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:
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.
| 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 |
A lack of access to primary care in the United States is one of the key reasons why the Commonwealth Fund ranks the U.S. as having the worst healthcare system in the affluent world. Looking to the future, the impending primary care provider shortage indicates that this problem is only to going to intensify, particularly in the South and Midwest.
Given the overwhelming evidence that NPs provide cost-effective, safe healthcare for their patients, it’s time for Oklahoma to disabuse itself of unnecessary practice restrictions so that NPs can help alleviate the looming primary care provider shortage.
Primary care, when accessible and publicized in communities, has been proven to diminish health disparities between social classes. The future of healthcare in the Northwest and all over the country is dependent on the reform insurance systems, policy, and education, among other aspects.
