As a licensed nurse in North Carolina, you not only carry the responsibility of meeting the healthcare needs of people in your state, but you have a legal responsibility, as well. Like most states, North Carolina has a strict set of laws regulating the practice of nursing for the purpose of maintaining consistent standards of care and ensuring patient safety. The primary statutes that regulate nursing are the North Carolina Nursing Practice Act (General Statutes Chapter 90, Article 9A) and the North Carolina Administrative Code (NCAC), Title 21, Chapter 36. These laws outline the responsibilities, scope of practice, and professional requirements for nurses, including Registered Nurses (RNs) and Licensed Practical Nurses (LPNs).
Part of your responsibilities as a licensed nurse in NC is to know and abide by these statutes. Most disciplinary actions taken against RNs and LPNs by the North Carolina Board of Nursing have to do with alleged violations of one or more of the rules contained in these laws. In fact, breaches of the Nursing Practice Act can easily result in having your nursing license suspended or revoked--not only impacting your ability to practice in the state of North Carolina but potentially elsewhere, as well.
The best way to safeguard your career, if you're accused of a violation, is to engage an experienced professional licensed defense attorney at the first indication of trouble. The Lento Law Firm's Professional License Defense Team has many years of proven experience defending nurses nationwide who are facing disciplinary actions. We are well-versed in the North Carolina Nursing Practice Act and other state regulations regarding nursing. We also understand how the Board of Nursing works, and we can advocate on your behalf to minimize the damage to your career and get you the best possible outcome. To schedule a consultation, call the Lento Law Firm today at 888-535-3686 or fill out our online form.
The North Carolina Nursing Practice Act
The North Carolina Nursing Practice Act (NPA) is the cornerstone of state nursing regulation. It establishes the legal boundaries within which nurses must practice, ensuring the delivery of safe and competent nursing care. First enacted in 1981, this statute has evolved over the years to reflect changes in healthcare and nursing practice standards. The NPA's primary purpose is to protect the public by setting minimum competency standards for individuals who wish to practice nursing in North Carolina.
Types of Nurses Recognized in North Carolina
North Carolina recognizes two primary categories of nurses, each with specific educational and licensure requirements. The two types of nurses licensed to practice in the state are Registered Nurses (RNs) and Licensed Practical Nurses (LPNs).
- Registered Nurses (RNs): Registered Nurses are highly trained healthcare professionals who provide comprehensive nursing care to patients. RNs in North Carolina must meet specific educational requirements, including graduating from an accredited nursing program, passing the NCLEX-RN exam, and maintaining licensure through continuing education and practice.
- Licensed Practical Nurses (LPNs): Licensed Practical Nurses in North Carolina work under the supervision of RNs or physicians, providing basic nursing care. While LPNs perform many of the same tasks as RNs, their role is more limited in scope and complexity. To become an LPN in North Carolina, individuals must complete an accredited practical nursing program and pass the NCLEX-PN. LPNs are also required to maintain their licensure through continuing education.
Advance Practice Registered Nurses (APRNs) in North Carolina
The roles of Advanced Practice Registered Nurses (APRNs) are also recognized and regulated by the North Carolina Board of Nursing (NCBON). These include the following:
- certified registered nurse anesthetist (CRNA)
- certified nurse-midwife (CNM)
- clinical nurse specialist (CNS)
- certified nurse practitioner (CNP)
The Nursing Practice Act in its current form does not lend detail to the roles of APRNs in the state, but by extension they are subject to the legal rules of RNs under the law. That said, the Administrative Code does provide job descriptions and scope of work for these professions, and the state legislature has enacted specific limitations on the scope of work for nurse practitioners (NPs). The North Carolina Medical Board and the Board of Nursing have collaborated on rules that empower NPs to prescribe medications on a limited basis.
(For purposes of the law and this article, the responsibilities of RNs below also apply to APRNs.)
