Nurse Practitioner (NP) Practice Authority By State & Scope of Practice
Nurse practitioners (NPs) are graduate-trained professionals who provide high-quality and cost-effective healthcare. They meet the needs of underserved and vulnerable populations, helping the United States to combat its looming primary care shortage. However, their ability to prescribe specific medications and fulfill functions as independent practitioners can be limited by the state in which they live.
Discover how limited and restricted practice laws affect NPs within these states—and how APRNs and advocates are fighting for full practice authority.
What is NP Practice Authority?
Nurse practitioners are essential physician extenders. They can provide much of the same care and services as physicians, with fewer years of education and often at a much lower cost. However, many states still restrict the extent to which nurse practitioners can practice and whether or not they must be supervised by a physician.
For example, a recent interview detailed how New Jersey nurse practitioners must have a Joint Protocol in place in order to have many practice privileges. Dr. Mary Ellen Roberts, an associate professor in the College of Nursing at Seton Hall University, stated in the 2021 interview that, “NPs that have started their own practices, and they have this Joint Protocol, they have to pay the physician to be a collaborator. They never see the physician. The physician doesn’t come to their office. But they’re still paying the physician a fee in order for him to sign this joint protocol. And the fees are oftentimes exorbitant.”
There are numerous organizations currently lobbying state legislatures for full practice authority for nurse practitioners. They include the American Nurses Association, the American the Association of Nurse Practitioners, the Veterans Administration, the AARP, the Institute of Medicine, the Federal Trade Commission, and many more. These efforts are often opposed by physician associations such as the American Medical Association, who argue that nurses cannot replace fully trained physicians.
In states with fewer restrictions, nurse practitioners help increase patient access to healthcare and serve in many underserved rural areas. The full practice authority model has been adopted in many states, with many more having a path to full practice authority after a period of supervision. Here are the three general levels of practice authority:
- Full practice: Laws in these states allow nurse practitioners to practice independently. They have full authority to perform services within the scope of their specialty, including prescribing medications, medical equipment, and treatments. There may be an additional application or continuing education required in order to receive prescriptive authority.
- Limited or reduced practice (but can transition to full practice): Some states require nurse practitioners to complete a supervised work experience prior to receiving autonomous practice privileges. The amount of time required varies by state but, upon completing the number of hours required, nurse practitioners may have full independent authority, including prescriptive abilities.
- Restricted practice: Nurse practitioners in restricted states will always need physician supervision or a collaborative agreement in order to carry out at least one aspect of their practice. In some states, nurse practitioners may be able to practice independently but need an agreement for prescriptive authority. In other states, there must be an agreement for any care provided beyond the scope of a registered nurse.
Below is a table detailing each state’s regulations regarding practice authority for nurse practitioners. It should be noted that there is pending legislation in several states, thanks to the tireless efforts of advocacy organizations, and this can change at any time. The Covid-19 pandemic has also reshaped the practice environments within some states. Included are links to each state’s nursing board and nurse practice act for the most up-to-date information.
From the Editor: Please note that some states’ statuses differ from the popular AANP map. We have included all states in our restricted state category that do not offer a pathway beyond “collaborative agreements” or “physician supervision.” As always, we encourage readers to reach out with any updates or corrections. Contact us here.
|State||Board of Nursing||Practice Act||Prescriptive Authority||Details & Resources|
|Alabama||Alabama Board of Nursing||Alabama Board of Nursing Administrative Code||Must have a collaborative practice with a supervising physician||Must be in a collaborative practice with a supervising physician. Collaborative practice is regulated by the Alabama Board of Medical Examiners.|
|Alaska||Alaska Board of Nursing||Alaska Nursing Statutes (article 4)||Full practice with current license||Must submit a separate application and fee to prescribe Schedule 2-5 controlled substances.|
|Arizona||Arizona Board of Nursing||Arizona Nursing Statutes, AZ Nurse Practice Act||Full practice with current license and DEA registration|| Nurse practitioners are highly encouraged to utilize the Arizona Controlled Substance Prescription Monitoring Program|
(CSPMP) to reduce the risk of harm.
