What states do nurse practitioners have full practice authority

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FIND NP PROGRAMS

Written By: Kasee Wiesen DNP, APRN, FNP-C

In the United States, there is currently a shortage of physicians despite the aging and growing population. According to the Association of American Medical Colleges, the population of people aged 65 years or older is expected to grow by 45.1%, and the general population will increase by 10.4% over the next 15 years. Therefore, there is a great need for providers to deliver care to these patients, whether in family practice or specialty settings.

One of the healthcare providers that can provide support and a solution to this dilemma is the nurse practitioner. As of May 2021, there are more than 325,000 practicing nurse practitioners in the United States. Of those 325,000, 70.2% practice in primary care. This number is expected to continue to grow, participating in the solution for the current physician shortage. While most, if not all, NPs take a similar board certification exam based on their specialty, the nurse practitioner scope of practice by state is different.

Have you wondered what is the scope of practice for nurse practitioners in your state? Below, I answer various questions regarding the nurse practitioner scope of practice, including nurse practitioner scope of practice by state.

What Does Nurse Practitioner Scope Of Practice Mean?

The scope of practice for the nurse practitioner defines the rules and regulations the NP must follow in practice. It describes the "who," "what," "where," "when," "why," and "how" of the NP practice. Nurse practitioners deliver care to patients and have been trained to assess, diagnose, and treat the patient through their education. The scope of practice defines to what degree they can do this. The scope of practice for nurse practitioners answers the questions NPs have, such as can they practice autonomously? Or, can they sign death certificates?

The nurse practitioner's scope of practice by state does vary. This makes it challenging for NPs who work in multiple states or even when moving to another state. It can lead to NPs accidentally practicing outside of their scope of practice. There is current discussion and support for moving towards the APRN consensus model, which would help provide uniformity of the APRN role across state lines. This would include the same process for licensure, accreditation, and certification. The standards for educational requirements and scope of practice would be streamlined across state lines, leading to the consistency of the APRN role across state lines.

What Is The Difference Between Nurse Practitioner Practice Authority And Scope Of Practice?

The nurse practitioner scope of practice laws encompasses nine different components. It lays out the rules and regulations that a nurse must comply with to practice in a specific state.

The nurse practitioner practice authority is one component of the scope of practice. It may also be referred to as the practice environment. The practice authority describes the extent to which the NP can practice. It is divided into full practice, reduced practice, and restricted practice. If the NP practice authority is full practice, the NP can practice independently of a physician. Reduced practice usually indicates a life-long collaboration is needed with a physician, and the NP may be reduced in other aspects of delivering care. Restricted practice requires the NP to have career-long supervision, delegation, or team management by another health provider. The NP is also typically restricted in practicing in a minimum of one additional element of the NP practice.

Who Determines The Scope Of Practice For Nurse Practitioners?

The scope of practice for nurse practitioners is determined by each state’s State Board of Nursing. Therefore, each state may have different nurse practitioner scope of practice laws. It is essential that once you obtain your APRN license, you have a complete understanding of the practice environment and scope of practice for the NP in the state you are licensed and will practice. For more information regarding the specific laws and regulations for the NP, visit your state board of nursing.

Do Scope Of Practice Laws Impact All Nurse Practitioners?

Yes, all nurse practitioners must abide by the nurse practitioner scope of practice laws determined by their state board of nursing. These are the laws that the NP must follow in order to deliver care or practice as an NP.

Are Nurse Practitioner Scope Of Practice Laws Same Across The Nation?

No. Each state has its own nurse practitioner scope of practice laws.

Why Does the Scope of Practice For Nurse Practitioners Vary From State To State?

Each state has its own NP scope of practice laws because each state has it’s own regulatory board, typically the state board of nursing, which determines the scope of practice for the NP. In other words, the state board of nursing for each state determines the scope of practice for nurse practitioners in their specific state. This can lead to confusion for the NP, especially if they have practiced in multiple states, and may lead the NP to practice outside of their current state's scope of practice laws for the nurse practitioner.

Currently, there is a push for legislation that would give NPs full practice authority in all 50 states. This would allow NPs to use their education and license to their fullest. It would also help eliminate confusion in regards to the NPs role in each state as the nurse practitioner scope of practice by state would be the same. There are also organizations looking for a nationwide approval of the APRN Compact legislation. This would allow the NP to obtain a state license in one state, but practice in other states much easier.

What Aspects Do Nurse Practitioner Scope Of Practice Laws Govern?

The nurse practitioner scope of practice laws governs various aspects of the NP practice. Again, each state is different in regards to the nurse practitioner's scope of practice. Therefore, it is vital to understand your scope of practice in the state you are practicing.

1. Regulatory Structure:

Regulatory structure regarding the NP scope of practice laws refers to whether the NP has full practice, reduced practice, or restricted practice. This varies state by state.

Full Practice:

Full practice indicates the ability to practice to the fullest extent of their education and license. They can practice independently and autonomously.

Reduced Practice:

Reduced practice means the NP has reduced ability to practice in one of the NP elements of practice. This may mean they cannot sign a death certificate or remain in a collaborative relationship with a physician.

Restricted Practice:

Restricted practice indicates the NP is restricted in their ability to practice in one of the NP practice elements. They may have to be supervised by a physician for the entire career or be restricted in one of the other elements of NP practice.

2. Medical Staff Membership:

The scope of practice of nurse practitioners also includes medical staff membership. Being a medical staff member as an NP is not allowed in all states. 12 states allow the NP to join the medical staff as a full member. Some states allow an NP to be a member of the medical staff, but at a reduced membership, indicating they cannot participate to the same extent as a physician. A handful of states do not allow the NP to be a medical staff member, and a few more states have no law about this.

