NP Full Practice Authority 2026

Nurse Practitioner practice authority—the degree of independence NPs have in their clinical practice—varies significantly across the United States. Understanding practice authority is crucial for NPs considering where to practice, especially those interested in opening independent practices or working without physician oversight.

What Is Practice Authority?

Practice authority refers to an NP’s legal ability to:

• Evaluate patients — Conduct assessments and make clinical decisions
• Diagnose conditions — Determine patient diagnoses independently
• Order and interpret tests — Lab work, imaging, and diagnostics
• Initiate treatment — Create and modify treatment plans
• Prescribe medications — Including controlled substances (Schedule II-V)

The American Association of Nurse Practitioners (AANP) classifies practice authority into three levels:

Practice Authority Levels

Full Practice Authority (FPA)

NPs in full practice authority states can:

• Practice to the full extent of their education and certification
• Evaluate, diagnose, and treat patients independently
• Prescribe all medications including controlled substances
• Open and operate independent practices
• No physician collaboration or supervision required

Reduced Practice

NPs in reduced practice states:

• Require a collaborative agreement with a physician
• May have limits on prescriptive authority
• Can practice within the scope of the collaboration agreement
• Typically can’t open fully independent practices

Restricted Practice

NPs in restricted practice states:

• Require physician supervision or delegation
• May have significant prescriptive limitations
• Practice under direct physician oversight
• Most limited scope of practice

State-by-State Practice Authority (2026)

Full Practice Authority States (27 + DC)

These states allow NPs to practice independently without physician oversight:

State	Prescriptive Authority	Notes
Alaska	Full, incl. Schedule II	FPA since 2017
Arizona	Full, incl. Schedule II	FPA since 1999
Colorado	Full, incl. Schedule II	—
Connecticut	Full, incl. Schedule II	—
Delaware	Full, incl. Schedule II	After 4,000 hours
Hawaii	Full, incl. Schedule II	—
Idaho	Full, incl. Schedule II	—
Iowa	Full, incl. Schedule II	—
Kansas	Full, incl. Schedule II	FPA since 2022
Maine	Full, incl. Schedule II	—
Maryland	Full, incl. Schedule II	—
Minnesota	Full, incl. Schedule II	—
Montana	Full, incl. Schedule II	—
Nebraska	Full, incl. Schedule II	—
Nevada	Full, incl. Schedule II	FPA since 2021
New Hampshire	Full, incl. Schedule II	—
New Mexico	Full, incl. Schedule II	—
North Dakota	Full, incl. Schedule II	—
Oregon	Full, incl. Schedule II	—
Rhode Island	Full, incl. Schedule II	—
South Dakota	Full, incl. Schedule II	—
Utah	Full, incl. Schedule II	FPA since 2024
Vermont	Full, incl. Schedule II	—
Washington	Full, incl. Schedule II	—
Washington D.C.	Full, incl. Schedule II	—
West Virginia	Full, incl. Schedule II	After transition period
Wyoming	Full, incl. Schedule II	—

Reduced Practice States (16)

These states require collaborative agreements but allow significant NP autonomy:

State	Collaboration Type	Prescriptive Limits
Alabama	Written protocol	Schedule III-V only
Arkansas	Collaborative agreement	Full with agreement
Illinois	Written collaborative	Full with agreement
Indiana	Collaborative agreement	Schedule II-V
Kansas	Transitioning	Full after hours
Kentucky	Collaborative agreement	Schedule III-V
Louisiana	Collaborative agreement	Schedule II-V
Mississippi	Collaborative agreement	Schedule II-V
New Jersey	Joint protocol	Full with agreement
New York	Collaborative agreement	Full with agreement
Ohio	Collaborative agreement	Schedule II limited
Pennsylvania	Collaborative agreement	Full with agreement
Virginia	Practice agreement	Full with agreement
Wisconsin	Collaborative agreement	Full with agreement

Restricted Practice States (7)

These states maintain significant physician oversight requirements:

State	Supervision Type	Prescriptive Limits
California	Physician supervision	Schedule II-V*
Florida	Physician supervision	Schedule III-V only
Georgia	Delegation protocol	Schedule III-V only
Michigan	Delegation agreement	Full with delegation
Missouri	Collaborative agreement	Schedule III-V
Oklahoma	Supervision agreement	Schedule III-V
South Carolina	Written protocols	Schedule III-V
Tennessee	Supervision required	Schedule II-V
Texas	Prescriptive delegation	Site-based only

*California recently passed legislation expanding NP practice authority with a transition period.

