How Does Nurse Practitioner Authority Vary By State?

How Does Nurse Practitioner Authority Vary By State?

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

StatePrescriptive Authority:Board of Nursing:Practice Act:Details & Resources:
AlabamaCollaborative practice under authority of a physicianAL Board of NursingAL Board of Nursing Administrative CodePrescriptive authority is regulated by the AL Board of Medical Examiners ( Code of AL 1975)
AlaskaFull authority with licensureAK Board of NursingAK Nursing Statutes (article 4)Separate application to prescribe schedule 2-5 controlled substances
ArizonaFull authority with DEA registrationAZ Board of NursingAZ Nursing StatutesAZ Nurse Practice ActMust complete a Controlled Substance Prescription Monitoring Program (CSPMP) application
ArkansasRequires collaborative practice agreement with a supervising physicianAR Board of NursingAR Nurse Practice ActMust also submit a quality assurance (QA) plan with collaborative practice agreement
CaliforniaRequires supervision of a physician or surgeonCA Board of NursingCA Nursing Practice ActPrescribing medication or medical devices requires a “furnishing number”
ColoradoFull privileges after 1,000 hours with “provisional prescriptive authority”CO Board of NursingCO Board of Nursing LawsNP must have a mentoring NP or physician while accruing 1,000 hours with provisional prescriptive authority
ConnecticutFull authority with licensure after three years of collaborative practice under physicianCT Board of Examiners for NursingCT Nurse Practice LawsNPs must maintain professional liability insurance
DelawareRequires a collaborative agreement with a physician unless NP has special permission from the BoardDE Board of NursingDE 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 ColumbiaFull authority with licensureDC Board of NursingDC Nurse Practice Act“An advanced practice registered nurse may initiate, monitor, and alter drug therapies”
FloridaRequires supervision of a physician or surgeonFL Board of NursingFL Nurse Practice ActNPs must have proof of malpractice insurance or an exemption
GeorgiaRequires a “protocol agreement” with a supervising physicianGA Board of NursingGA Nurse Practice ActPrescriptive authority for advanced practice registered nurses is regulated by the Georgia Composite Medical Board
HawaiiFull authority with APRN licensureHI Board of NursingHI Nursing Statutes  (subchapter 14)For prescriptive authority, NPs must show proof of 30 qualifying contact hours (i.e., continuing education or CE)
IdahoFull authority with APRN licensureID Board of NursingID Nurse Practice ActFor prescriptive authority, NP must show proof of 30 qualifying CE hours in pharmacology
IllinoisRequires a written collaborative agreement with a supervising physician or other healthcare professionalIL Board of NursingIL Nurse Practice ActThe IL Practice Act’s section on APNs is scheduled to be repealed in January 2018; please check back with the IL BoN for changes
IndianaRequires a collaborative practice agreement with a supervising medical professionalIN State Board of NursingIN Nurse Practice ActRequires separate applications for Controlled Substances Registration (CSR) and the provision of telemedicine
IowaFull authority with advanced registered nurse practitioner (ARNP) licensureIA Board of NursingIA Nurse Practice Act“In Iowa an ARNP may practice independently within their specialty area”
KansasRequires a written protocol from a responsible physicianKS State Board of NursingKS 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”
KentuckyRequires a written agreement (CAPA-NS) with a supervising physician or other healthcare providerKY Board of NursingKY Nurse Practice ActCAPA-NS stands for “Collaborative Agreement for the Advanced Practice Registered Nurse’s Prescriptive Authority for Nonscheduled Legend Drugs”
LouisianaRequires a Collaborative Practice Agreement (CPA) with a physicianLA Board of NursingLA Nurse Practice ActFor initial prescriptive authority, NPs must have all qualifying contact hours of education, including 45 hours of pharmacology
MaineFull authority with APRN licensureME Board of NursingME 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”
MarylandFull authority with APRN licensureMD Board of NursingMD Nurse Practice ActPhysicians and NPs in MD must register with the Prescription Drug Monitoring Program (PDMP), an attempt to combat opioid abuse in the state
MassachusettsUnder the authority of a supervising physicianMA Board of NursingMA Nursing StatutesCertified nurse practitioners (CNPs) must register with the Department of Public Health and DEA for prescriptive authority
MichiganCan prescribe nonscheduled drugs, but NPs need physician oversight to prescribe schedule 2-5 drugsMI Board of NursingMI 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
MinnesotaFull authority with APRN registrationMN Board of NursingMN Nurse Practice Act“APRNs can prescribe, procure, sign for, record, administer, and dispense OTC, legend, and controlled substances, including sample drugs”
MississippiUnder the supervision of a collaborative or consulting physicianMS Board of NursingMS 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”
MissouriRequires a Collaborative Practice Agreement (CPA) with a supervising physicianMO Board of NursingMO Nursing Rules & StatutesTo 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
MontanaFull authority with APRN licensure and Prescriptive Authority applicationMT Board of NursingMT Nurse Practice ActMust have completed three course prerequisites: pharmacology, differential diagnosis / disease management, and a supervised clinical practicum