Scope of Nursing Practice
The scope of nursing practice in North Carolina is determined by the nurse's level of education, training, and licensure. The North Carolina Board of Nursing (NCBON) plays a crucial role in defining and regulating the practice of both RNs and LPNs. Nurses must adhere to these guidelines to ensure they are providing care within their legal limits and professional competencies.
Registered Nurse (RN) Scope of Practice
Administrative Code (21 NCAC 36.0224) lays out the definitions and scope of practice of RNs in the state. The following components are central to the practice of nursing by an RN:
- Assessment of patient health: RNs are responsible for assessing patients' physical and mental health. This involves gathering information about patients' medical histories, conducting physical examinations, and evaluating patients' reactions to illnesses or treatments.
- Developing care plans: RNs create and implement comprehensive nursing care plans based on their assessments. These plans are designed to address the health needs of patients and may include medical treatments prescribed by physicians or other healthcare providers.
- Collaboration: RNs work closely with physicians, nurse practitioners, and other healthcare professionals to coordinate patient care. While they cannot prescribe medication or make medical diagnoses independently, they contribute to healthcare decisions by sharing their assessments and observations.
- Supervision and delegation: RNs are authorized to delegate certain nursing tasks to LPNs and other healthcare personnel. They must ensure that delegated tasks are within the competence of the individuals performing them and provide supervision to ensure the quality of care.
- Patient education and counseling: RNs play a vital role in educating patients and their families about health conditions, treatments, and preventive care. This aspect of nursing practice is essential for promoting patient empowerment and helping individuals manage their health effectively.
While RNs are highly trained professionals, their scope of practice is subject to certain limitations. For example, RNs in North Carolina are not permitted to:
- Prescribe medications: Only physicians and advanced practice registered nurses (APRNs) with specific prescriptive authority may prescribe medications in the state.
- Make independent medical diagnoses: RNs may not diagnose medical conditions unless they are working under the supervision of a physician or other healthcare provider with the legal authority to diagnose and prescribe treatments.
Licensed Practical Nurse (LPN) Scope of Practice
LPNs in North Carolina work in a more limited scope than RNs. The scope of practice for LPNs is defined in 21 NCAC 36.0225, which outlines their specific duties and responsibilities. These include:
- Assisting in patient assessments: LPNs participate in the assessment process by collecting data on patients' physical and mental health. However, they do not have the same level of authority as RNs in evaluating and interpreting this data.
- Implementing care plans: LPNs assist in implementing care plans developed by RNs or physicians. They may administer medications, change dressings, and monitor patients' vital signs, but they do so under the direction and supervision of an RN or physician.
- Recording and reporting patient responses: LPNs are responsible for documenting patient care and reporting any changes in patient's conditions to the supervising RN or physician. Their observations are critical for ensuring continuity of care and timely medical interventions.
- Patient education: LPNs may participate in educating patients about their health, but this is typically done under the supervision of an RN or physician. Their role in patient education is more focused on reinforcing the information provided by other healthcare professionals.
- Delegation: Like RNs, LPNs may delegate certain tasks to nursing assistants or other healthcare workers, but they must work under the supervision of an RN to ensure that tasks are completed safely and effectively.
LPNs must work within the limits of their education and licensure, and they are prohibited from performing tasks that require the clinical judgment and expertise of an RN. For example, LPNs cannot develop nursing care plans, prescribe medications, or independently administer complex treatments.
Responsibilities and Professional Ethos of Nurses
The nursing profession in North Carolina is grounded in a strong ethical framework that emphasizes patient safety, competence, and accountability. Nurses are expected to provide high-quality care while adhering to the legal and ethical standards set forth by the NPA and NCBON regulations.
Professional Accountability
Nurses in North Carolina are held to high standards of accountability and are expected to adhere to the guidelines established by the American Nurses Association (ANA) Code of Ethics. Key responsibilities include:
- Maintaining competence: Nurses must stay current with developments in healthcare and nursing practice. This involves pursuing continuing education and participating in professional development activities.
- Providing safe and effective care: Nurses are responsible for ensuring that the care they provide is safe, effective, and in the best interests of their patients.
