House Bill 514 would create a comprehensive statutory framework for advanced practice registered nurses (APRNs) in North Carolina, including certified nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists. The bill defines APRN practice, population foci, licensure, renewal, reinstatement, title usage, and the scope of practice for each APRN role. It also updates related nursing definitions and licensing provisions, and it directs the Board of Nursing to adopt rules to implement the new framework.
The bill also revises multiple cross-references throughout Chapter 90 and other statutes to replace older references to nurse practitioners and the abbreviation NP with certified nurse practitioners and CNP. It repeals provisions tied to the prior nurse practitioner structure, removes certain joint-rule mechanisms between the Medical Board and Board of Nursing, and expands or clarifies where APRNs may perform functions such as examinations, concussion clearance, anesthesia-related services, and prescribing, ordering, dispensing, and furnishing authority. In addition, it requires the Governor to seek a federal Medicare opt-out letter to maximize flexibility for anesthesia services in hospitals and other facilities.
HB514 would significantly alter North Carolina’s nursing and health-professions statutes by expressly defining APRN practice in statute and creating a direct APRN licensure structure under the Board of Nursing. It would repeal or replace older provisions that tied advanced practice authority to prior statutory arrangements, update title and abbreviation rules, and amend related laws in medicine, dentistry, pharmacy, education, and other areas to align with the new APRN framework. The bill would also require rulemaking by the Board of Nursing, the Medical Board, and the Dental Examiners Board, and it would direct a federal Medicare-related opt-out request affecting anesthesia reimbursement flexibility.
The bill’s stated findings and structure reflect strong support for expanding and clarifying APRN authority, emphasizing access to care, provider shortages, cost savings, and alignment with practices in other states. Because there is no committee transcript or recorded vote history provided, the available context does not show formal opposition or support from legislators, but the bill text itself is clearly framed as a pro-APRN modernization measure. Overall, the sentiment in the bill materials is favorable toward broader APRN practice authority and reduced regulatory barriers.
The main points of contention likely concern scope of practice and professional oversight, especially the bill’s move to define APRN authority more directly in statute and to reduce reliance on joint rulemaking with the Medical Board. Related issues include whether APRNs should have independent authority to diagnose, prescribe, and perform certain medical acts, and how title protection and licensure requirements should be enforced. The anesthesia-related provisions and the required federal opt-out request may also draw attention from hospitals, anesthesiology stakeholders, physicians, and nursing groups because they affect reimbursement, facility flexibility, and the division of clinical authority.