What it takes to become a licensed nursing home administrator in North Carolina: the Administrator-in-Training (AIT) internship and how long it really runs, the NAB exams, the State Exam and what it is drawn from, continuing education, and where to find a certified preceptor. Figures below are taken from the official sources listed on this page.
| AIT requirement | 12-week minimum at 40 hours a week (480 hours), shorter only under narrow rule exemptions; the Board sets the full length, and its nonbinding guideline runs up to 50 weeks |
|---|---|
| National exams | NAB Core of Knowledge + NHA Line of Service (both required) |
| State exam | Required: the North Carolina State Exam, given by the Board in Raleigh. Multiple choice, 75 percent to pass Details ↓ |
| Continuing education | 30 hours every two years, up to 10 of them by distance learning |
| License renewal | Every two years; licenses expire 30 September |
| Official sources | ncbenha.org · nabweb.org (national exams) |
Verified against the sources above, September 2026. Requirements change; the board's current published rule is always the final word.
North Carolina sets a minimum, not a fixed length. “The minimum AIT program is 12 weeks” at a minimum of 40 hours a week (21 NCAC 37D .0407(a)), and 12 weeks at 40 hours is where the often-quoted 480 hours comes from. Every program then adds “such additional weeks of on-the-job training appropriate to the individual applicant based upon education and experience” (37D .0412(a)). Your preceptor recommends the length and the Board decides it (37D .0405(a)).
The Board publishes a nonbinding guideline for the length, which it calls a useful guide rather than a rule. It runs from 12 weeks or less, for example for a director of nursing with 4 of the last 5 years in that role, or a hospital administrator with equivalent duties, up to 50 weeks, with 36 weeks listed for a bachelor’s degree. So unless you fit that narrow 12-week category, expect the Board to set a considerably longer internship.
Compare this against every other jurisdiction on AIT Hours by State.
The interactive AIT Planner turns the North Carolina requirement into a live hours-allocation plan across all eleven department rotations, with a self-assessment that shapes where your hours go. No account needed.
Open the free AIT PlannerNorth Carolina requires both national exams from NAB (the National Association of Long Term Care Administrator Boards): the Core of Knowledge exam, 125 questions in 150 minutes, and the NHA Line of Service exam, 75 questions in 90 minutes. Both are computer-based, multiple choice, and delivered at Pearson VUE testing centers; North Carolina’s own State Exam, below, is not. We break down the structure in NAB Exam Format and the content in The Core Domains Explained.
North Carolina adds an exam of its own to the NAB exams, and it works differently from them. The Board’s rules call it the State Exam, and the Board gives it itself: it is held at the Board office in Raleigh, not at a Pearson VUE test center, and the Board’s materials name no testing vendor for it. The statute makes administering an examination, at least twice a year, one of the Board’s own duties (G.S. 90-285(2)).
| Format | Multiple choice, four answer choices each, marked on an answer sheet. An undated Board memo for reciprocity applicants gives the count as 50 questions |
|---|---|
| Time | One hour for answering the questions, according to the Board’s examination information form |
| Passing grade | At least 75 percent (21 NCAC 37D .0704) |
| Fee | $150, non-refundable, each time you take it (37D .0703(b)) |
| When | About every six to eight weeks, on dates the Board lists on its State Exam application (seven in 2026, which it says are subject to change); the application must reach the Board three weeks before the exam |
| Deadline | Both the national and State exams passed within one year of completing the AIT program (G.S. 90-278(1)e; 37D .0703(d)) |
An AIT can apply for the exams once they are within 30 days of finishing the training portion of the program. You also sign a confidentiality form covering both the NAB exam and the State Exam, so be wary of anyone selling “recalled” questions. After a third failure of any exam the Board requires, the AIT and preceptor must submit a program to strengthen the weak areas; a fourth failure disqualifies the AIT from continuing in the program, though you may reapply (37D .0701).
The Board’s rules define it in one sentence, 21 NCAC 37B .0205:
“The term ‘State Exam’ as used in these Rules means the examination provided by this Board regarding North Carolina state laws and rules concerning nursing homes.”
