Practice authority of nurse practitioners by state
May 10, 2021
Introduction to nurse practitioners
Nurse practitioners, NPs, are an important component of our nation’s healthcare system. Although NPs can practice in a wide range of specialties and subspecialties, most of them work in a primary care or family practice setting. As a result, they represent an integral part of the primary care workforce.
Becoming an NP requires earning a bachelor’s degree in nursing, becoming a licensed registered nurse (RN), completing a graduate-level—either master’s or doctoral— NP degree program, and passing a national board certification examination. After satisfying all of these requirements, which are generally the same across all states, an NP is eligible to become state-licensed. However, the requirements for practicing as an NP once licensed vary widely among states. This means that your scope-of-practice as an NP may be reduced or restricted to requiring supervision by a physician depending on which state you live and practice in.
Regardless, laws regulating NP practice and full practice authority remain highly inconsistent among states.
Professional associations representing NPs, such as the American Association of Nurse Practitioners, advocate for the full practice authority of NPs across all states. This would mean that NPs could independently diagnose, treat, and prescribe medications to patients, without being supervised by a physician. These associations argue that the education and clinical training required to become an NP is sufficient for NPs to practice without physician supervision. Regardless, laws regulating NP practice and full practice authority remain highly inconsistent among states.
Due to state variations regarding the ability to practice as an NP, it is important for interested students to consider how their career could be affected based on the laws in their state. Therefore, this article summarizes restrictions on NP practice for each state so that students can better prepare themselves for a career as an NP.
State profiles of NP practice authority
The scope-of-practice level —full, reduced, or restricted—for NPs is assessed for each state based on the degree to which NPs can independently diagnose and treat patients according to state practice and licensure policies. Furthermore, the prescriptive authority level for NPs —independent or physician-authorized—is assessed for each state based on whether or not NPs can independently prescribe medications to patients. An asterisk (*) next to the scope-of-practice level or prescriptive authority level in the state profile indicates that the completion of an introductory period with physician oversight is required before NPs become eligible to practice or prescribe medications independent of a physician. Definitions for each scope-of-practice level and each prescriptive authority level are given below.
This means that NPs can diagnose and treat patients independent of a physician.
This means that NPs have a reduced authority to diagnose and treat patients. In reduced scope-of-practice states, an NP is required to have a collaborative practice agreement with a licensed and board-certified physician. A collaborative practice agreement is a professional collaboration between a physician and an NP that authorizes the NP to practice. The collaborative practice agreement generally includes a standard written protocol, which is a document that describes the terms of the physician–NP collaboration and lists the specific medical services and acts that the NP is authorized to perform under the collaboration.
Restricted scope-of practice
This means that NPs have a restricted authority to diagnose and treat patients. In restricted scope-of-practice states, an NP is required to practice under a licensed and board-certified physician, who serves as a delegating physician. The delegating physician supervises the practice of and delegates tasks to the NP to the extent that any diagnosis made or treatment performed by the NP requires oversight and final authorization by the delegating physician.
Independent prescriptive authority
This means that NPs can prescribe medications independent of physician supervision or collaboration.
Physician-authorized prescriptive authority
This means NPs can only prescribe medications in collaboration with or under the supervision of a physician.
It is important to note that the information in this article is up-to-date as of February 2021 and also that state laws regulating NP practice and prescriptive authority are frequently changing. Therefore, checking the most recently updated state laws regulating NPs using the links in this article is critical for obtaining the most up-to-date and accurate information.
Being aware of this will make it easier to have a personally fulfilling career.
As a final remark, it is crucial for aspiring NPs to consider how state regulations and laws on NP practice and prescriptive authority may impact their future career as an NP. Being aware of this will make it easier to have a personally fulfilling career.