Does A Nurse Practitioner Have to Work Under A Doctor?

Scope of Practice Rights For Nurse Practitioners

Nurse Practitioners (NPs) are licensed by their State Boards of Nursing and their scope of practice is defined by these boards. The licensing process involves the determination by the board that the NP meets all the state rules for licensure which include having passed the NCLEX-RN, graduation from an approved nursing program and national certification in the specialty area of intended practice.

Currently, 21 states plus the District of Columbia provide full practice authority to licensed Nurse Practitioners, meaning they can practice without the supervision of a physician.

Full scope of practice rights for NPs include:

  • evaluating patients
  • diagnosing, ordering and interpreting diagnostic tests
  • initiating and managing treatments
  • prescribing medications

NPs can admit patients to hospitals, refer patients to various specialists and promote preventive healthcare measures. They are accountable to the public and the state board of nursing to meet the standards of care in both practice and professional conduct.

The 21 states with full practice authority for Nurse Practitioners besides the District of Columbia are: Alaska, Arizona, Colorado, Connecticut, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, Washington and Wyoming.

17 states confer reduced practice to their NPs. This means that they are reduced in their ability to practice one or more elements of NP practice, and that the NP must have a regulated collaborative agreement with an outside health discipline. The 17 states with reduced practice regulation are: Alabama, Arkansas, Delaware, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, New Jersey, New York, Ohio, Pennsylvania, South Dakota, Utah, West Virginia and Wisconsin.

The remaining 12 states maintain restricted practice for NPs, meaning that they are restricted from engaging in at least one element of NP practice. Supervision, delegation or team-management by an outside health discipline is required in order for the NP to provide patient care. These 12 states are: California, Florida, Georgia, Massachusetts, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia.

Therefore, in 29 of the 50 states, NPs cannot practice independently from physician involvement. The restrictions can be limited to one area such as prescription of medication, or to the supervision of all advanced practice. Some use the term, "collaboration" rather than supervision. Currently, the states specifying supervision are: California, Florida, Idaho, Maine, Nebraska, North Carolina, Oklahoma, Tennessee, Texas and Virginia.

Nurse Practitioners have been providing comprehensive health services to the populace for over forty years. Numerous studies have affirmed that NPs provide safe, high quality care and that patient satisfaction is equal to that of physicians. Many may wonder, then, why full scope of practice rights are not seen across all fifty states.

One problem arises when outdated state laws and barriers in federal law and regulation prevent NPs from providing the full scope of services for which they were trained. There is a great loss then, in the potential healthcare services that are not being made available when the nation is suffering from a shortage of primary care services.

The American Association of Nurse Practitioners (NP) has worked to remove barriers to NP practice both at the federal and state levels. They are making clear that if these barriers are removed, primary care services can be extended to the public, especially at underserved areas, and the cost of medical care in the nation can be reduced.

Allowing nurse practitioners to practice to the full extent of their knowledge and skills will be a strong force toward the betterment of health of the people of this nation.

To learn more about becoming a nurse practitioner, contact the schools you see listed below for program details.