- As of September 2025, 28 states and the District of Columbia grant full practice authority to nurse practitioners.
- Practice authority is categorized into three types — full, reduced, and restricted.
- State laws dictate specific requirements for prescribing, the necessity of collaborative agreements with physicians, and continuing education hours.
- Because NP scope, prescriptive authority, and collaboration rules vary by state, organizations must align credentialing and operational policies with state practice authority requirements.
The shortage of primary care physicians means nurse practitioners are stepping into critical roles across the country. For practices employing or considering hiring NPs, understanding state-specific practice authority isn't just a regulatory requirement — it directly impacts how you structure your practice, what services you can offer, and how efficiently your team can deliver care.
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.
What do nurse practitioners do?
Nurse practitioners (NPs) are advanced practice nurses who assess patients, diagnose conditions, order and interpret tests, prescribe medications, and manage overall care. Their role is critical for practices looking to expand patient access and improve efficiency. NPs differ from registered nurses (RNs) by their advanced education and ability to practice with greater autonomy, often overlapping with physician duties in primary care.
Understanding the NP role is vital for practice operations. It impacts everything from team structure to service offerings.
- Practice settings: NPs work in private practices, hospitals, specialty clinics, and community health centers.
- Patient outcomes: Research shows NPs provide high-quality, safe care with outcomes comparable to those of physicians.
- Practice management: An NP's scope of practice influences scheduling, credentialing, and billing.
Understanding nurse practitioner practice authority types
State laws define an NP's level of autonomy through practice authority. These regulations fall into three distinct categories. Each category directly impacts how an NP can deliver care and how a practice must structure its clinical teams.
Here is a breakdown of the three types of practice authority:
| Feature | Full practice authority | Reduced practice authority | Restricted practice authority |
|---|---|---|---|
| Physician involvement | None required. NPs have complete clinical autonomy. | Required for at least one practice element (e.g., prescribing). | Career-long supervision or delegation required for practice. |
| Independent practice | NPs can establish and operate their own independent practices. | Practice setting or scope may be limited by collaborative agreement. | NPs cannot practice independently; must work under a physician. |
| Prescriptive authority | Full authority to prescribe, including controlled substances. | Often requires physician collaboration, especially for controlled substances. | Requires physician supervision and may have significant limitations. |
How reduced and restricted practice differ
The key distinction lies in the level of required physician involvement. Reduced practice requires a collaborative agreement for specific tasks, allowing for more NP independence in other areas. Restricted practice, however, mandates direct, career-long supervision for most clinical activities.
For a practice, this means an NP in a reduced state might manage their own patient panel with a physician collaborator for prescribing. In a restricted state, that same NP would work more like a direct extension of the supervising physician.
Nurse practitioner practice guidelines broken down by state
Here's a comprehensive overview of nurse practitioner practice authority across all 50 states and Washington D.C., organized by their level of autonomy.
| Practice authority level | Number of states | Key requirements | Prescriptive authority | Notable states |
|---|---|---|---|---|
| Full practice | 28 states + DC | No physician oversight required; some states require transition period (e.g., 2-3 years supervised practice) | Full authority including controlled substances | Alaska, Arizona, Colorado, Hawaii, Maine, New Mexico, Oregon, Washington |
| Reduced practice | 12 states | Collaborative agreement required for specific elements (typically prescribing) | Often requires physician collaboration for controlled substances | Alabama, Arkansas, Indiana, Kentucky, New Jersey, Pennsylvania, Wisconsin |
| Restricted practice | 10 states | Career-long physician supervision or delegation required | Requires physician supervision; significant limitations on Schedule II drugs | Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas |
Whether you're a practice manager credentialing a new NP, a physician owner expanding your team, or an NP considering where to practice, understanding state-specific regulations is essential. Below is a comprehensive breakdown of practice authority, licensure requirements, and CE mandates for all 50 states and Washington, D.C. Click on any state below to jump to its section.
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Alabama
Reduced practice
According to Alabama practice and licensure laws, NPs are required to have a career-long collaborative agreement with a physician to prescribe medications and perform certain medical acts. The collaborating physician must be present at least 10% of the NP’s scheduled hours. They also must visit each collaborative practice site at least quarterly. State law does not legally define NPs as primary care providers.
The Alabama Board of Nursing and Board of Medical Examiners jointly regulate NP practice. Every 2 years nurse practitioners must complete 24 contact hours of CE credit.
