2022 State by State Scope of Practice: Nurse Practitioner

Nurse practitioners are one type of advanced practice registered nurse (APRN). Each state’s Nurse Practice Act usually defines NP/APRN practice, but its Board of Nursing (BON) governs this practice. Other laws and regulations may also impact NP practice. The scope of practice (SOP) of nurse practitioners can significantly vary by state, making it challenging for NPs who work in more than one or move from one to another. NPs who inadvertently practice outside their scope of practice risk disciplinary action by their state BON, endanger their nursing licenses and could face a malpractice suit. To ensure you don’t do anything that might put you in a bad spot, you must know and understand the scope of practice in the state(s) in which they practice.

 

What Is Scope of Practice?

In the medical field, scope of practice is the set of rules and regulations that guide what a medical professional is legally allowed to do in their practice area. Therefore, a nurse practitioner’s scope of practice precisely defines who and what they can treat and where, when and how they can treat who and what they treat. NPs use their education to assess, diagnose and treat patients, and their SOP describes to what extent they can do all three things. Nurse practitioner scope of practice laws includes nine components; one reason it gets tricky with varying laws on each component in each state.

 

Responsibilities of NPs

Nurse practitioners conduct health assessments and physically examine patients to make a diagnosis, then develop treatment plans, which may include medications depending on state laws. However, detailed responsibilities vary based on their practice role and patient population. Some responsibilities overlap between different types of NPs. Among the most common types of nurse practitioners, primary responsibilities include:

 

Family Nurse Practitioner:

FNPs provide primary care to patients across the lifespan, from birth to geriatric, usually within primary care settings. They implement a holistic approach to providing comprehensive care to individuals and families, focusing on health promotion, management of common acute and chronic illnesses and disease prevention. FNPs are one of the most popular types of NPs, partially because they treat patients of all ages.

Women’s Health Nurse Practitioner:

WHNPs provide primary care to female patients, from older girls to women of all ages, focusing on preventing and treating illnesses unique to women. They provide primary and acute care, including reproductive health, prenatal, postpartum, menopause and preventive care.

Adult-Gerontology Primary Care Nurse Practitioner:

AGPCNPs provide treatment in a primary care setting, focusing on treating acute and chronic conditions in patients from young adults to seniors. The AGPCNP and FNP practice roles overlap, but FNPs care for patients of all ages, while AGPCNPs don’t treat children until they reach adolescence and may work with specific populations, such as college students.

Adult-Gerontology Acute Care Nurse Practitioner:

AGACNPs provide direct patient care in acute and complex care settings to patients from adults to elderly adults needing immediate medical treatment due to illnesses or injuries. They may practice in hospitals or other settings, and though they provide patients with a spectrum of care, their primary role is treating complex, acute conditions.

Pediatric Nurse Practitioner:

PNPs provide primary care to patients from newborn through young adulthood, including prevention and management of common acute illnesses and acute or chronic conditions impacting the pediatric population. PNPs provide many of the same duties as FNPs but don’t treat patients aged 21 or over. Besides diagnosing and treating pediatric patients, they may also provide advice and counseling to children and young people, and their families.

Neonatal Nurse Practitioner:

NNPs provide care to severely ill newborns, including high-risk infants needing care due to low birth weights, prematurity complications, infections, heart abnormalities, in utero drug exposure and other conditions. NNPs often work in neonatal intensive care units (NICUs), and some provide ongoing care to infants with long-term health conditions until age 2.

Psychiatric Mental Health Nurse Practitioner:

PMHNPs, also known as psychiatric NPs and mental health NPs, focus on helping patients with mental health issues, such as anxiety, depression, mood disorders, substance abuse and postpartum depression, among others. They assess patients’ mental health needs, provide mental health counseling and psychotherapy and prescribe medications to treat various psychiatric disorders.

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Laws Relevant to Nurse Practitioners

All U.S. states and territories have a Nurse Practice Act that established a state BON with the authority to develop rules and regulations that, once enacted, have the full force and effect of law. However, these rules and regulations must be consistent with the Nurse Practice Act and can’t go beyond it.

APRNs, including NPs, are primarily regulated by state BONs. Their scope of practice and state licensure laws determine which types of services they may perform independently or under the direct supervision of a physician or other medical provider. NPs may also enter into a collaborative agreement with physicians or other medical providers based on laws relevant to NPs in their state of practice.

A nurse practitioner’s authority to treat patients greatly varies by state. Given the variation of state statutes, rules and regulations, it’s essential that they clearly understand how local laws and regulations define their scope of practice.