The statute ties the exams to the subjects of the course every candidate completes: “the services provided by nursing homes, laws governing nursing homes, protection of patient interests and nursing home administration” (G.S. 90-278(1)c and e). The Board is more concrete about the source material. It lists two sets of rules as State Exam study materials: the rules and statutes for licensing nursing home administrators (G.S. Chapter 90, Article 20 and 21 NCAC 37), and the rules for licensing nursing homes, 10A NCAC 13D, material from which it says will be included on the State Exam.
The Board does not publish a content outline, exam specification or study guide for the State Exam. The Board’s FAQ says plainly: “There is no practice test for the State Exam,” and points candidates to the rules themselves. That is the honest starting point for studying: the exam is drawn from the two rule sets above, and the Board does not publish which parts carry the most weight.
One trap here. The subject list in the Board’s rules, 21 NCAC 37D .0605 (Resident Care and Quality of Life, Human Resources, Finance, Physical Environment and Atmosphere, Leadership and Management), described the national exam, not the State Exam, and it was repealed effective 1 May 2023. The Board’s own downloadable rules PDF still prints it, because that PDF predates the 2023 changes. If you see that list presented as the North Carolina exam outline, it is neither.
This is the structural point that decides how you study. Some of 10A NCAC 13D adopts the federal rule by reference: facilities certified for Medicare or Medicaid must also comply with 42 CFR Part 483 when employing nurse aides (.2304), and since 1 August 2026 the abuse rule (.2210) incorporates 42 CFR 483.12 and the dietary rule (.2701) incorporates 42 CFR 483.60 and 483.25(g) and (h), though .2210 keeps some North Carolina requirements of its own. Other rules are written out in North Carolina’s own text: nurse staffing (.2303), the quality assurance committee (.2212), CPR (.2309) and physician services (.2501). Resident rights run through state statute rather than the federal text: the facility enforces the Nursing Facility Patient’s Bill of Rights in G.S. 131E-115 through 131E-127 (.2207).
So for each topic, the question to ask is whether North Carolina adopted the federal rule or wrote its own. Where it wrote its own, study the North Carolina text, since the Board names 10A NCAC 13D as State Exam study material.
The North Carolina nursing home rules in 10A NCAC 13D were reviewed and readopted as a package (50 readoptions, 10 amendments and 4 repeals). The Rules Review Commission approved them on 28 April 2026, with an effective date of 1 August 2026. Several changes make older North Carolina material wrong:
The Board’s own rules, 21 NCAC 37, are also due for readoption by 1 June 2027, so their section numbers may change. The federal side moved too: CMS’s 2024 minimum staffing standards (3.48 total nurse staffing hours per resident day, and a registered nurse on site 24 hours a day, 7 days a week) were repealed effective 2 February 2026. Material written in 2024 or 2025 may still teach them.
The most expensive habit on a state exam is answering with the federal rule you learned for the NAB exams. Six places where North Carolina differs, or changed recently:
| Topic | Federal or NAB answer | North Carolina answer | 10A NCAC 13D |
|---|---|---|---|
| Nurse staffing numbers | An RN for at least 8 consecutive hours a day, 7 days a week (483.35(b)(1)). The 3.48, 0.55 and 2.45 hours-per-resident-day figures and the 24/7 RN requirement were repealed effective 2 February 2026 | At least one licensed nurse on duty for direct patient care at all times, and an RN at least 8 consecutive hours a day, 7 days a week, which may be spread over more than one shift. No general hours-per-patient-day figure | .2303(d)(1), (d)(2) |
| Director of nursing doubling up | May serve as a charge nurse only with an average daily occupancy of 60 or fewer residents (483.35(b)(3)) | May be counted toward both the director of nursing and patient staffing requirements in facilities with a total census of 60 nursing beds or less | .2303(d)(2) |
| Quality assurance committee | Director of nursing, medical director or designee, the infection preventionist, and at least three other staff including one in a leadership role (483.75(g)(1)) | Director of nursing, a physician designated by the facility, a pharmacist, and at least three other staff members; meets at least quarterly | .2212 |
| CPR | Staff provide basic life support, including CPR, before emergency medical personnel arrive (483.24(a)(3)). The regulation itself names no training body; CMS surveyor guidance sets the certification standard | Staff on duty 24 hours a day trained by someone with valid American Heart Association or American Red Cross certification, under the facility’s own CPR policy | .2309(a), (f) |
| Harm to the facility itself | Reporting covers misappropriation of resident property, among other allegations (483.12(c)(1)) | Misappropriation of facility property, diversion of facility drugs and fraud against the facility reported to the administrator and DHSR within 24 hours of becoming aware | .2210(c) |
| Abuse allegation reports | Immediately, but not later than 2 hours if abuse or serious bodily injury, otherwise not later than 24 hours (483.12(c)(1)); results within 5 working days of the incident (483.12(c)(4)) | Since 1 August 2026, the federal time periods, incorporated by reference. Before that, a flat 24 hours for allegations against health care personnel. Investigation report within 5 working days of the allegation being received | .2210(b), (e) |
North Carolina column: 10A NCAC 13D as readopted and amended effective 1 August 2026. Federal column: 42 CFR Part 483 as published in the eCFR, September 2026. One topic that looks like a trap and is not: physician visit intervals are the same in both, every 30 days for the first 90 days and every 60 days after that.
