House Bill 514 would create a comprehensive statutory framework for advanced practice registered nurses (APRNs) in North Carolina. It defines APRNs as a licensed category within four roles—certified nurse practitioner (CNP), certified nurse midwife (CNM), clinical nurse specialist (CNS), and certified registered nurse anesthetist (CRNA)—and spells out the scope of practice for each role. The bill also defines key nursing terms, sets out licensure, renewal, reinstatement, and grandfathering provisions for APRNs, and updates title and abbreviation rules so that APRNs may use the APRN designation and role-specific abbreviations.
The bill revises multiple chapters of state law to align with the new APRN framework. It repeals existing provisions tied to the older certified nurse practitioner structure, removes the prior joint subcommittee mechanism used to authorize certain medical acts by registered nurses, and instead authorizes the Board of Nursing to grant prescribing, ordering, dispensing, and furnishing authority to APRN license holders. It also updates related statutes involving medicine, dentistry, pharmacy, school concussion clearance, and health care provider definitions, and directs the Revisor of Statutes to replace references to “nurse practitioner” and “NP” with “certified nurse practitioner” and “CNP” in numerous laws.
The bill’s stated purpose is to reduce ambiguity and allow APRNs to practice to the full extent of their education, certification, and licensure. It includes findings asserting that APRNs improve access to care, can help address provider shortages, and may reduce health care costs. It also requires the Governor to request a federal Medicare anesthesia “opt-out” letter to maximize facility flexibility in obtaining reimbursement for anesthesia services, and directs the relevant licensing boards to adopt implementing rules.
Because there are no committee transcripts or recorded votes in the provided material, the overall sentiment can only be inferred from the bill text itself. The bill is framed positively and expansively, with strong support implied for expanding APRN authority, improving access to care, and removing outdated regulatory barriers. The sponsors’ findings emphasize patient access, cost savings, and safety, suggesting the bill is intended as a modernization measure rather than a narrow technical cleanup.
The main points of contention likely center on scope of practice and professional oversight. By defining APRN practice more broadly and shifting authority away from the prior joint medical-board/nursing-board structure, the bill could be viewed as expanding independent practice authority for APRNs and reducing physician oversight in some contexts. Related issues include the repeal of G.S. 90-18.2, the new prescribing/dispensing authority, and the anesthesia reimbursement opt-out request, all of which may draw scrutiny from medical, dental, or hospital stakeholders concerned about regulatory authority, patient safety, and reimbursement policy.
The bill would substantially revise North Carolina’s nursing statutes by formally defining APRN licensure and scope of practice in Chapter 90, Article 9A, while repealing older provisions tied to certified nurse practitioner practice and the prior medical-board/nursing-board approval structure. It would also amend related statutes in medicine, dentistry, pharmacy, education, and health care provider definitions to conform to the new APRN framework, including changes to title usage, licensure verification, and concussion clearance authority. In practical terms, the bill would affect APRNs, hospitals, clinics, dentists, pharmacies, and other health care facilities by clarifying who may practice, what titles may be used, and what authority APRNs may exercise.
The bill’s tone and findings are strongly supportive of APRN practice expansion and regulatory modernization. The text presents APRNs as an evidence-based solution to provider shortages, access problems, and high health care costs, and it frames the current statutory scheme as outdated and ambiguous. No opposing testimony or recorded votes are provided, so the available context suggests favorable sponsor intent and an advocacy-oriented presentation rather than a balanced legislative debate record.
The likely controversy is whether APRNs should receive broader, more clearly defined authority to diagnose, treat, prescribe, and administer care with less reliance on physician-supervised or joint-board approval structures. Medical and dental stakeholders may object to the repeal of older oversight provisions, the transfer of rulemaking and authority to the Board of Nursing, and the bill’s treatment of anesthesia-related practice and reimbursement. Supporters, by contrast, would likely emphasize access to care, workforce shortages, and cost savings, making the central dispute one of scope of practice versus professional regulation.