- Adhering to ethical principles: Nurses must uphold the principles of patient autonomy, beneficence, non-maleficence, and justice in their practice. This includes respecting patients' rights, providing culturally competent care, and advocating for patient well-being.
- Documenting care accurately: Proper documentation is a critical aspect of nursing practice. Nurses must maintain accurate and complete records of patient care, including assessments, treatments, and patient responses.
Delegation and Supervision
Both RNs and LPNs are responsible for delegating tasks appropriately and supervising the individuals performing those tasks. RNs, in particular, must ensure that any tasks they delegate are within the competence of the person receiving the assignment. Additionally, they must provide adequate supervision and ensure that the care delivered meets professional standards.
Continuing Competencies
All licensed nurses in North Carolina are required to take continuing education (CE) courses to maintain their licensure. Since all nurses must renew their licensure every two years to continue practicing, the CE requirements must be met within this two-year span. The requirements are the same for both RNs and LPNs in North Carolina. Generally speaking, the requirement is 15-30 hours of continuing education every two years, depending on the nurse's level of active practice. However, the state offers numerous alternative pathways for nurses to meet these requirements.
Authorized and Prohibited Acts
Nurses in North Carolina must adhere to specific guidelines regarding what they are authorized and prohibited from doing in their practice. The NPA and NCBON regulations provide clear directives on these matters.
Authorized Acts
- RNs are authorized to perform comprehensive assessments, develop nursing care plans, provide patient education, and delegate tasks to LPNs and other healthcare personnel.
- LPNs are authorized to assist in assessments, implement care plans, administer medications, and provide basic nursing care under supervision.
Prohibited Acts
- Prescribing medications: Neither RNs nor LPNs are authorized to prescribe medications. This authority is reserved for physicians and advanced practice nurses with prescriptive authority.
- Independent medical diagnoses: Nurses may not diagnose medical conditions independently. While RNs contribute to the assessment process, making clinical diagnoses is outside their legal scope of practice.
Other Violations Leading to Disciplinary Action
For all nurses, failure to adhere to the standards set by the NPA can result in disciplinary action. However, the NPA also notes specific acts of misconduct that can also cause disciplinary actions by the Board. These include, but aren't necessarily limited to:
- Exceeding Licensure Boundaries: Performing duties outside your licensed scope is unlawful and could lead to disciplinary measures.
- Violation of Patient Confidentiality: Breaching patient privacy is a grave infraction under both North Carolina statutes and federal HIPAA laws.
- Unprofessional Relationships: Maintaining professional boundaries with patients is essential, and nurses should avoid any personal or romantic involvement with those they care for.
- Substance Abuse: Engaging in illegal drug use or excessive alcohol consumption, even off-duty, can result in disciplinary actions, particularly if it affects on-the-job performance.
- Criminal Conduct: Being convicted of certain crimes, especially those involving moral turpitude, can disqualify a nurse from practicing in North Carolina.
The NCBON uses the "preponderance of the evidence" standard of proof to determine guilt or innocence--meaning they only have to be convinced that you are 51 percent likely to have committed the offense in question in order to discipline you. Disciplinary actions may include fines, probation, license restrictions, and even suspension or revocation of your license.
Disciplinary actions in North Carolina can also affect your ability to be licensed in other states. Adverse actions against nurses must be reported to national databases like Nursys and the National Practitioner Data Bank (NPDB), accessible to Boards of Nursing and potential employers across the country.
Professional License Defense for North Carolina Nurses
If you are a registered nurse, licensed practical nurse, or advanced practice registered nurse in North Carolina, a complaint suggesting a breach of the Nursing Practice Act could severely affect your career. Given the high stakes, it is crucial not to confront these allegations on your own. The Lento Law Firm's Professional License Defense Team offers extensive experience in defending nurses accused of misconduct nationwide. We can both advocate on your behalf at formal hearings and negotiate with the NCBON at multiple points, either to resolve the complaint in your favor or minimize the damage to your career. To arrange a consultation, contact the Lento Law Firm at 888-535-3686 or complete our online form.