State exam questions tend to turn on a number and its condition, so the condition is carried with the number here. Sections starting with a dot are in 10A NCAC 13D; the others are the Board’s rules (21 NCAC 37) or the statute.
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Board list of certified preceptors: NC Board (NCBENHA), with names, addresses and phone numbers (list dated August 2026). In North Carolina the AIT program is an individual internship with a Board-certified preceptor rather than a school program, and the Board says the very first step is finding a certified preceptor willing to train you. The Board does not publish a list of AIT programs.
State associations: North Carolina Health Care Facilities Association (NCHCFA) · LeadingAge North Carolina. Their member facilities are where many North Carolina administrators work, so they can be a useful place to make contacts.
For the full step-by-step on approaching facilities and preceptors, see How to Find an AIT Preceptor and an Approved Program.
The Board lists its fees on its fee page, and most of the amounts below also appear in its rules, 21 NCAC 37, cited where they do. The exam fees for the two NAB exams are paid to NAB; the State Exam fee is paid to the Board.
| AIT application | $300, non-refundable (Board fee page; 37D .0402) |
|---|---|
| NAB Core and NHA exams | $480 for the two together from 1 February 2026 ($320 for the Core alone, $190 for the NHA alone), paid to NAB |
| NAB processing fee | $50, which the fee page calls a “NAB processing fee payable to NC Board”, paid with your online exam registration. The page does not say whether it is charged per exam or per registration, or whether NAB’s price already includes it |
| North Carolina State Exam | $150, non-refundable, each time you take it (21 NCAC 37D .0703(b)) |
| Criminal background check | $38 (Board fee page) |
| Original license | $600, non-refundable, sent once you have passed the required exams (37D .0202) |
| Renewal, every two years | $600 (37G .0102) |
| Inactive list | $100 a year, for up to four years (37G .0201) |
| Reciprocity (endorsement) processing | $300, non-refundable (37E .0102) |
| Temporary license | $500; no further fee if the Board extends it (37F .0102; G.S. 90-280(f)) |
| Duplicate license; verification | $25; $50 (Board fee page) |
By our count, a first-time candidate on the AIT route pays $300 + $50 + $480 + $150 + $38 + $600 = $1,618 in Board and NAB fees for a first attempt at each exam, counting the $50 once. That total leaves out the AIT course fees the fee page also lists, $400 (2-Day), $800 (4-Day) and $1,200 (6-Day), because the page does not say who pays which; the Board sends AITs information about an “AIT 6 Day Lecture Class” with their permit letter, so ask the Board which applies to you. The Board’s FAQ says “Most AITs are unpaid positions”, so plan for that too. An administrator licensed in another state pays less: the Board’s reciprocity checklist puts it at $1,088 ($300 + $38 + $150 + $600). The fee page carries no effective date, so confirm the amounts with the Board before you pay.
“Every licensee shall document successful completion of at least 30 hours of approved continuing education for each biennial period of registration” (21 NCAC 37H .0101). The statute bars the Board from requiring more than 30 hours every two years (G.S. 90-286).
