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In many states, the laws that establish nurse practitioner (NP) roles are in flux. This guide defines a nurse practitioner’s scope of practice, explains the three levels of practice authority, and lists states by practice authority. Read on to understand how practice authority can affect your career as a nurse practitioner.
Scope of practice refers to the professional activities that each state authorizes nurses or other clinical staff to perform. An NP’s scope of practice can include assessing a patient’s condition, ordering tests, interpreting results and making diagnoses, prescribing medication, and ordering treatments.
Scope of practice varies by state. In some states, NPs must work under a physician’s supervision or in collaboration with a physician, while other states allow nurse practitioners to practice independently.
Scope of practice falls into three main categories, or levels, of practice authority: full, reduced, or restricted practice authority.
In full practice authority states, nurse practitioners can perform the full scope of practice without a supervising or collaborating physician. They can diagnose a patient, order tests, prescribe medication, and operate their own independent practices. Nurse practitioner independent practice states may require a certain level of experience working under a physician’s supervision or require additional training before allowing full practice authority. Because these requirements are not permanent, these states are still considered full practice authority states.
In reduced practice states, nurse practitioners can perform some of their scope of practice without physician supervision. These restrictions typically involve operating their own practices or prescribing certain types of medications. They rarely involve the nurse practitioner’s ability to order tests or diagnose conditions. For example, a nurse practitioner might need to be part of a practice that is supervised by a physician, rather than running their own practice, but within that practice, can operate with relative autonomy.
In restricted practice states, nurse practitioners must work under the supervision of a physician for all of their scope of practice. While they may have extensive autonomy in some nurse practitioner functions, they are not acting as independent practitioners. However, some states may loosen restrictions as the NP gains experience.
Each state establishes its own NP practice authority regulations. This list provides the latest nurse practitioner scope of practice by state or territory.
