6 Best States for Nurse Practitioner Practice

Dreaming of opening your own clinic? Or, perhaps you are tired of handing the red tape associated with practicing as a nurse practitioner? Laws regulating NP practice vary significantly between states and can affect what your job looks like on a day to day basis. For example, some states require NPs to work within a certain radius of an overseeing physician and others regulate nurse practitioner's prescribing abilities. One state's laws may permit you to open your own clinic with ease while another's could have you jumping through hoops.

Regardless of your reasons for seeking independence in your practice, living in a nurse practitioner friendly state can certainly give you more room to grow in your NP career. Which states fare best when it comes to nurse practitioner scope of practice laws?

1. Washington State

Residents of Washington State have an overall liberal mindset. You can't visit Seattle, after all, without seeing a some blue hair and a few wannabe rockers pining away for the 90's. This independent mindset extends to nurse practitioners practicing in the state. Physician involvement is not required in practice or prescribing for NPs living in Washington State. Furthermore, Washington was the first state, and remains one of the few in the nation, that currently allows nurse practitioners to prescribe medical marijuana.


2. New Mexico

New Mexico's Governor, Susana Martinez, is a big fan of nurse practitioners so the state has scope of practice laws to match. NPs practicing in New Mexico may practice and prescribe independently of physician oversight. Not only are New Mexico's laws regulating nurse practitioners among the most favorable in the nation, the state is actively recruiting NPs to its ranks. Recently, New Mexico implemented an ad campaign in neighboring Texas encouraging nurse practitioners to relocate to neighboring New Mexico where scope of practice laws are more favorable. As an added bonus, New Mexico also offers NPs practicing in rural areas a $3,000 tax credit.


3. Oregon

Oregon has long recognized the value of nurse practitioners to healthcare. For example, the state began allowing NPs to prescribe controlled substances as early as 1979. Nurse practitioners working in Oregon may both practice and prescribe without physician oversight. Aspiring NPs should note that in Oregon, new nurse practitioners are required to have at least 384 hours of registered nursing experience outside of the academic setting in order to obtain a nurse practitioner license, a requirement not held by most other states.


4. Alaska

Like Oregon, Alaska has a rich history of supporting nurse practitioners. Alaska began adapting scope of practice laws granting NPs more freedom as early as the 1980's and hasn't looked back since. Physician involvement in diagnosing, treating, and prescribing for patients is not required for nurse practitioners practicing in Alaska. Furthermore, new NPs may begin practicing immediately upon graduation, even while certification exam results are pending. This allows for a smooth transition from education to practice.


5. New Hampshire

"Live free or die", New Hampshire's state motto rings true for nurse practitioners practicing in the state. Like all other states on our list, New Hampshire does not require physician supervision or collaboration in practice or prescribing when it comes to NPs. The state also has a provision for newly graduated nurse practitioners allowing a temporary license to practice before sitting for the national certification exam. This gives new nurse practitioners a seamless transition from education to practice.


6. Arizona

Arizona completes our list of most nurse practitioner friendly states. Nurse practitioners working in Arizona enjoy the freedom to practice and prescribe independently. Within this freedom, however, state law specifies that NPs must practice only within their area of certification, they should not "exceed the limits" of their advanced practice specialty.

Overall, west is best when it comes to nurse practitioner scope of practice regulations. Five of the top six most favorable states for NP practice lie in the western half of the country. While these states stand out above others when it comes to offering nurse practitioners freedom in their practice, more and more states are jumping on the NP independence bandwagon. Soon, we could see all 50 states mirroring the practice and prescribing laws of the nation's most nurse practitioner friendly locales.


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I agree with the comments regarding the site name using 'Midlevel'. Consider that at NP's we have obtained the highest degree available in our field of practice. That is not midlevel.


Wow, as a nursing professional with over 20 years of primary care under my belt and looking to begin an NP program, the comments crying about being called a mid-level provider bother me. Face it, an NP or PA is a step above education and practice freedoms than an RN or LVN, but a step below a physician in education and practice freedoms. The term says nothing about the level of care that is provided, hopefully all level of practitioners strive to provide top level care to their patients. It is simply a reference to where in the education and practice freedoms the NP or PA resides when looking at the total care cycle. The attitude that it is belittling to be consider a mid-level provider is exactly why nurses in particular are not running healthcare and actually fixing the issues that plague our healthcare system.


Idaho should have been on your list. We have no physician oversight, completely practice independently (own clinic), and prescribe schedules II-V. Our state also has always supported us. I agree that the name has to go!


I appreciate the information about various states in practice! As an FNP, DNP and independent practice primary care provider, I am always insulted when I see or hear mid-level. I do not think it is acceptable to call NPs or PAs mid-level and suggests we provide middle of the road care. I was not mid-level when I was an ADN and BSN. I always gave very high level care as do my nursing colleagues! Just the fact that your site carries the mid-level title tells me that it is not truly an NP promoting, supporting, or friendly site. Maybe unintentionally but blatantly the same. I have 13 years of full time college (in my field) and 31 years of medical experience from an RN, FNP perspective - In practice 7 years as an FNP.
Patients are becoming more aware of what NPS do and who we are but words like mid-level is just insulting, confusing, and in my opinion a flat out lie. :) Blessings!

Cynthia Elliott...

No mention of our parity law in Oregon. Equal pay for the same cpt code is a pretty big draw in Oregon.

Jolyn Zeller

Why is Oregon not #1? It's the only state where NPs make as much as Physicians when in private practice.


@Wayne....I certainly agree with your points in regards to new NP's. My question is, what does that mean for experienced NP's looking to work in CT? Would the experienced NP have to accumulate 3,000 hrs alongside an MD, before he/she could practice independently, or would he/she be, "grandfathered in?"




In answer to a commenter's question, we have had two bills for NP independence in the last 4 years, SB 491 and most recently this year, SB 323. Both were defeated after lobbying efforts by the California AMA, despite broad support from nearly every other body. They were both sponsored by Senator Hernandez.

NP independence, CA

I agree with many of Wayne's points. As a nurse practitioner in Connecticut and having fulfilled the requisite requirements, I have been able to avail myself to the benefits of independent practice. One of the problems with Connecticut's legislation, is that it requires a nurse practitioner to garnish their 3000 hours of clinical experience under a Medical Doctor. Some of the very best training I received was under the tutelage of a nurse practitioner. The "MD" requirement circumvents and discounts the enormous benefits of "NP" experience. I do fall under the camp that believes new nurse practitioner grads require further training. That training, however, does not need to be provided via an MD exclusively. As a side bar, the midlevel thing is a bit hard to swallow.



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