Renewal date. A license expires “on the 30th day of September of the second year following its issuance” (37G .0101(a); G.S. 90-280(b)). The Board’s FAQ puts it this way: your first renewal “comes due the 2nd September 30th after issuance”, and after that “All licenses renew September 30th in an odd or even year”, depending on the year you were licensed. You apply to the Board for a new certificate of registration every two years. The form asks for your address and place of practice, any criminal convictions and any discipline by another licensing board in the preceding two years, and you send documentation of the 30 hours with it, plus the $600 fee (37G .0101(b), (c); 37G .0102). Renewal notices are sent “as a courtesy” to the last address on file, so keeping it current is your job, and you must tell the Board in writing within 15 days of any change of home or work address or of employment (37G .0101(d), (e)). Renewals run through the Board’s online licensing portal.
Inactive status. You can ask to go on the inactive list on the renewal form, for $100 a year, but the request and fee must be submitted no later than 30 days after your license expires, or the license expires automatically, back to the expiry date. The list allows up to four years (37G .0201; G.S. 90-280(e) limits it to people not serving as administrators). To reactivate after less than three years inactive you submit an application, 30 hours of Board-approved CE from the preceding 24 months and the current renewal fee; after three to five years you also pass the State Exam; after more than five years you meet all the licensure requirements again (37G .0202).
Lapsed license. If it has lapsed for less than two years, you submit an application, 30 hours of Board-approved CE from the preceding 24 months, the current license application fee, and you pass the State Exam. After more than two years, you submit an application and meet all the licensure requirements in 37D .0102 (37G .0302).
Endorsement. North Carolina calls this reciprocity, and it is in G.S. 90-287 (the Board’s duties section, G.S. 90-285(3), points to it). The Board “may issue a nursing home administrator’s license to any person who holds a current license as a nursing home administrator from another jurisdiction”, if it finds the other jurisdiction’s standards “are at least the substantial equivalent of those prevailing in this State” and the applicant “has passed the national and the State examinations administered by the Board and is otherwise qualified”. The rule, 21 NCAC 37E .0101(a), adds that you must show evidence that you:
The Board’s reciprocity memo adds that you must never have had an administrator’s license “revoked for cause”, and that you must keep your license active “until you have totally completed the licensure process in North Carolina”. The interview “is not a test of knowledge”: the questions “relate to your experience as a nursing home administrator and your suitability for licensure”. The rule sets no minimum years of practice. Once licensed here, the Board may, after notice and a chance to be heard, revoke or suspend your license if another state has lawfully revoked or suspended yours (37E .0103).
Exams. Yes, the North Carolina State Exam is required. The rule lists “successful completion of the state examination” as a condition, and the Board’s FAQ says every reciprocity/endorsement applicant “MUST take and pass” the State Exam. The $150 fee and the 75 percent pass mark are covered above and in the State Exam section. You do not retake the NAB exams if your results are accepted: the memo says the Board “will accept the results of your NAB or PES Examination taken in another state” if they meet North Carolina’s standard, which it gives as “a scaled score of 113 or higher after October, 1993”. The memo is undated and still mentions PES, so ask the Board how it reads your current NAB Core and NHA scores.
Applying. Under 37E .0102 you send a completed application, a resume, certified college transcripts, three reference forms (one employer, two character), a licensing questionnaire from every state where you have held a license, the $300 non-refundable processing fee, and fingerprint materials and the fee for the criminal background check. The memo also asks for a self-report from the National Practitioner Data Bank. The Board’s reciprocity page says the complete package must be in the Board office “3 weeks prior to the next Board Meeting”; the Board meets about every 6 to 8 weeks (Board FAQ). After approval and a passed State Exam, the Board issues the license “once all the current fees have been paid” (memo).
Temporary reciprocal license. This is not a general permit while you wait. If you do not submit the evidence of equivalent qualifications, education, training and experience, but are “otherwise qualified”, the Board “shall issue a temporary reciprocal license” to practice for six months in one nursing home you name when it is issued (37E .0101(b)). You agree to send, within one month before it expires, a statement that you ran the home to the owner’s satisfaction, and to complete any CE the Board requires if your education is not substantially equivalent. If you tell the Board before the six months end that circumstances have changed so you cannot meet those conditions, the Board may extend it for up to six more months (37E .0101(c)). The rule does not say whether you must pass the State Exam during the temporary period, so ask.
