How Does Nurse Practitioner Authority Vary By State?

October 26, 2020 | Staff Writers

The ability of nurse practitioners to work to the full extent of their training and education is an issue which affects NPs nationwide. As documented in recent interviews with some of Michigan’s nurse practitioners and researchers, the fight for full practice authority (FPA) is crucial to help meet the growing demand for qualified providers (particularly in rural areas) and to keep costs down with safe, effective healthcare services. While the VA, the AARP, the FTC, the Institute of Medicine, the Bipartisan Policy Center and many others advocate for granting FPA to NPs, many physician organizations still oppose these efforts. As Dr. Denise Hershey of Michigan State University stated in her 2017 interview, “The biggest challenge in this fight is getting the physician groups to understand that we are not in competition with them; as NPs, we are members of a healthcare team, which includes our physician colleagues and other healthcare professionals the patient may need. As a team, we need to work collaboratively in order to improve the health of our patients.”

The first step toward granting NPs full authority nationwide is to understand the current state practice environments. The American Association of Nurse Practitioners (AANP 2017) broadly defines three practice authority statuses nationwide:

Full practice: “State practice and licensure law provides for all 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:.”
Reduced practice: “State practice and licensure law reduces the ability of nurse practitioners to engage in at least one element of NP practice. State law requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care or limits the setting or scope of one or more elements of NP practice.”
Restricted practice: “State practice and licensure law restricts the ability of a nurse practitioner to engage in at least one element of NP practice. State requires supervision, delegation, or team-management by an outside health discipline in order for the NP to provide patient care.”

It’s important to note that due to the tireless efforts of NP legislative advocacy, the state practice environments are continually evolving and great efforts will be made to keep this information up-to-date. This table examines the status of NP practice authority across US states, including information about Prescriptive Authority:, links to local boards of nursing and Practice Act:s, and other details.

