This puzzles me…
How is it that NPs can provide safe, high-quality, independent care during a pandemic but cannot do the same once the pandemic is over (as is the case in some states)?
Meanwhile, research consistently shows that NP care is safe, effective, and well-received by patients.
So why don’t NPs, in some states, have full practice authority, even though it means better access to care, especially in underserved areas?
Could it be for political or territorial reasons? Or is it just that things are slower to change in some states than others?
I have my thoughts about it, and I’m sure you do too…
But regardless, our profession is moving forward…
We are making progress!
Against all opposition and pushback, the NP role has expanded and continues to develop.
Since the late 1990s, we have been recognized by Medicare and Medicaid. We enjoy federal recognition, fully integrating into the US healthcare delivery system.
Educational standards have grown from certification to Master’s Degree to today’s DNP programs.
And more states continue to grant NPs full practice authority (FPA), but not without legislative battles and advocacy for a broader scope of practice and autonomy.
Across the US, NP practice is classified into three categories: full, reduced, and restricted practice.
As of this year (2025), 27 states, two territories, and the District of Columbia have full practice authority, while the remaining 23 states and three territories maintain reduced or some restrictions on practice laws.
States lacking full practice authority…
States with reduced practice laws include:
Alabama, Arkansas, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Jersey, Ohio, Pennsylvania, and West Virginia.
Reduced practice requires NPs to maintain a collaborative agreement with a physician or to set a limit on some element of NP practice.
States with restricted practice laws include:
California, Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia.
These states require career-long supervision, delegation, or team management by a physician before NPs can provide patient care.
While there are still many states with limitations, practice authority in these states will change with time.
Bills to modernize practice acts and expand the scope of practice have been introduced in several states and are making their way through the legislative process.
Just recently, Wisconsin was the latest state to grant independence to APRNs who have completed 3,840 hours of supervised practice.
Congratulations to Wisconsin and Wisconsin NPs!
The Bottom Line…
Independent practice laws directly affect access to care, particularly in rural and underserved areas.
States with full practice authority see more NPs practicing in primary care and underserved settings, while enjoying greater patient satisfaction and fewer delays in care.
But for Nurse Practitioners, understanding the legislative and legal implications of practice acts goes beyond professional interest.
It’s about knowing where you can practice to the full extent of your education and where advocacy is still needed.
The above-quoted distribution of full, reduced, and restricted practice states probably won’t be accurate for long.
To keep up to date with developments and for legislative status updates, check the AANP website for the latest information.
We’d love to hear from you… Join the conversation by leaving a comment or question below.
By Johanna Hofmann, MBA, MAc., EAMP; regular contributor to the NPBusiness blog.
Thank you for the announcement and congratulations JoHanna regarding my state of WI! I am very excited about the new law finally passing! It took 3 tries to get it through the legislature and governor signal but we finally got there! I am a WHNP and who started my clinic, Wise Woman Wellness, in 2009 with help from Barbara Phillips and your team! I have also started The Wise Woman Institute to help other NP’s interested in opening their own female hormone, functional medicine wellness focused clinic by offering on-site training and support for other NP’s wanting to open their on clinic. We offer other NP’s on-site training to learn how we run our 7-figure business and help thousands of women (one can learn more by listening to the podcast Barbara and I recorded several years ago!) Yah NP’s!!! We still have some distance to go but I am so glad WI has joined the ranks of independent NP’s! Thank you for your help and support all these years!!!
Hello, all!
I am a DNP, and it always bothers me the logic of different states have different rules regarding NP practice. It is very strange after the education and certification, NPs in some states can't practice to their full potential, but others in her class can have full practice, just because she/he lives in a different state? From the very beginning of the history of nursing, nurses have suffered many types of discrimination. When this will end? After certain hours of experience as an NP, we all should have full practice authority regardless of which state are we living. Other professionals have same practice authority in every state. for example, Doctors, Therapists, Technicians, RNs, MAs, they have no restrictions in their practice authority in different states. The NP practice authority needs to be changed nationwide. There should be a rule, for how much experience they should need before the FPA is allowed for every NPs. I hope AANP and ANCC will work hard for a Nationwide FPA status for NPs. Every NP student should be informed by their Admission counselor regarding this existing restrictions on practice before they start their NP course. If so, they can choose to relocate to a FPA state before they start their NP/ DNP education. A large number of the NPs were not aware of this situation-before we went to the NP school and ended as frustrated. We are educated, certified, but not allowed to practice with FPA in some states, but not in others. It is a real problem, and it is not FAIR at all.
Thank you,
Mercy Prakash