Written By: Kasee Wiesen Kasee Wiesen DNP, APRN, FNP-C
Kasee Wiesen is a practicing family nurse practitioner. Her nursing background includes emergency medicine, pediatrics and peri-op. She started her health career as a nurse’s aid while pursuing her bachelor’s in nursing degree in a hospital setting. Education is a passion of Kasee’s, and after working as a BSN prepared nursed, she obtained in master’s in nursing education and began teaching adjunct for a local university. Read Full Bio »» DNP, APRN, FNP-C
The scope of practice for nurse practitioners is a hot topic in the medical community. The Association of American Medical Colleges (AAMC) projects that there will be a shortage of up to 124,000 physicians by 2034 across all specialties, including primary care. This is a worrisome statistic as the population continues to grow and people live longer, further supporting the need to improve healthcare access.
One way to improve access to healthcare is by expanding the scope of practice for nurse practitioners. Currently, there are 27 states where nurse practitioners can practice independently, with more hopefully on the way. I work in a state that grants NPs the ability to practice independently, and I know quite a few who do.
And now, you may be wondering, what are the states where nurse practitioners can practice independently? Below is a list of 27 states where nurse practitioners can practice independently.
The state determines the scope of practice for nurse practitioners, and as of the first half of 2023, nurse practitioners can practice independently in 27 states. Practicing independently means the NP can practice independently of direct physician supervision, but this does not guarantee the NP can perform all tasks, which may include authorizing physical therapy, signing DNRs, or signing death certificates. Some states grant independent practice, but a specified number of supervised practice hours must be completed before practicing independently. Therefore, you must research the NP's scope of practice in the state you practice to ensure you are practicing within the guidelines.
Also, just because your state allows you to practice independently, it does not require organizations to follow this. For example, I work in a state that allows NPs to practice independently, and I work for a large organization. While I have autonomy in my day-to-day practice, I have a supervising physician with whom I work.
No—not all states allow nurse practitioners to practice independently. As of the first half of 2023, nurse practitioners can practice independently in 27 states.
As of the first half of 2023, 27 states allow nurse practitioners to practice independently.
Improving access to healthcare is one of the primary reasons why states started allowing NPs to practice independently. Research has supported a current physician shortage and a lack of access to healthcare in rural communities, and NPs can help fill these voids. Over the past few years, I have known a handful of NPs who worked in primary care leave the urban setting and move to rural communities where they felt called to help improve access to those communities.
The education NPs receive also prepares them to practice independently. The education I received in my didactic and clinical courses prepared me to perform thorough assessments, understand appropriate diagnostic tests based on symptoms, and know how to treat various diseases and chronic conditions. The education received along with experience as a registered nurse allows NPs to transition into the role of independent provider—gaining the trust of other healthcare providers, state boards of nursing, and the community that NPs can be independent providers.
There are many advantages of working in a state where nurse practitioners can practice independently. I have listed five main advantages below, but this list may vary for others.
Independent nurse practitioners help improve access to healthcare, including in urban and rural communities—but I feel this is especially true in rural communities as there is a more significant shortage of physicians in those communities. NPs can also improve access to the aging population, which has been steadily growing over the last several years.
The job outlook for nurse practitioners is excellent. The Bureau of Labor and Statistics projects a 40% growth over the next ten years, much higher than other career fields. This is most likely due to the shortage of health care providers, including physicians, and the growing/aging population.
Many studies have shown high patient satisfaction with nurse practitioners, which has been demonstrated through HCAHP scores at several organizations. Patients have felt that patients receive high-quality care from NPs, and nurses have reported they have more confidence in patients’ ability to care for themselves after discharge when cared for by an NP.
Improved patient outcomes are linked to patients cared for by a physician. A recent study by the University of Pennsylvania School of Nursing reported that nurse practitioners lead to lower surgical mortality, lower readmission rates, and shorter hospital stays.
Working as an independent nurse practitioner requires no collaborative agreement or supervising physician to report to, leading to ultimate autonomy in your practice. NPs carry the knowledge and skill set to do this, leading to the complete use of their graduate degree. While there is full autonomy, developing relationships with other practices and physicians is essential when a consult or referral is needed. I know an NP-run practice, and while they practice independently, they collaborate with a practice in a local city to refer patients who need more advanced care than they can provide.
Listed below in alphabetical order as per the American Association of Nurse Practitioners (AANP), the following are the 27 states where nurse practitioners can practice independently in 2023. The information provided for each state also comes from the AANP.
Alaska is one of the nurse practitioner independent practice states where NPs can be a person’s primary care provider. They can assess, diagnose, and treat patients without direct supervision from a physician. They can also prescribe medications, order physical therapy, authorize parking permits, sign death certificates, and sign Provider Orders for Life-Sustaining Treatment (POLST) forms. NPs cannot sign DNR orders in Alaska, and each facility determines medical staff membership.
