Nurse Practitioner Scope of Practice Laws by State

Interactive Nurse Practitioner (NP) Scope of Practice Law Guide

Nurse practitioner (NP) scope of practice laws vary from state to state. If you’re working nurse practitioner jobs, it’s important to understand the varying laws. Barton Associates understands these laws may have an effect on the locum tenens nurse practitioners of all specialties we place throughout the United States, and so we put together this handy interactive guide that offers a snapshot of each state’s scope of practice laws. For more information on specific state requirements, please review each state’s nurse practice act (NPA).

 

Last Updated: October 20, 2023

  • Full, Reduced, or Restricted Practice

    Full, Reduced, or Restricted Practice.

  • Medical Staff Membership

    Medical Staff Membership.

  • Autonomous Practice

    Nurse practitioners can independently diagnose and treat patients without physician involvement.

  • Primary Care Provider

    State statute and/or Administrative Code recognizes nurse practitioners as primary care providers.

  • Independently Prescribe Schedule II Drugs

    Nurse practitioners have authority to prescribe without physician or Board of Medicine involvement, after completing specific state requirements.

  • Order Physical Therapy

    Nurse practitioners can make referrals for physical therapy, or a referral is not required.

  • Sign Death Certificates

    Nurse practitioners can sign death certificates.

  • Sign Disabled Person Placard Forms

    Nurse Practitioners can sign Handicap placard forms.

  • POLST/POST/MOLST/MOST/COLST

    Nurse Practitioners can sign workers' compensation forms.

Color Key:
Full

  • Full, Reduced, or Restricted Practice

  • Medical Staff Membership

  • Autonomous Practice

  • Primary Care Provider

  • Independently Prescribe Schedule II Drugs

  • Order Physical Therapy

  • Sign Death Certificates

  • Sign Disabled Person Placard Forms

  • POLST/POST/MOLST/MOST/COLST

Restricted

  • No Law

  • Not Allowed

Last Updated: October 20, 2023

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Nurse Practitioner Scope of Practice Wheel Overview

Have any questions about the information included in the NP Scope of Practice Wheel? Here’s a brief rundown of what area of NP practice each wheel segment refers to:

 

Full, Reduced, or Restricted Practice: 

Practice environment refers to the practice scope and licensure for nurse practitioners in a state. Some states offer a tremendous amount of independence and autonomy to nurse practitioners, while others restrict NP license and practice. The AANP recognizes three practice environments:

Full Practice: full NP scope of practice means state practice and licensure law allow all NPs to evaluate and diagnose patients, order and interpret diagnostic tests, initiate and manage treatments, and prescribe medications, under the authority of the state board of nursing.

Reduced Practice:  State practice and licensure law allow reduced ability for NPs to take part in at least one element of NP practice. In these states, the law allows NPs to provide patient care in a regulated collaborative agreement with an outside health discipline, or by limiting the setting or scope in other ways.

Restricted Practice:  State practice and licensure law allow the restricted ability of an NP to engage in at least one element of NP practice, as they are required to be supervised, delegated to, or otherwise managed by an outside health discipline to care for patients.

 

Nurse Practitioner Scope of Practice by State:

Full Practice NP States:
Currently, NPs have full practice authority in DC and 27 states: 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

Reduced Practice NP States:
Currently, NPs have reduced practice authority in 12 states: Alabama, Arkansas, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Jersey, Ohio, Pennsylvania, West Virginia, Wisconsin

Restricted Practice NP States:
Currently, NPs have restricted practice authority in 11 states: California, Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia

 

Do Nurse Practitioners Qualify for Medical Staff Membership?

The medical staff membership section of our NP Wheel refers to laws that regulate NPs’ ability to join a medical staff. Depending on the state, this law may fully allow, reduce, or restrict this ability, while some states have no law at all. Currently, permission for NPs to join a medical staff is fully allowed in 12 states, reduced in 31 states plus D.C., and restricted in four states. There is no law for NP medical staff membership in three states.

Do Nurse Practitioners Have Autonomous Practice?

Practice autonomy refers to the degree of physician involvement in different elements of NP practice, including diagnosing and treating patients. NPs can independently diagnose and treat patients without physician involvement in 27 states plus D.C. NPs must be supervised by a physician to some degree in the other states. Some restricted states require physicians to sign NP charts to qualify for reimbursement.

Are Nurse Practitioners Considered Primary Care Providers?

