Reference
What a nurse practitioner can do in your state
Scope of practice is written about endlessly for nurses and almost never for patients. This page is the patient version: what the three categories mean, which one applies where you live, and what actually changes about your appointment. Mostly, the answer is nothing.
The three categories
Every state places nurse practitioners into one of three regulatory categories. The naming comes from the American Association of Nurse Practitioners and is used by state boards of nursing, licensing bodies and health policy researchers.
Full practice authority
The nurse practitioner evaluates, diagnoses, orders tests and prescribes under the authority of the state board of nursing alone.
For you as a patient: Nobody else has to sign off on your care. There is no second clinician in the loop and no paperwork step between your appointment and your prescription.
Reduced practice authority
State law requires a career-long collaborative agreement with a physician for at least one element of practice, most often prescribing.
For you as a patient: A collaborating physician is named in the practice's paperwork. They are not a second appointment you attend, and in most cases you will never interact with them.
Restricted practice authority
State law requires supervision, delegation or team management by a physician for the duration of the nurse practitioner's career.
For you as a patient: The same as above from where you sit: an agreement exists on file. It does not add a visit, a referral, or a delay to getting seen.
Where each state falls
Covering the 23 states where Shumeka Hill holds an active license. Select a state to see what care is available there.
Full practice authority12 states
Restricted practice authority8 states
What the category does not change
It is worth being blunt about this, because the vocabulary is alarming and the reality is mundane. Moving from a full practice state to a restricted one does not change the provider's training, board certification, or ability to prescribe. It does not add an appointment, a referral, or a waiting period. It does not mean a physician reviews your visit before you are treated.
What it changes is a contract that exists in the practice's files. Patients in restricted states are frequently surprised to learn their care was ever categorised differently from anyone else's, because from the inside of an appointment, it isn't.
Common questions
- Does restricted practice authority mean I get worse care?
- No. The category describes a state's licensing paperwork, not the training of the clinician or the quality of the appointment. A nurse practitioner's education, board certification and prescribing ability are the same in all three categories. What changes is the administrative arrangement behind the scenes.
- Can a nurse practitioner prescribe controlled substances?
- In every state where this practice is licensed, yes — with a federal DEA registration, which is separate from state scope of practice. Some states add their own conditions on top. Stimulants for ADHD and buprenorphine for opioid use disorder are both controlled substances, and both can be prescribed by a nurse practitioner.
- Which category applies — where I live, or where my provider is?
- Where you are physically located during the appointment. Telehealth is regulated by the patient's location, so a visit is governed by the rules of the state you are sitting in at the time, and your provider must hold a license there.
- Is a nurse practitioner the same as a physician?
- No. They are separate professions with separate training paths and separate licenses. A nurse practitioner is educated and licensed as an advanced practice registered nurse. A doctorate held by a nurse practitioner, such as a DNP, is a nursing degree and not a medical degree.
- Why does this vary so much between states?
- Scope of practice is set by state legislatures, not federally, so it reflects decades of separate state-level policy. Several states have moved between categories in recent years, which is why any list of this kind carries a review date.
Sources and corrections
Categories follow the American Association of Nurse Practitioners' state practice environment classification, cross-checked against the relevant state board of nursing statutes. Scope of practice legislation changes; several states have moved category in recent years. If you believe something here is out of date, please tell us and we will correct it and note the change.
This page may be quoted or cited freely with attribution.
Medically reviewed by Shumeka Hill, DNP, PMHNP-BC, FNP-BC, CPNP-AC, LCDC II. Last reviewed .