3. Autonomous Practice:

Autonomous practice refers to the NP practicing autonomously and independently from collaborating with a physician or other healthcare provider. They may join a collaborative agreement voluntarily, but it is not required. This allows the NP to practice to the fullest extent of their advanced education and license. Not all state scope of practice laws for nurse practitioners allow for the NP to practice autonomously.

4. Primary Care Provider:

The scope of practice for nurse practitioners includes whether an NP can practice as a primary care provider. The education track majority of NPs pursued in graduate school prepared them to deliver primary care, but not all states recognize NPs as primary care providers. Forty-two states recognize NPs as primary care providers, and in eight states plus D.C. there is no law regarding NPs being primary care providers.

5. Independently Prescribe Schedule II Drugs:

Many states have restrictions or limitations in place regarding the NP independently prescribing schedule II drugs. Some states require a lifelong collaboration with a physician, while others require a collaborative agreement for a specified number of hours or years. Other states have specified educational requirements and applications that must be completed for permission to prescribe schedule II drugs. The state scope of practice laws for the nurse practitioner may also include additional rules and regulations before the NP can prescribe class II drugs.

6. Order Physical Therapy:

The NP scope of practice laws in a majority of states allow the NP to order or place consults for physical therapy or no consult is needed in the state for a patient to participate in PT. Some states do only allow physicians to consult, refer or order PT.

7. Sign Death Certificates:

The scope of practice of nurse practitioners includes the NP's ability to sign death certificates. In some states, the NP is granted full authority to sign death certificates. In other states, it is only allowed by an NP in specific specialties such as hospice, under certain conditions, or the physician must authorize the NP to sign. Some states do not allow the NP to sign a death certificate, and a physician must sign it.

8. Sign Disabled Person Placard Forms:

The nurse practitioner scope of practice includes if the NP is allowed to sign disabled person placard forms. A few states still require a physician to sign the disabled person's placard form and may even require the NP to prove the patient has a disability.

9. POLST/POST/MOLST/MOST/COLST:

There are a few acronyms that can be used synonymously depending on the state you where your practice. The National Physician’s Orders for Life-Sustaining Treatment (POLST), Practitioner Orders for Life-Sustaining Treatment (POLST), Physician Orders for Scope of Treatment (POST), Medical Orders for Life-Sustaining Treatment (MOLST), Medical Orders for Scope of Treatment (MOST), Clinician Orders for Life-Sustaining Treatment (COLST) are forms completed by a patient to clearly define and layout the patient’s wishes during end-of-life planning and treatment. The nurse practitioner scope of practice by state differs whether an NP can sign these forms. Some states, allows NPs to complete the forms, but other states still require these forms only to be completed by a physician. Some states do not have a law about this yet.

WHAT IS THE NURSE PRACTITIONER SCOPE OF PRACTICE IN YOUR STATE?

As I have stated above, the nurse practitioner's scope of practice by state is different. Below, you will find the latest information available on the American Association of Nurse Practitioners website, regarding the latest NP scope of practice laws by state.

1. NP SCOPE OF PRACTICE IN ALABAMA – (REDUCED PRACTICE)

The practice environment for a nurse practitioner practicing in Alabama is reduced practice. The NP cannot practice autonomously and must have a collaborative agreement with a physician to deliver care to patients. Once the collaborative agreement is in place, the NP can prescribe medications, order physical therapy, sign death certificates and sign disabled person placard forms. There is reduced practice in medical staff membership. There is no law for the NP practicing in Alabama regarding being a primary care provider or signing a POLST form. Still, again, they are not able to practice independently and must have a collaborating physician. Lastly, in regards to prescription medications, they can prescribe prescription medications, but most scheduled drugs must be co-signed by their collaborating physician.

2. NP SCOPE OF PRACTICE IN ALASKA – (FULL PRACTICE)

The practice environment for a nurse practitioner practicing in the state of Alaska is full practice authority. This allows the NP practicing in Alaska to practice autonomously, be a primary care provider and independently prescribe medications. In other words, they can assess, diagnose and treat the patient independently without having a collaborative agreement with a physician. They can also order physical therapy, sign disabled person placard forms, and sign POLST forms. They do, however, have reduced practice in regards to signing death certificates and medical staff membership. The NP can sign a death certificate in Alaska, but the physician must authorize the NP to sign the death certificate, and the physician must certify the certificate within 24 hours. They do also have reduced practice in medical staff membership.

3. NP SCOPE OF PRACTICE IN ARIZONA – (FULL PRACTICE)

The scope of practice for nurse practitioners in Arizona is full practice, allowing the nurse practitioner to practice autonomously. In Arizona, the NP may assess, diagnose and treat a patient without direct supervision or collaboration with a physician. They can prescribe medications, including class II-V scheduled medications. The NP practicing in Arizona may order physical therapy, sign death certificates, and sign disabled person placard forms. There is no law regarding their ability to sign POLST forms. Still, the state keeps track of the number of prescriptive authority applications received and may choose to limit this number. Lastly, they do have reduced practice in regards to medical staff membership.

4. NP SCOPE OF PRACTICE IN ARKANSAS – (REDUCED PRACTICE)

The practice environment for nurse practitioners in Arkansas is reduced practice. This indicates there are limitations to their scope of practice. First, they are not able to practice autonomously. They must have a collaborative agreement with a physician to practice. There is no law, though, about whether an NP can be a primary care provider. They can order physical therapy and sign disabled person placard cards but cannot sign POLST forms. Hospice NPs can sign death certificates. In regards to prescribing medications, they can prescribe schedule III-V but cannot prescribe schedule II drugs. It is important to note that before an NP can prescribe medicines in Arkansas, they must have 300 hours of precepted experience in the prescription of medications before receiving an initial certification for prescription authority.

