What you need to know about how your state defines and regulates nurse practitioners.
Nurse practitioners are a valuable resource for many practices. Today, approximately 1 in 3 Americans lack access to sufficient primary care. The Association of American Medical Colleges (AAMC) expects the shortfall of primary care physicians to reach nearly 40,000 in the next decade.
That primary care physician shortage is leading to the growth of the Nurse Practitioner (NP) role. In 2023, the United States Bureau of Labor Statistics ranked nurse practitioner as 1 of the 2 top jobs expected to experience the highest growth in demand over the next decade.
NPs have increasingly become an integral part of the healthcare system, filling gaps in primary and specialty care and improving patient outcomes. Already, over 385,000 NPs are licensed to practice in the US, with over 88% of them certified in primary care.
“ 1 in 3 Americans lack access to sufficient primary care ”
Nurse practitioners are in high demand — and research demonstrates that care provided by NPs is safe, effective, efficient, cost-effective, equitable, and evidence-based. Yet, practice authority laws differ widely across all 50 states and the District of Columbia.
Currently, NP practice falls into 1 of the following 3 categories:
In full practice states, state practice and licensure laws allow NPs to:
This means they can practice independently without the need for a supervisory or collaborative agreement with a physician. States that offer full practice authority recognize NPs as autonomous providers who can provide care directly to patients.
In reduced practice states, nurse practitioners are required to have a collaborative agreement with a physician to provide patient care or limit the setting of one or more elements of NP practice. The specific restriction can vary by state, but may include requirements for a certain level of supervision when prescribing medication or limitation on the types of medical issues NPs can manage.
In restricted practice states, state law requires career-long supervision, delegation, or team management by another health provider for NP patient care. This might involve direct supervision, restrictions on certain aspects of care (like prescription authority), or requiring a certain level of oversight for decision-making.
While both terms refer to limitations on NP practice, there are important differences between reduced and restriction practice:
In reduced practice states, NPs may be required to have a collaborative agreement with a physician or follow specific protocols and guidelines when providing care. While reduced practice allows NPs to provide patient care without direct physician supervision, they have limited authority compared to full practice.
Restricted practice, on the other hand, means that NPs are not allowed to practice independently. The nurse practitioner must work under the direct supervision of a physician. In some restricted practice states, NPs may only be able to provide care within a specific scope, such as performing certain procedures or prescribing certain medications. Restricted practice limits the ability of NPs to provide comprehensive care to patients, requiring them to work closely with physicians for many aspects of patient care.
Check each state’s section for information on NP practice guidelines, the governing bodies that regulate licensure, and legislative updates. Click on any state below to jump to its section.
