What Does Practice Authority for Nurse Practitioners Look Like?

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Nurses may earn a Master of Science in Nursing - Nurse Practitioner degree and pass a licensure exam to become a nurse practitioner. Nurse practitioners (NPs) have one of the most in-demand careers  with a projected 26% career field growth until 2028 (source).
Higher education and licensure permit a nurse practitioner (NP) to care for their patients in ways that registered nurses cannot. Nurse practitioners assess their patients and provide holistic care across the lifespan. In many states, NPs work similarly to physicians, where they can prescribe medication and order lab results. These duties fall within a nurse practitioner’s authorized scope of practice. 
Currently, 22 states and Washington D.C. have granted full practice authority for nurse practitioners. “Full practice authority” means that nurse practitioners are independent healthcare providers in these states and do not require a supervising physician to operate. 
In today’s article, we will examine nurse practitioner scope of practice by state.

22 states and Washington D.C. have granted full practice authority for nurse practitioners.

Levels of Nurse Practitioner Practice Authority

Nurse practitioner scope of practice by state tends to fall under the umbrella of one of three categories. The three categories currently include full practice authority, reduced practice authority, and restricted practice authority. While states’ scope of practice laws are labeled as falling into one of these categories, the state laws in each category aren’t uniform. While there are similarities between states, each state’s laws are different.

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Full Practice Authority

Nurse practitioners in full practice states have no limitations placed on their ability to treat patients. NPs are able to order and interpret a variety of tests, provide diagnosis, and prescribe medications – including controlled substances – to treat their patients.
In states that allow full practice authority for nurse practitioners, NPs work as independent providers. With no supervision required for them to operate, NPs may even run their own healthcare practice if they choose.
Some states with full practice authority initially require NPs to undergo a transition period during which they have a collaborative agreement with a supervising healthcare provider – this may include another NP, physician, or physician assistant. After the NP has completed a number of supervised hours, they may then transition to independent practice.
Currently, 22 states and the District of Columbia grant NPs full practice authority (source). 
Areas with full practice authority include:

  1. Alaska
  2. Arizona
  3. Colorado
  4. Connecticut
  5. District of Columbia
  6. Hawaii
  7. Idaho
  8. Iowa
  9. Maine
  10. Maryland
  11. Minnesota
  12. Montana
  13. Nebraska
  14. Nevada
  15. New Hampshire
  16. New Mexico
  17. North Dakota
  18. Oregon
  19. Rhode Island
  20. South Dakota
  21. Vermont
  22. Washington 
  23. Wyoming

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Reduced Practice Authority

When it comes to the reduced practice authority level, APRN scope of practice by state has different requirements. Each state’s board of nursing makes the laws regarding limitations on nurse practitioners’ independence. In these reduced practice authority states, nurse practitioners are limited in engaging in one or more areas of practice, and their work setting options may also be limited.
Additionally, NPs in these states are also often required to have a collaborative agreement with a physician in order to practice. This means that a physician needs to be available for the nurse practitioner to consult regarding diagnosing and treating their patients. In most cases, it’s not necessary for the physician to be present in the facility in which the NP is seeing patients.
States with reduced practice authority include:

  1. Alabama
  2. Arkansas
  3. Delaware
  4. Illinois
  5. Indiana
  6. Kansas
  7. Kentucky
  8. Louisiana
  9. Mississippi
  10. New Jersey
  11. New York
  12. Ohio
  13. Pennsylvania
  14. Utah
  15. West Virginia
  16. Wisconsin

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Restricted Practice Authority

When comparing the nurse practitioner collaborative agreement by state regulations, NPs working in restricted practice states have the most stringent requirements. Nurse practitioners working in restricted practice states must work under the supervision of a physician that must be present in the practice location.
Restricted practice states also place at least one restriction on one of the elements of advanced practice nursing. Procedures that the nurse practitioner is allowed to perform are detailed and delegated to the NP by the supervising physician or facility.
States with restricted practice authority:

  1. California
  2. Florida
  3. Georgia
  4. Massachusetts
  5. Michigan
  6. Missouri
  7. North Carolina
  8. Oklahoma
  9. South Carolina
  10. Tennessee
  11. Texas
  12. Virginia

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What Efforts Are Being Made to Advocate for Independent Practice?

Full practice authority is the recommendation that the National Academy of Medicine (formerly the Institute of Medicine) makes for state board of nursing. The American Association of Nurse Practitioners (AANP) advocates for nurse practitioners’ rights on both the state and federal levels, monitoring legislation that affects NP practice and patient care.
Nurse practitioners also often work work lawmakers to change existing laws and propose new ones. For example, the Virginia Council of Nurse Practitioners helped reduce practice restrictions in their state by lobbying and collaborating with lawmakers. 
Their efforts resulted in nurse practitioners gaining the ability to move to full practice authority after practicing with physician supervision for five years, or the equivalent of 9,000 hours. This new law allowed approximately 50% of NPs in the state of Virginia to begin practicing independently. 

The AANP advocates for nurse practitioners’ rights on both state and federal levels.

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Make a Difference as a Nurse Practitioner

Registered nurses considering the path of nurse practitioner will not only broaden their impact on lives, but help shape the future of healthcare delivery. Nurse practitioners reap the rewards of service, while enjoying more autonomy, a bright career outlook, and substantial pay raise. As more and more states make strides for full practice authority for nurse practitioners, the field is leaning towards positive change in the future. Consider enrolling in a RN to NP program to start your journey towards becoming a nurse practitioner.

Read our blogs about the day-to-day of a nurse practitioner and what you should know about the AANP and ANCC exams. 

Learn more and download the program guide today.

Sources: 

American Association of Nurse Practitioners. (2018). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment 

Bureau of Labor Statistics. (2019). Nurse anesthetists, nurse midwives, and nurse practitioners. https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm 

Health Resources and Services Administration. (2019). Nurse practitioners overview - Scope of practice policy. http://scopeofpracticepolicy.org/practitioners/nurse-practitioners/ 

Stringer, H. (2019). Nurse practitioners gain ground on full practice authority. https://www.nurse.com/blog/2019/07/24/nurse-practitioners-gain-ground-full-practice-authority/