The American Nurses Association (ANA) has a Policy & State Government Affairs program that monitors nursing-related trends in state legislation. Per the ANA, state legislatures review over 1,000 bills related to nursing and healthcare introduced each session. It provides select reports on its website, including legislation enacted by various states, such as those dealing with APRNs' scope of practice.

 

Difference Between Practice Environments

NPs must adhere to the scope of practice restrictions in the state(s) in which they practice. SOP restrictions stipulate the extent to which NPs can practice or prescribe independent of supervision or collaboration with a physician or other healthcare professional. Therefore, NPs in different states have varying levels of practice environments, with three distinct practice environments, including:

Full Practice:

NPs in full-practice states may evaluate and diagnose patients and initiate and manage treatments, including prescribing medications and controlled substances under state practice and licensure laws and the exclusive licensure authority of the state BON.

The full practice environment is the preferred model by the National Academy of Medicine (NAM) and the National Council of State Boards of Nursing (NCSBN). As of mid-July 2022, the U.S. had 26 NP independent practice states. Guam, the Northern Mariana Islands and Washington, DC, also allow full, independent practice among NPs.

Reduced Practice:

NPs in reduced-practice states have at least one practice element in which they have reduced abilities under state practice and licensure laws. State law may limit the setting of one or more NP practice elements or require a regulated, career-long collaborative agreement with another health provider so that NPs can provide patient care. Currently, 13 states, American Samoa, Puerto Rico and the Virgin Islands have reduced practice environments.

Restricted Practice:

NPs in restricted-practice states have their ability in at least one practice element restricted under state practice and licensure laws. They must adhere to delegation, team management or supervision by another health provider to provide patient care for their entire careers. Currently, 11 states have restricted practice environments.

 

Nurse Practitioner Scope of Practice by State 

The following is an overview of the nurse practitioner's scope of practice in each of the 50 states. However, for the most current and accurate information, contact your State Board of Nursing.

Alabama:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is restricted and requires a collaborative agreement with physicians. However, there’s no law defining whether NPs may be primary care providers or can independently prescribe Schedule II drugs. NPs in Alabama have full authority to make referrals for physical therapy if required, sign death certificates and sign disabled person placard forms.

Alaska:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Alaska are fully recognized as primary care providers, can make physical therapy referrals if required, sign disabled person placard forms and independently prescribe Schedule II drugs if they’ve completed 12 biennial CE hours in advanced pharmacotherapeutics. However, they have reduced authority to sign death certificates, which they can only do under certain circumstances.

Arizona:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Arizona are fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced authority to prescribe and dispense Schedule II drugs based on their certification and the population area of focus.

Arkansas:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is restricted and requires a collaborative agreement with physicians. They also have reduced prescriptive authority for Schedule II drugs limited to hydrocodone combination products, opioids and stimulants under specific requirements. However, there’s no law defining whether NPs may be primary care providers in Arkansas and have full authority to make physical therapy referrals if required, sign disabled person placard forms and sign death certificates.

California:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians. California NPs are also restricted from signing death certificates and have reduced authority for making referrals for physical therapy based on their collaborative relationship specifications. However, state statutes or administrative codes recognize NPs as primary care providers. NPs in California have full authority to sign disabled person placard forms and prescribe Schedule II drugs.

Colorado:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Colorado are fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms. However, they’re restricted from signing death certificates and have reduced authority for prescribing Schedule II drugs. NPs may only prescribe Schedule II drugs in Colorado based on their focus and patient population and whether they’ve completed three years of clinical experience, they’re on an advanced practice registry, and there’s a signed and review plan for responsible prescribing from their mentor.

Connecticut:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Connecticut are fully recognized as primary care providers, can make physical therapy referrals if required, sign disabled person placard forms, and sign death certificates. However, they have reduced authority to independently prescribe Schedule II drugs, which they may only do based on their relationship with their collaborating physician.

Delaware:

NPs have full practice authority in Delaware but restricted autonomous practice that requires them to enter a collaborative agreement with physicians. They also have reduced authority to independently prescribe Schedule II drugs that requires them to complete at least 30 hours in advanced pharmacology and pharmacotherapeutics within the last two years. However, they’re fully recognized as primary care providers, can make physical therapy referrals if required, sign disabled person placard forms, and sign death certificates.

Florida:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians. NPs in Florida have reduced authority to independently prescribe certain Schedule II drugs as specified in a protocol. However, they’re defined as primary care providers and have full authority to make physical therapy referrals if required, sign disabled person placard forms and sign death certificates.

Georgia:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians. NPs in Georgia are also restricted from prescribing Schedule II drugs and signing disabled person placard forms and can only sign death certificates under the authority of their collaborating physician. However, there aren’t any state statutes or administrative codes defining whether NPs can be primary care providers or state laws specifying whether they can make physical therapy referrals.

