Senate Bill 537 would create a comprehensive statutory framework for advanced practice registered nurses (APRNs) in North Carolina. It defines APRNs as a category of licensed nurses with four roles: certified nurse practitioners (CNPs), certified nurse midwives (CNMs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs). The bill spells out the scope of practice for each role, including assessment, diagnosis, treatment, prescribing, ordering and interpreting diagnostic tests, and referrals, and it also defines the broader practice of nursing for APRNs and for registered nurses and licensed practical nurses.
The bill also revises multiple parts of Chapter 90 and related statutes to align with the new APRN framework. It repeals older provisions tied to the prior certified nurse practitioner structure, updates licensing and renewal rules, creates grandfathering provisions for current APRNs, and changes title-use rules so that APRN role titles and abbreviations are protected. It further directs the Revisor of Statutes to replace references to “nurse practitioner” with “certified nurse practitioner” and “NP” with “CNP” in a list of statutes, and it requires state boards to adopt implementing rules. In addition, the bill asks the Governor to seek a federal Medicare anesthesia opt-out letter to maximize flexibility for facilities using CRNAs.
The bill’s impact on state law would be significant because it would formally define APRN practice in statute and expand/clarify the legal authority of APRNs across multiple health care settings. It would affect the North Carolina Board of Nursing, the North Carolina Medical Board, the State Board of Dental Examiners, health care facilities, employers, and APRNs themselves by changing licensure, title protection, and practice-authority rules. It also touches school athletics concussion clearance, medical examinations, pharmacy-related provisions, and other cross-referenced statutes that rely on the definition of nurse practitioner.
The overall sentiment reflected in the bill text is strongly supportive of APRN autonomy and expanded access to care. The findings section argues that APRNs improve access, quality, and cost-effectiveness, and it cites workforce shortages, Medicaid expansion, and projected savings from reducing regulatory barriers. There is no committee transcript or recorded vote history provided, so there is no direct evidence of opposition or amendment debate in the materials supplied.
The main point of contention implied by the bill is the shift away from physician-linked oversight toward a clearer, more independent APRN scope of practice. The bill repeals older provisions that tied APRN medical acts to joint rules of the nursing and medical boards, and it replaces them with a standalone APRN licensure and practice structure. That change would likely be of greatest concern to the medical and dental boards or other stakeholders who favor tighter supervision, while being welcomed by nursing organizations and APRNs seeking full practice recognition.
The bill would amend Chapter 90 and several related statutes to create a defined APRN licensure category, establish role-specific scopes of practice, protect APRN titles and abbreviations, and update cross-references throughout state law. It repeals older provisions governing certified nurse practitioners, revises licensing and renewal fees, requires board rulemaking, and directs statutory terminology changes from NP to CNP. It also affects employer verification, school athletic concussion clearance, dental anesthesia provisions, and a federal anesthesia reimbursement request for CRNAs.
The bill’s stated purpose and findings reflect a generally favorable view of APRNs and their role in expanding access to care, especially in light of provider shortages and Medicaid expansion. The text frames the measure as a modernization effort that would reduce unnecessary regulation and improve patient access, safety, and cost-effectiveness. No committee discussion or vote record was provided, so there is no documented legislative opposition or support beyond the bill’s own supportive framing.
The likely controversy centers on scope of practice and professional authority. By defining APRN practice directly in statute and repealing older provisions that relied on joint medical-board and nursing-board regulation, the bill reduces the role of physician oversight and could be viewed as expanding independent practice authority. Stakeholders most likely to object would be the North Carolina Medical Board or physician groups concerned about supervision and regulatory control, while APRNs, nursing advocates, and access-to-care proponents would likely support the change.