States Where Nurse Practitioners Can Practice Without Physician Supervision
One of the most critical reforms in healthcare policy today is the expansion of full practice authority (FPA) for nurse practitioners (NPs). In FPA states, NPs can evaluate patients, diagnose conditions, prescribe medications (including controlled substances), and manage treatment plans without physician supervision—under the exclusive licensure of the state board of nursing. The American Association of Nurse Practitioners (AANP) and the National Academy of Medicine endorse this model as essential for improving access and reducing provider shortages (nurse.org, aanp.org).
As of the latest available data, 27 states plus Washington, D.C. have granted FPA to NPs. These include:
Full Practice Authority (Independent) Jurisdictions:
Alaska
Arizona
Colorado
Connecticut
Delaware
District of Columbia
Hawaii
Idaho
Iowa
Kansas
Maine
Maryland
Massachusetts
Minnesota
Montana
Nebraska
Nevada
New Hampshire
New Mexico
North Dakota
Oregon
Rhode Island
South Dakota
Vermont
Washington
Wyoming
What “Full Practice Authority” Means
In these jurisdictions, NPs may:
Diagnose and treat patients.
Order/interprettests like labs and imaging.
Prescribe medications, including many controlled substances.
Open and operate independent practices, without needing a supervising or collaborating physician agreement. (online.simmons.edu, nursejournal.org, hire.vivian.com)
Note: Some states require initial experience under mentorship or conditional prescriptive authority before full independence, though these are transitional, not permanent, steps .
Benefits of Full Practice Authority
Improved access to primary and specialty care, especially in rural and underserved areas.
Faster, cost-effective care, as NPs bypass delays associated with obtaining physician oversight.
Promotion of interdisciplinary teams, fostering better care coordination through nurse-led clinics and direct referrals.
States with Reduced or Restricted Practice
In contrast, the non-FPA states (including: Alabama, Arkansas, California, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, Missouri, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Wisconsin, Michigan) require NPs to maintain formal collaborative or supervisory agreements for diagnosis or prescribing (online.simmons.edu).
Summary Table
Practice Authority
Allowed Without Supervision
Jurisdictions Covered*
Full practice
Diagnosis, referrals, treatment, prescribing, independent operation
AK, AZ, CO, CT, DE, DC, HI, ID, IA, KS, ME, MD, MA, MN, MT, NE, NV, NH, NM, ND, OR, RI, SD, VT, WA, WY
Reduced/Restricted
Requires physician oversight/collaboration for parts of scope
Remaining 23 states
* Sources: Simmons (2016), Maryville (2023), Nurse.org overviews (online.simmons.edu, en.wikipedia.org). AANP confirms the FPA framework .
Key Takeaways for Healthcare Administrators
FPA states offer leverage to deploy nurse-led clinics, especially in areas suffering provider shortages.
Insurance reimbursement and institutional credentialing should reflect NP autonomy to maximize efficiency and reduce administrative hurdles.
Pilot programs and policy shifts in reduced/restricted states are underway—tracking these could unlock broader NP utilization.
Quality metrics consistently show outcomes in FPA states matching or exceeding those overseen by physicians, making a strong business case for expanding NP-led care.
Final Thoughts
Full Practice Authority for NPs improves healthcare access, enhances cost efficiency, and empowers a skilled workforce—a model increasingly adopted across the U.S. As regulations evolve, healthcare leaders should keep FPA states top of mind when designing care delivery systems and advocating for broader provider utilization.