Can a North Carolina NP prescribe medication independently?

A North Carolina NP cannot prescribe medication independently. Prescriptive authority is exercised under a collaborative practice agreement with a supervising physician¹, and an NP may prescribe only when the supervising physician has provided written instructions and periodic review²; any NP prescription is deemed authorized by the supervising physician³.

Key requirements include:

• The collaborative practice agreement must list the drugs, devices, treatments, tests, and procedures the NP may prescribe and perform at each practice site⁴.
• If a needed drug or device is not listed, the NP may prescribe it only on a specific order from the supervising or back-up physician, documented in the patient record⁵.
• For controlled substances (Schedules II–V), prescribing must be established in the agreement; the NP must have a DEA number and the supervising physician must hold the same or greater schedules⁶.

For certain targeted controlled substances used in pain-management settings for more than 30 days, the NP must personally consult the supervising physician before prescribing and at least every 90 days thereafter⁷. North Carolina further defines “consult” as a documented, meaningful communication sufficient for the supervising physician to determine the prescription is medically indicated⁸.