Nurse practitioners are vital to modern medicine. Whether they’re collaborating with a physician or working independently, these skilled medical professionals help millions of Americans every day. But an NP’s ability to practice depends significantly on the state. So, in what states can nurse practitioners practice independently and where can NPs open their own practice?
27 states are nurse practitioner independent practice states, which means they can evaluate patients, order tests, and prescribe medication.
Other states, however, do not allow NPs to work autonomously via independent practice. Instead, these states require NPs be supervised by a physician.
Read on to learn more about the challenges NPs face, where NPs can practice independently, and what the best states are if you’re an NP looking to care for patients.
Challenges Facing NPs
A lack of independent practice autonomy creates obstacles for NPs to overcome, such as longer wait times for patients and limitations on how well NPs can actually care for their patients. These factors can lead to burnout, staffing shortages, and poor accommodations for patient’s needs. These restrictive laws are hurting the medical industry, affecting patient care, and deterring RNs who want to pursue NP careers.
Granting NPs full practice authority will help them work productively and efficiently. As the physician shortage continues to exacerbate, allowing NPs greater autonomy will improve not only their ability to perform their own jobs, but also the whole U.S. healthcare system.
For details on an NP’s scope of practice, see our infographic: Can an NP Do That?
In What States Can NPs Practice Independently?
Nurse Practitioners can practice independently in the 27 states with full practice authority: Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington, Wyoming.
Here’s a map using data from the AANP that illustrates the 27 NP Independent Practice States in light blue:
What does full practice authority for NPs mean?
There are 27 states that grant NPs full practice authority, which means they can “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,” according to the American Association of Nurse Practitioners (AANP). Full practice authority is the equivalent term for independent practice, which can make NP jobs easier.
A total of 12 states grant NPs what’s called “reduced practice authority,” which limits an NP in performing one or more of their duties or requires them to collaborate with another health provider to treat patients.
The remaining states operate under “restricted practice,” which requires NPs to be completely supervised by a health provider.
Which States Allow Nurse Practitioners to Open Their Own Practices?
Nurse practitioners can open their own practice in the same 27 states that offer full practice authority: Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington, Wyoming.
While most states with full practice authority officially recognize nurse practitioners as primary care providers, South Dakota does not have an official state law defining whether or not NPs can be primary care providers. This can make the bounds of NP jobs and their official titles subject to interpretation.
What Are the Best States for Nurse Practitioners (NPs)?
Some of the best states for nurse practitioners, in that they allow NPs to open their own practice with full autonomy and few restrictions, include:
- Alaska
- Washington
- Oregon
- Rhode Island
- New Hampshire
- Arizona
- New Mexico
As you may have noticed, many of the best states for nurse practitioners are located in the Northwest, Northeast, and Southwest. NP jobs in the states mentioned above face fewer obstacles compared to the other 43 states in the U.S.
The Northwest
Washington, Oregon, and Alaska all allow NPs autonomous practice and provide other freedoms.
The Evergreen State is often noted as one of the best states for NPs to open their own practice. Among Washington’s many freedoms for NPs is the ability to prescribe medicinal marijuana to patients.
Like its neighbor, Oregon grants NPs many freedoms, but not without some restrictions. According to 2017 state law, NPs are required to complete a minimum of 384 hours of practice as a registered nurse before being issued a NP license.
Compared to other states on this list, Alaska is one of the most lenient. The Last Frontier allows NPs to practice immediately following graduation from their program, despite any potential pending certificates or exams.
The Northeast
Rhode Island and New Hampshire stand out in the Northeast as welcoming states for NPs.
Only recently has Rhode Island embraced the potential role NPs can play in the healthcare system. Prior to 2008, the state did not allow NPs to have prescriptive authority, but a law passed that same year gave NPs the full autonomy that they have today.
The Granite State embraces the need for NPs in healthcare by allowing them complete autonomy to practice. New Hampshire also grants temporary licenses to recently graduated NPs who still need to complete the national certificate exam.
The Southwest
Arizona and New Mexico shine as welcoming states for NPs to start their practice with few restrictions.
Nurse practitioners within Arizona are granted nearly full practice autonomy. The state’s only limitation requires NPs to practice within their specialty and certification. Besides this one limitation, NPs enjoy many freedoms in the state.
Granting much of the same freedoms that its neighbor affords to NPs, New Mexico is considered one of the best states for NP practice. New Mexico offers a $3,000 tax credit for eligible NPs and healthcare providers who choose to work in rural areas. And for those still in school, New Mexico may cover two years of school payments in exchange for work in underserved areas.
Within the Southwest, Nevada and Utah also grant NPs independent practice, but restrict the prescribing of certain medications. Surprisingly, NPs do not have the same autonomy in California, contrasting with neighboring states.
Editor’s Note: This blog was originally written by Katie McBeth and updated by Nate Taylor in November 2024.
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