NebraskaFull authority following Controlled Substance Registration with the DEANebraska Center for NursingNE Nursing Regulations & Statutes  (including NP Act)Prescriptive authority requires at least 30 qualifying contact hours in pharmacology
NevadaFull authority with a license from the NV Board of PharmacyNV Board of NursingNV Nurse Practice ActSimilar to other states, NV NPs must register with the DEA to prescribe controlled substances
New HampshireFull authority with APRN licensureNH Board of NursingNH 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 JerseyRequires a “joint protocol” with a collaborating physicianNJ Board of NursingNJ Board of Nursing LawIn addition to physician oversight, APRNs need at least six extra hours of pharmacological education to prescribe medications and devices
New MexicoFull prescriptive authority with DEA registration and state certificationNM Board of NursingNM 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 YorkNewly certified NPs must have a written collaborative agreement and protocol with a physician and pursue DEA registrationNY Board of NursingNY Nurse Rules & RegulationsNPs 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 CarolinaPrescriptive authority requires a supervising physician and use of the Controlled Substances Reporting System (CSRS)NC Board of NursingNC Medical BoardNC Nurse Practice ActNPs are regulated by both the NC Board of Nursing and the Medical Board
North DakotaFull authority with application for prescriptive privilegesND Board of NursingND Nurse Practice ActRequires 30 hours of qualifying pharmacological education; NPs in ND are also encouraged to participated in the state’s Prescription Drug Monitoring Program
OhioA certificate to prescribe requires a “standard care agreement” with a collaborating physicianOH Board of NursingOH Board of Nursing Laws & RulesInitial Certificate of Authority (COA) allows NPs to prescribe schedule 2 controlled and noncontrolled substances
OklahomaRequires a written collaborative agreement with a physician licensed by the State Medical Board or Board of Osteopathic ExaminersOK Board of NursingOK Nurse Practice ActTo qualify for initial (supervised) prescriptive authority, NP must have at least 45 qualifying contact hours or a three-unit course in pharmacology
OregonFull prescriptive authority with APRN licensureOR Board of NursingOR Nursing Rules & ProceduresTo 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)
PennsylvaniaRequires a collaborative agreement with a physician and DEA registration (for controlled substances)PA Board of NursingPA Code of NursingCollaborative agreements with physicians must be reviewed and updated every two years
Rhode IslandFull prescriptive authority with Uniform Controlled Substances Act Registration (CSR)RI Board of NursingRI Nursing Rules & RegulationsNPs in RI boast “global signature authority” equivalent to physicians
South CarolinaRequires an approved written protocol with a collaborating physicianSC Board of NursingSC Nurse Practice Act“In addition to those activities considered the practice of registered nursing, an APRN may perform delegated  medical acts”
South DakotaRequires a collaborative agreement with a physician and DEA registration (for controlled substances)SD Board of NursingSD Laws & RegulationsPlease note that effective October 2016, SD relaxed the collaborative agreement rules and physicians no longer have to be on-site every 90 days
TennesseeRequires written protocol with a supervising physicianTN Board of NursingTN Nursing StatutesTN also requires DEA registration, the creation of a “Practitioner Profile,” and registration with the Controlled Substance Monitoring Data (CSMD) site
TexasRequires a separate application, a written “prescriptive delegation” from a supervising physician, DEA registration for controlled substances, and registration with TX Department of Public SafetyTX Board of NursingTX Nursing Practice ActTX recently eliminated the requirement of on-site physician supervision
UtahRequires 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 NursingUT 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
VermontFull practice after fulfilling “transition to practice” hours under a collaborative agreement with a physician, DEA registration, and VT Prescription Monitoring System (VPMS) registrationVT Board of NursingVT Nursing StatutesFollowing at least one year (1,600 practice hours), NPs may qualify for a “transition to practice
VirginiaNPs with less than five years of full-time, clinical experince need a “practice agreement” with a collaborating physicianVA Board of NursingVA Nursing Laws & RegulationsTo qualify for prescriptive authority, VA NPs must have at least 1,000 hours of qualifying experience or 30 credit hours of pharmacology education
WashingtonFull authority with prescriptive privileges applicationWA Nursing CommissionWA Nursing Care LawsWA NPs may “prescribe legend drugs and Schedule V controlled substances, as defined in the Uniform Controlled Substances Act”
West VirginiaAuthority 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 NursingWV 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”
WisconsinRequires “certification as an advanced practice nurse prescriber” with proof of collaborative physician agreementWI Board of NursingWI 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”
WyomingFull privileges with prescriptive authority applicationWY Board of NursingWY Nursing StatutesPrescriptive authority requires at least 30 contact hours of education in pharmacology
Jocelyn Blore

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

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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