Nurse Practitioner Practice Authority: A State-by-State Guide

Nurse Practitioner Practice Authority: A State-by-State Guide

In numerous states, the legislative landscape governing the roles of Nurse Practitioners (NPs) is undergoing changes. This comprehensive guide elucidates the scope of practice for nurse practitioners, delineates the three levels of practice authority, and presents a state-by-state breakdown of practice authority. Delve into the intricacies to comprehend how practice authority can significantly impact your career as a nurse practitioner. It is essential to recognize that nurse practitioner scopes of practice exhibit substantial variations across states. Explore this compilation detailing the scope of practice for nurse practitioners by state to gain insight into the regulatory framework in your specific region.

What is Scope of Practice?

The term “scope of practice” denotes the professional activities that each state authorizes nurses or other clinical staff to undertake. Within the realm of a nurse practitioner’s scope of practice, activities may encompass assessing a patient’s condition, ordering tests, interpreting results, making diagnoses, prescribing medication, and ordering treatments.

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Nursing Scope of Practice vs. Practice Authority: What’s the Difference?

The delineation of scope of practice is not uniform across states. Some jurisdictions necessitate nurse practitioners to work under the supervision or in collaboration with a physician, while others grant nurse practitioners the autonomy to practice independently.

Relationship Between Scope of Practice and Practice Authority

The concept of scope of practice aligns with three primary categories or levels of practice authority: full, reduced, or restricted practice authority.

1. Full Practice Authority

In states with full practice authority, nurse practitioners can engage in the entire spectrum of their practice without the need for supervision or collaboration with a physician. This includes diagnosing patients, ordering tests, prescribing medication, and establishing independent practices. While some states may impose prerequisites, such as a certain level of experience under a physician’s supervision or additional training, these requirements are not permanent, classifying such states as full practice authority states.

2. Reduced Practice

Reduced practice states permit nurse practitioners to execute a portion of their scope of practice without direct physician supervision. Typically, these restrictions involve aspects like managing their own practices or prescribing specific types of medications. However, limitations often do not extend to the nurse practitioner’s ability to order tests or diagnose conditions. For instance, a nurse practitioner may need to be part of a practice supervised by a physician but can operate with a considerable degree of autonomy within that framework.

3. Restricted Practice

In states with restricted practice, nurse practitioners are obligated to work under the supervision of a physician for all aspects of their scope of practice. While they might possess substantial autonomy in certain functions, they do not function as independent practitioners. It’s worth noting that some states may ease these restrictions as the nurse practitioner accumulates experience.

State-by-State NP Practice Authority

The regulatory landscape for NP practice authority is established independently by each state. The following chart offers the most recent information on nurse practitioner scope of practice by state or territory, providing a comprehensive overview of the regulatory framework across the United States and its territories.

Explore Top-Ranked Nurse Practitioner Programs

To obtain detailed information about the commencement dates, policies on credit transfers, availability of financial assistance, and more, connect with the universities provided below.

Advocating for Comprehensive Practice Authority

The movement toward expanding the authority of Nurse Practitioners (NPs) heralds numerous advantages for healthcare consumers. This initiative not only enhances accessibility to healthcare providers capable of diagnosing and treating health conditions but also addresses the shortage of family practitioners. Furthermore, owing to the generally lower salaries of nurse practitioners compared to physicians, it facilitates the delivery of cost-effective care.

Despite these advantages, concerns have been raised, particularly by physician organizations. They are apprehensive that conditions that should be diagnosed and treated by physicians might be handled by NPs. There are also fears that healthcare payers, particularly insurance companies, might pressurize healthcare providers to choose NPs over physicians, potentially compromising the quality of care and outcomes for patients with complex or serious health conditions.

Physicians, who stand to earn more by supervising NPs, may lose a significant revenue source if NPs are granted the ability to practice independently. Despite these concerns, the trend toward full practice authority states is rapidly growing, indicating that state legislators believe in the positive impact of expanding NP practice authority. To engage in the advocacy for NP full-practice authority, refer to our comprehensive advocacy guide.

Recent Developments in NP Practice Authority Legislation

• In a significant move, Utah Governor Spencer Cox signed Senate Bill 36 into law in March 2023, expanding the scope of practice for nurse practitioners in the state. This action makes Utah the 27th state to adopt full practice authority for NPs.
• In November 2022, California’s nurse practitioner association approved rules allowing for an expanded scope of practice for NPs in the state. Starting January 2023, NPs with three years of clinical practice in California will be authorized to work without contractual physician supervision in healthcare settings with at least one practicing physician or surgeon on staff. This enables qualified nurse practitioners to consult a physician if necessary.
• In February 2021, Pennsylvania introduced State Bill 25, which includes measures to expand the scope of practice for certified NPs. The bill is currently pending.
• As of July 1, 2020, under HB 607, advanced practice registered nurses in Florida who have completed 3,000 hours under the supervision of an MD or a DO in the last five years can apply for an unrestricted license.
• In 2018, South Carolina removed the previous requirement that collaborating or supervising physicians be located within a 45-mile radius of the NP’s practice and increased the number of NPs that a physician can supervise or collaborate with from three to six.

Frequently Asked Questions About Nurse Practitioner Practice Authority

How does nurse practitioner authority vary by state?

Each state establishes the laws governing nursing scope of practice. In full practice authority states, NPs can establish independent practices. In other states, NPs may need to work under a physician or with a physician, though they can otherwise diagnose and treat patients without limitations. Some states limit certain NP functions, such as prescribing medications.

In what states can an NP practice independently?

Currently, Alaska, Arizona, Colorado, Connecticut, Delaware, Florida, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington, and Wyoming are full practice authority states. However, this list is likely to grow as more states consider legislation to expand NP authority.

Are NPs licensed by state?

All nurses, including NPs, are licensed by the state in which they practice or by a multi-state license. State boards of nursing establish the criteria for becoming licensed. These criteria include graduating from an accredited program and passing a certification examination, as well as maintaining licensing through continuing education.

Where are NPs able to practice independently?

Currently, NPs can now practice independently in 27 states and in Washington, D.C. In other states, while NPs may perform many of their job functions with a high level of independence, they must work in collaboration with or under the supervision of a physician. For any further inquiries or additional information, feel free to reach out.

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