Alaska
Full practice
In Alaska, practice and licensure laws define NPs as primary care providers and confer on them full practice authority to evaluate patients, diagnose and prescribe medications, and therapeutic measures without physician oversight. Currently, Alaska does not allow NPs to sign Do Not Resuscitate (DNR) orders.
The Board of Nursing exclusively regulates NP licensure, and the state requires 30 CE hours every 2 years, though maintenance of national certification also satisfies the requirement.
Legislation has been introduced to the Alaska state legislature to adopt the Advanced Practice Registered Nurse (APRN) compact.
Arizona
Full practice
As of 2023, Arizona is a full practice authority state. NPs are defined as primary care providers and are authorized to evaluate patients, diagnose, prescribe medications, and manage treatment without physician oversight, including signing DNR orders. This recent change removed previous consultation and referral requirements, granting NPs full autonomy.
The Arizona State Board of Nursing solely regulates NP practice. CE requirements are met by maintaining national certification. Arizona has also enacted the APRN Compact, facilitating multistate licensure..
Arkansas
Reduced practice
Arkansas considers NPs as primary care providers. The Arkansas Nurse Practice Act prohibits NPs from prescribing select medication outside of a regulated protocol agreement with a physician. Under current statutes, NP prescriptive authority for Schedule II controlled substances is limited to hydrocodone combination products and opioids and stimulants under specific requirements.
The Board of Nursing and a joint regulatory body under the Department of Health share regulatory authority which must, by law, include physician membership. National certification CE requirements satisfy the state statute.
California
Restricted/Full practice (Transitioning)
California is in a multi-year transition toward full practice authority. Under current law, NP practice is restricted and requires a collaborative agreement with a physician. However, the state has created a pathway to greater autonomy:
- Phase 1: After completing 4,600 hours or 3 years of clinical experience, an NP can work without physician supervision in a facility that has a physician on-site.
- Phase 2: After an additional 3 years of practice in that setting, an NP can apply for full practice authority, allowing them to open an independent practice without physician oversight. This timeline puts the first wave of eligible NPs on track for full independence in 2026, allowing them to start their own medical practices.
NPs are classified as primary care providers. The Board of Registered Nursing regulates NP licensure and requires 30 CE hours every 2 years.
Colorado
Full practice
Colorado practice and licensure laws authorize NPs to evaluate patients, diagnose and prescribe medications and therapeutic measures and grants full practice authority upon NP attestation of successful completion of 750 hours of experience in an agreement with a physician or APRN mentor. Colorado state law classifies NPs as primary care providers. However, nurse practitioners cannot sign DNR orders.
The Board of Nursing exclusively regulates NP licensure and requires CE hours in accordance with national certification requirements.
Connecticut
Full practice
Connecticut practice and licensure laws define NPs as primary care providers and authorize them to evaluate patients, diagnose and prescribe medications and therapeutic measures, including signing DNR orders. Connecticut law requires NPs to practice in collaboration with a physician for a period of not less than 3 years and not less than 2,000 hours to be granted full practice authority.
The Board of Examiners for Nursing exclusively regulates NP licensure and requires 50 hours of CE every 2 years.
Delaware
Full practice
Delaware practice and licensure law defines NPs as primary care providers and grants full practice authority, enabling NPs to diagnose, treat, and prescribe without physician oversight, including signing DNR orders.
The Board of Nursing (BON) exclusively regulates NP licensure. Additionally, meeting the national CE requirement fulfills the state's CE requirement.
Florida
Restricted practice
Florida state practice and licensure laws restrict NP license and practice based on type of NP practice. As of 2020, NPs can apply for an unrestricted license if they have completed 3,000 hours of supervised practice under the guidance of a licensed MD or DO within the past 5 years. NPs are classified as primary care providers.
The Florida state legislature is currently reviewing the Autonomous Practice by Advanced Practice Registered Nurses Act, which exempts certain certified advanced practice registered nurses from specified medical direction and modifies the requirements for clinical privileges in hospitals.
The Board of Nursing regulates nurse practitioner licensure. NPs may submit 30 contact hours per 2-year licensure cycle or meet CE requirements for national certification.
Georgia
Restricted practice
Georgia practice and licensure law restricts patient access to NP care. Physician delegation or supervision of NPs is required for practice. Nurse practitioners cannot prescribe Schedule II agents. NPs are not classified as primary care providers.
