As healthcare continues to move beyond the hospital to other sites in the community, policymakers are looking especially to one type of advanced registered nurse -- the nurse practitioner (NP) -- to help meet the escalating need for high-quality and accessible medical care.

With an eye toward balancing quality and cost, health planners are relying increasingly on nurse practitioners as the providers of choice for a range of front-line health services, such as primary and preventive care, managing chronic health conditions, and teaching older patients how to avoid injury (and therefore the expense of hospitalization and nursing home care). Studies show that the quality of NP care is equal to, and at times better than, comparable care by physicians, and often at a lower cost.

A nurse practitioner is a registered nurse who has advanced education and clinical training in a healthcare specialty. Recognized as expert care providers, nurse practitioners deliver basic healthcare to infants, children, adults, and families in a wide range of outpatient and inpatient settings. Nurse practitioners provide the information patients need to make informed decisions about their health and lifestyle choices.

Nurse practitioners practice under the rules and regulations of the Nurse Practice Act of the state in which they work. NPs can prescribe medication in every state and in the District of Columbia. The degree of independence with which they can prescribe drugs, medical devices (crutches, boots, etc.) or medical services varies from state to state. In 22 states and the District of Columbia, NPs have what is called "Full Practice Authority", meaning they can practice independently without physician collaboration or supervision. Many nurse practitioners have their own practices and can be reimbursed by Medicare, Medicaid, or other third parties.

Full Practice Authority States

  • Alaska
  • Arizona
  • Colorado
  • Connecticut
  • Hawaii
  • Idaho
  • Iowa
  • Maine
  • Maryland
  • Minnesota
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Mexico
  • North Dakota
  • Oregon
  • Rhode Island
  • South Dakota
  • Vermont
  • Washington
  • Wyoming

States that don't allow Full Practice Authority for NPs may fall under what is called "Reduced Practice Authority". This means that NPs must have a collaborative agreement with a supervising physician in order to practice and prescribe meds.

Reduced Practice Authority States

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

States that don't fall into either of these two categories are considered Restricted Practice states, which require even more regulations, including career-long oversight, delegation, or management by another medical team member.

There are many organizations which advocate for full practice authority for nurse practitioners, including prescriptive privileges. The American Association of Nurse Practitioners (AANP) specifically recommends that:

  • Nurse practitioners should be able to prescribe without physician involvement.
  • State boards of nursing (not state boards of medicine) should be responsible for NP prescriptive authority regulation.
  • In addition to medication, nurse practitioners should be able to prescribe medical devices and services.

With a growing shortage of primary healthcare providers, it is in the best interest of all states to grant full prescriptive privileges to nurse practitioners in accordance with their level of education, training, and credentialing. 

Amanda Bucceri Androus, RN, BSN
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