The NP Practice Environment in South Carolina
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“As APRNs, we’re able to help fill those [healthcare] shortages, not by replacing physicians, but by practicing within our scope of practice and providing high quality care to patients.”
Dr. Sheryl Mitchell, Department Chair for the Advanced Professional Nursing Practice and Leadership Department and Professor at the University of South Carolina College of Nursing
America is increasingly struggling to provide comprehensive healthcare services to its citizens. As the nation’s largest generation enters retirement and heads into old age, medical schools can’t graduate primary care physicians fast enough to meet the population’s growing healthcare needs. A 2024 report from the National Center for Health Workforce Analytics projected a shortage of over 87,000 full-time equivalent primary care physicians by 2037. But in many states, including South Carolina, the gap is already acutely felt.
Over 17 percent of all South Carolinians don’t have a personal healthcare provider, and each year approximately 12.8 percent of South Carolina’s adults report not seeing one because of concerns around cost. Altogether, the state has 63 primary care shortage areas, which are home to over 1.39 million people, collectively; rural areas are particularly underserved. With a high obesity rate and over 9 percent of the population uninsured, South Carolinians desperately need access to high-quality, affordable healthcare.
The state has 5,850 nurse practitioners (NPs) who could be an elegant part of the solution. They are expertly trained to provide the type of holistic, patient-centered care that is so desperately needed in underserved areas. Unfortunately, South Carolina still restricts its NPs from practicing to the full extent of their training and education.
Meet the Expert: Sheryl Mitchell, DNP, APRN, FNP-BC, ACNP-BC, FAANP
Dr. Sheryl Mitchell is department chair for the advanced professional nursing practice and leadership department and professor at the University of South Carolina College of Nursing. A South Carolina native, she earned her bachelor of science in nursing, her bachelor of science in biology and psychology, and her doctor of nursing practice all from the University of South Carolina.
Dr. Mitchell teaches in the graduate nursing program at the University of South Carolina and has served as project chair for DNP students. Her research interests include vulnerable populations, graduate nursing education, simulation, policy, and breast cancer survivorship.
Dr. Mitchell currently serves on the South Carolina Board of Nursing’s Advanced Practice Committee. She has previously served on the South Carolina Nurses Association Board of Directors as President, President-Elect, and the Commission Chair on Public Policy and Legislation. She is also a Fellow of the American Association of Nurse Practitioners.
The Value of South Carolina’s NPs
“Nurse practitioners (NPs) have the ability to increase access to healthcare for patients in South Carolina,” Dr. Mitchell says. “NPs can practice in primary and specialty care. They can provide patient education and counseling. And they can assess, diagnose, and treat acute and chronic diseases. In general, NPs focus on preventing disease and promoting the health and wellbeing of patients. There’s so much that NPs can do.”
More than a half-century of research has shown that NPs provide high-quality primary, acute, and specialty healthcare services. And NPs are especially valuable in rural areas, where they are more likely to practice than physicians. That’s particularly relevant in a state like South Carolina, where 14 percent of residents live in rural areas. Through patient education and treatment, South Carolina’s NPs can play a critical role in fighting the state’s top health concerns, including heart disease, diabetes, respiratory disease, and infant and maternal mortality.
The Burdens of Restricted Practice for South Carolina’s NPs
“In South Carolina, we’re considered a restricted practice state, because NPs have to have a practice agreement with a physician in order to practice and to obtain prescriptive authority,” Dr. Mitchell says. “And that physician has to be within the borders of South Carolina. So, if the physician travels outside of the state for a conference or for a vacation, and the nurse practitioner does not have an alternate physician listed on their license, then they can’t practice during that time.”
Furthermore, the state mandates that a physician cannot enter into a practice agreement with more than the equivalent of six full-time NPs at once. As the workforce of primary care physicians ages into retirement, NPs who would otherwise practice in rural areas may instead have to close their practice due to being unable to secure a practice agreement with a physician. Even in situations where NPs are able to find a physician, restrictions around NP practice can cause delays in care for patients.
It doesn’t have to be this way. An increasing number of states have enacted full practice authority, which allows NPs to practice to the full extent of their education and training without added restrictions. It grants NPs no new powers or authorities; it simply makes it easier for them to provide the care they’ve been trained to provide.
“Full practice authority means the removal of delays in care for our patients,” Dr. Mitchell says. “It means providing better, high-quality care, and it also means a decrease in cost, because there would be fewer steps for NPs to go through in providing care. Full practice authority would allow us to practice to the fullest extent of how we’ve been educated and how we’ve been trained.”
Advocacy Efforts of South Carolina’s NPs
Things are getting better in South Carolina. In 2018, the state passed legislation that relaxed some restrictions around NP practice: a 45-mile radius limit between NPs and collaborating physicians was changed to anywhere within the state; the number of NPs a physician could have a practice agreement with at once was expanded from three NPs to the equivalent of six full-time NPs; and NPs were given the right to prescribe not only Schedule III-V drugs but Schedule II drugs as well.
