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Nurse Practitioner Practice Authority Update

Does my state provide full practice authority to nurse practitioners?

Understanding The Practice Status of Nurse Practitioners

Scope of practice guidelines for advanced nursing professions vary by state and it is always evolving.  As of 2022, there are now 33 states(including  DC) that allow nurse practitioners full practice authority (without physician oversight).  

However, some of these states still limit prescribing authority for nurse practitioners with only 24 having full prescribing and practice authority.  It is best to always consult your local state medical society if there are any questions about your state’s position.

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Nurse practitioner practice authority defined

1. Full Practice Authority

State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.

2. Reduced Practice Authority

State practice and licensure laws reduce the ability of NPs to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice.

3. Restricted Practice

State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care.

As of 2010, full practice status became the recommended model by the Institute of Medicine and the National Council for State Boards of Nursing. However, not all states are on board with the measure.  As mentioned above, there are still 18 states that require a collaboration agreement and and 27 states that restrict prescribing authority.

These practice guidelines do change slightly depending on location and whether or not you are in a federally designated underserved community, NPs must have either a signed collaboration agreement with a physician or direct oversight from a physician. Not all states require the physician to be physically present, be in the same building or even have limits on how many NPs a physician can supervise(crazy right) but your collaborating physician should always be available by phone or email.

NP Indepedence is gaining steam

When we initially wrote this article in 2018, there were only 22 states with full practice authority.  In four years, we have seen that number increase significantly with 11 more states signing legislation allowing full practice authority.  In addition to these 11 new states, there are bills being worked on currently in numerous other states.  

Within the next two years, it is our expectation that there will be 4-5 more states granting full practice authority.  

Stay Involved & Stay compliant

As the legislative process continues to proceed, it is vital that as a nurse practitioner, you stay informed about what’s happening in your state.  These laws have a dramatic impact on how you practice and it’s on you to get involved and let your voice be heard.  

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What does the future hold for nurse practitioner’s independence

Health care leaders across the board agree that we need more conversations addressing the use of NPs as independent practitioners.  The physician shortage isn’t going away and NPs are the best solution we have to this problem.  Both sides concur that the role of nurse practitioners is vital to the health and delivery of medical care in this nation.  Unfortunately, neither can agree on the best way to achieve this goal.

It is obvious that COVID-19 has had a significant role in advancing these conversations.  The problem will only continue to compound so our hope is that states will recognize the shortage we are facing and act.

Nurse Practitioner horror story

DISCLAIMER: The material contained in this is offered as information only and not as practice, financial, accounting, legal or other professional advice. Correspondents must contact their own professional advisors for such advice.

Updated: 9/1/2022