NP Practice Authority by State

State	Prescriptive Authority:	Board of Nursing:	Practice Act:	Details & Resources:
Alabama	Collaborative practice under authority of a physician	AL Board of Nursing	AL Board of Nursing Administrative Code	Prescriptive authority is regulated by the AL Board of Medical Examiners ( Code of AL 1975)
Alaska	Full authority with licensure	AK Board of Nursing	AK Nursing Statutes (article 4)	Separate application to prescribe schedule 2-5 controlled substances
Arizona	Full authority with DEA registration	AZ Board of Nursing	AZ Nursing Statutes, AZ Nurse Practice Act	Must complete a Controlled Substance Prescription Monitoring Program (CSPMP) application
Arkansas	Requires collaborative practice agreement with a supervising physician	AR Board of Nursing	AR Nurse Practice Act	Must also submit a quality assurance (QA) plan with collaborative practice agreement
California	Requires supervision of a physician or surgeon	CA Board of Nursing	CA Nursing Practice Act	Prescribing medication or medical devices requires a “furnishing number”
Colorado	Full privileges after 1,000 hours with “provisional prescriptive authority”	CO Board of Nursing	CO Board of Nursing Laws	NP must have a mentoring NP or physician while accruing 1,000 hours with provisional prescriptive authority
Connecticut	Full authority with licensure after three years of collaborative practice under physician	CT Board of Examiners for Nursing	CT Nurse Practice Laws	NPs must maintain professional liability insurance
Delaware	Requires a collaborative agreement with a physician unless NP has special permission from the Board	DE Board of Nursing	DE Nursing Laws	“Advanced practice nurses desiring to practice independently or to prescribe independently must do so pursuant to § 1906(a)(20) of Title 24”
District of Columbia	Full authority with licensure	DC Board of Nursing	DC Nurse Practice Act	“An advanced practice registered nurse may initiate, monitor, and alter drug therapies”
Florida	Requires supervision of a physician or surgeon	FL Board of Nursing	FL Nurse Practice Act	NPs must have proof of malpractice insurance or an exemption
Georgia	Requires a “protocol agreement” with a supervising physician	GA Board of Nursing	GA Nurse Practice Act	Prescriptive authority for advanced practice registered nurses is regulated by the Georgia Composite Medical Board
Hawaii	Full authority with APRN licensure	HI Board of Nursing	HI Nursing Statutes (subchapter 14)	For prescriptive authority, NPs must show proof of 30 qualifying contact hours (i.e., continuing education or CE)
Idaho	Full authority with APRN licensure	ID Board of Nursing	ID Nurse Practice Act	For prescriptive authority, NP must show proof of 30 qualifying CE hours in pharmacology
Illinois	Requires a written collaborative agreement with a supervising physician or other healthcare professional	IL Board of Nursing	IL Nurse Practice Act	The IL Practice Act’s section on APNs is scheduled to be repealed in January 2018; please check back with the IL BoN for changes
Indiana	Requires a collaborative practice agreement with a supervising medical professional	IN State Board of Nursing	IN Nurse Practice Act	Requires separate applications for Controlled Substances Registration (CSR) and the provision of telemedicine
Iowa	Full authority with advanced registered nurse practitioner (ARNP) licensure	IA Board of Nursing	IA Nurse Practice Act	“In Iowa an ARNP may practice independently within their specialty area”
Kansas	Requires a written protocol from a responsible physician	KS State Board of Nursing	KS Nurse Practice Act	“The advanced practice registered nurse may not dispense drugs, but may request, receive and sign for professional samples and may distribute professional samples to patients pursuant to a written protocol as authorized by a responsible physician”
Kentucky	Requires a written agreement (CAPA-NS) with a supervising physician or other healthcare provider	KY Board of Nursing	KY Nurse Practice Act	CAPA-NS stands for “Collaborative Agreement for the Advanced Practice Registered Nurse’s Prescriptive Authority for Nonscheduled Legend Drugs”
Louisiana	Requires a Collaborative Practice Agreement (CPA) with a physician	LA Board of Nursing	LA Nurse Practice Act	For initial prescriptive authority, NPs must have all qualifying contact hours of education, including 45 hours of pharmacology
Maine	Full authority with APRN licensure	ME Board of Nursing	ME Nurse Practice Act	“When a provision of law or rule requires a signature, certification, stamp, verification, affidavit or endorsement by a physician, that requirement may be fulfilled by a certified nurse practitioner”
Maryland	Full authority with APRN licensure	MD Board of Nursing	MD Nurse Practice Act	Physicians and NPs in MD must register with the Prescription Drug Monitoring Program (PDMP), an attempt to combat opioid abuse in the state
Massachusetts	Under the authority of a supervising physician	MA Board of Nursing	MA Nursing Statutes	Certified nurse practitioners (CNPs) must register with the Department of Public Health and DEA for prescriptive authority
