Protocol · NP · South Carolina
Practice Protocol for Nurse Practitioners in South Carolina
Required. South Carolina law names the instrument a Written Practice Agreement, and the clinical protocol is the content that instrument carries. Below: the board that governs it, what it must contain, and the terms it has to carry.
SC removed the word 'supervision' from its Nurse Practice Act in 2018, but NPs still require a written practice agreement to practice or prescribe — no experience-based independence pathway exists today. A pending bill (S.45/H.3580) would create a 2,000-clinical-hour pathway to full practice authority; not yet law.
What a South Carolina Written Practice Agreement must contain
Governed by the South Carolina Board of Nursing and the South Carolina Board of Pharmacy. Each numbered item is a statutory requirement the Written Practice Agreement must satisfy.
The Nurse Practitioner shall perform medical acts only pursuant to a written practice agreement with the Physician, as required by S.C. Code § 40-33-34. The practice agreement shall state the names, addresses, and South Carolina license numbers of the Nurse Practitioner and the Physician; the nature of practice and practice location(s) of each; the dates the agreement was entered into and last reviewed or amended; how the Physician's consultation is provided; and the medical conditions for which the Nurse Practitioner may initiate or modify therapy, the treatments and drug therapies permitted, and the situations requiring the Physician's direct evaluation or referral.
The practice agreement shall be reviewed, dated, and signed by the Physician and the Nurse Practitioner at least annually, and shall be produced to the South Carolina Board of Nursing within seventy-two (72) hours of a request. The Physician must remain readily available to the Nurse Practitioner in person, by telecommunication, or by other electronic means.
- The Written Practice Agreement also carries 1 scope, 1 education and 1 registration clauses, authored in the document itself.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the Written Practice Agreement has to carry, from South Carolina's supervision rules.
Proximity
Available remotely (no on-site requirement)
§40-33-34: the collaborating physician must be 'readily available for consultation' and must practice within SC's geographic boundaries. No mile/minute radius or on-site standard is codified.
Supervision ratio
Up to 6 at a time (combined across provider types)
Same combined cap as `pa` — §40-47-195(D)(1)(c) counts NP, CNM, and CNS practice agreements together with PA scope-of-practice guidelines toward one physician's shared limit of 6.
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
§40-33-34: Schedule III–V if listed in the practice agreement; Schedule II nonnarcotic capped at a 30-day supply per prescription; Schedule II narcotic capped at a 5-day initial supply, with any further prescription requiring written physician agreement (exempt for hospice, palliative-care, or long-term-care patients). Requires 45 contact hours of pharmacotherapeutics education (15 on controlled substances if reciprocating from another state) and 20 CE hours every 2 years to renew (2 of which on controlled-substance prescribing).
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation under Title 33, Chapter 19 for nursing services, or a physician-owned entity per SC's common-law CPOM doctrine (see `pa` entry).
Sources for the supervision rules (3)
- S.C. Code § 40-33-34 — Performance of Medical Acts; Qualifications; Practice Agreements; Prescriptive Authorization; Anesthesia Care; Definitionssecondary
- S.C. Code § 40-47-195 — Supervising Physicians; Scope of Practice Guidelines (combined 6-provider cap)
- 2025-2026 S.C. Bill S.45/H.3580 — proposed APRN full-practice-authority pathway (pending, not enacted)
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.