Hawaii:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Hawaii are also fully recognized as primary care providers, can make physical therapy referrals if required, sign disabled person placard forms, sign death certificates and independently prescribe Schedule II drugs.

Idaho:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Idaho are also fully recognized as primary care providers, can make physical therapy referrals if required, and sign disabled person placard forms and death certificates. They’re also fully authorized to prescribe legend drugs and Schedules II-V controlled substances but must comply with all applicable state and federal laws.

Illinois:

Full practice, authorized by state law to see and diagnose patients and prescribe medications, but they’re restricted from autonomous practice and must have a collaborative agreement with physicians. They have reduced authority to independently prescribe Schedule II drugs in 30-day amounts based on their relationship with their collaborating physician and completion of a pharmacology course. NPs in Illinois are also restricted from signing death certificates, but they’re fully authorized to make physical therapy referrals if required and sign disabled person placard forms. No state statutes or administrative codes define whether NPs can be primary care providers.

Indiana:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is restricted and requires a collaborative agreement with physicians. NPs in Indiana also have reduced prescriptive authority for Schedule II drugs based on their relationship with collaborating physicians and completion of a specified number of pharmacology course hours. There’s no law defining whether NPs may be primary care providers in Indiana, but they have full authority to make physical therapy referrals if required, sign disabled person placard forms and sign death certificates.

Iowa:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Iowa are also fully recognized as primary care providers, can make physical therapy referrals if required, and sign disabled person placard forms and death certificates. They’re also fully authorized to independently prescribe drugs, devices and medical gases. NPs may also prescribe controlled substances once they register with the U.S. DEA and Iowa Board of Pharmacy.

Kansas:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Kansas are also fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms. However, they’re restricted from signing death certificates and have reduced authority to independently prescribe Schedule II drugs based on their specialty and whether they’ve filed a Controlled Substance Verification Form (CSVF) with the Kansas State BON.

Kentucky:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements, but they’re recognized as primary care providers. Autonomous practice is restricted and requires a collaborative agreement with physicians. They also have reduced prescriptive authority for Schedule II based on their relationship with their collaborating physicians but can prescribe controlled drugs in 30-day amounts with a KASPER account. NPs in Kentucky have full authority to sign disabled person placard forms and death certificates, but there’s no law specifying whether they can make physical therapy referrals if required.

Louisiana:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements, but Louisiana recognizes NPs as primary care providers. Autonomous practice is restricted and requires a collaborative agreement with physicians. NPs in Louisiana also have reduced prescriptive authority for Schedule II drugs that a collaborative practice agreement with their authorizing physicians must outline. However, they can prescribe prescription drugs and Schedule II-V controlled substances. NPs also have full authority to make physical therapy referrals and sign disabled person placard forms but can’t sign death certificates.

Maine:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Maine are also fully recognized as primary care providers, can make physical therapy referrals if required, and sign disabled person placard forms and death certificates. However, they have reduced authority to independently prescribe Schedule II drugs based on their specialty but can certify patients for medical marijuana. NPs can prescribe certain drugs after pharmacology course completion or a set amount of prescribing experience.

Maryland:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Maryland are also fully recognized as primary care providers, can make physical therapy referrals if required, and sign disabled person placard forms and death certificates. However, they have reduced authority to independently prescribe Schedule II drugs but may prescribe legend drugs with a certification to practice as a certified registered nurse practitioner (CRNP).

Massachusetts:

NPs have full practice authority in Massachusetts and are recognized as primary care providers, but they have restricted autonomous practice that requires them to enter a collaborative agreement with physicians. They also have reduced authority to independently prescribe Schedule II drugs requiring them to obtain authorization of practice guidelines written with their collaborating physicians. After obtaining pharmacology education, they may prescribe certain drugs, but amounts and refills will be limited. NPs can make physical therapy referrals if required, sign disabled person placard forms and sign death certificates.

Michigan:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians. NPs in Michigan are also restricted from signing death certificates and have limited authority to prescribe Schedule II drugs under the authority of their collaborating physicians, with a limited number of Schedule II prescriptions allowed in hospitals. They have full authority to order physical therapy and sign disabled person placard forms, but there aren’t any state statutes or administrative codes defining whether NPs can be primary care providers.

Minnesota:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Minnesota are also fully recognized as primary care providers, can make physical therapy referrals if required, sign disabled person placard forms, sign death certificates and independently prescribe Schedule II drugs.