Emergency temporary license. A separate, facility-driven license is “issued in an emergency situation only”, and “Holding a Temporary License does not qualify you to have a permanent license” (Board temporary license page). Under 21 NCAC 37F .0101 the facility must show the administrator’s sudden death, unexpected transfer or unforeseeable termination, and the license covers only that home (37F .0102(d)). The length is described three ways: until the next Board meeting, plus one renewal of up to six months (37F .0101(a), (d)); “up to a total of six months” (Board FAQ); and renewable “up to one year” (G.S. 90-278(3)). Confirm the current term with the Board.
Military and spouses. G.S. 93B-15.1 applies to boards “as defined in G.S. 93B-1”, meaning a body “established for the primary purpose of regulating the entry of persons into, and the conduct of persons within, a particular profession or occupation, and which is authorized to issue licenses”, a description that appears to fit the Board. A military spouse who “Holds a current license, certification, or registration from another jurisdiction” with requirements “substantially equivalent to or exceed” North Carolina’s, can show competency, has committed no act that would be grounds for refusal, and is in good standing with no pending complaints, is entitled to a license (subsection (b)). Military-trained applicants have their own route in subsections (a) and (a2), and the statute credits relevant military and spouse experience toward years of practice (subsection (c)). The board “shall issue a temporary practice permit” to a military-trained applicant or spouse licensed elsewhere “no later than 15 days following receipt of an application”, valid for “the later of one year or the required renewal date” or until a license is granted (subsection (f)), and “shall not charge” such an applicant “an initial application fee” (subsection (k)). Ask the Board how it applies G.S. 93B-15.1 to nursing home administrator applicants, including whether the State Exam and the $300 processing fee still apply. The Board is at 919-571-4164 or nhaboard@ncbenha.org.
These are the legal sources that govern nursing home administrator licensure in North Carolina. The Board names the first two together, and 10A NCAC 13D, as State Exam study material.
Citations verified against official sources, September 2026. Provided for reference, not legal advice; the current official text governs. Mirrors are labeled where an official public link is not available.
The Board’s rules define the State Exam as the examination provided by the Board regarding North Carolina state laws and rules concerning nursing homes (21 NCAC 37B .0205). The Board lists the rules and statutes for licensing nursing home administrators and the rules for licensing nursing homes, 10A NCAC 13D, as State Exam study materials. The Board does not publish a content outline or study guide, and the Board says there is no practice test. Note that 10A NCAC 13D was readopted effective 1 August 2026, so older study material may be out of date.
North Carolina sets a minimum AIT program of 12 weeks at a minimum of 40 hours a week, which is 480 hours, plus additional weeks the Board sets from your education and experience. The Board’s nonbinding guideline runs up to 50 weeks, with 36 weeks listed for a bachelor’s degree. You and your certified preceptor appear before the Board for an interview before starting, and the national and State exams must both be passed within one year of completing the program.
Candidates take the NAB national exams at Pearson VUE and the North Carolina State Exam, which the Board gives at its office in Raleigh: a multiple-choice exam, with 75 percent needed to pass. Both the national and State exams must be passed within one year of completing the AIT program. Confirm the current exam list with the Board before you apply.
Licensed administrators must complete 30 hours of approved continuing education in each two-year renewal period, of which no more than 10 hours may be distance learning. Licenses expire on 30 September in the second year after issuance. CE rules change between renewal cycles, so verify the current requirement with the Board.
The Board publishes a list of certified preceptors, with names, addresses and phone numbers, on ncbenha.org. North Carolina does not use a list of approved AIT programs: the AIT is an individual internship with a certified preceptor, approved at a Board interview, and the first step is finding a certified preceptor willing to train you. The state associations, North Carolina Health Care Facilities Association (NCHCFA) and LeadingAge North Carolina, may be able to help you make contacts with member facilities.
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