31 Comments

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.

 

You Might Also Like: Legislative Lash Out- NP Scope of Practice Laws in the News

 

Are you ready to Thrive?

Support + education for early career nurse practitioners.

Learn More
clipboard

31 thoughts on “6 Best States for Nurse Practitioner Practice”

  • Abigail Carvalho says:

    I’m here in California! What prospects of autonomy do NPs have in the near future here? …And when? Great article. Thanks!
    Abigail, MS, ANP-BC , RN

  • Beverlee Furner says:

    I would also add Idaho to this list as an awesome place to work as an independent practice NP. It is a great place to live too.

  • Maine was a leader in NP independent practice. It is a good practice environment. It should be up there at the top unless you dislike cold winters.

  • Colorado is not friendly for new grads. You must complete 1800 hours of mentored practice to obtain provisional prescriptive authority. Sadly, only physicians can mentor you during these hours. Many places will not hire new grads as a result. After you complete the hours, you can practice and prescribe independently

  • It is very unfortunate that this website refers to NPs as Midlevels. Is that the kind of service you guys offer…midlevel service and not high level service? Respect comes from within.

  • Agree with the comment about “midlevel” . It’s a demeaning term. No NP or PA should ever use it. I am not, have never been, and will never provide, “mid level” care.

  • Wayne Rockhill, APRN says:

    Connecticut recently passed legislation allowing NPs to practice independently after 3 years (and at least 2000 hours) of collaborative physician practice. As a NP, I think this is more than fair. NPs want unfettered access to patients without physician collaboration; however, we clearly do not consider the fact that our education and clinical requirements are not nearly as rigorous as those required of the MD. While I do believe NPs should be able (within their scope) to practice independently of physician oversight, I also think there should be a period of time in which the NP practices under and learns from the MD. Think of it as a post-grad residency/fellowship. There should be no opposition or feeling of inadequacy on the part of the NP to learn from and work with a MD who has spent 4 years in medical school and another 3-6 years in residency. I applaud Connecticut for allowing NPs to practice independently with the stipulation that they first spend at least 3 years working with (and learning from) a physician. If NPs have a problem with this, then they need to accept that the education and clinical requirements for NP programs should become more rigorous, because they currently pale in comparison to what the physician is required to achieve.

  • Caroline Hermann says:

    Midlevel U ?? You really gotta change the name. I correct anyone I hear using the term.
    It does not sound professional. I provide high quality, compassionate evidence based care. There is nothing midlevel about me. I am assuming that this is a website is not run by APRNs or PAs.
    Caroline Hermann CNM

  • I was immediately turned off by your site due to the name. MidlevelU!!??? Really? NPs and PAs are not midlevel to anything. Please read the position statement from the AANP regarding this term

  • I couldn’t agree more with the comments about referring to NPs and PAs as “mid-levels”. It’s demeaning. NPs are independent practitioners. Time to come out of the dark ages & rename your blog…and why was there no response to these comments?

  • Wayne…it is that attitude that is a setback, and frankly you should be ashamed. Yes, there is a residency for medical students, but let’s be clear on what that really entails…tons of rotations, jack-of-all-trades, abuse, and nurses end up telling the medical students the next move for the patient anyway. Also nurses who enter practice want to work with physicians, not under them–and there is a difference. I do not see anything wrong with requiring a physicians guidance for a year in the initial practice, but you make it sound like they are so much more trained than we are, and that is simply not true in a primary care setting. Specialties, absolutely. So do us practitioners a favor–and simply slink off quietly in a corner. One of the main reasons legislation didn’t pass this last time in California is because the CNA union here was against full practice for their brethren. Give me a break. We want full practice, the literature supports full practice, so WAYNE, believe in yourself and your colleagues.