Mississippi:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements, and there aren’t any laws defining whether NPs can be primary care providers. Autonomous practice is restricted and requires a collaborative agreement with physicians. They also have reduced prescriptive authority for Schedule II drugs that requires them to apply for controlled substance prescription authority after practicing a set number of monitored hours by the Mississippi BON. Mississippi NPs are restricted from signing death certificates but are fully authorized to make physical therapy referrals if required and sign disabled person placard forms.

Missouri:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians. NPs in Missouri also have limited authority to prescribe Schedule II drugs and are only authorized to prescribe hydrocodone combination products. They have full authority to make physical therapy referrals if required and sign disabled person placard forms and death certificates. No statutes or administrative codes define whether NPs can be primary care providers.

Montana:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Montana are also fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs but can prescribe certain drugs after completion of an advanced pharmacology course.

Nebraska:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision, but there aren’t any laws defining whether NPs in Nebraska can practice as primary care providers. They can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs but can prescribe certain drugs after completion of a pharmacotherapeutics course.

Nevada:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision, but there aren’t any laws defining whether NPs in Nevada can practice as primary care providers. They can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs based on protocol developed by their collaborating physicians. They can prescribe certain drugs after completion of an advanced pharmacotherapeutics course.

New Hampshire:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in New Hampshire are also fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs but can prescribe certain drugs after completion of educational requirements.

New Jersey:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements, but they’re recognized as primary care providers. Autonomous practice is restricted and requires a collaborative agreement with physicians. NPs in New Jersey have reduced prescriptive authority for Schedule II drugs, but they can prescribe certain drugs after completion of a pharmacology course. They also have full authority to make physical therapy referrals and sign disabled person placard forms but can only sign death certificates in specified situations.

New Mexico:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in New Mexico are also fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs but can prescribe certain drugs after verification and a set number of work experience hours.

New York:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in New York are also fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs but can prescribe certain drugs after completion of educational requirements in pharmacotherapeutics and a set number of practice hours with their collaborating physician.

North Carolina:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians. There also aren’t any statutes or administrative codes defining whether NPs can be primary care providers. NPs in North Carolina have limited authority to prescribe Schedule II drugs based on their education and certification but can prescribe limited amounts of legend drugs and controlled substances. They have full authority to make physical therapy referrals if required and sign disabled person placard forms and death certificates.

North Dakota:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in North Dakota are also fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs but can prescribe certain drugs after completion of educational requirements in pharmacotherapy, pathophysiology and physical assessment.

Ohio:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements, but they’re recognized as primary care providers. Autonomous practice is restricted and requires a collaborative agreement with physicians. NPs in Ohio have restricted prescriptive authority and aren’t authorized to prescribe Schedule II drugs in convenience care clinics. However, they have full authority to make physical therapy referrals if required and sign disabled person placard forms, but they can't sign death certificates.

Oklahoma:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians, but Oklahoma recognizes NPs as primary care providers. NPs in Oklahoma also are restricted from signing death certificates and fully restricted from holding prescriptive authority for Schedule II drugs. However, they have full authority to make physical therapy referrals and sign disabled person placard forms.

Oregon:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Oregon are also fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs based on their scope of practice but can prescribe certain drugs after completion of a set number of pharmacology education hours.

Pennsylvania:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is restricted and also requires a collaborative agreement with physicians, but Pennsylvania recognizes NPs as primary care providers. NPs can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, NPs have a reduced authority to independently prescribe Schedule II drugs based on their specialty and relationship with their collaborating physician.

Rhode Island:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Rhode Island are also fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs but may earn certification to prescribe Schedule II controlled substances.

South Carolina:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians, and South Carolina doesn’t have any laws recognizing NPs as primary care providers. NPs are restricted from signing disabled person placard forms but have full authority to make physical therapy referrals and sign death certificates. However, they have reduced authority for prescribing Schedule II drugs. NPs can prescribe certain drugs if they sign the prescription and provide their South Carolina BON-assigned prescriptive authority number, where they practice and information on their collaborating physician.

South Dakota:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. However, no laws define whether NPs in South Dakota can practice as primary care providers. NPs can make physical therapy referrals if required and sign death certificates, but they can't sign disabled person placard forms. They also have reduced practice authority for independently prescribing Schedule II drugs, but they can prescribe a limited amount of controlled substances under certain circumstances.

Tennessee:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians, but Tennessee recognizes NPs as primary care providers. NPs are restricted from signing death certificates but can sign disabled person placard forms. No laws specify whether NPs can make referrals for physical therapy. Tennessee NPs have reduced authority to independently prescribe Schedule II drugs but can prescribe limited amounts with preauthorization.

