the collaborative agreement. All controlled substances under the State and Federal Controlled Substances Act that may be procured, prescribed or ordered by the NP must be in the collaborative practice agreement, provided that you have an assigned DEA number. You may be able to prescribe a drug or device not included in the collaborative practice agreement if you receive a written or verbal from a primary or backup supervising physician.

If you plan to prescribe or order controlled substances as an NP or CNM, you must first obtain a DEA number by contacting the Drug Enforcement Agency at 1-888-219-8689.

Collaborative Agreement

To practice as a CRNA in North Carolina, you must enter into a collaborative agreement with a physician, dentist, podiatrist or other healthcare provider. You may not prescribe a medical treatment or make a medical diagnosis unless you are under the supervision of a physician.

To practice as an NP in North Carolina, you must enter into a collaborative agreement with a primary supervising physician. To maintain a collaborative agreement with a supervision physician, you and the physician must always be available to each other for consultation, either by direction communication or telecommunication. The collaborative practice agreement must:

  • Be signed by both the NP and the supervising physician
  • Be made available at each practice site
  • Be made readily available for inspection by members or agents of the Board
  • Include a detailed list of all drugs, devices, medical treatments, tests and procedures that may be prescribed or performed by the NP
  • Include a pre-determined emergency plan of action
  • Be reviewed on an annual basis
  • Include a written plan for evaluating any frequently encountered clinical problems and a plan for improving outcomes within an identified time frame
  • Include scheduled meeting times between the NP and the supervising physician at least once every six months, and it must include documentation of those meetings

To practice as a CNM in North Carolina, you must work under the supervision of a physician who is actively engaged in obstetrics in North Carolina. You must present the following evidence to the Midwifery Joint Committee:

  • Clinical practice guidelines, which include clearly defined responsibilities of the CNM and the supervising physician, that have been approved by both the CNM and the supervising physician
  • Clinical practice guidelines for ongoing communication and consultation between the CNM and the supervising physician
  • Periodic and joint evaluation of charts, patient, outcome statistics and written medical clinical practice guidelines


 

Step 4. Renewing Your License

Continuing Competence

To be approved for license renewal as an APRN in North Carolina, you must provide evidence of continuing competence, which includes:


  • The completion of a self-assessment highlighting your professional responsibility, your knowledge-based practice, your legal-ethic practice and your collaboration with others
  • Your continued learning in the preceding renewal cycle, which must include at least one of the following:
    • National certification or re-certification in your practice role by a national credentialing body recognized by the Board
    • At least 30 contact hours of continuing education activities related to your practice role
    • The completion of a Board-approved refresher course
    • The completion of at least two semester hours of post-licensure academic education related to your practice role
    • At least 15 contact hours of a continuing education activity related to your practice role, and the completion of a nursing project in which you are the principal or co-principal investigator
    • At least 15 contact hours of a continuing education activity related to your practice role, and the completion of a published, nursing-related article, paper, book or book chapter in which you are the author or co-author
    • At least 15 contact hours of a continuing education activity related to your practice role, and the completion of an educational presentation or presentations which you designed, developed and conducted (it must total a minimum of 5 contact hours for nurses or other health professionals)
    • At least 15 contact hours of a continuing education activity related to your practice role, and at least 640 hours of active practice within the last two years

NP Renewal

To renew your NP approval to practice, you must first renew your RN license. You must renew your approval to practice before the last day of your birth month each year. If you fail to renew your approval to practice before it expires, it will automatically be considered inactive and you will need to reapply for approval to practice by completing the approval to practice application. The Board will send notification in the mail when it is time to renew your approval to practice.

Before renewing your NP approval to practice, make sure:

  • Your collaborative practice agreement is in place and updated
  • Your collaborative agreement meetings are documented and include all required content
  • Your CE requirements (50 contact hours between each annual review; 20 hours of which must be granted by the American Nurses Credentialing Center or Accreditation Council on Continuing Medical Education) are documented with certificates

To apply for renewal, you must complete the online Nurse Practitioner Approval to Practice Annual Renewal via the Board’s online renewal system.

Note: Renewal certificates are not mailed out; instead, you can print your annual renewal certificate on the confirmation page. The cost to renew your Nurse Practitioner Approval to Practice Annual Renewal is $50 per physician renewed.

If you were previously licensed as an NP in North Carolina, if you changed practice or changed primary supervising physician, or if you want to add an additional practice, you may do so by completing the Nurse Practitioner Subsequent Approval or Change to Practice form. The fee is $100 for per physician.

CRNA Renewal

In order to verify that you are meeting your regulatory requirements as a CRNA in North Carolina, you must verify your certification status with the Board, and you must continue to do so on a periodic basis that is consistent with your national certification renewal cycle.

As such, you are expected to renew your national certification biannually every July. You will receive a notice to update your CRNA recognition from the Board about 60 days prior to the expiration of your national certification. Once you have received your current national certification number and expiration date, you must pass this information along to the Board by completing the Update NC CRNA Recognition online form and submitting an administrative charge of $25 to the Board using a valid credit card or checking account.

CNM Renewal

You must renew your CNM approval to practice on an annual basis, according to your birth month. No renewal notices are sent from the Midwifery Joint Committee. To renew your CNM approval to practice, you must download, print, complete and sign the Application for Annual Renewal as a Certified Nurse-Midwife on the Board of Nursing’s website (click on “Practice,” then “APRN,” and then “CNM”). You must either type or print using black ink on the application.

When renewing your CNM approval to practice, it is important to make sure your clinical practice guidelines and collaborative agreement are updated and available at each clinical site. This information should include:

  • Your written clinical practice guidelines for each clinical practice in which you work, including your collaborative agreement with a supervision physician. Guidelines must include all drugs and devices you prescribe or plan to prescribe, as well as your plan for ongoing communication and appropriate consultation with your supervising physician. You and the supervising physician must sign all guidelines.
  • Your process for periodic and joint evaluation of services
  • Your process for periodic and joint review of the written guidelines between you and the supervising physician

Mail your renewal application and a $50 renewal fee (for each approved collaborative practice agreement) made payable to the “Midwifery Joint Committee” (If you fail to renew your approval to practice before the expiration date, you must pay an additional $5 reinstatement fee) to the: Midwifery Joint Committee, P. O. Box 2129, Raleigh, NC 27602-2129.

Inactive Status

If you have an inactive APRN license in North Carolina, you must complete the following to be removed from inactive status:

  • Submit evidence of your unencumbered RN license
  • Attest to meeting all continuing competence requirements
  • Submit a renewal fee

If your APRN license has been inactive for more than five years, you must also submit:

  • Completion of a Board-approved refresher course, or
  • An active license in another jurisdiction with the last five years

If you want to claim an inactive status for your CRNA recognition, you can do so by completing the Update NC CRNA Recognition online form. There is no fee for this service.

If you want to claim inactive status for your NP approval to practice, you can do by completing the Nurse Practitioner Request Inactive Status online form.

Lapsed License

If you want to reinstate a lapsed APRN license, you must complete the following:

  • Submit evidence of your unencumbered RN license
  • Attest to meeting all continuing competence requirements
  • Provide a statement detailing the reason why you did not apply for renewal before the deadline
  • Submit the reinstatement and renewal fee

If your APRN license has lapsed for more than five years, you must also submit:

  • Evidence of the completion of a Board-approved refresher course, or
  • An active license in another jurisdiction with the last five years

Contact the Board of Nursing at 919-782-3211 for additional information regarding reinstating lapsed APRN licenses.

Advanced Practice Registered Nurse Associations in North Carolina

There are a number of professional organizations that support APRNs in North Carolina:

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