In Arizona, nurse practitioners have full practice authority to evaluate, diagnose, and treat patients without requiring direct physician supervision. They can access people’s primary care providers, order physical therapy, authorize parking permits, sign DNR, and sign death certificates. The state of Arizona does not currently have an approved POLST form.
Colorado is one of the states where nurse practitioners can practice independently, but before NPs can practice independently, they must complete 750 practice hours in agreement with a physician or APRN mentor.
Once the NP has completed the required 750 hours under supervision, they can assess, diagnose, and treat patients without direct supervision from a mentor. They can access a person’s primary care provider, order physical therapy, authorize disability parking permits, and sign DNRs and POLST forms. They cannot sign death certificates and must carry malpractice insurance that pays at least $500,000 per claim and $1,500,000 in the aggregate.
Nurse practitioners can practice independently in Connecticut, and this includes being a person’s primary care provider. They do however require NPs to practice alongside a physician for at least 3 years and a minimum of 2,000 hours. NPs can assess, diagnose, prescribe medications, sign physical therapy orders, authorize disability parking permits, and sign DNRs. They can also sign DNRs and POLST forms.
NPs in Connecticut must carry malpractice insurance that pays at least $500,000 per claim and $1,500,000 in the aggregate.
Nurse practitioners can practice independently in Delaware, including providing primary care to patients. They can order physical therapy, authorize disability parking permits, and sign death certificates. NPs can also sign the Medical Orders for Scope of Treatment (MOST) form.
Hawaii is one of the states where nurse practitioners can practice independently, allowing them to assess, diagnose, and treat patients independently from a physician. In Hawaii, NPs can practice as primary care providers and can refer to physical therapy. They can also authorize disability park permits and sign DNRs, death certificates, and POLST forms.
Nurse practitioners can practice independently in Idaho, allowing them to assess, diagnose, and treat patients without direct supervision from a physician. They can practice as primary care providers and refer patients to physical therapy. NPs in Idaho are also authorized to sign death certificates and Physician Orders for Scope of Treatment (POST) forms.
Iowa is one of the 27 states where nurse practitioners can practice independently, and the Hawkeye State defines NPs as primary care providers. In Iowa, NPs can refer to physical therapy, sign death certificates, and sign POST forms. At this time, they are not authorized to sign DNR orders.
Nurse practitioners working in Kansas are granted full practice authority—allowing them to assess, diagnose, and treat patients without direct supervision from a physician. They are authorized to refer to physical therapy and give permission for disability parking permits. They are not currently authorized to sign DNR orders and death certificates. It is also not defined if they are considered a primary care provider.
Maine is one of the states where nurse practitioners can practice independently, but some limitations are in place during the first couple of years of practice. NPs in Maine must practice for at least 24 hours under the supervision of a physician or APRN, or they must be employed by an organization (clinic or hospital) with a licensed physician as a medical director.
In Maine, nurse practitioners can practice as primary care providers and refer to physical therapy. They can authorize disability parking permits and sign DNR orders, death certificates, and POLST forms. In regards to third-party reimbursement, insurers in Maine are required to cover NP services.
Maryland is a nurse practitioner independent practice state where nurse practitioners can practice independently after completing an 18-month mentorship with a certified APRN or physician. They can order physical therapy, sign death certificates, and sign DNR orders. They can also sign Medical Orders for Life Sustaining Treatment (MOLST) forms. They are also defined as primary care providers.
Massachusetts grants nurse practitioners full practice authority but does require two years of experience under the supervision of an APRN or physician—and in some circumstances, exemptions are made for equivalent experience.
NPs in Massachusetts are required to have professional malpractice liability insurance and can practice as primary care providers. They are authorized to sign physical therapy referrals, DNR orders, and MOLST forms.
Minnesota is one of the nurse practitioner independent practice states, but NPs must complete 2,080 hours in a collaborative agreement with a physician or APRN. They are defined as primary care providers authorized to sign physical therapy referrals. NPs in Minnesota can sign death certificates and POLST forms but cannot sign DNR orders.
Montana is one of the states where nurse practitioners can practice independently without direct supervision from a physician. They are defined as primary care providers and are authorized to refer to physical therapy. They can also sign death certificates, DNR orders, and POLST forms.
In Nebraska, nurse practitioners can practice independently after completing 2,000 hours under the supervision of a supervising provider. NPs can authorize referrals to physical therapy and sign death certificates. They are also able to authorize disabled parking permits. In Nebraska, NPs cannot sign DNR orders.
Nevada is one of the states where nurse practitioners can practice independently. However, before the NP can prescribe Schedule II controlled substances, they must complete two years of clinical experience or 2,000 hours of clinical experience, or the NP can prescribe in accordance with a protocol approved by a collaborating physician.
NPs in Nevada must be covered by malpractice insurance. They are authorized to refer to physical therapy and provide proof of disability for disabled parking permits. They can sign DNR orders, death certificates, and POLST forms.
