Nurse Practitioner (NP) Practice Authority By State & Scope of Practice

Nurse practitioners (NPs) are graduate-trained professionals who provide high-quality and cost-effective healthcare. They meet the needs of underserved and vulnerable populations, helping the United States to combat its looming primary care shortage. However, their ability to prescribe specific medications and fulfill functions as independent practitioners can be limited by the state in which they live.

Discover how limited and restricted practice laws affect NPs within these states—and how APRNs and advocates are fighting for full practice authority. NPSchools.com has interviewed professors from all of the states with bold outlines on the map. Check out the complete practice authority details for all states in the table below.

– Full NP Practice State

– Limited NP Practice State

– Restricted NP Practice State

What is NP Practice Authority?

Nurse practitioners are essential physician extenders. They can provide much of the same care and services as physicians, with fewer years of education and often at a much lower cost. However, many states still restrict the extent to which nurse practitioners can practice and whether or not a physician must supervise them.

For example, a recent interview detailed how Kentucky nurse practitioners must have a collaborative agreement in place to have many practice privileges. Specifically, they must have a Collaborative Agreement Prescriptive Authority for Controlled Substances (CAPA-CS) and a Collaborative Agreement Prescriptive Authority for Non-Scheduled Drugs (CAPA-NS) to presecribe medications. Dr. Angela Wood, clinical faculty and FNP program coordinator at Eastern Kentucky University School of Nursing stated in the 2024 interview that “It’s a compromise. We were ultimately looking to eliminate the CAPA-CS altogether. But for NPs who’ve been in practice for a long time, this is still a big barrier that’s been removed. For new NPs, there’s some oversight where they must demonstrate safe prescribing practices. It’s a baby step in the right direction.”

There are numerous organizations currently lobbying state legislatures for full practice authority for nurse practitioners. They include the American Nurses Association, the American Association of Nurse Practitioners, the Veterans Administration, the AARP, the Institute of Medicine, the Federal Trade Commission, and many more. Physician associations such as the American Medical Association often oppose these efforts, arguing that nurses cannot replace fully trained physicians.

In states with fewer restrictions, nurse practitioners help increase patient access to healthcare and serve in many underserved rural areas. The full practice authority model has been adopted in many states, with many more having a path to full practice authority after a period of supervision. Here are the three general levels of practice authority:

Full practice: Laws in these states allow nurse practitioners to practice independently. They have full authority to perform services within the scope of their specialty, including prescribing medications, medical equipment, and treatments. However, an additional application or continuing education may be required to receive prescriptive authority.
Limited or reduced practice (but can transition to full practice): Some states require nurse practitioners to complete a supervised work experience before receiving autonomous practice privileges. The amount of time required varies by state, but upon completing the required hours, nurse practitioners may have full independent authority, including prescriptive abilities.
Restricted practice: Nurse practitioners in restricted states will always need physician supervision or a collaborative agreement to carry out at least one aspect of their practice. In some states, nurse practitioners may be able to practice independently but need an agreement for prescriptive authority. In other states, there must be an agreement for any care provided beyond the scope of a registered nurse.

Below is a table detailing each state’s regulations regarding practice authority for nurse practitioners. It should be noted that there is pending legislation in several states, thanks to the tireless efforts of advocacy organizations, and this can change at any time. The Covid-19 pandemic has also reshaped the practice environments within some states. Included are links to each state’s nursing board and nurse practice act for the most up-to-date information.

From the Editor: Please note that some states’ statuses may differ from the popular AANP map. Also, in the wake of the Covid-19 pandemic, some states have expanded practice authority for NPs to assist with healthcare shortages. As always, we encourage readers to reach out with any updates or corrections. Contact us here.

State	Board of Nursing	Practice Act	Prescriptive Authority	Details & Resources
Alabama	Alabama Board of Nursing	Alabama Board of Nursing Administrative Code	Must have a collaborative practice with a supervising physician	Must be in a collaborative practice with a supervising physician. Collaborative practice is regulated by the Alabama Board of Medical Examiners.
Alaska	Alaska Board of Nursing	Alaska Nursing Statutes (article 4)	Full practice with current license	Must submit a separate application and fee to prescribe Schedule 2-5 controlled substances.
Arizona	Arizona Board of Nursing	Arizona Nursing Statutes, AZ Nurse Practice Act	Full practice with current license and DEA registration	Nurse practitioners who prescribe controlled substances will need to apply to the Drug Enforcement Administration for a DEA number as well as utilize the Controlled Substance Prescription Monitoring Program (CSPMP)
Arkansas	Arkansas Board of Nursing	Arkansas Nurse Practice Act	Must have a collaborative practice agreement with a supervising physician and proof of completion of a board-approved pharmacology course.

Among her many diverse writing endeavors, Kimmy Gustafson has also lent her expertise to NPSchools.com since 2020, providing insightful and engaging content about the significant role of education in shaping our future generations of nurse practitioners. Many of her pieces include interviewing experts on timely topics such as healthcare workplace violence and moral distress.

Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working, she can be found outdoors, parenting, kiteboarding, or cooking.