|Arkansas||Arkansas Board of Nursing||Arkansas Nurse Practice Act||Must have a collaborative practice agreement with a supervising physician and proof of completion of a board-approved pharmacology course||Nurse practitioners can only prescribe Schedule 3-5 controlled substances. Schedule 2 substances may be prescribed under limited circumstances and under the supervision of a physician.|
|California||California Board of Registered Nursing||CA Nursing Practice Act||Must be under the supervision of a physician||Nurse practitioners may prescribe Schedule 2-5 controlled substances, under the supervision of a physician, and as long as the practitioner has completed a pharmacology course. They must also have a furnishing number.|
|Colorado||Colorado Board of Nursing||Colorado Nurses and Nurse Aides Practice Act||Full prescriptive authority with a current license after meeting board requirements|| Requirements for provisional prescriptive authority include three years of nursing work experience and education in controlled substances and prescriptions. |
Once provisional authority has been granted, NPs must complete 750 hours of mentorship with an advanced practice nurse or physician. When the hours are complete, NPs may prescribe under their own authority.
|Connecticut||Connecticut Board of Examiners for Nursing||Connecticut Nurse Practice Act||Must initially have a collaborative practice with a supervising physician. Full practice after three years in a collaborative practice||For the first three years of holding a license, nurse practitioners must be in collaboration with a physician. Upon completing three years and at least 2,000 hours of supervision, NPs may practice under their own authority.|
|Delaware||Delaware Board of Nursing||Delaware Nursing Laws||Must initially ha e a collaborative practice with a supervising physician. Independent practice may be obtained after two years of clinical experience|| Nurse practitioners have full practice authority as long as they are under a supervising physician. |
After two years and 4,000 hours of working under a collaborative agreement, nurse practitioners may apply for an independent license to practice under their own authority.
|District of Columbia||Washington DC Board of Nursing||Washington DC Nurse Practice Act||Full prescriptive authority with a current license||Nurse practitioners are authorized to sign any document that must be signed by a physician. They can prescribe Schedule 2-5 controlled substances.|
|Florida||Florida Board of Nursing||Florida Nurse Practice Act||Must complete 3,000 hours of collaborative practice and three semester-hours of graduate coursework in the past five years||Nurse practitioners are required to maintain professional liability insurance.|
|Georgia||Georgia Board of Nursing||Georgia Nurse Practice Act||Must have a protocol agreement with a practicing physician||Nurse practitioners may not prescribe Schedule 1-2 controlled substances. All prescriptions must be within the scope of the protocol agreement.|
|Hawaii||Hawaii Board of Nursing||Hawaii Nursing Statutes (subchapter 14)||Full prescriptive authority with a current license and approved prescriptive authority application||To be eligible to apply for prescriptive authority, NPs must have a current state license, national certification, a graduate degree, and proof of 30 continuing education hours in pharmacology.|
|Idaho||Idaho Board of Nursing||Idaho Nurse Practice Act||Full prescriptive authority with a current license||Upon completion of 30 hours of continuing education in pharmacology, NPs may prescribe Schedule 2-5 controlled substances.|
|Illinois||Illinois Board of Nursing||Illinois Nurse Practice Act||Must complete 4,000 hours of clinical experience and 250 hours of continuing education training||In order to prescribe Schedule 2 controlled substances or benzodiazepines, NPs must have a collaborative agreement with a physician. They must also obtain an Illinois controlled substance license and a federal Drug Enforcement Administration number.|
|Indiana||Indiana State Board of Nursing||Indiana Nurse Practice Act||Must have a collaborative practice with a supervising physician||Nurse practitioners must complete a pharmacology course of at least two semester-hours in the last five years. If more than five years have elapsed, they may complete 30 hours of continuing education.|
|Iowa||Iowa Board of Nursing||Iowa Nurse Practice Act||Full prescriptive authority with a current license||Nurse practitioners must practice within their specialty area.|
|Kansas||Kansas State Board of Nursing||Kansas Nurse Practice Act||Must have a written protocol from a physician to prescribe medications||Prescriptions must include the name of the physician. In order to prescribe controlled substances, a nurse practitioner must register with the DEA and notify the nursing board of the name and address of the responsible physician.|
