CNS · South Carolina
Collaborative Practice Agreement for Clinical Nurse Specialists in South Carolina
Yes, a written physician agreement is required. South Carolina does not name a specific instrument.
CNSs fall under the same §40-33-34 practice-agreement regime and combined 6-provider ratio cap (§40-47-195(D)(1)(c)) as NP/CNM — no independence pathway or experience threshold exists in current SC law, unlike VA's scope-based CNS carve-out.
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
Available remotely (no on-site requirement)
Same standard as general NPs (§40-33-34) — no on-site or mile/minute standard is codified.
Supervision ratio
Up to 6 at a time (combined across provider types)
Same combined PA+NP+CNM+CNS cap under §40-47-195(D)(1)(c).
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Same statutory scope as general NPs (§40-33-34): Schedule III–V per practice agreement; Schedule II nonnarcotic ≤30-day supply; Schedule II narcotic ≤5-day initial supply with physician agreement required for renewal. No CNS-specific carve-out (narrower or broader) was found — treated as identical to general NP scope.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation under Title 33, Chapter 19 for nursing services, or physician-owned per SC's common-law CPOM doctrine.
Legal sources for these rules (1)
What a collaborating physician costs here
Typical monthly cost in South Carolina
$500 – $600
Estimate for one Clinical Nurse Specialist. This state's rules add a restrictive-tier premium.
About South Carolina's rules
A physician may not hold practice agreements/scope-of-practice guidelines with more than a COMBINED 6 full-time-equivalent PA+NP+CNM+CNS at once (§40-47-195(D)(1)(c)) — a single shared cap, not four separate ones. A widely-repeated '3 PA' cap was repealed in 2019 (Act 32). SC remains restricted-practice for APRNs; a 2,000-hour full-practice-authority bill (S.45/H.3580) is pending, not yet law.
Other clinicians in South Carolina: see the state overview.