State Practice Environments for Nurse Practitioners

The compliance landscape for nurse practitioners varies widely across the U.S. To establish and maintain compliant collaborations, it’s important to understand varying levels of NP autonomy across the country and the regulatory structure for the state(s) where you practice.

Hover over the map below to view a specific state’s practice environment. Click on a state to learn more and download a collaboration checklist.

Compliant Healthcare Collaborations

As the landscape of healthcare evolves, collaboration between NPs and Physicians is crucial for delivering high-quality patient care. This guide breaks down basic regulations governing collaborative practice* across the US. From state-specific requirements to best practices, Zivian is here to equip you with the knowledge needed to navigate the compliance landscape, enhance collaborative efforts, and ultimately contribute to an improved healthcare system for all.

*State regulations and requirements are subject to change. Always check with your state medical or nursing board to confirm information.

Practice Environment Definitions

  • Full practice authority for nurse practitioners refers to the legal scope of practice that offers the highest level of autonomy to NPs. Full practice states allow NPs to evaluate patients, diagnose conditions, order and interpret diagnostic tests, initiate and manage treatments, and prescribe medications independently without physician oversight or collaboration. In states or regions where NPs have full practice authority, they can practice to the full extent of their education and training, providing more accessible and timely healthcare services to patients, especially in underserved areas.

    Full practice authority is often advocated for by nursing organizations and policymakers as a means to improve healthcare access and efficiency.

  • Reduced practice authority for nurse practitioners places some restrictions on the scope of practice of NPs, and usually requires them to work under the supervision, collaboration, or delegation of a physician. In states or regions with reduced practice authority, NPs may have limitations on their ability to independently evaluate patients, diagnose conditions, prescribe medications, order diagnostic tests, and initiate treatments. These restrictions can vary widely depending on local regulations.

    Reduced practice authority is often subject to debate among healthcare professionals, policymakers, and advocacy groups regarding its impact on patient care, healthcare access, and the utilization of nurse practitioners' skills and expertise.

  • Restricted practice authority for nurse practitioners refers to the most limited scope of practice among the three common models of NP regulation. In states or regions with restricted practice authority, nurse practitioners typically have significant limitations on their ability to independently evaluate, diagnose, treat, and prescribe medications for patients. These limitations often require NPs to work under the direct supervision, collaboration, or delegation of a physician.

    Advocates for expanding NP scope of practice often argue that restricted practice authority unnecessarily restricts the utilization of NPs' skills and expertise, ultimately hindering efforts to improve healthcare access and quality. Conversely, opponents may raise concerns about patient safety and the need for physician oversight in certain healthcare settings.