CRNA · North Carolina
Collaborative Practice Agreement for Certified Registered Nurse Anesthetists in North Carolina
Yes, a written physician agreement is required. North Carolina does not name a specific instrument.
No independent-practice pathway exists for CRNAs in NC. A 2023 bill that would have required a physically present supervising anesthesiologist ('CRNA Supervision Modifications') did not pass and is not current law — do not encode a physical-presence requirement on that basis.
What the collaboration must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · no controlled-substance authority
CRNAs do not have independent prescriptive authority in NC; they administer anesthesia-related drugs under standing orders/protocols and RN licensure rather than DEA prescriptive authority. 21 NCAC 36 .0226 prohibits prescribing a treatment regimen or making a medical diagnosis except under physician supervision.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation (PC) or PLLC — a CRNA may co-own a nursing-services entity with any combination of RN/NP/CNS/CNM, or with a physician (N.C. Gen. Stat. § 55B-14); non-licensees may not hold equity.
Legal sources for these rules (4)
What a collaborating physician costs here
Typical monthly cost in North Carolina
$500 – $600
Estimate for one Certified Registered Nurse Anesthetist. Standard-tier state.
About North Carolina's rules
The NP 'SAVE Act' (full practice authority) has failed every session since 2021, most recently as S.B. 966 (2026) — NC NPs have no independent-practice pathway. PA 'team-based practice' (S.L. 2025-37/H.B. 67) is now LIVE: its June 30, 2026 trigger has passed, regardless of whether NCMB's conforming rules were finished by then. Several categories below (CRNA proximity/ratio/chart-review, CNM proximity) have no codified numeric standard — treat as open items to verify with the board, not an absence of one.
Other clinicians in North Carolina: see the state overview.