AN ACT to promote health care PRACTITIONER transparency through advertisement requirements and to define the practice of nursing for advanced practice registered nurses: Nurse practitioners (NP), certified nurse midwives (CNM), certified REGISTERED nurse anesthetists (crna), and clinical nurse specialists (CNS).

The General Assembly of North Carolina enacts:

SECTION 1.(a)  Article 37 of Chapter 90 of the General Statutes is amended by adding a new Part 1 to be entitled Health Care Practitioner Identification and to consist of G.S. 90‑640.

SECTION 1.(b)  Article 37 of Chapter 90 of the General Statutes is amended by adding a new Part to read:

Part 2. Health Care Practitioner Transparency Act.

§ 90‑641.  Short title.

This Part shall be known as the Health Care Practitioner Transparency Act.

§ 90‑642.  Definitions.

The following definitions apply in this Part:

(1)        Advertisement. – Any communication or statement that is printed, electronic, or oral which names the health care practitioner in relation to their practice, profession, or institution where the health care practitioner is employed, volunteers, or otherwise provides health care services, including business cards, letterhead, patient brochures, email, internet, audio and video, or any other communication or statement used in the course of business.

(2)        Deceptive or misleading. – Any verbal or written representation or advertisement that misstates, falsely describes, or holds out in a false light the profession, skills, expertise, education, board certification, or licensure of the health care professional.

(3)        Health care practitioner. – An individual who is licensed, certified, or registered to engage in the practice of medicine, nursing, dentistry, pharmacy, or any related occupation involving the direct provision of health care to patients.

(4)        Licensee. – A health care practitioner who holds an active license with a licensing board that governs the health care practitioner's occupation in this State.

§ 90‑643.  Advertisement and representation requirements.

(a)        An advertisement for health care services that names a health care practitioner shall identify the type of license, certification, or registration held by the health care practitioner. The advertisement shall not contain any deceptive or misleading information.

(b)        A health care practitioner shall not make a representation about the health care practitioner's license, certification, or registration that is deceptive or misleading.

(c)        Any individual not licensed to practice medicine under Article 1 of this Chapter shall not hold himself or herself out to the public by calling oneself a physician or any of the following titles, or using any similar title or description of services with the intent to represent that the individual practices medicine: surgeon, medical doctor, doctor of osteopathy, M.D., D.O., anesthesiologist, cardiologist, dermatologist, endocrinologist, family medicine, family physicians, gastroenterologist, general practitioner, gynecologist, hematologist, hospitalist, internist, intensivist, laborist, laryngologist, nephrologist, neurologist, obstetrician, oncologist, ophthalmologist, orthopedic surgeon, orthopedist, osteopath, otologist, otolaryngologist, otorhinolaryngologist, pathologist, pediatrician, primary care physician, proctologist, psychiatrist, radiologist, rheumatologist, rhinologist, or urologist. Nothing in this subsection shall be construed to prevent a health care practitioner from using any title or abbreviation which is authorized for such health care practitioner pursuant to licensing statutes.

(d)       Nothing in this section shall be construed to prevent health care practitioners with doctorate‑level degrees in their field of practice from holding themselves out or referring to themselves as doctor or Dr..

§ 90‑644.  Violations and enforcement.

(a)        Any health care practitioner subject to this Article who does any of the following shall be in violation of this Article:

(1)        Knowingly aids, assists, procures, employs, or advises an unlicensed individual or entity in practicing or engaging in acts outside of the scope of the health care practitioner's degree of licensure.

(2)        Knowingly delegates or contracts the performance of health care services to a health care practitioner that is unqualified to perform those health care services.

(3)        Fails to comply with any provision of this Article.

(b)        Any health care practitioner who violates this Article as provided under subsection (a) of this section shall be guilty of unprofessional conduct and may be subject to disciplinary action under the health care practitioner's licensure board or other appropriate governing provisions.

(c)        Each day of noncompliance with this Article by a health care practitioner shall constitute a separate and distinct violation.

(d)       Any health care practitioner who practices in more than one office shall be required to comply with this Article in each practice setting.

(e)        Health care practitioners that work in non‑patient settings and do not have any direct patient health care interactions are not subject to this Article.

SECTION 2.  The following boards shall adopt temporary rules to implement the provisions of this act. Those temporary rules shall remain in effect until permanent rules are adopted that replace those temporary rules:

(1)        North Carolina Medical Board.

(2)        North Carolina Board of Nursing.

(3)        North Carolina Board of Pharmacy.

(4)        North Carolina State Board of Dental Examiners.

(5)        North Carolina Addictions Specialist Professional Practice Board.

(6)        North Carolina State Board of Examiners in Optometry.

(7)        North Carolina State Board of Chiropractic Examiners.

(8)        Board of Podiatry Examiners for the State of North Carolina.

(9)        Board of Licensed Clinical Mental Health Counselors.

(10)      North Carolina Psychology Board.

(11)      North Carolina Respiratory Care Board.

(12)      Board of Examiners for Speech and Language Pathologists and Audiologists.

(13)      North Carolina Board of Physical Therapy Examiners.

(14)      North Carolina Board of Occupational Therapy.

(15)      North Carolina Board of Dietetics/Nutrition.

