Full practice, reduced, restricted... oh my!
The world of becoming a nurse practitioner (NP) can be very confusing for prospective NPs. Many people want to be an NP for the autonomy, but are surprised to find out they cannot easily practice on their own in every US state.
Did you know that every state has its own laws for nurse practitioners and how they can practice? Which is different than a registered nurse (RN) license, Physician Associate/Assistant (PA) License and Physician License, which easily transfer from state-to -state and can carry out the same role in each state.
When it comes to NP licenses, there are three categories of "restriction". Full practice, reduced practice and restricted practice. Let's review (generally) what each of those means. (Because OF COURSE each state also has its own individual laws and restrictions to follow.)
The colorful map below from the AANP.org website shows a visual of each state. Green=Full practice
Yellow= Reduced practice
Red= Restricted practice
Okay, but what does that mean? According to AANP.org:
"Full Practice:
State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing
medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called The Institute of Medicine, and the National Council of State Boards of Nursing"
Essentially, an NP in this state can practice "independently" without working with a physician or other health provider.
"Reduced Practice:
State practice and licensure laws reduce the ability of NPs to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice."
In reduced practice states, NP can perform SOME of their scope independently and without physician provider.
"Restricted Practice:
State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation or team
management by another health provider in order for the NP to provide patient care. "
Nurse practitioners in restricted practice states cannot perform ANY of their scope of work independently without a collaboration with a physician.
Additionally, within each state, there are often a separate list of rules and regulations. For example, some states may restrict and NPs license for a few years until they have more experience and after they are granted full practice authority. You have to do your own research depending on your state or hope that your NP program reviews this in your course of study (mine did!).
Our friends at NurseJournal.org organized a beautiful list to all US states, their NP license status and links to each state's Nursing Statutes and Regulations for NPs! Click here to check that out! Or if you work with a company like Collaborating Docs, who help NPs in restricted states match with physicians who want to collaborate, they have a team of people who know all the laws and regulations (you can read more about this company at the end of this article).
Are you even more confused than when you started this article? Honestly, you're not alone. Physician groups have lobbied long and hard to make NP practice as restricted as possible and I'm convinced they want it to be confusing for us to understand! But, that's a conversation for a different day.
Keep supporting bills and laws that help NPs reach full practice authority in ALL 50 states. The AANP and NAPNAP have an advocacy pages to look into current bills to support.
Hope this helped clear up some questions!
XO, Nurse Nat
If your dream is to one day open your own aesthetics practice or work as a telehealth Psych NP and make your own schedule (to name a few), even if you are in a restricted state, you can still do that! You just need a collaborating physician.
Luckily, our friends at Collaborating Docs match NPs to available doctors who WANT to collarborate with NPs to help make their dreams of opening their own business a reality.
Collaborating Docs also have specialists who know ALL the details of each state's laws and regulations, and provide any document or contract you need to make it possible and support for NPs. They basically take all the guesswork and logistic nightmares out of opening your own practice. SO HELPFUL!
Collaborating Docs is a great way to start your OWN practice as an NP, but not worry about a physician taking too much of your profit or being unreliable. They even take care of physician malpractice insurance, lawyers invoices and guarentee a match within 14 days!
It's free to get a quote, and if you use my code NATALIEPNP250 you get $250 off when you sign up! For full transparency, I also receive a referral bonus of $250 every time an NP calls to get a quote.
Here’s the link to get a free quote today!
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