The first family nurse practitioner program in North Carolina began at the University of North Carolina in Chapel Hill in 1968. This article describes the process of achieving and implementing a framework for the legal accommodation of nurse practitioner practice. The recommendations of a Legislative Study Commission helped to achieve enabling amendments of the Nursing Practice Act and the Medical Practice Act in 1973 which established a Joint Subcommittee of the two groups. The legislation charged the committee with developing rules and regulations for the approval of expanded practice for nurses. Since 1974 more than 150 nurse practitioners have been approved based upon: review of the educational preparation of the nurse; the type of practice setting; descriptions of medical acts to be performed with accompanying protocols; and provision for indirect physician supervision, consultation and emergency back up. The physician, nurse and practice site are approved as a unit. An amendment to the Pharmacy Practice Act in 1974 permits these nurses to be issued a a prescribing number, to write prescriptions for standing orders within their practice protocols and the framework of a general formulary. Controlled substances may not be prescribed. A review of the educational program for acceptance is discussed and future directions for joint subcommittee tasks are projected.