Can Nurse Practitioners Prescribe Medication?

The ability to prescribe medications is a crucial part of administering quality health care. Although highly educated and trained, the power to independently prescribe medications for nurse practitioners varies from state to state.

Currently, only 27 states plus Washington, D.C. and Guam allow full practice authority, which allows nurse practitioners to prescribe medications without the supervision of a physician. In states with restricted or reduced practice authority, NPs are rallying for full practice authority and securing legislative victories during the pandemic.

Can Nurse Practitioners Prescribe Medication Without Physicians?

Yes, nurse practitioners can prescribe medications in all 50 states. This includes the power to prescribe antibiotics, narcotics, and other Schedule II drugs such as Adderall. 

However, whether this task requires physician supervision depends on each state's practice authority. Some states require additional applications, training, and supervision to prescribe medications, while others grant full practice authority to NPs.

Furthermore, in some states, NPs must enroll in the Prescription Drug Monitoring Program and/or Controlled Substances Reporting System. NPs must register with specific states before practicing. If employed and licensed in multiple states, they must register in each state. Physicians also must enroll in these programs in order to monitor opioid prescription distribution and combat the ongoing opioid epidemic.

What Medications Can’t an NP Prescribe?

NPs can prescribe ALL types of medications including narcotics and chemotherapy but it specifically depends on the state of practice. For example, an NP in New York can prescribe Oxycodone, a Schedule II drug and narcotic, to their patients without the approval of a medical doctor as long as they are properly registered in the state. 

On the other hand, an NP in Florida, a state with restricted practice, can not prescribe Schedule II drugs and is severely limited in its prescriptive authority.

All drugs (including medications) and substances are classified into five categories according to the Drug Enforcement Administration (DEA). Medical providers, including NPs, do not prescribe Schedule I drugs. However, one exception is prescribing marijuana. While marijuana is considered a Schedule I drug, it also has become legal in some states and used to treat a variety of illnesses and ailments. 

Schedule	Explanation	Examples
Schedule I	Drugs with no currently accepted medical use and high potential for abuse.	Heroin, LSD, Marijuana
Schedule II	Drugs with a high potential for abuse, potentially leading to severe psychological or physical dependence.	Vicodin, Oxycodone, Adderall
Schedule III	Drugs with a moderate to low potential for physical and psychological dependence.	Tylenol with codeine, anabolic steroids, testosterone
Schedule IV	Drugs with a low potential for abuse and low risk of dependence.	Xanax, Ativan, Tramadol
Schedule V	Drugs with lower potential for abuse. Drugs are used for antidiarrheal, antitussive, and analgesic purposes.	Motofen, Lyrica,

Nurse Practitioner Practice Authority

Practice authority refers to the powers a nurse practitioner legally has to provide healthcare. These are set forth by the state and require legislation to change.

The American Association of Nurse Practitioners defines three statuses of practice authority:

Full Practice

“State practice and licensure laws permit all NPs to 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.”

Reduced Practice

“State practice and licensure laws reduce the ability of NPs to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice.”

Restricted Practice 

“State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care.”

Nurse Practitioners must be aware of the privileges and limitations in their state’s practice authority.

Nurse Practitioner Prescriptive Authority by State

The practice authority for NPs varies by state. Here's where each state stands as of 2025.

Full Practice Authority States

• Alaska
• Arizona
• Colorado
• Connecticut
• Delaware
• Guam
• Hawaii
• Idaho
• Iowa
• Kansas
• Maine
• Maryland
• Massachusetts
• Minnesota
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Mexico
• New York
• North Dakota
• Northern Mariana Islands
• Oregon
• Rhode Island
• South Dakota
• Utah
• Vermont
• Washington
• Washington, D.C.
• Wyoming

Reduced Practice Authority States

• Alabama
• American Samoa
• Arkansas
• Illinois
• Indiana
• Kentucky
• Louisiana
• Mississippi
• New Jersey
• Ohio
• Pennsylvania
• Puerto Rico
• Virgin Islands
• West Virginia
• Wisconsin

Restricted Practice Authority States

• California
• Florida
• Georgia
• Michigan
• Missouri
• North Carolina
• Oklahoma
• South Carolina
• Tennessee
• Texas
• Virginia

History of Nurse Practitioner Scope of Practice

The history of nurse practitioners dates back to 1965 with the development of its first program at the University of Colorado. Initially developed as a certificate program, it later became a master’s program in the 1970s. By 1973 there were more than 65 NP programs in the United States and a National Association of Pediatric Nurse Practitioners.

During the 1990s, nurse practitioners continued to fight for legitimacy in healthcare in the courts and the workplace. The Balanced Budget Act of 1997 granted NPs direct reimbursement and by 2000 NPs were legally able to practice in all 50 states. 

In 2004, the American Association of Colleges of Nursing (AACN) began its initiative to require all NP master’s programs to transition into Doctor of Nursing Practice (DNP) programs. 

The AACN initially hoped to reach this goal by 2015. However, in a study released in October 2014, the AACN’s Task Force on the Implementation of the DNP stated that less than a quarter of NP programs had transitioned into DNP programs.

Beginning in the fall of 2008, the CCNE started to accredit NP programs as a doctorate. As of 2024, 373 DNP programs have been accredited by CCNE