5. NP SCOPE OF PRACTICE IN CALIFORNIA – (RESTRICTED PRACTICE)

The nurse practitioner scope of practice in California is restricted. They cannot practice autonomously, meaning they must have a physician's career-long supervision, delegation, or team management. They cannot sign death certificates. They are, however, able to practice as a primary care provider, sign disabled person placard forms, and sign POLST or similar documents. Regarding ordering physical therapy, they can refer to PT, but it depends upon the collaborative agreement with their supervising physician. They can also independently prescribe schedule II drugs after six months of supervision by a physician, completion of a pharmacology course, and completion of a specific pharmacology course about schedule II controlled substances.

6. NP SCOPE OF PRACTICE IN COLORADO – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Colorado is full practice. This does allow for the NP to practice autonomously without having a collaborative agreement with a physician. In other words, the NP may assess, diagnose and treat the patient independently. They may also order PT, sign disabled person placard forms and sign POLST forms. The NP in the state of Colorado can independently prescribe schedule II drugs, but for their first 1000 hours of practice, they must have a “prescribing mentorship” with a physician or APRN. The communication between the new NP and the mentor may be completed remotely, but it must occur in a synchronous form and not via email. However, they are not able to sign death certificates as only a licensed physician can do that in the state of Colorado.

7. NP SCOPE OF PRACTICE IN CONNECTICUT – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Connecticut is full practice. This allows the NP to assess, diagnose and treat the patient independently of a collaborative relationship with another healthcare provider. It is within their scope of practice to deliver primary care, order physical therapy, sign death certificates, sign disabled person placard forms, and sign POLST forms. Regarding independently prescribing schedule II drugs, the NP can but must collaborate with a physician for three years and a minimum of 2,000 hours. The NP must also complete 30 hours of pharmacology education and apply for a Controlled Substance Registration before prescribing class II drugs.

8. NP SCOPE OF PRACTICE IN DELAWARE – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Delaware is full practice. This allows the NP to assess, diagnose and treat the patient, allowing the NP to practice to the fullest extent of their license. The NP in Delaware can deliver care as a primary care provider, order PT, sign death certificates, sign disabled person placard forms and sign POLST or similar documents in their state. The NP can prescribe schedule II drugs, but a collaborative agreement with a physician is required before applying for prescriptive authority. There are specifics regarding the pharmacology courses needed to maintain a license to continue prescribing schedule II drugs. They are not able to practice autonomously and must have a collaborative agreement with a physician.

9. NP SCOPE OF PRACTICE IN FLORIDA – (RESTRICTED PRACTICE)

The nurse practitioner scope of practice in Florida is restricted practice. This indicates the patient must have a physician's career-long supervision, delegation, or team management. There are typically restrictions regarding what they can do under their NP license. In Florida, the NP cannot practice autonomously. Still, they can deliver care as a primary care provider, order PT, sign death certifications, and sign disabled person placard forms. There are restrictions in place regarding prescribing medications, specifically schedule II drugs. They can prescribe medications under their written collaborative agreement with a physician. They are also able to prescribe class II drugs, but there is a seven-day limit. Regarding psychiatric drugs, these can be prescribed for a longer length of time, but only a psychiatric NP can prescribe these medications to a patient under the age of 18. The NP must also complete a specified number of AMA PRA 1 credit hours in the prescription of controlled substances before prescribing the medications. They have reduced practice in medical staff membership. In Florida, there is no specific law dedicated to the NP signing the POLST or similar form.

10. NP SCOPE OF PRACTICE IN GEORGIA – (RESTRICTED PRACTICE)

The NP scope of practice in Georgia is restricted practice. In the state of Georgia, the NP is not able to practice autonomously. Therefore, they must have a physician's career-long supervision, delegation, or team management. NPs can prescribe medications if their collaborating physician delegates this task, but they cannot prescribe schedule II drugs. They are also restricted in their ability to sign disabled person placard forms. The NP in Georgia can sign a death certificate only under the authority of their collaborating physician and may sign POLST or similar documents in specific situations. They have reduced practice in medical staff membership. There is currently no law regarding their ability to deliver primary care or order PT.

11. NP SCOPE OF PRACTICE IN HAWAII – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Hawaii is full practice. This allows the nurse practitioner to assess, diagnose and treat patients independently, and they are allowed to practice autonomously. The NP in Hawaii can order PT, sign death certificates, sign disabled person placard forms and deliver care as a primary care provider. They are also able to prescribe medications independently, including schedule II drugs. There is currently no law regarding the NP in Hawaii and medical staff membership.

12. NP SCOPE OF PRACTICE IN IDAHO – (FULL PRACTICE)

The nurse practitioner's scope of practice in the state of Idaho is full practice. The NP in Idaho may practice autonomously and deliver care in the primary care setting, allowing the NP to assess, diagnose and treat the patient independently. They can also order PT, sign death certificates, sign disabled person placard forms and sign POLST or similar documents. They are also able to prescribe controlled II substances independently. They have reduced practice to medical staff membership.

13. NP SCOPE OF PRACTICE IN ILLINOIS – (REDUCED PRACTICE)

The NP scope of practice in Illinois is reduced, indicating limitations on their scope of practice. The NP may not practice autonomously but instead must be in a collaborative practice agreement with a physician. The NP can prescribe schedule II drugs as stated explicitly in the collaborative agreement with the physician. If the physician delegates this task, the NP can prescribe 30-day supplies. They must also complete 5 hours of continuing education in pharmacology annually, and other requirements may be in place as well. The NP in Illinois can order PT, sign disabled person placard forms, and sign POLST or similar documents. They cannot sign death certificates, and there is currently no law in place that defines if an NP can be a primary care provider. Lastly, they have reduced practice for medical staff membership.

