Scope of Practice for Nurse Practitioners by State 2023

Which States have Full Practice?

Due to recent times, the push for full practice is being made at a federal level to provide qualified nurses with the necessary documentation and designation to assert full autonomy over their decisions. This means they can act without having to consult with a doctor.

While there is a difference between authority and scope of practice, there are certain states that are more favorable to nurses than others, depending on the circumstances. One such state is Arizona, which allows the Nurse Practioner full authority over her or his own autonomy. They are able to prescribe medications, sign death certificates, and other class II-V scheduled drugs.

Other states with this privilege include 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, Vermont, Washington, and Wyoming.

Even though the full practice is allowed in these states, it is best to first check with your medical healthcare staffing professional prior to being sent over, as it is great to obtain confirmation prior to doing anything. It is also best recommended to speak to the physician at the target medical care facility if there are certain restrictions or regulations that should be adhered to.

Which States Have Reduced Practice?

Reduced practice is a gray area that targets most states. This means that although some of the scopes of NPs are allowed, some are not. A reduced practice can be as strict as restricting all but one element of practice, or as autonomous as minimally restricting the ability to perform one item within the scope without guidance or direction. This includes prescribing certain drugs, ordering physical therapy, and signing death certificates. It also restricts the nurse's ability to become the primary care provider in some circumstances.

One such state is Arkansas. In particular, Arkansas restricted nurses to their ability to practice autonomously; they must do so in accordance or in conjunction with a licensed physician. Although they are able to order physical therapy and sign placard cards for those who are disabled, they cannot sign POLST forms. Also, 300 hours of experience need to be earned before being allowed to autonomously prescribe medications.

Alabama, for example, is one such state that is mainly autonomous but limits its NPs. Most nurses are allowed to sign death certificates, prescribe medication, and sign placard cards, but cannot operate independently. Most medication can be prescribed but must usually be co-signed.

Most states fall into the category of full or restricted, but other states that have reduced authority include, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Jersey, Ohio, Pennsylvania, Utah, West Virginia, and Wisconsin.

Which States have Restricted Practice?

States with a restricted practice mean that the nurse practitioner is not able to perform one or more of the duties that would otherwise fall within their scope. While a state with full practice would grant full autonomy, a reduced one would limit their ability. The restricted practice bars them from doing one or more things altogether. These are usually very limited due to their observance of professional medical care.

They are notably encountered in California, Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia - with Georgia being restrictive in most categories.