The Board of Nursing exclusively regulates NP licensure. The BON also requires the completion of specified CE and practice hours.
Hawaii
Full practice
In Hawaii, NPs are considered primary care providers. They are also recognized as medical staff in hospitals and facilities licensed in the state. Hawaii practice and licensure laws authorize NPs to evaluate patients, diagnose and prescribe medications and therapeutic measures, including signing DNR orders.
The Board of Nursing (BON) exclusively regulates NP licensure, and requires 30 CE contact hours every 2 years.
The Hawaii legislature is currently considering legislation regarding the adoption of the Advanced Practice Registered Nurse (APRN) Compact.
Idaho
Full practice
Idaho practice and licensure laws authorize NPs to evaluate patients, diagnose and prescribe medications and therapeutic measures, including signing DNR orders and workman’s compensation. Idaho state law defines NPs as primary care providers.
The Board of Nursing (BON) exclusively regulates NP licensure and requires 30 CE contact hours every 2 years.
Illinois
Reduced/Full practice
Illinois practice and licensure laws do not define NPs as primary care providers. The state restricts licensure and practice based on the setting of NP practice. NPs practicing in select settings are required by law to maintain a regulated collaborative agreement with a physician or complete practice, continuing education, and maintain a consultative relationship with a physician to prescribe select Schedule II medications and benzodiazepines within state law quantity limitations.
NPs can apply for Advanced Practice Registered Nurse — Full Practice Authority (APRN-FPA) licensure if they obtain national certification as either a nurse midwife, clinical nurse specialist, or nurse practitioner, complete at least 250 hours of continuing education or training and complete at least 4,000 hours of clinical experience after becoming nationally certified in their field.
The Board of Nursing oversees NP licensure and requires 80 CE contact hours every 2 years.
Indiana
Reduced practice
Indiana recognizes NPs as primary care providers, however state licensure and practice laws require NPs to maintain a regulated collaborative agreement with a physician for at least 1 element of NP practice.
NPs are not presently authorized to prescribe Schedule II controlled substances for the purpose of weight reduction or to control obesity. However, legislation was recently introduced to the Indiana state legislature that would remove the requirements for APRNs to have a collaborative agreement with a supervising physician and would also allow NPs to prescribe controlled substances for weight reduction or obesity control.
The Board of Nursing exclusively regulates NP licensure and requires 30 CE hours every 2 years.
Iowa
Full practice
Iowa NPs have full practice authority, according to state licensure and practice laws, enabling them to diagnose, treat, and prescribe without physician oversight. State law defines NPs as primary care providers. However nurse practitioners cannot sign DNR orders.
The Board of Nursing exclusively regulates NP licensure and requires the completion of CE hours in accordance with national certification requirements.
According to Iowa statute, hospitals cannot deny clinical privileges to NPs solely based on their license or the accredited school at which they received their training.
Kansas
Full practice
Kansas became a full practice authority state in 2022. Under the updated practice and licensure laws, NPs can evaluate patients, diagnose, and prescribe medications and therapeutic measures without a collaborative agreement. However, state law does not define NPs as primary care providers, and they cannot sign DNR orders.
The Kansas State Board of Nursing exclusively regulates NP licensure and requires 30 hours of CE every 2 years.
Kentucky
Reduced practice
Kentucky license and practice laws require NPs to enter into a collaborative agreement with a physician as a condition of prescribing controlled and non-controlled substances, unless exempt by the Board of Nursing (BON) under statute. According to state law definition, NPs are primary care providers.
The Board of Nursing exclusively regulates NP licensure. Specific CE hours and content areas required based on specialty.
Louisiana
Reduced practice
Louisiana license and practice laws require NPs to have a collaborative practice agreement in place with a supervising physician. NPs are defined as primary care providers, but are not authorized to prescribe Schedule II controlled substances for the treatment of chronic or intractable pain or obesity and are not authorized to sign DNR orders or death certificates.
NPs with prescriptive authority must complete 6 CE hours annually in pharmacotherapeutics. The Board of Nursing exclusively regulates NP licensure.
Maine
Full practice
Maine license and practice laws grant full practice authority after the NP practices for at least 24 months under the supervision of a licensed physician or a supervising NP. Alternatively, the NP must be employed at a facility with a licensed physician as medical director. Maine state law defines NPs as primary care providers.