“We had significant changes in 2018, but it didn’t happen in one or two years,” Dr. Mitchell says. “I’m optimistic that we’ll have more changes in the future, but it’s going to take additional time.”
Legislative progress has largely come through grassroots efforts by NPs themselves. In South Carolina, the South Carolina Nurses Association (SCNA) and the Coalition for Access to Health Care (CAHC) have been instrumental in coordinating advocacy efforts. South Carolina NPs can find multiple ways to get involved at the local, state, and federal levels.
“In addition to joining professional organizations, I always tell my NP colleagues and students to become the experts of their practice,” Dr. Mitchell says. “What I mean by that is in your local community, you need to be an expert, so that if a legislator asks questions about healthcare, or has questions about the healthcare that their constituents are receiving or are not receiving because there’s a lack of access, then you can be that resource for the legislator.”
When the Covid-19 pandemic hit the US, a majority of states with restrictions on NP practice waived those restrictions to better address the healthcare needs of their populations. In South Carolina, those waivers weren’t as comprehensive as they were in other states; they were also rescinded when the state of emergency ended. But South Carolina’s NPs remain hopeful that it’s a sign that the state can and should turn to its NPs to help ensure the health of its citizens.
“I’m a South Carolinian for life,” Dr. Mitchell says. “And when it’s your state and your home, you understand it, you know the culture, and you know the improvement that you want to see. I’m optimistic that we can have full practice authority in South Carolina. It’s not going to happen overnight, but I think it’s the future of NP practice in the state.”
Update 2025: Fighting for the Patient at the Center of Care
South Carolina’s NPs are preparing for their breakthrough moment. Although the state removed the term “supervision” from its law in 2018, its NPs and other APRNs still practice under burdensome collaborative practice agreements. But that could change in 2026, when the state legislature reconvenes.
“The work starts well before the legislative session,” Dr. Mitchell says. “You have to find sponsors for your bill. You have to figure out who you need to have conversations with—people who may support and oppose your bill. You have to strategize. Timing is a big part of it. But it’s advocacy. It never stops.”
If passed, a new bill (SB45/HB3580) would create a pathway to achieve full practice authority by removing the collaborative practice agreement requirement for the state’s APRNs (in this instance, NPs, CNSs, and CNMs) who have completed 2,000 clinical hours.
SB45 is part of a wider conversation taking place in South Carolina around the state’s healthcare workforce shortages. On September 11, 2025, the South Carolina Senate Medical Affairs Subcommittee heard testimony on 11 separate bills, including SB45. Lawmakers heard from physicians, PAs, pharmacists, dentists, and APRNs.
“It really served as a conversation starter, and I hope it will continue,” Dr. Mitchell says. “Our lawmakers asked for a lot of additional information. But anytime you’re putting forth new legislation, you have to retain a level of optimism.”
One of those 11 bills, however, would actually tighten rules around APRN and PA practice. SB669 proposes a team-based structure, regardless of setting, in which physicians sit at the center. It’s one of the stricter anti-full practice authority bills of any state.
“We have some concerns about the way SB669 is currently structured, particularly in who is leading the healthcare team,” Dr. Mitchell says. “We strongly believe that the patient should be the center. If they need physical therapy, then a physical therapist should lead at that time. If they need an APRN, it should be an APRN. Same with a physician. The patient’s needs should determine which provider leads.”
South Carolina’s patients have urgent healthcare needs. The state has drastic deficits in maternal healthcare, with entire areas lacking OBGYNs or certified nurse midwives. A primary care physician shortage impacts many rural communities. SB45 would not grant APRNs any authority beyond what they’ve already been trained and educated to provide—but it would remove barriers to providing that care to the patients who need it most. And it would address provider shortages in a way that more restrictive bills like SB669 would only exacerbate.
“As APRNs, we’re able to help fill those [healthcare] shortages, not by replacing physicians, but by practicing within our scope of practice and providing high quality care to patients,” Dr. Mitchell says.
Notably, states with full practice authority for their NPs rank higher on overall state health, health outcomes, clinical care, care quality, and care access (Nursing Outlook 2025). Multiple peer-reviewed studies associate NP independence with more routine care and fewer ED visits, particularly for ambulatory conditions (Journal of Health Economics 2018). As of 2025, 29 US states allow full practice authority for their NPs. South Carolina could join them in 2026.
“It’s about increasing access to healthcare,” Dr. Mitchell says. “That’s at the center of all of this. We’re hopeful that this bill [SB 45] will pass.”
Matt Zbrog
WriterMatt Zbrog is a writer and researcher from Southern California, and he believes nurse practitioners (NP) are an indispensable component of America’s current and future healthcare workforce. Since 2018, he’s written extensively about the work and advocacy of NPs, with a particular focus on the rapid growth of specialization programs, residencies, fellowships, and professional organizations. As part of an ongoing series on state practice authority, he’s worked with NP leaders, educators, and advocates from across the country to elevate policy discussions that empower NPs. His articles have featured interviews with the leadership of the American Association of Nurse Practitioners (AANP), the National Association of Pediatric Nurse Practitioners (NAPNAP), and many other professional nursing associations.