14. NP SCOPE OF PRACTICE IN INDIANA – (REDUCED PRACTICE)

The nurse practitioner scope of practice in Indiana is reduced practice. In other words, there are some limitations on their scope of practice. In Indiana, the NP cannot practice autonomously but instead must have a collaborative agreement with a physician. The NP can prescribe schedule II drugs, but the prescriptive authority must be outlined in the collaborative agreement with the physician. The NP in Illinois can order PT, sign death certificates, sign disabled person placard forms and sign POLST or similar documents. They have reduced practice for medical staff membership. There is no current law stating whether an NP can be a primary care provider.

15. NP SCOPE OF PRACTICE IN IOWA – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Iowa is full practice. They can be primary care providers and order PT, sign death certificates, sign disabled person placard forms and sign POLST or similar documents. This allows for the ability to practice autonomously, including assessing, diagnosing, and treating the patient. They are also able to prescribe medications independently. This does include schedule II drugs, but they must register with the Board of Pharmacy before prescribing schedule II drugs.

16. NP SCOPE OF PRACTICE IN KANSAS – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Kansas is full practice. This indicates limitations to their scope of practice, including the inability to practice autonomously or sign death certificates. To practice as an NP in the state of Kansas, you must have a collaborative agreement with a physician. You can, however, order PT and sign disabled person placard forms. Regarding independently prescribing schedule II drugs, the NP can prescribe but must have a written collaborative agreement and protocol with the physician, and the DEA must have a copy. They have full practice to medical staff membership. There are currently no laws about whether an NP can be a primary care provider or sign a POLST or similar form.

17. NP SCOPE OF PRACTICE IN KENTUCKY – (REDUCED PRACTICE)

The scope of practice for nurse practitioners in Kentucky is reduced practice. The NP in Kentucky cannot practice autonomously but instead must have a collaborative agreement with a physician. They also cannot sign POLST forms or similar forms. They can deliver care in the primary care setting, sign death certificates and sign disabled person placard forms. There are no laws in place regarding the NP ordering PT. The NP in Kentucky must have a separate collaborative agreement with a physician to prescribe controlled substances. This agreement must be in place for four years. They have reduced practice to medical staff membership.

18. NP SCOPE OF PRACTICE IN LOUISIANA – (REDUCED PRACTICE)

The nurse practitioner scope of practice in the state of Louisiana is reduced practice. The NP cannot practice autonomously and must have a collaborative agreement in place with a physician. In Louisiana, the NP cannot sign death certificates or POLST and similar forms. They can practice as a primary care provider, order PT, and sign disabled person placard forms. Regarding prescribing schedule II drugs, the NP can prescribe class II drugs, but a specific collaborative agreement must be between the NP and a physician. They must also obtain approval through a separate application to the Louisiana state board of nursing. The NP in Louisiana has reduced practice to medical staff membership.

19. NP SCOPE OF PRACTICE IN MAINE – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Maine is full practice. This scope of practice permits the NP to practice autonomously, allowing them to assess, diagnose and treat the patient independently. They can order PT, sign death certificates, sign disabled person placard forms and sign POLST and similar documents. They have reduced practice for medical staff membership. Regarding prescribing schedule II drugs, NPs must be supervised by a physician or NP or be employed by a clinic or hospital that has a physician as the medical director for their first 24 months of practice. After 24 months, the NP can practice independently as long as they stay current on education requirements.

20. NP SCOPE OF PRACTICE IN MARYLAND – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Maryland is full practice. In other words, the NP can assess, diagnose and treat the patient independently. The NP is able to practice autonomously, deliver care in the primary care setting, order PT, sign death certificates, and sign disabled person placard forms. They are also able to sign POLST forms or similar forms. The NP is able to independently prescribe schedule II drugs but for their first 18 months or practice, a collaborative agreement with a physician is needed. The NP must also complete and maintain the educational requirements to prescribe schedule II drugs. There is no law in the state of Maryland regarding the NP and medical staff membership.

21. NP SCOPE OF PRACTICE IN MASSACHUSETTS – (FULL PRACTICE)

The NP scope of practice in Massachusetts is full practice. They can assess, diagnose, and prescribe treatment plans independently but cannot practice autonomously in Massachusetts. They must have a collaborative agreement in place with a physician. They can deliver care in the primary care setting, order PT, sign death certificates, sign disabled person placard forms and sign POLST forms or similar forms. They also have full practice to medical staff membership. The NP may prescribe schedule II drugs, but there must be a collaborative agreement with a physician outlining specific guidelines regarding prescribing medications. The NP must also complete a specified number of pharmacology continuing education hours in addition to their graduate program.

22. NP SCOPE OF PRACTICE IN MICHIGAN – (RESTRICTED PRACTICE)

The scope of practice for nurse practitioners in Michigan is restricted practice. Therefore, the NP must have a physician's career-long supervision, delegation, or team management. They are not able to practice autonomously or sign death certificates. They can order PT, sign disabled person placard forms, and sign POLST forms and similar forms. They have reduced practice to medical staff membership. In regards to prescribing medications, the NP can prescribe nonscheduled drugs. To prescribe schedule II drugs, the physician must delegate and outline in the collaborative agreement.