Maine’s law requires insurers to cover NP services. The Maine state legislature is currently considering legislation that would allow hospitals to offer a training license and training program for 6 physician assistants and nurse practitioners
The Maine Board of Nursing has full regulatory authority and requires 50 hours CE every 2 years.
Maryland
Full practice
According to Maryland license and practice laws, NPs have full authority to independently evaluate patients, diagnose and prescribe medications and therapeutic measures, including signing DNR orders, after 18 months in a mentorship with a certified NP or physician. Maryland state law defines NPs as primary care providers.
The Board of Nursing exclusive regulates NP licensure. To fulfill CE requirements, NPs must satisfy the national requirement.
The Maryland state legislature is currently considering legislation to adopt the Advanced Practice Registered Nurse (APRN) Compact.
Massachusetts
Full practice
Massachusetts license and practice laws require NPs to practice for 2 years with a qualifying nurse practitioner or license physician. Exemptions for equivalent experience may be available. NPs are defined as primary care providers and are authorized to evaluate patients, diagnose and prescribe medications and therapeutic measures, including signing DNR orders.
The Massachusetts Board of Registration in Nursing has exclusive regulatory authority and requires 15 CE hours every 2 years. To prescribe controlled substances, NPs must complete additional CE hours.
The Massachusetts state legislature is currently considering legislation to promote transparent and equitable reimbursement for services provided by APRNs.
Michigan
Restricted practice
Michigan license and practice laws restrict patient access to NP and require NPs to have a collaborative agreement in place to perform certain medical acts and prescribe medications. Physicians must delegate prescription of controlled substances.
Michigan law does not defined NPs as primary care providers.
The Michigan Board of Nursing has full regulatory authority. National requirements must be met to satisfy the state's CE requirements.
Legislation has been introduced to the Michigan state legislature that would allow hospital administrators to issue a controlled substances license to an individual licensed as a registered professional nurse if the individual has been granted a specialty certification as a nurse practitioner by the Michigan board of nursing.
Minnesota
Full practice
Minnesota practice and licensure laws grant NPs full authority to evaluate patients, diagnose and prescribe medications and therapeutic measures, though they are not authorized to sign DNR orders, upon completion of at least 2,080 hours in a collaborative agreement with a physician or advanced practice registered nurse.
The Board of Nursing exclusively regulates NP licensure. In addition to the national CE hours requirement, Minnesota requires NPs to meet RN requirements for 24 CE hours every 2 years.
Mississippi
Reduced practice
Mississippi practice and licensure laws require a career-long collaborative agreement with a physician for certain medical acts and the prescription of Schedule II controlled substances. Mississippi does not define NPs as primary care providers. Therefore, nurse practitioners are not authorized to sign DNR orders.
The Mississippi Board of Nursing has exclusive regulatory authority and requires 40 CE hours every 2 years.
The Mississippi state legislature is currently considering legislation that would amend the law to allow NPs who have completed 3,600 supervised practice hours to end their collaborative practice agreement.
Missouri
Restricted practice
Missouri practice and licensure laws require NPs to maintain a career-long collaborative practice arrangement with a supervising physician. NP are restricted in terms of:
- The mileage and proximity to supervising physicians
- Patient ratio limits
- Frequency of chart review
- Prescribing controlled substances
NP prescriptive authority for Schedule II controlled substances is limited to hydrocodone combination products. Exemptions apply for qualifying NPs based on employment and practice setting. By legal definition, NPs are not primary care providers.
The Missouri Board of Nursing has full regulatory authority for NP licensure.
The state legislature is currently evaluating legislation that would allow qualifying NPs with 2000 documented hours of supervision end their collaborative agreement as well as legislation that would change existing laws so that the state Board of Nursing cannot enforce geographic proximity restrictions for collaborative practices agreements.
Montana
Full practice
Montana practice and licensure laws define NPs as primary care providers and confer upon them full authority to evaluate patients, diagnose, and prescribe medications and therapeutic measures, including signing DNR order and death certificates. Montana state law defines NPs as primary care providers
The Board of Nursing exclusively regulates NP licensure. Additionally, every 2 years the BON requires the completion of 24 CE hours.
Legislation has been introduced into the Montana state legislature that would begin requiring NPs with less than 2 years of experience to enter into a collaborative agreement with a qualifying supervising provider.
