Earning a nurse practitioner degree and becoming an NP is a rewarding career path for nurses in many locations around the nation. However, some states allow NPs to oversee more than others, effectively granting them much more autonomy.
While some states grant NPs partial autonomy, others offer full practice authority (FPA), which enables them to practice without the oversight of a physician.
23 States with NP Practice Autonomy
Discover which 23 states have NP practice autonomy as of January 1st, 2021, and learn where nurse practitioners can find higher level working environments. Note that state regulations change frequently, and advance practice nurses should check with state nursing boards for the most current regulations.
In Alaska, all NPs have FPA. As Nurse Practitioner Schools explains, this allows them to evaluate and diagnose patients, analyze tests, and manage treatment plans. NPs may also apply for the authority to prescribe Schedule II to V controlled substances, though not all professionals in the field have this ability.
In Arizona, licensure through the Arizona Board of Nursing includes full prescriptive authority. NPs must submit a Controlled Substance Prescription Monitoring Program (CSPMP) application and register with the Drug Enforcement Agency (DEA) before prescribing medications to patients.
NPs who work in Colorado have FPA and the potential to gain full prescriptive authority after completing 1,000 hours of practice with provisional prescriptive authority. Before obtaining full prescriptive authority, NPs require oversight from a physician or a mentoring NP.
Like NPs in Colorado, those who work in Connecticut require physician oversight for a time. In Connecticut, NPs must work with a physician for three years before earning FPA.
Hawaii may have one of the smallest pools of licensed NPs, but according to NurseJournal, salaries in this island state are among the highest in the nation. In addition to having FPA, NPs in Hawaii earn an annual mean wage of over $117,000.
NPs in Idaho have FPA, so they can advise, diagnose, and treat patients. In this largely rural state, professionals who earn advanced practice registered nurse (APRN) licensure also have the authority to prescribe medications to patients. They must complete 30 hours of qualifying continuing education (CE) courses to earn prescriptive authority. In Idaho and neighboring Wyoming, advanced practice nurses can practice in both states, due to advance practice nursing (APN) compact legislation.
In Iowa, NPs can advise, diagnose, and treat patients without physician oversight. Those with advanced registered nurse practitioner (ARNP) licensure may also lead their own independent practices while focusing on their area of specialty. While not all NPs can prescribe medications, professionals with ARNP licensure can do so without oversight.
NPs in Maine have full practice authority. Those with APRN licensure can prescribe medications.
In Maryland, licensed NPs can treat patients without the oversight of a primary care physician. Professionals with APRN licensure can also prescribe drugs, but they have to register with the state’s Prescription Drug Monitoring Program (PDMP). This is intended to lessen opioid abuse among at-risk patients.
Under the new law for Massachusetts, certified nurse practitioners who have completed at least 2 years of qualifying supervised prescriptive practice will have independent practice authority.
The Minnesota Board of Nursing gives NPs full practice authority. APRNs also have the authority to prescribe and dispense a variety of medications, including over-the-counter drugs and controlled substances.
Montana NPs do not need physician oversight, but they must complete courses in pharmacology and disease management. In addition, APRNs who submit a successful application to the Prescriptive Authority can prescribe medications.
NPs working in Nebraska have FPA, along with the full authority to prescribe medications. They must complete 30 hours in pharmacology before gaining prescriptive authority.
In Nevada, NPs receive FPA and a Nevada Board of Pharmacy license to prescribe medications. In order to prescribe controlled substances, the DEA requires NPs to register.
15. New Hampshire
Those who earn APRN licensure gain full practice authority in New Hampshire. They may also prescribe a variety of controlled and non-controlled substances.
16. New Mexico
In New Mexico, NPs care for, diagnose, and develop treatment plans for patients and communities. Those who register with the DEA and get state certification can prescribe Schedule II through V controlled substances.
17. North Dakota
North Dakota NPs can treat patients independently, and they can also prescribe medications after completing 30 hours of coursework in pharmacology. Though they are not yet required to join the state’s Prescription Drug Monitoring Program, this may change in the future.
Average NP salaries in Oregon are among the highest in the nation, and professionals also have FPA. Professionals with APRN licensure also have full prescriptive authority.
19. Rhode Island
In Rhode Island, NPs must complete a Uniform Controlled Substances Act Registration before gaining full prescriptive authority. They gain global signature authority, so they can issue prescriptions without physician oversight.
20. South Dakota
One of the most recent additions to this list, South Dakota granted nurse practitioners full authority in February 2017. As Nurse.org explains, this bodes well for the state, whose residents primarily live in rural areas that do not typically receive comprehensive coverage from family doctors.
NPs who want to gain FPA must complete 1,600 practice hours with a physician’s oversight. With the state’s Prescription Monitoring System registration, they can also prescribe medications.
Washington NPs may diagnose and treat patients without physician oversight. They can also prescribe Schedule V controlled substances and certain other medications.
Wyoming NPs have FPA, and the licensure guidelines in this state are among the most lenient in the nation. Both Wyoming and Idaho, two neighboring and largely rural states, have passed (APN) compact legislation. According to the Advance Healthcare Network, this enables NPs with licensure in one state to practice in another, making it easier for NPs to practice their specialties.
Demand for NPs with FPA continues to grow
As more and more doctors choose to pursue lucrative specialties rather than family medicine or primary care, the demand for NPs with FPA continues to increase rapidly. Experienced NPs in states that offer the most practice autonomy may pursue rewarding careers and become valuable members of the health care system.
Visit the Maryville’s Nurse Practitioner Program’s page to learn more about this fast-growing field and the opportunities it offers.