A BILL TO BE ENTITLED
AN ACT defining the practice of nursing by certified registered nurse anesthetists under the nursing practice act.
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 90‑18(c) is amended by adding a new subdivision to read:
"(14a)	The practice of nursing by a certified registered nurse anesthetist as defined in G.S. 90‑171.20."
SECTION 2.  G.S. 90‑171.20 reads as rewritten:
"§ 90‑171.20.  Definitions.
As used in this Article, unless the context requires otherwise:
(1)	Board. – The North Carolina Board of Nursing.
(2)	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. – A permit issued by the Board to practice nursing as a registered nurse or as a licensed practical nurse, including a renewal thereof.
(3a)	Nurse anesthesia activities. – As defined in 21 NCAC 36.0226.
(4)	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. – Any educational program in North Carolina offering to prepare persons to meet the educational requirements for licensure under this Article.
(6)	Person. – An individual, corporation, partnership, association, unit of government, or other legal entity.
(6a)	The "practice of nursing by a certified registered nurse anesthetist." – Consists of the following components:
a.	Performing nurse anesthesia activities in collaboration with a physician, dentist, podiatrist, or other lawfully qualified health care provider, with each provider contributing his or her respective area of expertise consistent with the lawful scope of practice and according to established policies, procedures, practices, and channels of communication that (i) lend support to nurse anesthesia activities and (ii) define the roles and responsibilities of the certified registered nurse anesthetist within the practice setting.
b.	Maintaining individual accountability for the outcome of individual actions.
(7)	The "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 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.  This act is effective when it becomes law.