5 Worst States for Nurse Practitioner Practice

States are increasingly passing laws allowing nurse practitioners more freedom in their practice. Some legislators are even running marketing campaigns attempting to lure NPs from other states within their boarders on the basis of more favorable scope of practice legislation. But, some states lag behind in the NP independent practice movement (ahem, Deep South, we're looking at you). 

Which states fall notoriously short when it comes to granting nurse practitioners freedom in their practice?

1. Florida

If you want to work in healthcare, Florida should be at the bottom of your list of dream destinations. Yes, the Sunshine State may have palms, sun, and sand, but state laws may make your day job a less than illuminating experience. 

Florida's nurse practitioner supervision laws are among some of the strictest in the nation. State law requires that nurse practitioners work under the supervision of a physician when it comes to practice and prescribing. Even when working within a physician supervision agreement, NPs practicing in Florida are not allowed to prescribe controlled substances. This is a major setback, especially considering the state is facing a significant shortage of primary care providers. 

2. Alabama

With the highest rate of obesity in the nation and over 25 percent of its residents smokers, you would think Alabama could use nurse practitioners more than ever. Unfortunately, the state's legislators don't feel the same. Not only must nurse practitioners work in collaboration with a physician, the physician must be physically on site with the NP ten percent of the time. 

Prescribing laws in Alabama are similarly strict for nurse practitioners. NPs working in Alabama may only prescribe Schedule III, IV and V medications limiting their utility in certain settings. 

3. North Carolina


While known for its predictably strong college basketball teams, laws concerning NPs in North Carolina are far from a slam dunk. Like our prior two picks, nurse practitioners practicing in North Caorlina must work in collaboration with a physician. Not only does North Carolina require a collaborative agreement with an MD, nurse practitioners are also restricted within this arrangement. For example, nurse practitioners may only refill certain controlled substances a limited number of times. Complex rules and regulations when it comes to prescribing and supervision limit NPs ability to practice in the Tar Heel State. 

4. Georgia

The last state to grant nurse practitioners the ability to prescribe, Georigia still lags perilously behind when it comes to scope of practice laws. NPs practicing in the Peach State are not allowed to prescribe Schedule II controlled substances. Nurse practitioners in Georgia must also practice under a so called "delegating physician". Georgia may be one of the fastest growing states in the nation, but it's view of nurse practitioners remains limited.  

5. Oklahoma

Oklahoma is as all-American as they come. Famous for cowboys, Tornado Alley, and outlaws, the Sooner state has an adventurous spirit. Unfortunately, these ideals do not extend to laws governing nurse practitioners. NPs practicing in Oklahoma are prohibited from prescribing Schedule II controlled substances not to mention, they must be supervised by a physician in order to prescribe. Sorry Sooner's, the NP scope of practice in Oklahoma leaves something to be desired. 

While the West might be best when it comes to nurse practitioner scope of practice laws, the South presents a pretty sorry picture. How do scope of practice laws in your state affect your practice?


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@ Dr. Kel.

Blah, blah, blah Dr. Kel!! If you were an actual doctor you wouldn’t have time to be on here bashing NP’s. Why don’t you just report the NP’s and PA’s from your everyday practice if there are so many diagnostic errors with inappropriate medication use resulting in deleterious medication complications and side effects? Maybe you’re making errors yourself!! Just because whatever the NP’s and PA’s decided to do for their patient is not what you would have done, doesn’t make it wrong!!!! We are all practicing medicine with a strong emphasis on practicing!!!! There is no exact answer all the time. The main focus should be the patient not how much shade can be thrown at the “midlevels”!!! Get a life!!!

NP south

Wow, West coast I will stay. No one is trying to be a medical doctor. Rest assure when their shortage starts impacting care they will loosen their antiquated restrictions so NPs can practice their full scope


Given that a nurse practitioner with 30 years of experience cost my wife and I our first child, I may not be sympathetic to please for "less supervision..." There is a profound difference in training and that cannot be denied, ignored or wished away. Every day, in my practice, I see referrals from NPs and PAs who have made significant diagnostic errors. These errors have lead to inappropriate medication use which has then resulted in deleterious medication complications and side effects... all of which arose from basic errors in medical decision making. I know I am not the only physician seeing this trend. If a self-delcared "professional" does not have the wisdom to understand when s/he is practicing beyond their scope of training.... well, I guess that is what trial lawyers are for.

Dr Kel

Mississppi definitely should be added to the worst list. First year new graduates need work 720 supervised hours by a MD to get DEA license. Meanwhile, new NPs need meet up with a Board site visitor every two months and your supervising MD must meet with the site visitor every three months to discuss your performance. NPS are treated like step children especially new graduates in MS. I am on my way out, heard NPs in D. C. Oregon and VA are in much better place and can seeing patients and prescribe independently without Physician on site

Doomed in MS

Please stop your belly aching. If you wanted to me medical doctors, you should have studied harder and gotten into medical school. But you didn't. You did your bachelor's in nursing and then might have done some extra coursework to get a "master's" level NP designation. Your training is mid-level compared to physicians. Deal with your choices like adults.

Physician Joe

Michigan should definitely be added to this list.

While I love my job, there are definite restrictions our practice ability. In addition, I feel the people of the great mitten state are very physician driven. I don't think there is a lot of knowledge for who we are and the great care we deliver.


Stop using the term midlevel. I'm not a midlevel to anyone. And do your research. There are many states that are restrictive to NPs. MO is at the top of that list.

Vashti Ivey

These least progressive states are all conservative voting zones that obviously don't believe the research indicating outcomes of NP directed treatment is as good or better than that directed by physicians. This is yet another illustration of the power and influence of the AMA over a political spectrum that is not swayed by facts.

Ed A.

Worked in one of 5 worst GA for 4 yrs., the best state WA for 10 yrs., then TX for nearly 4 more and now going to try the number 2 state on the best of list NM. I see a pattern developing......

William C.

Florida passed law nurse practitioners can prescribe narcotics. No thanks. I have seen too many doctors sued when the patient dies due to an overdose. With more responsibility comes more liability. The doctors are just going to use this law to benefit themselves like dumping their problem narcotic patients on nurse practitioners on us to reduce their liability...work load...ect. I've already told my employer that I will not get a DEA license. I refuse to do it.



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