Nurse Practitioner Practice Authority: A State-by-State Guide
- Scope of Practice Defined
- Scope of Practice vs. Practice Authority
- State Practice Authority
- Push For Full Practice Authority
- FAQ
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Credit: Boy_Anupong | Moment | Getty ImagesIn many states, the laws establishing nurse practitioner (NP) roles are in flux. This guide defines a nurse practitioner’s scope of practice, explains the three levels of practice authority, and lists states by practice authority. Read on to understand how practice authority can affect your career as a nurse practitioner.
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What is Scope of Practice?
Scope of practice refers to the professional activities that each state authorizes nurses or other clinical staff to perform. An NP’s scope of practice can include assessing a patient’s condition, ordering tests, interpreting results and making diagnoses, prescribing medication, and ordering treatments.
Scope of practice varies by state. In some states, NPs must work under a physician’s supervision or in collaboration with a physician, while other states allow nurse practitioners to practice independently.
How Scope of Practice Relates to Practice Authority
Scope of practice falls into three main categories, or levels, of practice authority: full, reduced, or restricted practice authority.
Full Practice
In full practice authority states, nurse practitioners can perform the full scope of practice without a supervising or collaborating physician. They can diagnose a patient, order tests, prescribe medication, and operate their own independent practices. Nurse practitioner independent practice states may require a certain level of experience working under a physician’s supervision or require additional training before allowing full practice authority. Because these requirements are not permanent, these states are still considered full practice authority states.
Reduced Practice
In reduced practice states, nurse practitioners can perform some of their scope of practice without physician supervision. These restrictions typically involve operating their own practices or prescribing certain types of medications. They rarely involve the nurse practitioner’s ability to order tests or diagnose conditions. For example, a nurse practitioner might need to be part of a practice that is supervised by a physician, rather than running their own practice, but within that practice, can operate with relative autonomy.
Restricted Practice
In restricted practice states, nurse practitioners must work under the supervision of a physician for all of their scope of practice. While they may have extensive autonomy in some nurse practitioner functions, they are not acting as independent practitioners. However, some states may loosen restrictions as the NP gains experience.
State-by-State NP Practice Authority
States by Nurse Practitioner Practice Authority
Each state establishes its own NP practice authority regulations. This list provides the latest nurse practitioner scope of practice by state or territory.
Full Practice Authority States/Territories
Massachusetts
New Hampshire
North Dakota
Northern Mariana Islands
Rhode Island
South Dakota
Washington, D.C.
Reduced Practice Authority States
Pennsylvania
U.S. Virgin Islands
West Virginia
Restricted Practice Authority States
North Carolina
South Carolina
The Push for Full Practice Authority
Expanding NP practice authority produces many benefits for healthcare consumers. It increases the availability of healthcare providers who can diagnose and treat health conditions; expands the availability of family practitioners during current and projected shortages; and because nurse practitioner salaries are lower than physician salaries, provides care at a lower cost.
However, many individuals and organizations, especially physician organizations, express concerns that many conditions that should be diagnosed and treated only by physicians are instead being treated by NPs and that healthcare payers, especially insurance companies, may pressure healthcare providers to use NPs instead of physicians. This, they argue, can result in a lower quality of care and outcomes for patients with complex or serious health conditions.
Physicians also earn more from supervising NPs and would lose out on this revenue source if NPs practice independently. Given the rapid growth in full practice authority states, it seems that state legislators believe in the positive impact of expanding NP practice authority.
Learn how you can get involved in the push for NP full-practice authority with our advocacy guide.
Frequently Asked Questions About Nurse Practitioner Practice Authority
Each state establishes the laws that govern 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 otherwise can diagnose and treat patients without limitations. Other states limit certain NP functions, such as prescribing medications.
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