Nebraska
Full practice
Nebraska practice and licensure laws authorize NPs to evaluate patients, diagnose and prescribe medications and therapeutic measures upon completion of 2,000 hours under the supervision of a supervising provider. Nebraska state law does not define NPs as primary care providers are not authorized to sign DNR orders.
The Board of Advanced Practice Registered Nurses exclusively regulates NP licensure. NP CE requirements are based on the satisfactory completion of the national requirements.
Nevada
Full practice
Nevada practice and licensure laws confer the authority to evaluate patients, diagnose and prescribe medications and therapeutic measures, though NPs may not prescribe Schedule II controlled substances unless the NP has 2 years or 2,000 hours of clinical experience, or prescribes pursuant to a protocol approved by a collaborating physician.
The Board of Nursing exclusively regulates NP licensure and requires 45 CE hours every 2 years.
New Hampshire
Full practice
In New Hampshire, practice and licensure laws define NPs as primary care providers and grant them full authority to evaluate patients, diagnose and prescribe medications and therapeutic measures, including signing DNR orders and death certificates.
The Board of Nursing exclusively regulates NP licensure. In addition to completing RN CE requirements, NPs must also complete 30 CE hours every 2 years.
The New Hampshire state legislature is evaluating legislation that would require insurers to reimburse for services provided by NPs within their scope of practice.
New Jersey
Reduced practice
New Jersey licensure and practice laws require NPs to maintain joint protocols with a collaborating physician to prescribe medications and devices. NPs are defined as primary care providers and are not authorized to sign DNR orders.
The New Jersey Board of Nursing has exclusive regulatory authority. In addition to completing 30 hours of RN CE requirements, NPs must complete CE as required for national certification and CE related to specific issues and specialties.
Legislation has been introduced into the state legislature that would eliminate practice restrictions on APRNs, including collaborative agreements for NPs with more than 2,400 hours of supervised practice.
New Mexico
Full practice
In New Mexico, licensure and practice laws define NPs as primary care providers and give them full authority to evaluate patients, diagnose and prescribe medication, including signing DNR orders and death certificates.
State law requires insurers to provide coverage for services provided by NPs.
The Board of Nursing regulates nurse practitioner licensure. They also require CE completion in accordance with national certification. NPs with DEA registration shall obtain 5.0 contact hours in the management of non-cancer pain.
New York
Full practice
In 2022, New York modernized its licensure and practice laws to grant full practice authority to experienced NPs. Nurse practitioners with more than 3,600 practice hours are no longer required to have a written practice agreement with a physician. NPs with less than 3,600 hours must still maintain a collaborative agreement. NPs are authorized to evaluate patients, diagnose, prescribe, and sign DNR orders and death certificates. The state defines NPs as primary care providers.
The New York Board of Nursing exclusively regulates NP licensure. CE requirements are met by maintaining national certification. NPs with DEA registration must complete 3 CE hours every 3 years in pain management, palliative care, and addiction.
North Carolina
Restricted practice
In North Carolina, practice and licensure laws restrict NP practice by requiring physician delegation and a career-long supervisory agreement with a physician as a condition of licensure and practice. North Carolina does not define NPs as primary care providers.
The Joint Subcommittee of the Board of Nursing and the Medical Board regulate nurse practitioner licensure. NPs must complete 50 CE hours every 2 years.
North Dakota
Full practice
North Dakota practice and licensure laws grant NPs gained full practice authority, allowing them independence in evaluating, diagnosing and prescribing medication and therapeutic measures, including signing DNR orders and death certificates.
The Board of Nursing has exclusive regulatory authority. NPs with prescriptive authority must complete 15 pharmacology CE hours every 2 years. For other nurse practitioners, evidence of current national certification is required.
Ohio
Reduced practice
Ohio practice and licensure laws constrain NP licensure and practice by requiring a career-long standard care arrangement with a collaborating physician or podiatrist. Law also requires
NPs to abide by patient and settings limitations on Schedule II medications, including prohibiting NPs from prescribing Schedule II controlled substances in convenience care clinic settings. The state defines NPs as primary care providers.
The Board of Nursing regulates NP licensure and requires 24 CE hours every 2 years.
