Professional License Lawyer in North Carolina

GUEST BLOG, Nurse Practitioner Regulation, Part Four by Gale Adcock

GUEST BLOG, Nurse Practitioner Regulation, Part Four by Gale Adcock

Thanks for joining in for the fourth installment of our Nurse Practitioner Regulation series. We are excited to present content from friend of the firm Gale Adcock, FNP and member of the NC House of Representatives.


To recap Part 3, the continued work of a joint subcommittee (JSC) task force resulted in new NP Rules effective January 1, 1996. These new Rules made many changes. The most substantive were a streamlined approval to practice process; no longer tying NP ‘approval to practice’ to the practice site; simplifying the procedure for adding backup supervising physicians; prescriptive authority for a 30-day supply of certain drugs for the treatment of ADD/ADHD; “inactive status” for NPs not currently employed; a new requirement for 30 hours of CE every 2 years for ‘approval to practice’ renewal; and addition of an NP scope of practice.

Early interest in collaboration

Coinciding with the reconvened JSC NP/physician task force that recommended those rule changes, in December 1994 Dr. Harvey Estes, a highly respected former NC Medical Society (NCMS) president and outspoken NP supporter, assembled a collaborative practice task force charged “to consider various aspects of the interactions between APRNs and physicians in the practice setting, in the interest of enhancing relationships and improving services to the people of North Carolina”. Task force members included APRNs, physicians who had experience working with APRNs, and staff of the NC Nurses Association (NCNA) and NCMS.
This collaborative practice task force held 9 meetings from December 1994 to April 1996 when it issued a final report which included a definition of collaboration; suggested guidelines for collaborative practice; discussion of collaboration in practice between physicians and nurses in general roles and in advanced practice roles; a discussion of the context of a shared practice between a physician and an APRN (aka a co-owned practice under the newly amended professional corporations act); general recommendations; and a glossary of terms.
The following definition of collaboration, jointly developed by the American Nurses Association (ANA) and the American Medical Association (AMA) and adopted by ANA in 1994, was adopted by the task force early in its work:
“Collaboration is the process whereby physicians and nurses plan and practice together as colleagues, working interdependently within the boundaries of their scopes of practice, shared values and mutual acknowledgment and respect for each other‘s contributions to care for individuals, their families, and their communities.”


The final task force report included these recommendations:

The legacy of the collaborative practice task force

In fall 1996, the NCNA House of Delegates and the NCMS House of Delegates each passed a resolution adopting the collaborative practice task force report. This was a noteworthy accomplishment in 1996.
At the next ANA House of Delegates meeting (1997), the NCNA delegation sponsored a resolution that ANA adopt the task force report. It passed without opposition. That same year, the NCMS delegation to the AMA House of Delegates proposed the same resolution, but with very different results.
In a July 1, 1997 memo from Dr. Estes to task force members, he described the process as “interesting, though stressful and saddening. Our chief opposition was from the Georgia and Texas delegations. They were adamant that nothing would suffice other than defeat of our resolution. When we realized that victory was not to be achieved, our first choice was to refer the issue to the Board of Trustees, assuming that we could educate some to except our position. Georgia and Texas would have none of that. We found that we were alone in defending it. I do not believe that we are actually alone, but the opposition had so inflamed the process that our friends did not want to fight with us.” Dr. Estes went on to state “though we lost the battle, we caused a number of delegates to question the position of the AMA, and to look at the positive side of a good working relationship between nurses and physicians. Certainly, we have developed a positive relationship in North Carolina, and I hope that this will continue and spread elsewhere. “
The professional camaraderie among the 1994-96 collaborative practice task force members, their final report and its adoption by NCNA and NCMS, were the genesis for yet another task force a few years later—this one appointed by the NCBON and NCMB. The hope was that the groundbreaking work of the collaborative practice task force would be a springboard for thought-provoking discussions and substantive changes to NP Rules.
The story of that (final) task force, coming up next in Nurse Practitioner Regulation, Part 5.
Gale Adcock is an FNP and member of the NC House of Representatives. Contact the author at