Physician duties · NP · North Carolina
Signing for a Nurse Practitioner in North Carolina: what the physician takes on
The agreement is mandatory for the clinician, which makes its duties mandatory for you. North Carolina calls the instrument a Collaborative Practice Arrangement.
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 you take on as the physician
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
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
What physicians charge for this role
Typical monthly compensation in North Carolina
$500 – $650
Estimate for one Nurse Practitioner. This state's proximity rules add a small premium.
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.