Autonomous Practice an Option for Many of Today’s DNPs

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A DNP, or Doctor of Nursing Practice, is one of the two terminal doctorate degrees available in nursing. While the PhD is ideal for those interested in research or teaching, a DNP can help nurses advance on the clinical side or reach a manager or executive-level job. Plus, in a society that is seeing an increasing shortage of doctors, nurses who hold DNPs are filling a critical role.

Discover more about the autonomy some states are now offering DNPs and how this degree can help further your career.

Filling an Important Need

Anyone who has visited a doctor’s office recently can attest to the long wait times. A decrease in the number of young people entering the field, an increase in the number of physicians retiring, and the aging baby boomer population are all putting a strain on the healthcare system. Even more troubling is that the Association of American Medical Colleges (AAMC) predicts the physician shortage across the United States is only going to get worse.

According to the AAMC’s report, by 2025 there will be a shortage ranging from 34,600 to 88,000 doctors. Additionally, by 2030, that shortfall might be anywhere from 40,800 to 104,900. These shortages will span nearly every medical field but it’s expected that non-primary care specialties will be the hardest hit, with an estimated shortage of 33,500 to 61,800 physicians.

How DNPs Can Help

One way certain states are starting to solve the physician shortage problem is by granting more autonomy to nurse practitioners (NPs) with DNPs. This trend is growing in popularity as people realize how it benefits multiple groups. First, it helps NPs because they no longer have to pay fees for physician supervision. Additionally, states are saving money as regulations that require constant tracking and enforcement decrease. Finally, citizens are getting access to the medical help and advice they need, especially those living in rural communities underserved by physicians.

States with Full Autonomy

The following states offer NPs with a DNP degree full autonomy:

  • Alaska
  • Arizona
  • Colorado
  • Connecticut
  • Hawaii
  • Idaho
  • Iowa
  • Maine
  • Minnesota
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Mexico
  • New York
  • North Dakota
  • Oregon
  • Rhode Island
  • Vermont
  • Washington
  • Washington, D.C.
  • Wyoming

In these states, nurses can make a diagnosis, prescribe medicine, and treat patients without physician oversight. They have the authority to make their own decisions and use their knowledge to treat their patients. With full autonomy, nurses in these states can even open their own practices if they so desire.

The first states to offer full autonomy in the 1980s were Alaska, New Hampshire, Oregon, and Washington. In the 1990s, some more rural states followed suit to help cope with physician shortages.

States with Partial Autonomy

The following states grant partial autonomy to NPs with a DNP degree:

  • Alabama
  • Arkansas
  • Delaware
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Maryland
  • Mississippi
  • New Jersey
  • Ohio
  • Pennsylvania
  • South Dakota
  • Utah
  • West Virginia
  • Wisconsin

With partial autonomy, nurses can diagnose and treat patients, but they still need physician oversight to prescribe medicine. However, the practice guidelines for oversight in these states vary. Some states do not require the actual presence of the physician in the room or even in the same building, only that the physician be available by email or phone. Other states simply require the NPs to have a signed collaboration agreement with a physician.

States with Restricted Autonomy

The following states currently offer restricted autonomy to NPs with a DNP degree:

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

In these states, nurses need physician oversight to diagnose and treat patients and prescribe medicine.

Full Autonomy Not Just for States

States are not the only entities loosening their restrictions on how NPs can practice. According to, the Veterans Administration (VA) recently granted full practice autonomy to certified clinical nurse specialists, certified nurse midwives, and certified nurse practitioners. This move helps alleviate some of the burdens on the overtaxed VA system, gives veterans much-needed access to care, and gives NPs a better position to bargain for full autonomy across the country.

Changing Attitudes on Autonomy

It does seem as though more states are welcoming DNPs as viable primary care practitioners. There are signs that legislators in Massachusetts, North Carolina, and Pennsylvania are looking into lighter restrictions on NPs. If a few more follow suit, we could see most states offering full autonomy to NPs within the foreseeable future.

Understanding the DNP Program

If you think a DNP might be right for you, it helps to understand the program before you make a final decision. Most DNP programs take an average of four to six years to complete. However, if you choose to pursue an online nurse practitioner program, you may be able to complete the program in as little as 36 months.

DNP programs usually require spending time focusing on your research area of choice, history and philosophy of nursing science, statistics and data analysis, and leadership skills.

Is a DNP Program Right for You?

Because of the commitment level and advanced stage of education, not all NP’s take the initiative to complete their DNP each year. If you are trying to decide if a DNP is the right choice for you, there are a few things to keep in mind. You need to decide if this level of education matches your career goals, if you have the time and motivation to pursue it, and if you are interested in starting your own practice, do live in or close to a state that offers full autonomy? If all these factors align, the DNP degree might be ideal for you.

As the country looks for ways to deal with the impending physician shortage crisis, many states are turning to the idea of allowing full autonomy to NPs, and those with DNPs are ready to step up and lead the way. Visit the Maryville University Online Doctor of Nursing Practice degree program to learn more about the program and see if it is right for you.


CBS News – New report predicts “troubling” shortage of doctors in the U.S. – NP Practice Authority Grows – March 2017 Update