Texas:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians, and Texas only considers NPs to be primary care providers in certain situations. NPs in Texas can only sign death certificates under certain circumstances but can sign disabled person placard forms.

They have reduced prescriptive authority for Schedule II drugs in select practice types and settings.

Utah:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is restricted and also requires a collaborative agreement with physicians, and Utah doesn’t have any laws recognizing NPs as primary care providers. However, NPs can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have a reduced authority to independently prescribe Schedule II drugs but can prescribe certain drugs after completion of educational requirements.

Vermont:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision, but there aren’t any laws defining whether NPs in Vermont can practice as primary care providers. They can make physical therapy referrals if required and sign death certificates and disabled person placard forms. However, they have reduced practice authority for independently prescribing Schedule II drugs, but they can prescribe certain drugs after completion of advanced pharmacotherapeutics educational requirements.

Virginia:

Restricted practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is also restricted and requires a collaborative agreement with physicians, and Virginia doesn’t have any laws recognizing NPs as primary care providers. NPs have reduced authority for prescribing Schedule II drugs but can prescribe certain drugs after completion of pharmacology or pharmacotherapeutics educational requirements and informing patients they’re NPs. However, they have full authority to make physical therapy referrals if required and sign death certificates and disabled person placard forms.

Washington:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision. NPs in Washington are also fully recognized as primary care providers, can make physical therapy referrals if required and sign disabled person placard forms and death certificates. However, they have reduced practice authority for independently prescribing Schedule II drugs but can prescribe certain drugs after completion of pharmacotherapeutics education and a set number of experience hours.

West Virginia:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is restricted and also requires a collaborative agreement with physicians, but West Virginia recognizes NPs as primary care providers. NPs can make physical therapy referrals and sign disabled person placard forms and death certificates. However, NPs in West Virginia are fully restricted from prescribing Schedule II controlled substances.

Wisconsin:

Reduced practice by state law, NPs must enter a collaborative agreement with physicians for one or more NP practice elements. Autonomous practice is restricted and also requires a collaborative agreement with physicians, and Wisconsin doesn’t have any laws recognizing NPs as primary care providers. However, NPs can make physical therapy referrals if required and sign disabled person placard forms but not death certificates. Wisconsin NPs have a reduced authority to independently prescribe Schedule II drugs based on their practice area but can prescribe certain drugs after completion of pharmacology or therapeutics educational requirements.

Wyoming:

Full practice, authorized by state law to see and diagnose patients and prescribe medications. Autonomous practice is fully authorized, so NPs can independently diagnose and treat patients without physician supervision, but there aren’t any laws defining whether NPs in Wyoming can practice as primary care providers. They can make physical therapy referrals if required and sign death certificates and disabled person placard forms. However, they have reduced practice authority for independently prescribing Schedule II drugs, and Wyoming has pharmacology and clinical pharmacotherapeutics educational requirements.

 

Relevant Current Events

Nurse practitioners are one type of advanced practice registered nurse and, as such, would be included in the APRN Compact if adopted. The APRN Compact is similar to the Nurse Licensure Compact and would allow APRNs to hold a single multistate license with privileges to practice in other compact states. Although the APRN Compact was adopted on August 12, 2020, it won’t be implemented until 7 states enact legislation.

Unlike the NLC, support of the APRN Compact has been much less forthcoming. Nearly two years after its adoption, only Delaware, North Dakota and Utah have enacted the APRN Compact, and Maryland and New York have pending legislation. Currently, the other 45 states don’t have any pending legislation, leaving the initiative short 2 states of being able to move forward despite current discussions and support for transitioning to the APRN consensus model.

In other relevant events, there’s been a push for legislation that would provide NPs in all 50 states with full practice authority to help eliminate the confusion over NP scope of practice by state because it would be the same. Full practice authority for NPs also allows them to use their education and licenses to the fullest extent and helps alleviate physician shortages.

Schedule a demo with Vivian Health to see how we can help you find and recruit the nurse practitioners and other advanced practice RNs to fill your facility’s needs.

 

Disclaimer: The information provided in this blog is for informational purposes only and shouldn’t be construed as legal or professional advice. Please contact your own professional advisors for the latest information regarding scope of practice for nurse practitioners in any state in which you practice. Source: AANP.org.

Moira K. McGhee

Moira K. McGhee

Moira K. McGhee has been a professional writer since 1999. She’s written 1,000s of print or digital feature articles, blogs, advertorials, how-to guides, and landing pages throughout her career. Her work has been featured in several nationally distributed magazines, on numerous websites, and in two super-fun cozy crime anthologies. Moira especially enjoys writing about nurses and the amazing jobs they do!

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