Oklahoma
Restricted practice
Oklahoma practice and licensure laws require NPs to have a written statement documenting supervision by a physician as a condition of prescriptive authority. NPs cannot prescribe Schedule II controlled substances. Their prescriptive authority is restricted to no more than a 30-day supply of Schedule III-V medications. State law does not define NPs as primary care providers.
The Oklahoma Board of Nursing has sole regulatory authority and sets the number CE hours required.
Oregon
Full practice
Oregon practice and licensure laws grant full practice authority to NPs to evaluate patients, diagnose and prescribe medications and therapeutic measures, including DNR orders and death certificates. Oregon defines NPs as primary care providers.
The Board of Nursing regulates NP licensure. As a result, and in accordance with national certification requirements, NPs must complete CE hours.
Pennsylvania
Reduced practice
Pennsylvania practice and licensure laws require NPs to maintain a career-long written agreement with 1 or more physicians. NPs with current prescriptive authority approval must have a prescriptive authority collaborative agreement with at least 2 physicians as a condition of prescribing, dispensing or ordering drugs or other therapeutic or corrective measures.
NPs cannot join medical staffs or sign DNR orders even though, by definition, they are primary care providers.
The Pennsylvania Board of Nursing has regulatory authority and requires 30 CE hours every 2 years.
Rhode Island
Full practice
Rhode Island practice and licensure laws define NPs as primary care providers. The state grants NPs full authority to:
- Evaluate patients
- Diagnose and prescribe medications
- Diagnose and prescribe therapeutic measures
- Sign death certificates and DNR orders
The Board of Nursing regulates the state's NP licensure and requires 10 hours of CE every 2 years.
South Carolina
Restricted practice
South Carolina practice and licensure laws require NPs to have a practice agreement with a physician as a condition of practice. They must abide by law supply limitations on scheduled controlled substances. Furthermore, the Board of Medical Examiners must review cases when a physician supervises more than 6 NPs. By definition, NPs are not primary care providers. Additionally, NPs do not have the authority to provide proof of disability for disabled parking permits.
The Board of Nursing exclusively regulates NP licensure in South Carolina. The Board requires NPs to complete 30 CE hours every 2 years.
An expansion of APRN's scope practice and certification was introduced to the state legislature in 2023 via a piece of proposed legislation.
South Dakota
Full practice
South Dakota practice and licensure laws confer full authority to: evaluate, diagnose and prescribe medication and therapeutic agreements upon completion of 1,040 practice hours under a written collaborative agreement with a physician, certified NP or certified nurse midwife.
By definition, NPs are primary care providers and have the authority to sign DNR orders and death certificates. However, nurse practitioners are not authorized to provide proof of disability.
The South Dakota Board of Nursing oversees regulation of NP licensure and requires the completion of CE hours in accordance with national requirements.
The state legislature is currently considering legislation to adopt the Advanced Practice Registered Nurse (APRN) Compact.
Tennessee
Restricted practice
Tennessee practice and licensure laws require NPs to practice under the supervision of a licensed physician and restricts NPs from prescribing Schedules II-IV medications unless specifically authorized by the formulary or approved after consultation with the supervising physician before initial issuance of the prescription. NPs must also adhere to supply limitations on Schedule II and III opioids. Even though Tennessee technically defines the role as primary care providers, NPs in Tennessee may not join a medical staff.
The Tennessee Board of Nursing has exclusive regulatory oversight. NPs must fulfill CE hours for national certification. NPs with prescriptive authority must maintain additional CE hours in controlled substance prescribing.
Texas
Restricted practice
Texas practice and licensure laws require physician delegation and supervision for NP practice. NPs must maintain career-long written protocols with a physician. Nurse practitioners have the authority to prescribe Schedule II medications in select settings and practice types. Legally, the state defines select instances during which NPs are acknowledged as primary care providers.
The Texas Board of Nursing has sole regulatory oversight. NPs satisfy their CE requirements upon completion of the corresponding national requirements.
Utah
Full practice
Following a 2023 legislative change, Utah is now a full practice authority state with no transition-to-practice requirements. State law grants NPs immediate authority to evaluate, diagnose, prescribe medications, and sign DNR orders and death certificates without physician oversight. However, Utah law does not legally define NPs as primary care providers.
The Utah Board of Nursing has full regulatory oversight. State CE requirements are fulfilled by maintaining national certification. Utah has also enacted the APRN Compact.