23. NP SCOPE OF PRACTICE IN MINNESOTA – (FULL PRACTICE)

The scope of practice for nurse practitioners in Minnesota is full practice. In Minnesota, the NP can practice autonomously, allowing them to assess, diagnose and treat patients independently. They can deliver care in the primary care setting, order PT, sign death certificates, sign disabled person placard forms and sign POLST forms or similar forms. The NP is also able to prescribe class II scheduled drugs independently. In Minnesota, the NP has reduced practice for medical staff membership.

24. NP SCOPE OF PRACTICE IN MISSISSIPPI – (REDUCED PRACTICE)

The scope of practice for nurse practitioners in the state of Mississippi is reduced practice. This means there are limitations to their scope of practice. In the state of Mississippi, the NP is not able to practice autonomously. They are also not able to sign death certificates or POLST, or similar forms. They can order PT and sign disabled person placard forms. They have reduced practice for medical staff membership. NPs in Mississippi can prescribe schedule II drugs but must complete the board-approved educational program before applying to prescribe controlled substances.

25. NP SCOPE OF PRACTICE IN MISSOURI – (RESTRICTED PRACTICE)

The nurse practitioner scope of practice in Missouri is restricted price, indicating there are restrictions on their practice. They must have a physician's career-long supervision, delegation, or team management. They are not able to practice autonomously, and there are restrictions regarding medical staff membership. They can order PT, sign death certificates and sign disabled person placard forms. There are currently no laws about whether an NP in Missouri can be a primary care provider or sign POLST or similar documents. The NP can prescribe medications, and it must be stated explicitly in the collaborative agreement for an NP to prescribe certain schedule II drugs.

26. NP SCOPE OF PRACTICE IN MONTANA – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Montana is full practice. The NP practicing in Montana can practice autonomously and deliver care in the primary care setting. They can also order PT, sign death certificates, sign disabled person placard forms and sign POLST and similar documents. They have full practice to medical staff membership. They can prescribe schedule II drugs independently, but they must complete a separate license. The NP must also meet a specified number of hours in pharmacology, pharmacotherapeutics, and clinic management in their specialty.

27. NP SCOPE OF PRACTICE IN NEBRASKA – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Nebraska is full practice. In Nebraska, the NP can practice autonomously or independently from a physician. They can order PT, sign death certificates and sign disabled person placard forms. Regarding prescribing schedule II drugs, the NP can prescribe but must have a collaborative agreement with a physician for their first 2,000 hours of practice. They have reduced practice for medical staff membership. There are currently no laws about whether an NP can be a primary care provider or their ability to sign POLST and similar forms.

28. NP SCOPE OF PRACTICE IN NEVADA – (FULL PRACTICE)

The scope of practice for the nurse practitioners in the state of Nevada is full practice. The NP can practice autonomously, order PT, sign death certificates, sign disabled person placard forms and sign POLST and similar documents. There is no law regarding the ability of the NP to be a primary care provider. They have full practice to medical staff membership. Regarding prescribing schedule II drugs, the NP must have a collaborative agreement in place with a physician. They must also complete two years or 2,000 hours of clinical experience, and if they do not, there must be a specific protocol with the collaborating physician. There is currently no law stating whether an NP can deliver care in the primary care setting.

29. NP SCOPE OF PRACTICE IN NEW HAMPSHIRE – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of New Hampshire is full practice. This means the NP can practice autonomously and be a primary care provider. They can also order PT, sign death certificates, sign disabled placard forms and POLST, and similar documents. There is no law regarding their ability to be a member of the medical staff. Nurse practitioners in New Hampshire can prescribe class II scheduled drugs but must complete specified education requirements before being allowed to prescribe.

30. NP SCOPE OF PRACTICE IN NEW JERSEY – (REDUCED PRACTICE)

The nurse practitioner scope of practice in New Jersey is reduced practice. They are not able to practice autonomously and must enter a collaborative agreement with a physician. NPs in New Jersey are only allowed to sign death certificates in specific circumstances. They can, however, order PT, sign disabled person placard forms, and sign POLST or similar documents. They have reduced practice for medical staff membership. In New Jersey, the NP can prescribe schedule II drugs as long as they have a collaborative agreement with a physician and complete the educational requirements.

31. NP SCOPE OF PRACTICE IN NEW MEXICO – (FULL PRACTICE)

The scope of practice for nurse practitioners in New Mexico is full practice. They can practice autonomously, allowing them to use their advanced education to its fullest extent. The NP in New Mexico can be a primary care provider, order PT, sign death certificates, sign disabled person placard forms and sign POLST and similar documents. They also have full practice to medical staff membership. Regarding prescribing schedule II drugs, they must have a specified number of contact hours and hours of work experience before they can prescribe independently.

32. NP SCOPE OF PRACTICE IN NEW YORK – (FULL PRACTICE)

The nurse practitioner scope of practice in New York is full practice. In New York, the NP cannot practice autonomously and must be in a collaborative agreement with a physician. They can, however, be a primary care provider, order PT, sign death certificates, sign disabled person placard forms and sign POLST and similar documents. They also have full practice to medical staff membership. The NP in New York can prescribe schedule II drugs, but they must have a collaborative agreement with a physician and complete a required amount of pharmacotherapeutics hours.

33. NP SCOPE OF PRACTICE IN NORTH CAROLINA – (RESTRICTED PRACTICE)

The nurse practitioner scope of practice in North Carolina is restricted practice. The NP is not able to practice autonomously and must have a physician's career-long supervision, delegation, or team management. In practice, they can order PT, sign death certificates, sign disabled person placard forms and sign POLST and similar documents. They have full practice to medical staff membership. They can prescribe class II drugs, but it must be outlined in the collaborative agreement, and the NP must complete the education requirements. In North Carolina, there is currently no law regarding the NP being a primary care provider.