SECTION 3.(a)  G.S. 90‑171.20 reads as rewritten:

§ 90‑171.20.  Definitions.

As used in this Article, unless the context requires otherwise:

(1)        Advanced Practice Registered Nurse or APRN. – An individual licensed by the Board as an advanced practice registered nurse within one of the following four roles:

a.         Certified nurse midwife or CNM.

b.         Certified nurse practitioner or CNP.

c.         Certified registered nurse anesthetist or CRNA.

d.         Clinical nurse specialist or CNS.

(1a)      Board means the Board. – The North Carolina Board of Nursing.

(2)        Health care provider means any Health care provider. – Any licensed health care professional and any agent or employee of any health care institution, health care insurer, health care professional school, or a member of any allied health profession. For purposes of this Article, a person enrolled in a program that prepares the person to be a licensed health care professional or an allied health professional shall be deemed a health care provider.

(3)        License means a License. – A permit issued by the Board to practice nursing as a registered nurse or as a licensed practical nurse, including a renewal thereof.

(3a)      Licensee means any Licensee. – Any person issued a license by the Board, whether the license is active or inactive, including an inactive license by means of surrender.

(4)        Nursing is a Nursing. – A dynamic discipline which includes the assessing, caring, counseling, teaching, referring and implementing of prescribed treatment in the maintenance of health, prevention and management of illness, injury, disability or the achievement of a dignified death. It is ministering to; assisting; and sustained, vigilant, and continuous care of those acutely or chronically ill; supervising patients during convalescence and rehabilitation; the supportive and restorative care given to maintain the optimum health level of individuals, groups, and communities; the supervision, teaching, and evaluation of those who perform or are preparing to perform these functions; and the administration of nursing programs and nursing services. For purposes of this Article, the administration of required lethal substances or any assistance whatsoever rendered with an execution under Article 19 of Chapter 15 of the General Statutes does not constitute nursing.

(5)        Nursing program means any Nursing program. – Any educational program in North Carolina offering to prepare persons to meet the educational requirements for licensure under this Article.

(6)        Person means an Person. – individual, corporation, partnership, association, unit of government, or other legal entity.

(7)        The practice of nursing by a registered nurse consists Practice of nursing by a registered nurse. – Consists of the following 10 components:

a.         Assessing the patient's physical and mental health, including the patient's reaction to illnesses and treatment regimens.

b.         Recording and reporting the results of the nursing assessment.

c.         Planning, initiating, delivering, and evaluating appropriate nursing acts.

d.         Teaching, assigning, delegating to or supervising other personnel in implementing the treatment regimen.

e.         Collaborating with other health care providers in determining the appropriate health care for a patient but, subject to the provisions of G.S. 90‑18.2, not prescribing a medical treatment regimen or making a medical diagnosis, except under supervision of a licensed physician.

f.          Implementing the treatment and pharmaceutical regimen prescribed by any person authorized by State law to prescribe the regimen.

g.         Providing teaching and counseling about the patient's health.

h.         Reporting and recording the plan for care, nursing care given, and the patient's response to that care.

i.          Supervising, teaching, and evaluating those who perform or are preparing to perform nursing functions and administering nursing programs and nursing services.

j.          Providing for the maintenance of safe and effective nursing care, whether rendered directly or indirectly.

(8)        The practice of nursing by a licensed practical nurse consists Practice of nursing by a licensed practical nurse. – Consists of the following seven components:

a.         Participating in the assessment of the patient's physical and mental health, including the patient's reaction to illnesses and treatment regimens.

b.         Recording and reporting the results of the nursing assessment.

c.         Participating in implementing the health care plan developed by the registered nurse and/or prescribed by any person authorized by State law to prescribe such a plan, by performing tasks assigned or delegated by and performed under the supervision or under orders or directions of a registered nurse, physician licensed to practice medicine, dentist, or other person authorized by State law to provide the supervision.

c1.       Assigning or delegating nursing interventions to other qualified personnel under the supervision of the registered nurse.

d.         Participating in the teaching and counseling of patients as assigned by a registered nurse, physician, or other qualified professional licensed to practice in North Carolina.

e.         Reporting and recording the nursing care rendered and the patient's response to that care.

f.          Maintaining safe and effective nursing care, whether rendered directly or indirectly.

SECTION 3.(b)  G.S. 90‑171.43 reads as rewritten:

§ 90‑171.43.  License required; rules.

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(a1)      The abbreviations for the APRN designation of a certified nurse midwife, a clinical nurse specialist, a certified registered nurse anesthetist, and a certified nurse practitioner shall be APRN, plus the role title, i.e., CNM, CNS, CRNA, and CNP.

(a2)      It shall be unlawful for any person to use the title APRN or APRN plus their respective role titles, the role title alone, authorized abbreviations, or any other title that would lead a person to believe the individual is an APRN, unless permitted by this act.

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SECTION 4.  No later than October 1, 2025, the North Carolina Board of Nursing shall adopt temporary rules to implement the provisions of Section 3 of this act. Those temporary rules shall remain in effect until permanent rules are adopted to replace the temporary rules.

SECTION 5.  Sections 1 and 3 of this act are effective October 1, 2025. The remainder of this act is effective when it becomes law.