Michigan	Can prescribe nonscheduled drugs, but NPs need physician oversight to prescribe schedule 2-5 drugs	MI Board of Nursing	MI Public Health Code (1978)	For a detailed look at the state of practice authority in MI, please visit Michigan Nurse Practitioners: The Fight for Full Practice Authority
Minnesota	Full authority with APRN registration	MN Board of Nursing	MN Nurse Practice Act	“APRNs can prescribe, procure, sign for, record, administer, and dispense OTC, legend, and controlled substances, including sample drugs”
Mississippi	Under the supervision of a collaborative or consulting physician	MS Board of Nursing	MS Nursing Practice Law	“Each collaborative /consultative relationship shall include and implement a formal quality assurance / quality improvement program which shall be maintained on site and shall be available for inspection by representatives of the board”
Missouri	Requires a Collaborative Practice Agreement (CPA) with a supervising physician	MO Board of Nursing	MO Nursing Rules & Statutes	To get prescriptive authority for controlled substances, MO NPs need not only a CPA, but also proof of 300 hours of guided pharmacological experience and 1,000 practice hours
Montana	Full authority with APRN licensure and Prescriptive Authority application	MT Board of Nursing	MT Nurse Practice Act	Must have completed three course prerequisites: pharmacology, differential diagnosis / disease management, and a supervised clinical practicum
Nebraska	Full authority following Controlled Substance Registration with the DEA	Nebraska Center for Nursing	NE Nursing Regulations & Statutes (including NP Act)	Prescriptive authority requires at least 30 qualifying contact hours in pharmacology
Nevada	Full authority with a license from the NV Board of Pharmacy	NV Board of Nursing	NV Nurse Practice Act	Similar to other states, NV NPs must register with the DEA to prescribe controlled substances
New Hampshire	Full authority with APRN licensure	NH Board of Nursing	NH Nurse Practice Act	“An APRN shall have plenary authority to possess, compound, prescribe, administer, and dispense and distribute to clients controlled and noncontrolled drugs within the scope of the APRN’s practice”
New Jersey	Requires a “joint protocol” with a collaborating physician	NJ Board of Nursing	NJ Board of Nursing Law	In addition to physician oversight, APRNs need at least six extra hours of pharmacological education to prescribe medications and devices
New Mexico	Full prescriptive authority with DEA registration and state certification	NM Board of Nursing	NM Nurse Practice Act	“Certified nurse practitioners may practice independently and make decisions regarding health care needs of the individual, family or community and carry out health regimens, including the prescription and distribution of dangerous drugs and controlled substances included in Schedules II through V of the Controlled Substances Act”
New York	Newly certified NPs must have a written collaborative agreement and protocol with a physician and pursue DEA registration	NY Board of Nursing	NY Nurse Rules & Regulations	NPs with more than 3,600 hours of qualifying experience may opt for a “collaborative relationship,” which offers relatively more professional autonomy than the written agreement
North Carolina	Prescriptive authority requires a supervising physician and use of the Controlled Substances Reporting System (CSRS)	NC Board of Nursing, NC Medical Board	NC Nurse Practice Act	NPs are regulated by both the NC Board of Nursing and the Medical Board
North Dakota	Full authority with application for prescriptive privileges	ND Board of Nursing	ND Nurse Practice Act	Requires 30 hours of qualifying pharmacological education; NPs in ND are also encouraged to participated in the state’s Prescription Drug Monitoring Program
Ohio	A certificate to prescribe requires a “standard care agreement” with a collaborating physician	OH Board of Nursing	OH Board of Nursing Laws & Rules	Initial Certificate of Authority (COA) allows NPs to prescribe schedule 2 controlled and noncontrolled substances
Oklahoma	Requires a written collaborative agreement with a physician licensed by the State Medical Board or Board of Osteopathic Examiners	OK Board of Nursing	OK Nurse Practice Act	To qualify for initial (supervised) prescriptive authority, NP must have at least 45 qualifying contact hours or a three-unit course in pharmacology
Oregon	Full prescriptive authority with APRN licensure	OR Board of Nursing	OR Nursing Rules & Procedures	To qualify for OR NP license, candidates must have completed a program within two years or fulfill experience requirements (192 contact hours in previous two years or 960 hours in five years)
Pennsylvania	Requires a collaborative agreement with a physician and DEA registration (for controlled substances)	PA Board of Nursing	PA Code of Nursing	Collaborative agreements with physicians must be reviewed and updated every two years
Rhode Island	Full prescriptive authority with Uniform Controlled Substances Act Registration (CSR)	RI Board of Nursing	RI Nursing Rules & Regulations	NPs in RI boast “global signature authority” equivalent to physicians
