Finding a Collaborating Physician in South Carolina
The regulatory landscape for Nurse Practitioners (NPs) is complex because it varies widely by state. However, Zivian was created to handle all the challenges of finding a collaborating physician so that you can focus on providing care. If you are an NP trying to find a collaborating physician in South Carolina, Zivian has you covered.
The state of South Carolina requires nurse practitioners to have a collaborating physician. South Carolina’s regulatory structure is Restricted Practice Authority.
In this post, we break down state regulations and key considerations to establish a meaningful collaboration with a physician in the Palmetto State.
Note: State regulations and requirements are subject to change. Always check with your state medical or nursing board to confirm the most up-to-date information.
What Is the Practice Environment for NPs in South Carolina?
In which category does the state fall: NP independent practice, transition to independence, or collaboration required?
A nurse practitioner is required to have a collaborating physician. South Carolina’s regulatory structure is Restricted Practice Authority. NPs are required to work under the direct supervision of a physician, with restrictions on their ability to diagnose and treat patients autonomously.
Delegation Authority and Process
Is a collaboration agreement required?
Yes, a written practice agreement.
What form of agreement is required and what are the requirements for the substance of the agreement? Is use of a state template required?
To receive a full breakdown of the required components of a written practice agreement in South Carolina, contact Zivian today!
Where must the agreement be stored?
No requirement.
Does the agreement need to be filed with the state?
No requirement.
Are there requirements to file the agreement after the initial filing?
No requirement.
Who must sign the agreement?
The NP and the physician must sign the agreement.
How often must the agreement be reviewed or reauthorized?
The practice agreement and any amendments to it must be reviewed at least annually, dated and signed by the NP and physician, and made available to the Board for review within seventy-two (72) hours of request.
A random audit of the practice agreement must be conducted by the South Carolina Board of Nursing at least biennially.
What are the required qualifications for the collaborating physician?
The collaborating physician must be licensed by the South Carolina Board of Medical Examiners and possess an active, unrestricted, permanent license to practice medicine in the state, and who actively is practicing within the geographic boundaries of this state.
The physician shall not enter into a practice agreement with an NP performing a medical act, task, or function that is outside the usual practice of that physician or outside of the physician’s training or experience. However, the board may approve an exception to this requirement upon application by the physician, if the board determines that an exception is warranted and that quality of care and patient safety will be maintained.
What are the required qualifications for the NP?
An Advanced Practice Registered Nurse (APRN) in South Carolina must be trained in an advanced formal education program of nursing in a specialty area that is approved by the board. The categories of APRN are nurse practitioner, certified nurse-midwife, clinical nurse specialist, and certified registered nurse anesthetist.
The APRN must hold a doctorate, a post-nursing master’s certificate, or a minimum of a master’s degree that includes advanced education composed of didactic and supervised clinical practice in a specific area of advanced practice registered nursing. APRNs must achieve national certification within two years post-graduation. An APRN may perform those activities considered to be the practice of registered nursing or advanced practice consisting of nonmedical acts, such as population health management; quality improvement or research projects within a health care system; and analysis of data and corresponding system recommendations, revisions, developments, or informatics.
Is an alternate collaborating physician required?
No requirement.
Collaboration Requirements
Are there ratios or limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
A physician may supervise up to 6 FTE NPs or PAs combined. The Board of Medical Examiners may approve an exception to these requirements upon application by the physician, if the board determines that an exception is warranted and that quality of care and patient safety will be maintained.
Is there an express requirement to review a certain number or percentage of charts?
No requirement.
Is there a requirement to meet and, if so, how often and how?
No requirement.
Are there proximity requirements?
No requirement.
Are there location-specific requirements?
The collaborating physician must “be actively practicing medicine within the geographic boundaries of this State.” There are no statutes, regulations, or guidance that would exempt a physician practicing telemedicine within the state from meeting this requirement.
See Frequently Asked Questions on APRN Practice for more details.
The application for NP’s prescriptive authority states that “collaborating physicians must be physically present at a practice site located within the geographic boundaries of SC.”
Is remote supervision allowed, and are there limitations on remote supervision?
Remote supervision is permitted if the collaborating physician is “readily available” for consultation. “Readily available” means the physician who enters into a practice agreement with an NP must be able to be contacted either in person or by telecommunications or other electronic means to provide consultation and advice to the NP performing medical acts.
Physician and NP Filing Requirements
Outside of filing the collaboration agreement, must the physician or NP file any separate forms?
NPs must notify the Board of Nursing within fifteen (15) business days of initiating, changing, or terminating a Practice Agreement.
Prescription Requirements and Controlled Substance Prescribing
What are the prescription requirements?
Authorized prescriptions by an APRN with prescriptive authority:
Must comply with all applicable state and federal laws and executive orders
Are limited to drugs and devices utilized to treat medical problems within the specialty field of the nurse practitioner or clinical nurse specialist as prescribed in the practice agreement
Must be signed or electronically submitted by the APRN with the prescriber’s identification number assigned by the board and all prescribing numbers required by law. Written prescription forms must include the name, address, and phone number of the APRN and physician. Electronic prescription forms must include the name, address, and phone number of the APRN and, if possible, the physician through the electronic system. All prescriptions must comply with the provisions of Section 39-24-40. A prescription must designate a specific number of refills and may not include a nonspecific refill indication;
Must be documented in the patient record of the practice and must be available for review and audit purposes.
An APRN who holds prescriptive authority may request, receive, and sign for professional samples and may distribute professional samples to patients as listed in the practice agreement, subject to federal and state regulations.
An NP who applies for prescriptive authority must:
Be licensed by the State Board of Nursing as a NP
Submit a completed application and requisite fee
Provide evidence of completion of forty-five (45) contact hours of education in pharmacotherapeutics acceptable to the board, within two years before application or during the time of the organized educational program shall provide evidence of prescriptive authority in another state meeting twenty (20) hours in pharmacotherapeutics acceptable to the board, within two years before application
Provide at least fifteen (15) hours of education in controlled substances acceptable to the board as part of the twenty hours required for prescriptive authority if the NP has equivalent controlled substance prescribing authority in another state; and
Provide at least fifteen (15) hours of education in controlled substances “acceptable to the board as part of the forty-five contact hours required for prescriptive authority if the NP” initially is applying to prescribe in Schedules II through V controlled substances.
What are the requirements for controlled substance prescribing?
Authorized prescriptions by a nurse practitioner, certified nurse-midwife, or clinical nurse specialist with prescriptive authority:
May include Schedules III through V controlled substances if listed in the practice agreement and as authorized by Section 44-53-300;
May include Schedule II non-narcotic substances if listed in the practice agreement and as authorized by Section 44-53-300, provided, however, that each such prescription must not exceed a thirty-day supply;
May include Schedule II narcotic substances if listed in the practice agreement and as authorized by Section 44-53-300, provided, however, that the prescription must not exceed a five-day supply and another prescription must not be written without the written agreement of the physician with whom the nurse practitioner, certified nurse-midwife, or clinical nurse specialist has entered into a practice agreement, unless the prescription is written for patients in hospice or palliative care or for patients residing in long-term care facilities;
May include Schedule II narcotic substances for patients in hospice or palliative care, or for patients in long-term care facilities, if listed in the practice agreement as authorized by Section 44-53-300, provided, however, that each such prescription must not exceed a thirty-day supply;
Sources for Reference
S.C. Code Ann. § 40-33-34
S.C. Code Ann. § 40-33-20
S.C. Code Ann. § 40-47-195
Frequently Asked Questions Regarding New Law Governing APRN Practice (2018)
Alerts for APRNs: Prescriptive Authority and Recertifications
