Bill
HB 746
HB 746 creates limited immunity from malpractice liability for nurses who follow supervising providers’ orders within their scope of practice.
Status (latest): Committee substitute reported favorably (Reptd. Fav. Com. Sub. 2). Latest committee action April–May 2025. (Bill text appears as additions to Article 1B of Chapter 90 of the North Carolina General Statutes.)
Purpose
- HB 746 would create a statutory, limited immunity from medical malpractice liability for registered nurses who act under the supervision or direction of a supervising health care provider. The bill seeks to restore/clarify the pre-2022 rule articulated in Byrd v. Marion General Hospital (1932) after that rule was changed by the North Carolina Supreme Court in Connette v. Charlotte-Mecklenburg Hospital Authority (2022). The General Assembly sponsors characterize the change as a legislative determination of nurses’ legal duties when following supervising-provider orders.
Key provisions (plain-language)
- New statutory provision added to Article 1B, Chapter 90 (versions cite § 90‑21.15B or § 90‑21.14A in successive drafts).
- When a nurse acts at the direction of a supervising health care provider during treatment:
- The nurse does not owe a separate, independent duty of care to the patient that is distinct from the supervising provider’s duty (i.e., the nurse is not independently liable solely for executing the provider’s directions).
- The nurse is not treated as part of a collaborative team with joint legal responsibility for the supervising provider’s orders in these circumstances.
- The nurse’s primary duty is to diligently execute the supervising provider’s orders; collaboration with other supervising providers does not, by itself, create an independent duty of care.
- Limited immunity from malpractice damages applies so long as the nurse’s actions are within the nurse’s scope of practice and consistent with the supervising provider’s directions (later committee language clarifies scope-of-practice requirement and defines “nurse” by license articles).
- Explicit exceptions — the immunity does NOT apply if the nurse:
- Acts outside the supervision of a health care provider;
- Commits acts or omissions contrary to professional standards of practice;
- Engages in acts so obviously negligent that substantial injury is foreseeable;
- Commits gross negligence, recklessness, wanton conduct, or intentional wrongdoing.
- Some draft variations also state that a nurse acting in good faith who raises safety concerns about another provider’s order is not liable (appears in intermediate drafts).
Who is affected
- Nurses licensed under the cited provisions of Chapter 90 (registered nurses and related nurse licensees identified in the final draft).
- Supervising health care providers (physicians and other providers who give orders).
- Patients and their legal representatives (changes the legal basis for malpractice claims against nurses who followed orders).
- Health care employers and professional liability insurers (potentially fewer malpractice exposures/claims against individual nurses when acting under supervision).
Practical impact
- Legal: Codifies a rule limiting individual malpractice liability for nurses who act under supervision, while preserving remedies for cases of gross negligence or conduct outside supervision.
- Clinical/operational: May reduce malpractice exposure for nurses executing orders and could influence hospital policies on delegation and supervision.
- Litigation: May narrow grounds for suits against bedside nurses in cases where plaintiffs rely solely on a nurse’s separate duty theory.
Timing / Effective date
- Drafts vary: earlier drafts were effective upon enactment; later committee substitute sets an effective date (example: Oct. 1, 2025) and applies to acts/omissions on or after that date. Check the enacted version or final committee report for the definitive effective date.
Context & legislative history
- Motivated by the 2022 NC Supreme Court decision (Connette) that altered the prior rule; sponsors seek to reinstate protection for nurses who follow supervising-provider orders.
- Multiple committee substitutes were reported favorably in spring 2025 (committee substitute and substitute #2). Consult the General Assembly’s bill tracking for final passage, veto/signature, and the enacted statute text.
Compiled from official sources — confirm details with the bill’s official record.
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