HB 185 / SB 143 – Nurse Scope Expansion

SB 143 / HB 185  – The SAVE Act

*This bill was filed jointly in the House and Senate.

Primary Senate Sponsor: Sen. Ralph Hise (R-Madison)

Primary House Sponsors: Rep. Donny Lambeth (R-Forsyth), Rep. Josh Dobson  (R-Avery), Rep. Sarah Stevens (R-Surry), Rep. Gale Adcock (D-Wake)

Bill Summary

This bill defines Advanced Practice Registered Nurses as the following:

  • Nurse Practitioner (NP)
  • Certified Nurse Midwife (CNM)
  • Certified Nurse Specialist (CNS)
  • Certified Registered Nurse Anesthetist (CRNA)

Nurse Anesthesia Definitions

The bill defines nurse anesthesia activities as the following:


  • Performing health assessment
  • Recommending, requesting, and evaluating diagnostic studies
  • selecting and administering preanesthetic medications

Anesthesia induction, maintenance, and emergence

  • Providing safety checks
  • Selecting, implementing, and managing anesthesia
  • performing tracheal intubation and extubation and providing mechanical ventilation
  • Managing blood, electrolyte, fluid, and acid base balance
  • Evaluating client’s response from anesthesia, and implementing pharmaceutical treatment

Postanesthesia care

  • Providing follow up care: evaluations, complications, implementing corrective actions, requesting consultations
  • Administering respiratory support via pharmacological or fluid suport
  • Documenting all aspects of care to provider that assumes patient’s care following anesthesia
  • Releasing clients from care

Other Care Scopes

  • Central vascular access catheters and epidural catheters
  • Emergency situations including cardiopulmonary resucitation
  • Consultations on respiratory and ventiltor care
  • Initiating and managing pain relief therapy

Population Focus Areas

The bill outlines the following APRN population focus areas:

  • Family/Individual across life span
  • Adult gerontology
  • Neonatal
  • Pediatrics
  • Women’s health/Gender-related issues
  • Psychiatric/Mental Health

The bill outlines  the scope of CNMS, CRNAs, CNS, and NPs, practicing independently.

The bill changes the language of supervision to collaboration between dentists and CRNAs.

The bill also removes the subcommittee of the Nursing Board to work jointly with the NC Medical Board to develop rules and regulation on medical acts and to determine fees.

The bill also sets fees for APRNS.

The bill also allows the Board to have grandfathering exemptions for APRNS.

Bill Movement

This bill was filed in the House and Senate on February 26, 2019.


More Posts in Previous Legislative Sessions


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  • Charles E Kober

    Who is going to pay to have another fee for service provider?

  • Gregory Adams

    We have had PA’s and NP working in our office for years and they serve patients and the community well, as long as they are well supervised by an attentive physician. They do not have the same background, depth of knowledge or training to be allowed these privileges. this bill would result in the deterioration in health care delivery.

  • mary pylipow

    While NPs are a very helpful & important part of the healthcare team, their training (~2 years) is not as extensive as MD/DO, residency and fellowship (>10 years). This is a very dangerous and slippery slope for patient care, often motivated by cost alone.

  • G Thomas A Morris

    How will the insurance companies respond if a physician is no longer on the hook via supervision ?

    • NCMS Advocacy Team

      In the past, medical malpractice insurers currently active in NC have expressed hesitation about insuring APRNs without supervision.

  • Joseph Kittinger MD

    The training our nurse anesthetists have received is not equivalent to medical school and residency training. We should not promote any legislation which could endanger the care of our patients. I am particularly concerned about crnas practing in environments where Physicians are not even present like a dentist office or a Botox center.

    I do support trying to involve the state medical board evolvement withe nurses. The state nursing board does a poor job protecting patients.

  • Dangerous

  • Elizabeth Bullard, MD

    I do not support this bill or independent practice by mid levels. I have seen mismanagement of APRNs too many times even with “supervision.” Why would I spend the time (college + master’s degree + medical school + 4 yr residency) if someone can complete 18 months of online classes and practice independently. The replacement of medical doctors by mid levels is a cost saving measure and nothing else. This is absolutely NOT in the best interests of patients!

  • D. R. Boyette, MD

    Defeat this bill which is a threat to patient safety and the provision of our current accepted level
    Of competent medical care.