South Carolina	Requires an approved written protocol with a collaborating physician	SC Board of Nursing	SC Nurse Practice Act	“In addition to those activities considered the practice of registered nursing, an APRN may perform delegated medical acts”
South Dakota	Requires a collaborative agreement with a physician and DEA registration (for controlled substances)	SD Board of Nursing	SD Laws & Regulations	Please note that effective October 2016, SD relaxed the collaborative agreement rules and physicians no longer have to be on-site every 90 days
Tennessee	Requires written protocol with a supervising physician	TN Board of Nursing	TN Nursing Statutes	TN also requires DEA registration, the creation of a “Practitioner Profile,” and registration with the Controlled Substance Monitoring Data (CSMD) site
Texas	Requires a separate application, a written “prescriptive delegation” from a supervising physician, DEA registration for controlled substances, and registration with TX Department of Public Safety	TX Board of Nursing	TX Nursing Practice Act	TX recently eliminated the requirement of on-site physician supervision
Utah	Requires a UT Controlled Substances License, DEA registration, and at least two years (or 2,000) hours of post-licensure experience (to prescribe schedule 2 controlled substances)	UT Board of Nursing	UT Nurse Practice Act (under Statutes & Rules)	In the psychiatric NP specialty, candidates for prescriptive authority must complete 3,000 post-licensure hours of clinical practice
Vermont	Full practice after fulfilling “transition to practice” hours under a collaborative agreement with a physician, DEA registration, and VT Prescription Monitoring System (VPMS) registration	VT Board of Nursing	VT Nursing Statutes	Following at least one year (1,600 practice hours), NPs may qualify for a “transition to practice”
Virginia	NPs with less than five years of full-time, clinical experince need a “practice agreement” with a collaborating physician	VA Board of Nursing	VA Nursing Laws & Regulations	To qualify for prescriptive authority, VA NPs must have at least 1,000 hours of qualifying experience or 30 credit hours of pharmacology education
Washington	Full authority with prescriptive privileges application	WA Nursing Commission	WA Nursing Care Laws	WA NPs may “prescribe legend drugs and Schedule V controlled substances, as defined in the Uniform Controlled Substances Act”
West Virginia	Authority to prescribe after three documented years of experience under a collaborative agreement and with conditions (e.g., schedule III drugs limited to a 30-day supply)	WV Board of Nursing	WV Nursing Code	“…those categories of drugs which shall not be prescribed by advanced practice registered nurse including, but not limited to, Schedules I and II of the Uniform Controlled Substances Act, antineoplastics, radiopharmaceuticals and general anesthetics”
Wisconsin	Requires “certification as an advanced practice nurse prescriber” with proof of collaborative physician agreement	WI Board of Nursing	WI Nursing Laws & Regulations	“Advanced practice nurse prescribers shall work in a collaborative relationship… with a physician, in each other’s presence when necessary, to deliver health care services within the scope of the practitioner’s training, education, and experience”
Wyoming	Full privileges with prescriptive authority application	WY Board of Nursing	WY Nursing Statutes	Prescriptive authority requires at least 30 contact hours of education in pharmacology

Jocelyn Blore

Editor

Jocelyn Blore is the Managing Editor of NursePractitionerSchools.com. After graduating from UC Berkeley, Jocelyn traveled the world for five years as freelance writer and English teacher. After stints in Japan, Brazil, Nepal, and Argentina, she took an 11-month road trip across the US, finally settling into lovely Eugene, OR. When Jocelyn isn’t writing about college programs or interviewing professors, she satirizes global politics and other absurdities at Blore’s Razor (Instagram: @bloresrazor). Thank you for being interested.

Dr. Melissa DeCapua, DNP, PMHNP-BC

Author

Melissa DeCapua is a board-certified psychiatric nurse practitioner who graduated from Vanderbilt University. She has a background in child and adolescent psychiatry as well as psychosomatic medicine. Uniquely, she also possesses a bachelor’s degree in studio arts, which she uses to enhance patient care, promote the nursing profession, and solve complex problems. Melissa currently works as the Healthcare Strategist at a Seattle-based health information technology company where she guides product development by combining her clinical background and creative thinking. She is a strong advocate for empowering nurses, and she fiercely believes that nurses should play a pivotal role in shaping modern health care. For more about Melissa, check out her blog www.melissadecapua.com and follow her on Twitter @melissadecapua.

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