|Kentucky||Kentucky Board of Nursing||Kentucky Nurse Practice Act||Must complete four years under a Common Collaborative Agreement with a supervising physician||If a nurse practitioner wants to prescribe Schedule 2-5 controlled substances, then they must still be under a Common Collaborative Agreement.|
|Louisiana||Louisiana Board of Nursing||Louisiana Nurse Practice Act||Must have a collaborative practice agreement||In order to prescribe medications, NPs must have 500 hours of work experience (as NPs) and 45 continuing education hours (or three semester-hours) in pharmacology, advanced health assessment, and advanced physiology.|
|Maine||Maine Board of Nursing||Maine Nurse Practice Act||Full prescriptive authority after 24 months under supervision||The supervision for the 24-month clinical experience can be completed by a physician or a nurse practitioner.|
|Maryland||Maryland Board of Nursing||Maryland Nurse Practice Act||Full prescriptive authority with a current license||An NP who has completed their national certification and education program and has applied to the state for licensure may practice under the supervision of a licensed NPs or physicians until their license is approved.|
|Massachusetts||Massachusetts Board of Nursing||Massachusetts Nursing Statutes||Full prescriptive authority as of January 2021||Any form that must be certified by a physician may be completed by a Certified Nurse Practitioner (CNP).|
|Michigan||Michigan Board of Nursing||Michigan Public Health Code (1978)||Must have physician supervision in order to prescribe Schedule 2-5 controlled substances.||Both the supervising physician and the nurse practitioner must supply a DEA number and sign a prescription in order to provide Scheduled 2-5 controlled substances.|
|Minnesota||Minnesota Board of Nursing||Minnesota Nurse Practice Act||Full practice after 2,080 hours under a collaborative management||Once collaborative management hours have been completed, there are no prescription restrictions.|
|Mississippi||Mississippi Board of Nursing||Mississippi Nursing Practice Law||Must have a collaborative agreement with a physician||In order to prescribe Schedule 2-5 controlled substances, NPs must complete a Mississippi State Board of Nursing approved educational program.|
|Missouri||Missouri Board of Nursing||Missouri Nursing Rules & Statutes||Must practice under a Collaborative Practice Agreement (CPA) with a supervising physician||All prescriptive privileges must be outlined in the CPA. If the CPA specifies it, NPs may prescribe Schedule 2-5 controlled substances|
|Montana||Montana Board of Nursing||Montana Nurse Practice Act||Full authority to practice independently with a current license and an approved perspective authority application||In order to prescribe medications, NPs must complete an application for prescriptive authority. Application requirements include proof of completed coursework in pharmacology.|
|Nebraska||Nebraska Department of Health and Human Services||Nebraska Nursing Regulations & Statutes (including NP Act)||Must complete 2,000 hours of clinical practice in a transition-to-practice collaborative agreement||In order to prescribe Schedule 2-5 controlled substances, DEA registration is required.|
|Nevada||Nevada Board of Nursing||Nevada Nurse Practice Act||Must complete 2,000 hours of clinical practice and submit an approved application from the Nevada Board of Pharmacy||Nurse practitioners who wish to prescribe controlled substances must also register with the DEA.|
|New Hampshire||New Hampshire Board of Nursing||New Hampshire Nurse Practice Act||Full practice authority with a current license||There are no additional requirements in order to prescribe controlled substances.|
|New Jersey||New Jersey Board of Nursing||New Jersey Board of Nursing Law||Must have a joint protocol with a supervising physician in order to have prescriptive authority||The joint protocol agreement must outline how, when, and why prescriptions may be issued as well as whether or not the NP may prescribe controlled substances.|
|New Mexico||New Mexico Board of Nursing||New Mexico Nurse Practice Act||Full practice authority with a current license||Nurse practitioners who prescribe Schedule 2-5 controlled substances must register with the DEA.|
|New York||New York Board of Nursing||New York Nurse Rules & Regulations||Must have a collaborative agreement with a supervising physician||After completing 3,600 hours of clinical practice, an NP may apply for a collaborative relationship agreement, which allows for greater professional independence.|
|North Carolina|| North Carolina Board of Nursing, NC |
|North Carolina Nurse Practice Act||Must have a collaborative agreement with a supervising physician||The collaborative agreement must outline the scope of practice. The NP and physician must be available to each other at all times.|
|North Dakota||North Dakota Board of Nursing||North Dakota Nurse Practice Act||Full authority to practice independently with a current license and an approved perspective authority application.||To be eligible for prescriptive authority, nurse practitioners must complete 30 hours of pharmacology continuing education. Nurse practitioners must utilize the North Dakota Prescription Drug Monitoring Program.|
