States with Full Practice Authority for Nurse Practitioners

Practice authority for nurse practitioners continues to change in response to increased nurse training and the shortage of physicians and family medicine practitioners. The question of whether nurse practitioners have to work under a physician depends on the state they practice in and which qualifications or certifications it requires. States where nurse practitioners can practice independently have changed over the past few years, with the scope of practice varying from partial to full practice autonomy.

• Full Practice Autonomy: State licensure allows NPs to evaluate patients including examination, diagnosis, ordering and interpretation of diagnostic tests, establishing a treatment plan, and prescribing medication.
• Reduced Practice Autonomy: NPs are limited in at least one area of patient evaluation and must collaborate with other medical professionals, such as physicians, to care for patients. They are not permitted to provide all levels of care independently, often including prescribing controlled substances, and must coordinate with other medical professionals.
• Restricted Practice Autonomy: State practice authority limits the ability of NPs to provide patient care and requires them to work under the delegation or team management of another medical professional throughout their career. NPs in restricted practice autonomy states must have the direction of a medical supervisor, such as a leading physician, to deliver care to patients.

States with full practice authority for nurse practitioners allow nurses to streamline care for patients. While the healthcare system does not function without collaboration and teamwork between medical professionals, granting additional authority to NPs allows them to provide direct care to patients, eliminating some of the backlog for physicians and increasing the efficiency of care delivery. With advanced certifications, NPs can provide optimal long-term care to their patients.

As of August 2021, 24 states and the District of Columbia have approved NP practice autonomy. Note that state regulations change frequently, and advanced practice nurses should check with state nursing boards for the most current regulations.

In Alaska, all NPs have FPA. As the American Association of Nurse Practitioners explains, this allows them to evaluate and diagnose patients, analyze tests, and manage treatment plans. NPs may also apply for the authority to prescribe Schedule II to V controlled substances, though not all professionals in the field have this ability.

In Arizona, licensure through the Arizona Board of Nursing includes full prescriptive authority. NPs must submit a Controlled Substance Prescription Monitoring Program (CSPMP) application and register with the Drug Enforcement Agency (DEA) before prescribing medications to patients.

NPs who work in Colorado have FPA and the potential to gain full prescriptive authority after completing 1,000 hours of practice with provisional prescriptive authority. Before obtaining full prescriptive authority, NPs require oversight from a physician or mentoring NP.

Like NPs in Colorado, those who work in Connecticut require physician oversight for a time. In Connecticut, NPs must work with a physician for three years before earning FPA.

NPs in Delaware have full practice authority as of August 2021.

The District of Columbia grants NPs with an RN license, graduate degree, and national NP certification full practice autonomy.

Hawaii may have one of the smallest pools of licensed NPs, but they do have full practice authority.

NPs in Idaho have FPA, so they can advise, diagnose, and treat patients. In this largely rural state, professionals who earn advanced practice registered nurse (APRN) licensure also have the authority to prescribe medications to patients. They must complete 30 hours of qualifying continuing education (CE) courses to earn prescriptive authority. In Idaho and neighboring Wyoming, advanced practice nurses can practice in both states, due to advanced practice nursing (APN) compact legislation.

In Iowa, NPs can advise, diagnose, and treat patients without physician oversight. Those with advanced registered nurse practitioner (ARNP) licensure may also lead their own independent practices while focusing on their area of specialty. While not all NPs can prescribe medications, professionals with ARNP licensure can do so without oversight.

NPs in Maine have full practice authority. Those with APRN licensure can prescribe medications.

In Maryland, licensed NPs can treat patients without the oversight of a primary care physician. Professionals with APRN licensure can also prescribe drugs, but they have to register with the state’s Prescription Drug Monitoring Program (PDMP). This is intended to lessen opioid abuse among at-risk patients.

Under the new law for Massachusetts, certified nurse practitioners who have completed at least two years of qualifying supervised prescriptive practice will have independent practice authority.

The Minnesota Board of Nursing gives NPs full practice authority. APRNs also have the authority to prescribe and dispense a variety of medications, including over-the-counter drugs and controlled substances.

Montana NPs do not need physician oversight, but they must complete courses in pharmacology and disease management. In addition, APRNs who submit a successful application to the Prescriptive Authority can prescribe medications.

NPs working in Nebraska have FPA, along with the full authority to prescribe medications. They must complete 30 hours in pharmacology before gaining prescriptive authority.

In Nevada, NPs receive FPA and a Nevada Board of Pharmacy license to prescribe medications. To prescribe controlled substances, the DEA requires NPs to register.

Those who earn APRN licensure gain full practice authority in New Hampshire. They may also prescribe a variety of controlled and noncontrolled substances.

In New Mexico, NPs care for, diagnose, and develop treatment plans for patients and communities. Those who register with the DEA and get state certification can prescribe Schedule II through V controlled substances.

North Dakota NPs can treat patients independently, and they can also prescribe medications after completing 30 hours of coursework in pharmacology. Though they are not yet required to join the state’s Prescription Drug Monitoring Program, this may change in the future.

Average NP salaries in Oregon are among the highest in the nation, and NPs also have FPA. Professionals with APRN licensure have full prescriptive authority.

In Rhode Island, NPs must complete a Uniform Controlled Substances Act Registration before gaining full prescriptive authority. They gain global signature authority, so they can issue prescriptions without physician oversight.

One of the most recent additions to this list, South Dakota granted nurse practitioners full authority in February 2017. This bodes well for the state, whose residents primarily live in rural areas that do not typically receive comprehensive coverage from family doctors.

NPs who want to gain FPA must complete 1,600 practice hours with a physician’s oversight. With the state’s Prescription Monitoring System registration, they can also prescribe medications.

Washington NPs may diagnose and treat patients without physician oversight. They can also prescribe Schedule V controlled substances and certain other medications.

Wyoming NPs have FPA, and the licensure guidelines in this state are among the most lenient in the nation. Both Wyoming and Idaho, two neighboring and largely rural states, have passed APN compact legislation. This enables NPs with licensure in one state to practice in another, making it easier for NPs to practice their specialties.

As more doctors choose to pursue lucrative specialties rather than family medicine or primary care, the demand for NPs with FPA continues to increase rapidly. Experienced NPs in states that offer the most practice autonomy may pursue rewarding careers and become valuable members of the healthcare system.

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