Full Practice Authority for Nurse Practitioners by State

The role of nurse practitioners (NPs) in healthcare is crucial for providing comprehensive and accessible care to patients. However, the scope of practice for nurse practitioners differs across states due to varying regulations. 

In this article, we explore the concept of practice authority for nurse practitioners. We'll examine the state-by-state variation of NP scope of practice and their impact on expanding NP roles. In doing so, we'll also identify barriers and opportunities to empower NPs in delivering high-quality care and improving patient access nationwide.

Read on to learn about what full practice authority means, NP full practice authority states, and the benefits and arguments against expanding NP scope of practice.

What Is Full Practice Authority and What Does It Mean?

Full practice authority (FPA) refers to an NP's ability to practice to the full extent of their education, training, and competence, according to the American Nurses Association (ANA). The ANA fully supports full practice authority for NPs in APRN states. 

The American Association of Nurse Practitioners (AANP) offers a more specific definition of full practice authority: 

“[FPA is] the collection of state practice and licensure laws that allow for nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing.”

In full practice authority states, NPs can:

• Evaluate patients
• Diagnose medical conditions
• Initiate and manage healthcare treatment plans
• Order and interpret diagnostic tests
• Prescribe medications
• Provide other healthcare services without physician oversight or collaboration

Essentially, states with FPA are states where nurse practitioners can practice independently. They have the autonomy to make clinical decisions, enabling them to deliver primary and specialized healthcare services to patients. 

This model recognizes NPs’ unique expertise and aims to maximize their contribution to the healthcare system while increasing access to high-quality care.

Types of Nurse Practitioner Practice Authority

There are three levels of practice authority granted to nurse practitioners in the US. These include full, reduced, and restricted practice. Let’s take a closer look at each type of NP practice authority and how it impacts their practice:

Full Practice Authority

Full practice authority means NPs can diagnose, treat, prescribe medications, and manage patient care without physician oversight or collaboration. They have the autonomy to practice to the full extent of their education and training.

Reduced Practice Authority

In states with reduced practice authority, nurse practitioners have limitations on their ability to practice independently. They may require a collaborative agreement or supervision by a physician to perform certain activities, like prescribing medications or ordering diagnostic tests.

Restricted Practice Authority

In areas with restricted practice authority, nurse practitioners have more significant limitations on their practice. They may have to work under the direct supervision of a physician, limiting their autonomy and decision-making authority.

Full Practice Authority States for Nurse Practitioners

The AANP’s Interactive State Practice Environment map shows NP practice authority in every state, Washington D.C., and all US territories.

>> Related: What is Autonomy in Nursing?

Nurse Practitioner Full Practice Authority States

1. Alaska
2. Arizona
3. Colorado
4. Connecticut
5. Delaware
6. Guam
7. Hawaii
8. Idaho
9. Iowa
10. Kansas
11. Maine
12. Maryland
13. Massachusetts
14. Minnesota
15. Montana
16. Nebraska
17. Nevada
18. North Dakota
19. New Hampshire
20. New Mexico
21. New York
22. Northern Mariana Islands
23. Oregon
24. Rhode Island
25. South Dakota
26. Utah
27. Vermont
28. Washington
29. Washington D.C.
30. Wyoming

Nurse Practitioner Reduced Authority States

1. Alabama
2. American Samoa
3. Arkansas
4. Illinois
5. Indiana
6. Kentucky
7. Louisiana
8. Mississippi
9. New Jersey
10. Ohio
11. Pennsylvania
12. Puerto Rico
13. U.S. Virgin Islands
14. West Virginia
15. Wisconsin

Nurse Practitioner Restricted Authority States

1. California
2. Florida
3. Georgia
4. Michigan
5. Missouri
6. North Carolina
7. Oklahoma
8. South Carolina
9. Tennessee
10. Texas
11. Virginia

Benefits of Full Practice Authority for Nurse Practitioners

Proponents of full practice authority for nurse practitioners say that the model brings several benefits, such as:

Increased Access to Care

NPs in full-practice authority states may help address the growing demand for primary care providers, especially in rural and underserved areas. 

By removing restrictive regulations, NPs can independently deliver comprehensive healthcare services. This expanded scope of practice helps to bridge the gap in access to care, particularly in rural or remote communities.

Better Healthcare Efficiency

Full practice authority for nurse practitioners can also help reduce unnecessary patient care delays. 

With FPA, NPs can initiate and manage treatment plans more efficiently. This autonomy improves patient outcomes, reduces wait times, and increases healthcare system efficiency.

Lower Healthcare Costs

A nurse practitioner with full practice authority is often more cost-effective than physicians, as they provide similar quality care at a lower cost. 

With increased autonomy, NPs can make independent decisions regarding patient care, resulting in more streamlined and cost-conscious healthcare delivery.

Patient Satisfaction

Research demonstrates that patients are highly satisfied with the care provided by NPs. 

Known for their patient-centered approach, NPs spend ample time with patients, actively listen to their concerns, and engage in shared decision-making. FPA allows NPs to practice in a manner that aligns with their patient-centered philosophy, leading to higher patient satisfaction rates.

Arguments Against Full Practice Authority for Nurse Practitioners

While the movement towards creating more full-practice authority states for NPs has gained significant momentum, there are still arguments against it. 

It's important to note that healthcare professionals do not universally agree with these arguments against FPA. There are ongoing debates and discussions regarding the best practice model for NPs. Many states have already implemented FPA for NPs, citing positive outcomes and patient satisfaction.

However, some arguments against FPA for NPs include the following:

Patient Safety

Opponents of full practice authority for NPs may argue that independent practice without physician oversight could compromise patient safety. They may also suggest that physicians with extensive medical training and experience are better equipped to handle complex medical cases and diagnose rare conditions. 

Variability in Education and Training

Without regulations and physician involvement, critics worry about the variability in NP education. They suggest that it could lead to inconsistent care quality and patient outcomes.

Fragmentation of Healthcare

Opponents also argue that independent practice by NPs may result in separate care delivery systems. They claim this outcome would lead to poor coordination and communication among healthcare providers. Therefore, these critics reject independent practice for NPs, arguing that physician oversight and guidance promote patient safety.

History of Expanding Nurse Practitioner Scope of Practice

The movement to expand nurse practitioner authority has gained momentum in recent years. As a result, an increasing number of states and countries are implementing legislative changes to grant NPs full practice authority.

The push for expanding NP authority goes back several decades. The AANP and other nursing organizations have advocated removing regulatory barriers to NPs' practice authorities. They strive to allow NPs the autonomy to practice to the full breadth of their education and training.

Here are some historical developments and legislative milestones:

1965: Dr. Loretta Ford and Dr. Henry Silver created the first-ever NP program at the University of Colorado.

1973: There are over 65 nurse practitioner programs by this year.

1980s: According to Kaiser Health News, Alaska, New Hampshire, Oregon, and Washington emerged as pioneers by adopting progressive nurse licensing authority.

2001: There are about 82,000 nurse practitioners in the US at this time

2020: Florida NPs became eligible to apply for an unrestricted license if they have completed 3,000 hours of supervised practice under the guidance of a licensed MD or DO within the past five years.

2021: Introduction of Pennsylvania State Bill 25. This bill would allow NPs in Pennsylvania to practice independently without physician oversight after completing a three-year, 3,600-hour collaboration agreement with a physician. The bill is pending further action.

2023: Utah became the 27th state to embrace full practice authority for NPs.

2024: At present, there are 30 full practice authority states and U.S. territories for nurse practitioners, including Washington, D.C.