|Ohio||Ohio Board of Nursing||OH Board of Nursing Laws & Rules||Must practice in collaboration with a supervising physician||The prescriptive authority of an NP is limited by the authority of the supervising physician. Nurse practitioners may only prescribe Schedule 2 controlled substances in limited circumstances.|
|Oklahoma||Oklahoma Board of Nursing||Oklahoma Nurse Practice Act||Must practice in collaboration with a supervising physician||Nurse practitioners must complete 45 hours of pharmacology education.|
|Oregon||Oregon Board of Nursing||Oregon Nursing Rules & Procedures||Full authority to practice independently with a current license and an approved prescriptive authority application||Nurse practitioners who wish to have prescriptive authority must submit an application and complete 45 hours of pharmacology education.|
|Pennsylvania||Pennsylvania Board of Nursing||Pennsylvania Code of Nursing||Must practice under a collaborative agreement with a supervising physician||Nurse practitioners must register with the DEA in order to dispense controlled substances.|
|Rhode Island||Rhode Island Department of Health Nursing Licensing||Rhode Island Nursing Rules & Regulations||Full prescriptive authority||Nurse practitioners many only prescribe within their population focus|
|South Carolina||South Carolina Board of Nursing||South Carolina Nurse Practice Act||Must have a practice agreement with a collaborative physician|| In order to receive prescriptive authority, nurse practitioners must complete 45 hours of continuing education in pharmacology, of which 15 hours must be in controlled substances. |
If listed on the practice agreement, nurse practitioners may provide Schedule 2 controlled substances. Otherwise, they are limited to Schedule 3-5.
|South Dakota||South Dakota Board of Nursing||South Dakota Laws & Regulations||Must complete 1,400 hours of clinical practice to get prescriptive privileges||There are no additional requirements to prescribe controlled substances.|
|Tennessee||Tennessee Board of Nursing||Tennessee Nursing Statutes|| Must be under the supervision of a physician who has “control and responsibility for|
prescriptive services rendered by the nurse”
|Nurse practitioners are required to register with the DEA for prescribing controlled substances and must maintain a practitioner profile with the Board of Nursing.|
|Texas||Texas Board of Nursing||Texas Nursing Practice Act||Must have a protocol or written authorization from a physician||Prescriptive authority for nurse practitioners must be outlined in a prescriptive authority agreement with a supervising physician.|
|Utah||Utah Board of Nursing||Utah Nurse Practice Act||Must have at least 2,000 hours of clinical experience||In order to prescribe Schedule 2 controlled substances, NPs must have at least 2,000 hours of clinical experience.|
|Vermont||Vermont State Board of Nursing||Vermont Nursing Statutes||Full independent practice with a current license||There are no additional requirements for full practice authority.|
|Virginia||Virginia Board of Nursing||Virginia Nursing Laws & Regulations||Must have five years of clinical practice under the supervision of a physician to qualify for Autonomous Practice Licensure (APL)||If an NP has not met the requirements for independent practice, they must have a practice agreement with a supervising physician in order to prescribe Schedule 2-5 controlled substances.|
|Washington||Washington State Nursing Commission||Washington Nursing Care Laws||Full privilege with current license||With commission approval, can prescribe legend drugs and schedule 2-5 controlled substances.|
|West Virginia||West Virginia RN Board||West Virginia Nursing Code||Must have three years in a collaborative practice agreement||In order to prescribe medications, even in collaborative practice, NPs must complete 45 hours of education in pharmacology. Schedule 2 drug prescriptions are limited to a 30-day supply.|
|Wisconsin||Wisconsin Board of Nursing||Wisconsin Nursing Laws & Regulations||Must have a collaborative practice with a supervising physician||Nurse practitioners may only prescribe Schedule 2-5 controlled substances within areas of competence defined by education, training, or experience, and in collaboration with a supervising physician.|
|Wyoming||Wyoming State Board of Nursing||Wyoming Nurse Practice Act||Full privilege with current license||Must complete three hours of continuing education on substance use disorders in order to prescribe Schedule 2-5 controlled substances.|
Kimmy Gustafson is a freelance writer with extensive experience writing about healthcare careers and education. She has worked in public health, at health-focused nonprofits, and as a Spanish interpreter for doctor’s offices and hospitals. She has a passion for learning and that drives her to stay up to date on the latest trends in healthcare. When not writing or researching, she can be found pursuing her passions of nutrition and an active outdoors lifestyle.