  • Wayne is pretty on target. I went to a very rigorous NP school, and I am not ready to practice independently. I am a very good ICU nurse and I have a lot of experience and skills. But for the safety of patients, nurse practitioners either need a residency requirement or mentored hours in the area. I learned a lot as a nurse that is helping me as a practitioner, but nursing and medicine are very different. And for all the talk about nurse practitioners providing advanced nursing care, we are also expected to practice clinical medicine. That means we won’t be prescribing a new untested drug, or doing heart surgery independently, but nurse practitioners are great and probably better than some physicians at doing the things we see frequently. We can be excellent educators as well, which is really important. Patient education is really lacking in the physician world sometimes. Some doctors don’t have the time or inclination to teach. But physicians have the corner on medicine. We can catch up, of course, but if you look at the programs, medical schools teach anatomy and physiology, and pathology in a much more in-depth way. If your school spent a semester in the cadaver lab please correct me. Somebody please tell me why I spent semesters in ethics and nursing theory, when I could have had a semester in the skills lab or learned more patho? I think physicians and nurse practitioners complement each others strengths. I definitely learned a lot as a nurse, especially as an ICU nurse, but seeing 2 patients a day, and seeing 20 are very different. There are some things that the med students know that I don’t, and vice versa. 3rd year residents are much faster than I am, and they know more, but in a few years Ill probably deliver the same care as a physician. Not yet, however, I’d put my assessment skills at resident or physician level in some areas….heart and lung sounds. And I’m definitely above the curve at identifying sick patients and emergency prescribing. As far as thyroid exams, lymph nodes, and musculoskeletal, I need more practice.

  • 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.

  • NP independence, CA says:

    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.

  • WHY ON EARTH WOULD YOU NAME YOUR SITE MID-LEVEL??? DOES ANYONE EVEN STILL USE THAT TERM IN CONJUNCTION WITH WELL EDUCATED AND SOLIDLY PERFORMING NURSE PRACTITIONERS??? WHAT COMPLETE DISRESPECT TO THE PROFESSION!!! :-(( SOUNDS LIKE AN ILL-INFORMED AND VERY DATED PHYSICIAN STARTED THIS SITE.

  • @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?”

  • Cynthia Elliott, FNPC, DNP says:

    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!

  • 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!

  • 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.

  • 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.

  • Arizona should NOT be on this list. They may have no restriction but their board prosecutes nurses for anything and everything violating due process rights. The governor is absolutely useless. It’s a politically driven and discriminating state which is reflected massively at the BON. They revoke licenses for a cyberbullying. This female nurse was stalked by a male who made sexual advances and they believed HIM. What a CROOKED state. Don’t ever think about working in this state. ANYONE…. YOU ARE AT RISK FOR THIS TARGETING.

  • Stop whining! Yes, mid-level is used across this nation and especially where a supervising provider must be present. If you don’t like the term then change it. I am sick of nurses crying and whining across the entire span of nursing from working too hard, not being appreciated, having to give baths, not having a tech, having to count their anesthesia cart, and then not knowing that the slightest detail missed could be an opportunity missed to rescue. Sometimes I am embarrassed by my profession. We want the highest pay to have a 2 year preparation or MSN/DNP and then gripe about “tech versus nurse or NP versus physician.” Who cares? It is nursing and it serves you and others well. If you don’t like it, take action and join your professional organization and encourage slackers to get out or do better. When nurses refuse to carry out basic care and do not know the meaning of verifying orders, documenting well and its importance, giving a good handoff, assessing fully, including family in care, being compassionate instead of worrying how much time they have to spend talking to the patient, then many do not need to be in this profession at any level. The better the experience/encounter a patient has when dealing with an NP, the more public support we will have when seeking scope of practice changes from government. Currently, I work with CRNAs and FNPs that are being as rude and derogatory to patients as many physicians used to be. Nursing is losing ground as the compassionate profession in many ways and I am beginning to see why. Pay is important but practicing to our full ability and demonstrating pride in providing excellent, compassionate care should be job one. DNP, FNP, Ga.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes:

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>