Nurse Practitioner Scope of Practice by State

Prepared through advanced education and clinical training, Nurse Practitioners (NPs) fill roles that involve enormous levels of autonomy and responsibility. Providing a wide range of services, a Nurse Practitioner is responsible for evaluating patients; ordering and interpreting diagnostic tests; making diagnoses; and initiating and managing treatment plans, which includes prescribing medications.

NPs have a variety of options when it comes to practice specialty and the settings in which they choose to practice. Regardless, these professionals must adhere to the scope of practice for Nurse Practitioners within the state in which they provide care. As NP scope of practice is determined by state regulatory bodies — typically state boards of nursing — it varies from state to state. Below is a closer look at Nurse Practitioner scope of practice by state and the answer to a frequently asked question: “In what states can Nurse Practitioners practice independently?” Following the scope of practice discussion is a brief overview of several Nurse Practitioner specialties and related responsibilities.

States Where Nurse Practitioners Can Practice Independently

According to the American Association of Nurse Practitioners (AANP), there are three distinct categories of scope of practice for Nurse Practitioners: full practice, reduced practice, and restricted practice.

The AANP describes full practice (i.e., independent practice) as such: “State practice and licensure laws provides for all Nurse Practitioners to evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.” This is the model recommended by the National Academy of Medicine and the National Council of State Boards of Nursing (PDF, 645 KB).

The following states allow NPs to enjoy full, independent practice:

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

In the remaining states, the NP scope of practice has reduced or restricted practice laws, which affect scope of practice for Nurse Practitioners as described by the AANP.

Impact of Specialization on Scope of Practice for Nurse Practitioners

There are a variety of specialization options for Nurse Practitioners, and each involves particular responsibilities. In some frameworks, scope of practice may be connected to a Nurse Practitioner’s responsibilities related to the individual’s specialization, advanced education, clinical training, certification, and competencies in a specific area.

However, the context of the scope of practice language here refers to state-level regulations for Nurse Practitioners, which override scope of practice language for specialty certifications. As such, we will examine how different specialties have related responsibilities that are carried out within the context of state-specific scope of practice regulations.

Family Nurse Practitioner Responsibilities

Family Nurse Practitioners (FNPs) are clinical experts who implement a holistic approach while working in primary care settings to provide comprehensive care to individuals and families. FNPs focus on:

  • Health promotion
  • Disease prevention
  • Management of common acute and chronic illnesses

Women’s Health Nurse Practitioner Responsibilities

Women’s Health Nurse Practitioners (WHNPs) act as primary care providers for women throughout the life span. They focus on treating and preventing illnesses unique to women as well as providing focused care in areas such as:

  • Prenatal and postpartum care
  • Life span care through menopause
  • General wellness and preventive care
  • Reproductive health care

Adult Gerontology Acute Care Nurse Practitioner Responsibilities

Adult Gerontology Acute Care Nurse Practitioners (AG-ACNPs) are Nurse Practitioners who have acute care experience and provide direct patient management in acute and complex care settings. The Adult Gerontology Acute Care Nurse Practitioner role includes:

  • Integration of evidence-based practice
  • Alleviation of patient and family suffering
  • Facilitation of ethical decision-making

Nurse-Midwifery Women’s Health Nurse Practitioner Responsibilities

Nurse-Midwifery Women’s Health Nurse Practitioners (NM-WHNPs) manage a woman’s normal obstetric and gynecologic needs during the childbearing years, manage the care of the healthy newborn, and provide primary care to women throughout the life span.

Doctor of Nursing Practice Responsibilities

The Doctor of Nursing Practice (DNP) is the highest clinically focused nursing degree in the field. DNPs lead developments across the health system — whether improving health outcomes in the clinical setting, implementing systems-level change, or advocating for policies that improve population health. DNPs typically specialize in a specific area of practice, such as those mentioned previously.

Overall, Nurse Practitioners have many opportunities to embrace careers that align with their personal and professional goals. Since the scope of practice for Nurse Practitioners varies from state to state, where they choose to practice will have a significant influence on how autonomous they can be.

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Citation for this content: Nursing@Georgetown, the online MSN program from the School of Nursing & Health Studies