34. NP SCOPE OF PRACTICE IN NORTH DAKOTA – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of North Dakota is full practice. In North Dakota, the NP can practice autonomously and deliver care in the primary care setting. They can also order PT, sign death certificates, sign disabled placard forms, and sign POLST or similar documents. The NP in North Dakota can prescribe schedule II drugs independently but must complete the required education. They have full practice to medical staff membership.

35. NP SCOPE OF PRACTICE IN OHIO – (REDUCED PRACTICE)

The nurse practitioner scope of practice in Ohio is reduced practice. They are not able to practice autonomously and must have a collaborative agreement in place with a physician. They are not allowed to sign death certificates as these must be signed by a physician. However, they can be a primary care provider, order PT, and sign disabled person placard forms. They have reduced practice to medical staff membership. They can prescribe schedule II drugs, but it must be in the collaborative agreement and complete the required education. In Ohio, there is no law regarding the NP signing POLST or similar forms.

36. NP SCOPE OF PRACTICE IN OKLAHOMA – (RESTRICTED PRACTICE)

The nurse practitioner scope of practice in the state of Oklahoma is restricted practice. In Oklahoma, the NP cannot practice autonomously and must have a physician's career-long supervision, delegation, or team management. They can also not sign death certificates or sign POLST or similar forms as these must be signed by a physician. The NP in Oklahoma can order PT and sign disabled person placard forms. They are also able to deliver care in the primary care setting. They have reduced practice medical staff membership. In Oklahoma, the NP is not able to prescribe schedule II drugs. They can prescribe schedule III-V as long as a collaborative agreement is in place with a physician.

37. NP SCOPE OF PRACTICE IN OREGON – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Oregon is full practice. The NP can practice autonomously and deliver care in the primary care setting. They can also order PT, sign death certificates, sign disabled person placard forms and sign POLST or similar documents. The NP is also able to prescribe schedule II drugs, but they must first complete educational requirements. They have reduced practice for medical staff membership.

38. NP SCOPE OF PRACTICE IN PENNSYLVANIA – (REDUCED PRACTICE)

The nurse practitioner scope of practice in Pennsylvania is reduced practice. The NP can’t practice autonomously, indicating the need for a life-long collaboration with a physician. The NP can deliver care in a primary care setting, order PT, sign death certificates and disabled person placard forms, and sign POLST or similar documents. When prescribing schedule II drugs, the NP can prescribe but must be in the collaborative agreement. They must also complete specified educational requirements. NPs in Pennsylvania have restricted practice to medical staff membership.

39. NP SCOPE OF PRACTICE IN RHODE ISLAND – (FULL PRACTICE)

The scope of practice for the nurse practitioner in Rhode Island is full practice, allowing the nurse to practice autonomously and independently from a physician. In Rhode Island, they can also deliver care in the primary care setting, order PT, sign death certificates and disabled person placard forms, and sign POLST or similar documents. They have reduced practice to medical staff membership. There are some limitations for the NP to prescribe schedule II drugs in Rhode Island. They can prescribe medications, but to prescribe schedule II drugs, the NP must have a population focus on psychiatric or mental health, allowing them to prescribe stimulants. Otherwise, it does appear NPs cannot prescribe schedule II drugs in Rhode Island.

40. NP SCOPE OF PRACTICE IN SOUTH CAROLINA – (RESTRICTED PRACTICE)

The nurse practitioner scope of practice in the state of South Carolina is restricted practice. The NP cannot practice autonomously and must have a physician's career-long supervision, delegation, or team management. The NP in South Carolina can order PT, sign death certificates and POLST or similar documents. They cannot sign disabled person placard forms. There is also no law specifying if an NP can be a primary care provider or have medical staff membership. In South Carolina, the NP cannot prescribe schedule II drugs.

41. NP SCOPE OF PRACTICE IN SOUTH DAKOTA – (FULL PRACTICE)

The scope of practice for the nurse practitioner in South Dakota is full practice. The NP can practice autonomously without the need for a collaborative agreement with a physician. They can order PT, sign death certificates and sign POLST or similar documents. They cannot sign disabled person placard forms. In South Dakota, the NP can prescribe schedule II drugs, but for the first 1,040 hours of practice, they must be in a collaborative agreement with a physician. There is currently no law regarding the NP being a primary care provider. The NP in South Dakota does have reduced practice to medical staff membership.

42. NP SCOPE OF PRACTICE IN TENNESSEE – (RESTRICTED PRACTICE)

The nurse practitioner scope of practice in Tennessee is restricted practice. The NP cannot practice autonomously and must have a physician's career-long supervision, delegation, or team management. They are also restricted from medical staff membership or signing death certificates. In Tennessee, the NP can be a primary care provider, sign disabled person placard forms and sign POLST or similar document. There is no current law regarding the NP ordering PT. NPs in Tennessee can prescribe schedule II drugs, but they must be supervised by a physician and complete the education requirements.

43. NP SCOPE OF PRACTICE IN TEXAS – (RESTRICTED PRACTICE)

The nurse practitioner scope of practice in Texas is restricted practice. The NP cannot practice autonomously and must have a physician's career-long supervision, delegation, or team management. However, they can order PT, sign disabled person placard forms, and sign POLST or similar documents. In Texas, the NP can only sign death certificates and practice as a primary care provider under certain circumstances. They have reduced practice for medical staff membership. Regarding prescribing schedule II drugs, the NP in Texas can prescribe schedule II drugs with, but they must maintain a prescriptive authority or protocol with a physician. They must also complete the education requirements before receiving prescriptive authority.