According to the AANP, more NPs are choosing primary care than physicians and PAs: Three out of four NPs deliver primary care, and more than 89 percent of NPs have been prepared in primary care. However, not all states have a state statute or administrative code that recognizes NPs as primary care providers. The law recognizes NPs as primary care providers in 42 states. In eight states plus D.C., the law doesn’t define whether NPs can be primary care providers.

Can Nurse Practitioners Independently Prescribe Schedule II Drugs?

Out of all areas of practice, prescriptive authority is the most variable from state to state.

Many states reduce an NP’s ability to prescribe schedule II drugs. Roughly half of states provide full prescriptive authority — including the ability to prescribe, dispense, administer, and procure Schedule II drugs — but even those states often have a number of conditions pertaining to the regulation of prescriptive authority.

Some require NPs to apply for permission, some have laws that depend on an NP’s area of population focus and certification, some require the physician to be in the specialty or practice area as the NP, and others enforce a variety of other requirements. This can include a number of continuing education credits, limits on refills or prescription supply, or they contain additional regulations on specific drugs like Hydrocodone. Refer to your state’s section of the NP wheel for more information.

Can Nurse Practitioners Order Physical Therapy?

In many states, NPs are fully authorized to make referrals for physical therapy, or a referral is not required in that state. In other states, a physician must make the referral. The former is true for 46 states plus D.C., and the latter in four states.

Can Nurse Practitioners Sign Death Certificates?

In most states, yes, nurse practitioners can sign death certificates. In 40 states and DC, NPs can sign death certificates in at least some situations, but several states only permit it in very narrow circumstances. For a state-by-state breakdown, visit our full article on which states a nurse practitioner can sign a death certificate.

 

Can Nurse Practitioners Sign Handicap Parking Permits and Disabled Person Placard Forms?

In a majority of states (48 plus D.C.), NPs are legally allowed to certify disability for  disabled person placard forms or handicap plates.

Three states do not allow NPs to sign disabled person placard forms:

  • South Dakota
  • Georgia

Can Nurse Practitioners Sign POLST/POST/MOLST/MOST/COLST Forms?

The National Physician’s Orders for Life-Sustaining Treatment (POLST) Paradigm was put into place to help honor a patient’s wishes during end-of-life planning and treatment.

The acronym varies across states, with some referring to it as Practitioner Orders for Life-Sustaining Treatment (POLST), Physician Orders for Scope of Treatment (POST), Medical Orders for Life-Sustaining Treatment (MOLST), Medical Orders for Scope of Treatment (MOST), Clinician Orders for Life-Sustaining Treatment (COLST), and others.

NPs may sign their state’s form in 37 states. Several state programs are still developing.

 

 

Frequently Asked Questions (FAQS) About Nurse Practitioner Scope of Practice Laws

How Do I Learn More About My State’s Laws Regarding Scope of Practice? 

The Scope of Practice wheel is a great starting point for understanding your state’s laws regarding nurse practitioners.  Our guide to the NP Scope of Practice wheel also contains a run-down of the information contained in each practice category by state, However, for a more in-depth examination of your state’s up-to-date laws and regulations, we recommend checking with your state’s official resources or the AANP’s state-by-state policy sheets.

 

What Are the Most Recent Changes to Nurse Practitioner Scope of Practice Laws?

In the last two years, three more states have expanded the scope of practice for Nurse Practitioners to grand full authority. In 2022, Kansas and New York passed legislation to grant full practice authority for NPs. In 2023, Utah granted full practice authority. No states have reduced scope of practice in recent years.

 

How Do the Leading Professional Organizations Weigh In On Scope of Practice Laws?

Two of the largest medical professional organizations take opposing viewpoints. The American Medical Association, a professional association and lobbying group that primarily represents physicians has publicly voiced disapproval for the expansion of scope of practice laws. The AMA refers to it as “Scope Creep” and has stated that expanded NP scope threatens patient safety. The American Association of Nurse Practitioners (AANP), the largest member organization of NPs, has voiced support for expanded scope of practice and presciptive authority as ” essential to providing timely, cost-effective, quality health care.”

 

 

Disclaimer: This chart is for informational purposes only and is not intended to provide legal advice.

The wheel was most recently updated most recently in October 2023 to reflect the increased scope of practice legislation passed in 2022 and 2023 by the states of New York, Kansas, and Utah to grant Nurse Practitioners full practice authority.

We aim to keep all information included in the wheel accurate and up-to-date, but it’s always possible we’ve missed a scope of practice change, given the nuances of practice authority and medical staff privileges by state. If you believe any information included in the wheel is inaccurate, please let us know at marketing@bartonassociates.com.

Sources:
Scope of Practice: AANP.org
Prescriptive Authority: DEA Diversion Control Division