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

Updated November 23, 2022 · 5 Min Read

check mark Reviewed by

Our Integrity Network

NurseJournal.org is committed to delivering content that is objective and actionable. To that end, we have built a network of industry professionals across higher education to review our content and ensure we are providing the most helpful information to our readers.

Drawing on their firsthand industry expertise, our Integrity Network members serve as an additional step in our editing process, helping us confirm our content is accurate and up to date. These contributors:

  • Suggest changes to inaccurate or misleading information.
  • Provide specific, corrective feedback.
  • Identify critical information that writers may have missed.

Integrity Network members typically work full time in their industry profession and review content for NurseJournal.org as a side project. All Integrity Network members are paid members of the Red Ventures Education Integrity Network.

Explore our full list of Integrity Network members.

Nurse practitioner scopes of practice vary widely. Read this listing of nurse practitioner scope of practice by state to understand your state's regulations.
mini logo
NurseJournal.org is an advertising-supported site. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site.

Are you ready to earn your online nursing degree?

Credit: Boy_Anupong | Moment | Getty Images

In many states, the laws that establish 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.

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

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


Reduced Practice Authority States


Restricted Practice Authority States


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 could 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.

Recent NP Practice Authority Legislation

  • In February 2021, Pennsylvania State Bill 25 was introduced. The measures in this bill include expanding 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 raised 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 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.

In what states can an NP practice independently?

Currently, Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, 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 practice independently in 25 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.


Related Resources

NurseJournal.org is an advertising-supported site. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site.

Are you ready to earn your online nursing degree?

Whether you’re looking to get your pre-licensure degree or taking the next step in your career, the education you need could be more affordable than you think. Find the right nursing program for you.

Popular Resources

Resources and articles written by professionals and other nurses like you.