44. NP SCOPE OF PRACTICE IN UTAH – (REDUCED PRACTICE)

The scope of practice for the nurse practitioner in Utah is reduced practice. In other words, the NP cannot practice autonomously and must be in a collaborative agreement with a physician. In Utah, the NP can order physical therapy, sign death certificates and disabled person placard forms, and sign POLST or similar documents. They also have full practice to medical staff membership. The NP can prescribe schedule II drugs, but for their first two years of practice, or 2,000 hours of practice, the NP must have a collaborative agreement with a physician if they desire to prescribe schedule II drugs. They must also complete the specified educational requirements.

45. NP SCOPE OF PRACTICE IN VERMONT – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Vermont is full practice. This allows the NP to practice independently and autonomously. They can order physical therapy, sign death certificates and disabled person placard forms, and sign POLST or similar documents. They also have full practice to medical staff membership. To prescribe schedule II drugs in Vermont, the NP keep a written collaborative agreement with a physician for their first two years of practice or 2,400 hours of practice. They must also complete the required education for prescriptive authority. There is currently no law about the NP being a primary care provider.

46. NP SCOPE OF PRACTICE IN VIRGINIA – (RESTRICTED PRACTICE)

The nurse practitioner scope of practice in Virginia is restricted practice. This prohibits the NP from practicing autonomously. Therefore, they must have a physician's career-long supervision, delegation, or team management. However, they can order PT, sign death certificates and disabled person placard forms, and sign POLST or similar documents. They do have reduced practice to medical staff membership. In Virginia, all drugs are considered scheduled, and the NP must have a separate license for prescriptive authority. They can prescribe schedule II drugs as part of a patient care team and complete the specific education requirements. There is currently no law about an NP in Virginia being a primary care provider.

47. NP SCOPE OF PRACTICE IN WASHINGTON – (FULL PRACTICE)

The nurse practitioner scope of practice in the state of Washington is full practice. Full practice authority allows the NP to practice autonomously and independently from a physician. In Washington state, the NP can be a primary care provider, order physical therapy, and has full practice to medical staff membership. They can also sign death certificates and disabled person placard forms and sign POLST or similar documents. To prescribe schedule II drugs, the NP must complete the specified educational requirements regarding prescriptive authority.

48. NP SCOPE OF PRACTICE IN WEST VIRGINIA – (REDUCED PRACTICE)

The nurse practitioner scope of practice in the state of West Virginia is reduced practice. This indicates the NP is not able to practice autonomously and must be in a collaborative agreement with a physician. In West Virginia, the NP is able to be a primary care provider, order physical therapy, and sign death certificates. They can also sign disabled person placard forms and POLST or similar documents. They have reduced practice for medical staff membership. The NP in West Virginia can prescribe medications, but cannot prescribe schedule II drugs.

49. NP SCOPE OF PRACTICE IN WISCONSIN – (REDUCED PRACTICE)

The scope of practice for nurse practitioners in Wisconsin is reduced practice. Therefore, the NP cannot practice autonomously or independently and must be in a collaborative agreement with a physician. They can order physical therapy and sign disabled person placard forms. In Wisconsin, the NP cannot sign death certificates as these must be signed by a physician. There is currently no law regarding the NP signing POLST or similar documents or the NP being a primary care provider. The NP can prescribe medication, but they must have a collaborative agreement and supervision by a physician. They can prescribe schedule II drugs, but it is limited to specific circumstances. NPs in Wisconsin have reduced practice for medical staff membership.

50. NP SCOPE OF PRACTICE IN WYOMING – (FULL PRACTICE)

The scope of practice for nurse practitioners in Wyoming is full practice. Full practice authority grants the NP the ability to practice independently and autonomously. The NP can order physical therapy in Wyoming, sign death certificates and disabled person placard forms. They are also able to sign POLST or similar documents. There is currently no law in Wyoming regarding an NP being a primary care provider. The NP in Wyoming can prescribe schedule II drugs without a collaborative agreement, but they must complete the specified educational requirements for prescriptive authority. Lastly, they have reduced practice for medical staff membership.

5 Sure-Shot Ways To Ensure You Always Work Within The Nurse Practitioner Scope Of Practice In Your State

You must know the state scope of practice laws for nurse practitioners for the state you work. This is important because the NP scope of practice is the practice law you must follow. This can get confusing if you work in more than one state or have worked in other states in the past. Below, I will discuss five ways to ensure you always work within the nurse practitioner's scope of practice in your state.

1. Review the state board of nursing website:

The state board of nursing should have a page dedicated to the scope of practice of the nurse practitioner. This will allow you to ensure you are practicing within the law and following the rules and regulations for nurse practitioners.

2. Visit national websites such as AANP and the ANA for current information:

Visiting national nurse practitioner websites will keep you up-to-date regarding the nurse practitioner scope of practice by state. Not all national websites or professional organizations will have this information, but the AANP is an example of one organization that does provide current information.

3. Have a hard copy of the specifics regarding your state’s nurse practitioner scope of practice laws:

Having a hard copy of your state’s scope of practice laws will allow for you to reference quickly when needed. This can be a handwritten copy or a document you printed from a website. This is also beneficial if you work in multiple states as it is a quick reference.

4. Do not be shy to seek clarification:

If you are confused about a certain component regarding your scope of practice, do not be shy to seek clarification from your state board of nursing or NP regulatory organization. This can usually be done quickly by email and you should receive a timely response.

5. Be mindful, that while the scope of practice may state one thing, an organization does not have to allow it:

It is important to be mindful, that while your state may allow you to practice autonomously, if you work for an organization, the organization may require you to work “under” a physician or have a collaborative agreement with a physician. You may also not be allowed to have your own patients. Therefore, while it is most important for you to know the scope of practice of nursing practitioners in the state you work, you must also follow the rules of the organization or practice you work for.

