According to the U.S. Bureau of Labor Statistics, the number of nurse practitioners in America is anticipated to grow 28.2% between 2018 and 2028, making this profession one of the nation’s fastest-growing fields.
The increase is largely due to the fact that nurse practitioners fill healthcare gaps left behind by an older, retiring physician workforce and a lack of physicians in underserved communities, such as rural areas. Trained to work on their own, family nurse practitioners (FNPs) have the ability to do virtually anything physicians can do. Recognizing this reality, the National Academy of Medicine and the National Council of State Boards of Nursing, among others, recommend that FNPs be permitted to evaluate, diagnose, and treat patients independently.
State laws sometimes—but not always—prevent FNPs from operating in this manner. Regulations differ from one state to another, with some states allowing FNPs full autonomy and others restricting their authority to various degrees. Before entering practice, newly graduated FNPs should understand the rules under which they will be operating in different states and choose a practice area that suits their needs.
This knowledge can be obtained through academic programs, such as Duquesne University’s Family (Individual Across the Lifespan) Nurse Practitioner online MSN. Also offering Post-Master’s Certificate programs to meet the needs of all healthcare providers, Duquesne’s online master’s in nursing helps candidates understand nurse practitioner state laws as they embark on MSN careers.
Scope of Practice
The American Association of Nurse Practitioners (AANP) keeps a database of state laws regarding FNP practice. Specific rules and regulations vary widely but, in general, an FNP’s permitted scope of practice falls into one of three categories:
In full-practice states, nurse practitioners may legally evaluate patients; diagnose patients; order and review the results of diagnostic tests; and determine/manage patients’ course of treatment. This level of authority includes prescribing medications and controlled substances and operating independent practices.
Full-practice states: According to the AANP, full-practice states and territories as of January 2020 were Alaska, Arizona, Colorado, Connecticut, Guam, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Northern Mariana Islands, Oregon, Rhode Island, South Dakota, Vermont, Washington state, Washington, D.C., and Wyoming.
In reduced-practice states, the laws give nurse practitioners some authority but reduce their rights in certain areas. In some states, this policy means that nurse practitioners must have an ongoing, career-long collaborative arrangement with a physician to be able to provide services. A restriction on the right to prescribe certain medications is another common scope-of-practice limitation.
Reduced-practice states: According to the AANP, reduced-practice states and territories as of January 2020 were Alabama, American Samoa, Arkansas, Delaware, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, New Jersey, New York, Ohio, Pennsylvania, Puerto Rico, Utah, the Virgin Islands, and Wisconsin.
In restricted-practice states, nurse practitioners are restricted from engaging independently in at least one element of healthcare practice. By law, they must be supervised by a physician throughout their career or be otherwise subject to delegation or team management.
Restricted practice states: According to the AANP, restricted-practice states as of January 2020 were California, Florida, Georgia, Massachusetts, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia.
States with the Fewest Restrictions to Practice
For FNPs who want to practice autonomously, any of the full-practice states offer a welcoming professional environment. Such states include:
Not only does Washington give FNPs full autonomy, it also confers prescribing privileges, including the ability to prescribe medical marijuana.
Arizona has virtually no restrictions on FNP practice. It requires only that NPs must practice within their area of specialty and certification.
New Mexico offers practice autonomy for FNPs plus a $3,000 tax credit and tuition reimbursement to qualified candidates who work in underserved areas, particularly rural areas.
Most Restrictive States to Practice
At the other end of the spectrum are a handful of states that significantly restrict nurse practitioners’ authority. Severely restricted-practice states include:
- NPs cannot diagnose or treat patients in Florida without physician involvement, and they can only prescribe certain limited medications. State law does not define whether NPs can be primary care providers.
- Despite a severe shortage of primary care providers in rural areas, Georgia has thus far not lifted restrictions to give NPs more autonomy.
- The state of Tennessee places significant restrictions on NPs, and physicians in the state have actively opposed scope-of-practice expansion for NPs.
Although significant restrictions on FNPs still exist nationwide, the trend is toward greater autonomy. The website Nurse.com points out that in the past 10 years, 10 states have removed some restrictions on nurse practitioners, and legislation is in the works to loosen things further. According to the National Nurse-Led Care Consortium, full-practice authority bills are currently pending in Pennsylvania and Massachusetts. So-called barrier reduction bills, which do not necessarily authorize full authority but which reduce some restrictions on nurse practitioners, are pending in seven states: California, Florida, Indiana, New Jersey, North Carolina, Ohio, and Texas.
As America’s healthcare shortages deepen, holdout states are becoming more likely to see the advantages of granting full autonomy to nurse practitioners. In the meantime, newly graduated FNPs should carefully evaluate their practice options when seeking employment in any state.
About Duquesne University’s Online MSN-FNP and FNP Post-Master’s Certificate Programs
As a leader in online nursing education, Duquesne University has helped RNs and APRNs learn skills, strategies, and evidence-based practices to become FNPs. The coursework is presented entirely online, so students can maintain their careers and personal lives while pursuing their education goals. Graduates are prepared to successfully complete the American Academy of Nurse Practitioners Certification Board (AANPCP) and American Nurses Credentialing Center (ANCC) Family Nurse Practitioner certification examinations.
Duquesne offers six online MSN tracks: Nursing Education, Family Nurse Practitioner, Forensic Nursing, Psychiatric-Mental Health Nurse Practitioner, Adult-Gerontology Acute Care Nurse Practitioner, and Executive Nurse Leadership and Healthcare Management.
For more information, contact Duquesne University today.
Anticipated growth of nurse practitioner profession – U.S. Bureau of Labor Statistics
Organizations recommending independent FNP practice – Business Insider
Scope of practice – American Association of Nurse Practitioners
Best states to practice – Florence Health
Worst states to practice – Business Insider
States removing barriers in past 10 years – Nurse.com
Pending legislation – National Nurse-Led Care Consortium