Understanding Collaboration Requirements

What Collaboration Agreements Require

In reduced practice states, collaboration agreements typically include:

• Named collaborating physician — Specific MD/DO who reviews your practice
• Chart review — Periodic review of a percentage of patient charts
• Availability — Physician available for consultation (not necessarily on-site)
• Protocol scope — Written scope of what conditions NP can manage
• Renewal — Agreements must be renewed regularly

Collaboration Challenges

• Finding willing collaborating physicians
• Paying collaboration fees ($500-$2,000+/month in some areas)
• Geographic limitations (physician must be reasonably accessible)
• Practice restrictions based on collaborator’s comfort level
• Administrative burden of maintaining agreements

Impact on NP Practice

Full Practice Authority Benefits

1. Independent practice ownership — Open your own clinic without a physician
2. No collaboration fees — Save thousands annually
3. Practice autonomy — Make clinical decisions independently
4. Telehealth flexibility — Practice across state lines more easily
5. Rural access — Serve underserved areas without physician requirements

Salary Impact

Studies show mixed results on salary differences:

• Some FPA states have lower NP salaries (more competition)
• Restricted states may pay higher due to physician collaboration overhead
• Independent practice NPs in FPA states can earn significantly more
• Hospital-employed NPs see less salary variation by state

State Trends

Recent FPA Expansions

Several states have recently expanded NP practice authority:

State	Year	Change
Utah	2024	Moved to full practice authority
Kansas	2022	Full practice after 4,000 hours
Nevada	2021	Removed collaboration requirements
Massachusetts	2021	Expanded prescriptive authority

Pending Legislation

States with active FPA legislation as of 2026:

• California (AB 890 implementation ongoing)
• Florida (annual FPA bills introduced)
• Texas (active advocacy efforts)
• Georgia (coalition pushing for reform)

Prescriptive Authority Details

Controlled Substances

Even in FPA states, prescribing controlled substances requires:

1. DEA registration — Federal requirement for all prescribers
2. State controlled substance license — Most states require separate registration
3. PDMP registration — Prescription Drug Monitoring Program access
4. Continuing education — Many states require opioid/controlled substance CE

Schedule II Prescribing

Schedule II medications (opioids, stimulants, etc.) have varying rules:

FPA Level	Schedule II	Notes
Full Practice	✅ Yes	With DEA registration
Reduced Practice	Varies	Some require physician co-signature
Restricted Practice	❌ Limited/No	Often prohibited or highly limited

Choosing Where to Practice

Factors Beyond Practice Authority

When choosing a practice location, consider:

1. Job market — FPA states may have more NP competition
2. Salary — Check regional salary data, not just practice authority
3. Cost of living — Higher salary states often have higher costs
4. Malpractice climate — Some states have higher malpractice premiums
5. Patient population — Urban vs. rural practice needs

Starting Your Own Practice

If you want to open an independent practice:

1. Choose an FPA state — Eliminates collaboration requirements
2. Understand business requirements — LLC formation, billing, credentialing
3. Secure malpractice insurance — Required in all states
4. Build referral network — Even independent NPs need specialists
5. Consider telehealth — Expand reach while maintaining brick-and-mortar

Advocacy and Future Outlook

AANP Advocacy

The American Association of Nurse Practitioners advocates for:

• Full practice authority in all 50 states
• Removal of outdated collaboration requirements
• Consistent prescriptive authority
• Fair reimbursement policies

Evidence Supporting FPA

Research consistently shows:

• NPs provide high-quality primary care
• No increase in adverse events in FPA states
• Improved access to care, especially in rural areas
• Cost-effective care delivery
• Patient satisfaction comparable to physician care

How to Get Involved

1. Join AANP — Supports national advocacy efforts
2. Contact legislators — Support state FPA bills
3. Share your story — Patient impact testimonials matter
4. Stay informed — Track legislation in your state

Summary

Practice authority significantly impacts where and how nurse practitioners can practice. Full practice authority states offer the most independence, while restricted states require varying degrees of physician oversight. The trend continues toward expanded NP autonomy as research supports the safety and effectiveness of independent NP practice.

Next Steps

1. Check your state — View NP licensing requirements by state
2. Understand your specialty — NP Licensing by State
3. Plan your career — How to Become a Nurse Practitioner

Whether you’re planning to practice in a full, reduced, or restricted state, understanding practice authority helps you make informed career decisions and advocate for changes in your state.