Permissibility of Nurses Following Orders of Licensed Physicians Assistants

Subject:

Requested By: Mr. Ed McClearen Staff to Mental Health Commission

Question: Do the North Carolina statutes proscribe a registered or licensed practical nurse from carrying out orders given by a licensed physician’s assistant?

Conclusion: Yes.

As pertinent to the question, G.S. 90-158(3) contains the following definitions:

"(a) Nursing by Registered Nurse. — The practice of nursing by registered nurse means the performance for compensation of any act in the observation, care, and counsel of persons who are ill, injured, or experiencing alterations in normal health processes, and/or in the supervision and teaching of others who are or will be involved in nursing care; and/or the administration of medications and treatment as prescribed by a licensed physician or dentist. . . .

(b) Nursing by Licensed Practical Nurse. — The practice of practical nursing means the performance for compensation of selected acts in the care of persons who are ill, injured, or experiencing alterations in normal health processes. Such performance requires a knowledge of and skill in simple nursing procedures, gained through prescribed preparation, but does not require the specialized knowledge, judgment, and skill essential for nursing by registered nurse.

Practical nursing is performed under orders of a licensed physician or a licensed dentist, and/or under directions issued by a registered nurse." (Emphasis supplied).

G.S. 90-18 prohibits the practice of medicine or surgery by individuals who have not been licensed and registered to do so in the manner provided by the General Statutes. It describes activities which shall be regarded as practicing medicine or surgery. As applicable to physicians’ assistants, it contains the following exempting language:

". . . Provided, that the following cases shall not come within the definition above recited:

* * *

(13)

Any act, task or function performed by an assistant to a person licensed as a physician by the Board of Medical Examiners when

(a)

Such assistant is approved by and annually registered with the Board as one qualified by training or experience to function as an assistant to a physician, except that no more than two assistants may be currently registered for any physician, and

(b)

Such act, task or function is performed at the direction or under the supervision of such physician, in accordance with rules and regulations promulgated by the Board, and

(c)

The services of the assistant are limited to assisting the physician in the particular field or fields for which the assistant has been trained, approved and registered; . . ." (Emphasis supplied).

G.S. 90-18.1 contains some additional authorization for registered nurses or physicians’ assistants to prescribe drugs under written standing orders of supervising physicians. Nothing contained in that statute serves to change the conclusion stated above.

Examining the contents of all of these statutes it is clear that the exemptions granted to a physician’s assistant permitting his functioning in the medical field should be very strictly limited to those described in G.S. 90-18 (13). Further, the statutory language dealing with the activities of registered nurses and licensed practical nurses is also clear and unambiguous. It manifests a legislative intent that the professional actions of both must be carried out under the direct orders of a physician licensed to practice medicine or a dentist — with the exception that a licensed practical nurse may act under the directions of a registered nurse. None of this statutory language requires or permits their carrying out orders of a physician’s assistant in the fulfillment of their respective practices of nursing.

Rufus L. Edmisten Attorney General

William F. O’Connell Special Deputy Attorney General