Vermont
Full practice
Vermont practice and licensure laws require NPs with less than 24 months and 2,400 hours of active practice to have a collaborating agreement with a Vermont licensed physician or APRN. Upon completion of this requirement, NPs have full authority to:
- Evaluate patients
- Diagnose and prescribe medications and therapeutic measures
- Sign DNR orders and death certificates
Vermont does not legally define NPs as primary care providers.
The Vermont Board of Nursing has sole regulatory oversight and sets specific CE requirements depending on specialty.
Virginia
Restricted practice
Virginia state licensure and practice laws require NPs to practice as part of a patient care team supervised by a licensed physician, unless the NP can attest to the completion of the equivalent of 5 years of full-time clinical experience. NPs have the authorization to sign DNR orders and death certificates. However, Virginia law does not define NPs as primary care providers.
The Board of Nursing and Board of Medicine share regulatory oversight. Nurse practitioners must complete CE hours in accordance with national requirements. NPs with prescriptive authority must complete 8 CE hours every 2 years.
Washington
Full practice
Washington state licensure and practice laws define NPs as primary care providers and authorize them to:
- Evaluate patients
- Diagnose and prescribe medications and therapeutic measures
- Sign DNR orders and death certificates
The Washington state Nursing Commission oversees licensure and requires NPs to complete 30 CE hours every 2 years. NPs with prescriptive authority must also complete an additional 15 CE hours during that time frame.
The state legislature is currently considering legislation that would require equal reimbursement for APRNs, PAs and physicians.
Washington, DC
Full practice
Washington, DC licensure and practice laws grant full practice authority to NPs to:
- Evaluate patients
- Diagnose and prescribe medications
- Diagnose and prescribe therapeutic measures
D.C. legally defines NPs as primary care providers. NPs have the authority to sign DNR orders and death certificates.
The District Board of Nursing regulates licensure and requires 15 hours of CE every 2 years.
West Virginia
Reduced practice
West Virginia state licensure and practice laws require NPs to have collaborative agreement with a physician in place to prescribe medication for 3 years. NPs may prescribe Schedule II controlled substances for no more than a 3-day supply. West Virginia legally defines NPs as primary care providers. Therefore, nurse practitioners have the authorization to sign DNR agreements and death certificates.
The Board of Examiners for Registered Professional Nurses oversees licensure and requires 24 CE hours every 2 years.
Wisconsin
Reduced practice
In Wisconsin, licensure and practice laws mandate that NPs must have a collaborative agreement in place with a physician as a condition of practice. NPs cannot prescribe, dispense or administer certain Schedule II controlled substances, though some exemptions apply. Based on the legal definition, NPs are not primary care providers.
The Wisconsin Board of Nursing has regulatory authority and requires 16 hours of CE every 2 years.
Wyoming
Full practice
Wyoming practice and licensure laws authorize NPs to evaluate, diagnose and prescribe medications and therapeutic treatments, including signing DNR orders and death certificates. However, NPs are not legally primary care providers.
The Wyoming Board of Nursing has full regulatory oversight and requires NPs to fulfill national CE requirements and to complete 3 hours related to prescribing controlled substances to maintain prescriptive authority.
The movement toward full practice authority for NPs
The landscape of NP practice authority has shifted dramatically over the past decade. Since 2010, when the Institute of Medicine recommended full practice authority as the standard, 15 additional states have removed restrictions on NP practice. This expansion reflects mounting evidence that NPs provide safe, effective, high-quality care.
The primary driver is the persistent shortage of physicians, particularly in primary care and rural areas. States increasingly recognize that empowering NPs is a practical solution to expand the healthcare workforce. The COVID-19 pandemic accelerated this movement, as many states temporarily waived restrictive regulations to meet surging healthcare demands.
Research consistently supports the safety and efficacy of independent NP practice. Studies show patient health outcomes in full practice states are comparable to those in more restrictive states. Despite this evidence, some physician organizations have opposed these changes, citing safety concerns.
Recent legislative wins highlight the momentum of this movement.
Practice impact: For practices in these states, expanded authority can unlock new care models and improve operational efficiency. It can also make it easier to recruit and retain top NP talent.
Key states: Recent expansions in New York, Kansas, and Utah signal a continued trend toward deregulation.
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- Current Version – Dec 04, 2025Written by: Jean LeeChanges: Updated to reflect the most information available.
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