New Hampshire is one of the states where nurse practitioners can practice independently including assessing, diagnosing, and treating patients in all areas, including primary care. They are authorized to refer to physical therapy and authorize disabled parking permits. They can sign DNR orders, death certificates, and POLST forms.
New Mexico grants NPs rights to practice independently, including diagnosing and prescribing medications and treatment plans for patients. NPs can be primary care providers in New Mexico, and insurers must provide coverage for services provided by NPs. Nurse practitioners in New Mexico can refer to physical therapy and authorize disabled parking permits. They are also authorized to sign DNR orders, death certificates, and MOST forms.
In 2022, New York passed the law to authorize NPs to practice independently after completing 3,600 hours of experience as an NP and developing practice protocols with a supervising physician. NPs are defined as primary care providers and can refer patients to physical therapy. They can also sign DNR orders, death certificates, and MOLST forms.
North Dakota is another one of the nurse practitioner independent practice states. NPs in North Dakota are defined as primary care providers. They are authorized to refer to physical therapy and serve on medical staff. NPs in North Dakota can sign death certificates and POLST forms.
Oregon is one of the nurse practitioner independent practice states where NPs can assess, diagnose, and prescribe medications and treatment plans. They are considered primary care providers and are authorized to refer to physical therapy. NPs in Oregon can sign DNR orders, death certificates, and POLST forms.
Nurse practitioners in Rhode Island are able to practice independently, including prescribing medications. They are defined as primary care providers and are required to carry malpractice insurance in the amount of $100,000 per claim and $300,000 in the aggregate. NPs in Rhode Island can refer to physical therapy. They are authorized to sign DNR orders, death certificates, and MOLST forms.
Nurse practitioners working in South Dakota can practice independently once they have completed 1,040 hours under a written collaborative agreement with a physician, APRN, or midwife. They can practice as primary care providers and refer patients to physical therapy. NPs are authorized to sign DNR forms, death certificates, and MOST forms. In South Dakota, NPs cannot provide proof of disability for disabled parking permits.
In Utah, nurse practitioners can practice independently, including assessing, diagnosing, and prescribing medications and treatment plans without direct supervision from a physician. They can also refer to physical therapy and provide proof of disability for disabled parking permits. NPs in Utah can also sign death certificates, DNR orders, and POLST forms.
Vermont is one of the 27 states that allow nurse practitioners to practice independently. However, NPs with less than 24 months and 2,400 hours of NP experience must have a collaborating agreement with a Vermont licensed physician or APRN. Vermont nurse practitioners can authorize referrals to physical therapy and provide proof of disability for disabled parking permits. NPs may sign DNR orders, death certificates, and Clinician Orders for Life Sustaining Treatment (COLST) forms.
The state of Washington allows nurse practitioners to practice independently, which includes assessing, diagnosing, and prescribing medications and treatment plans specific to the patient. In Washington, NPs are defined as primary care providers and can refer to physical therapy. They are also authorized to sign DNR orders, death certificates, and POLST forms.
Wyoming is one of the 27 states where nurse practitioners can practice independently, including assessing patients, formulating a diagnosis, and prescribing medications or treatment plans for their patients. NPs in Wyoming can also refer to physical therapy and provide proof of disability of disabled parking permits. NPs can also sign death certificates and POLST forms.
Did I answer what are the states where nurse practitioners can practice independently? While there are only 27 where nurse practitioners can practice independently, I predict that over the next 5-10 years, there will be more states where NPs can practice independently. This may be due to the projected physician shortage or the aging and growing population. Regardless of the reason, I predict that more states will grant full practice authority, allowing NPs to utilize their degree to the fullest.
The first 4 states to allow nurse practitioners to practice with a broader scope of practice include Alaska, New Hampshire, Oregon, and Washington, which happened in the 1980s. Several more states followed in the 1990s due to a need to improve access to healthcare.
No—Nurse practitioners can not practice independently in any state. This is determined state by state, and if clarification is needed regarding practice regulations for a specific state, I recommend contacting that state’s board of nursing.
No—nurse practitioners cannot practice independently in California.
No—Nurse practitioners cannot practice independently in Florida.
No—Nurse practitioners cannot practice independently in Texas.
Yes—nurse practitioners can practice independently in New York.
No—Nurse practitioners cannot practice independently in Pennsylvania.
No—Nurse practitioners cannot practice independently in Georgia.
Yes—Nurse practitioners can practice independently in Massachusetts.
No—Nurse practitioners cannot practice independently in Illinois.
No—Nurse practitioners cannot practice independently in Ohio.
No—Nurse practitioners cannot practice independently in North Carolina.
Kasee Wiesen DNP, APRN, FNP-C
Kasee Wiesen is a practicing family nurse practitioner. Her nursing background includes emergency medicine, pediatrics and peri-op. Education is a passion of Kasee’s, and she has taught BSN, RN-BSN and DNP students, and has enjoyed every moment of it!