6 Possible Consequences Of Not Working Within The Legal Nurse Practitioner Scope Of Practice In Your State

If you do not follow the scope of practice laws for nurse practitioners in your state, there are potential consequences. These consequences range from disciplinary action by your employer to litigation against you by a patient or organization. Below, I discuss six possible consequences of not working within your state's legal nurse practitioner's scope of practice.

1. Potential Harm to the patient:

If you practice outside of your NP scope of practice, there is a potential to harm the patient. For example, this can occur if you prescribe class II schedule drugs without completing the required education. You may not practice evidence-based medicine in the delivery of schedule II drugs, thus potentially harming the patient.

2. Disciplinary action or termination of employment by your workplace:

Disciplinary action may be te taken or even termination of employment by your workplace if you practice outside the scope of practice for nurse practitioners. The severity of the consequence would depend on multiple factors, such as if it led to a poor patient outcome or if it was your second or third time practicing outside of your scope of practice.

3. Suspension of License:

Another consequence for practicing outside of your NP scope of practice is possibly having your NP and RN license suspended. This suspension could be for a couple of months or even a year. There would most likely be additional education requirements that would have to be completed before having your license reinstated.

4. Termination of License:

If it is your second or third violation of practicing outside the NP scope of practice or your choice led to harm to a patient, the state board of nursing may decide to terminate your license.

5. Litigation against you:

Practicing outside of your scope of practice as a nurse practitioner may also lead to litigation or legal action against you. You may be sued by a patient, healthcare organization, or even another healthcare provider. The lawsuit's outcome can hurt your reputation as an NP and may lead to being unable to find new jobs or even termination of your NP and RN license.

How Has The Scope Of Practice For Nurse Practitioners Changed In The Face Of COVID-19?

The nurse practitioner scope of practice by state did change during Covid-19, but it is not permanent. A lot of the states granted emergency (temporary) acts to grant nurse practitioners full practice authority. This allowed for NPs to use their education to their fullest. By allowing the NP to have full practice authority, the NP can help meet the healthcare needs of the people and ensure they receive the care they need, specifically during the pandemic.

This change is not permanent in many states, and some states have already returned to their previous scope of practice laws. It did bring greater awareness to gaps in the healthcare system and demonstrated the NPs' ability to aid the physicians and increase access to healthcare, especially in rural communities. It proves that NPs and physicians can work together to improve the overall health, and collaborative agreements are not always needed to ensure the delivery of high-quality healthcare. The temporary full practice authority act also helped bring to light inconsistencies in the scope of practice between states. These inconsistencies can lead to confusion for both the patient and healthcare providers, potentially affecting the quality of care delivered.

My Final Thoughts

The growing need for nurse practitioners is continuing to become more evident. After reading the nurse practitioner scope of practice by state, I hope you can see some of the inconsistencies between the states in allowing NPs to practice to their fullest extent. There have been many positive changes for NPs over the last several years, and hopefully the there are several more changes to come in the future.

TOP FREQUENTLY ASKED QUESTIONS ANSWERED BY OUR EXPERT

1. What Are The Full Practice States For Nurse Practitioners?

Below, you will find the most current list of 24 full practice authority states from the AANP. Full practice authority indicates the nurse practitioner can practice to the fullest extent of their education and license. They do not need a life-long collaboration with a physician and can practice independently of a physician if they choose.

2. What Are The Reduced Practice States For Nurse Practitioners?

The 15 states listed in the table below are the states that have issued reduced practice authority for the nurse practitioner. This indicates that the NP will need a life-long collaboration with a physician. There are also typically other areas within the nurse practitioner's practice where limitations may be in place.

3. What Are The Restricted Practice States For Nurse Practitioners?

There are currently eleven states listed in the table below where the NP has restricted practice. This indicates that the NP must have career-long supervision, delegation, or team management by another health provider. The NP is also typically restricted in practicing in a minimum of one additional element of the NP practice.

4. Does Signing A DNR Fall Within The NP’s Scope Of Practice?

As stated above, the scope of practice for nurse practitioners by state varies. In some states, the NP can sign DNR forms, while other states require this form to be completed by a physician. It is necessary to know what your scope of practice laws are for the state where you practice.

5. Does Giving Referrals Fall Within The NP’s Scope Of Practice?

In most states yes. Again, this is impacted by nurse practitioner scope of practice by state laws. Therefore, please be sure you are aware of your scope of practice in the state you are practicing. For specific information, visit your state board of nursing or state NP regulatory organization website.

6. As An NP, What Should I Do If I Were Asked To Do Something Outside My Scope Of Practice?

If you are asked to do something outside of your scope of practice, you must speak up and inform that person you are not able to do the task. This is important, because it is illegal for you to practice outside of your scope of practice. Therefore, if you do a task outside of your scope of practice, you must politely tell the person that is outside of your scope of practice and you are not able to complete or perform that task. If this leads to problems, you need to talk to your manager, supervisor, or another person in a leadership position.

7. Can An NP Work In Different States With Varying Scope Of Practice Laws?

Yes, NPs can work in different states with varying scope of practice laws. It is important for the NP to have complete understanding of the nurse practitioner scope of practice by state they are practicing in because they vary. Just because they can order PT in one state, doesn’t mean they can place the same order in another state. They must follow the specific scope of practice laws for the state they are practicing in.

How many states have full practice authority for NPs?

Which states are full practice states?

What states do NP have autonomy?

What does full practice authority for NP mean?