The NALC believes all doctrines should and must be judged by the teaching of the Holy Scriptures (the Bible), in keeping with the historic Lutheran Confessions.

The primary issue of concern for these groups was a 2009 decision by the ELCA which changed its teaching and policy on sexual ethics, allowing clergy / ministers to be in committed same-sex relationships.

On August 9, 2019, Dan Selbo, pastor of St. Timothy's Lutheran Church in San Jose, California, was elected and installed as the third bishop of the NALC.

[9] The Joint Commission on Theology and Doctrine of the NALC and Lutheran CORE endorsed an anti-abortion stance on abortion in the document "The Lord Is with You" – A Word of Counsel to the Church – The Sanctity of Nascent Life", on December 14, 2012.

[12] He was also one of the American religious leaders who signed the open letter "Free Exercise on Religion: Putting Beliefs into Practice", expressing his support for the Roman Catholic Church in its opposition to the HHS mandate.

[13] The membership of the North American Lutheran Church is composed of congregations and ordained pastors who have subscribed to the NALC constitution.

[16] The North American Lutheran Church is divided into 28 mission districts, usually based on geographical groupings of congregations.

The NALC held an ecumenical summit with representatives of the ACNA, the LCMS, and the LCC on May 3–5, 2013, at the Church of the Holy Communion in Dallas, Texas, on the theme of "Biblical Teaching on Marriage and Sexuality".

[30] At its 2012 Convocation, the NALC approved, by the required majority of two thirds of the voters, a resolution to seek membership in the Lutheran World Federation.

[31] The application request was not approved by the LWF, remaining in a pending decision, according to a letter issued at May 2014, despite the support of the Lutheran Churches of Ethiopia and Tanzania.

In September 2018, the Global Forum met again in Bishoftu, Ethiopia, and on Reformation Day (October 31), they released a letter to the Lutheran worldwide community of churches, referred to as the “Bishoftu Letter to the Churches.” The forum referred to this letter as "a summary and clarification of the teachings that are our biblical and confessional heritage" and "an invitation to Lutherans worldwide to confess, repent, be renewed, reformed and refocused by the Word of God, that together we may be a witness to the world, bringing others to Jesus Christ as Lord and Savior".