Carter Lee|10/3/2023|3 min read

A Nurse Practitioner’s Guide to Full Practice Authority

What is FPA and Which States Have it?

Male nurse practitioner looking at a laptop

Throughout the United States, many healthcare laws and regulations vary from state to state. Typically in a traditional healthcare setting, a provider is only concerned about the laws and regulations that affect their state and scope of practice. However, with the rise of telehealth and many clinicians providing care across state lines, understanding how laws differ from state to state is becoming increasingly crucial. And if you are a Nurse Practitioner (NP) or looking to become a NP, one of the most important regulations to pay attention to is whether or not a state grants Full Practice Authority (FPA).

According to the American Association of Nurse Practitioners, Full Practice Authority is the authorization of nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests and initiate/manage treatments - including prescribing medications - under the exclusive licensure authority of the state board of nursing. Essentially, a Nurse Practitioner in a FPA licensure state does not need a physician to provide oversight or co-sign their work in order to practice medicine.

Full Practice Authority (FPA) is a pivotal concept that has sparked intense debates and discussions within the industry. It has evolved over many years, shaped by changes in healthcare, advances in medical education and evolving roles for various healthcare professionals. So, if you are a Nurse Practitioner or looking to become one, here is what you need to know about Full Practice Authority and which states have it. 

Why do some states grant FPA and others don’t?

Over the years, the role of NPs has continued to evolve with ongoing efforts to expand their practice authority and address the changing healthcare landscape. However, some states still maintain regulations and restrictions on a NP’s scope of practice. Some common reasons why states don’t grant FPA include:

State tradition: In some states, the restriction of NP scope of practice is rooted in historical practices and traditions, which can be resistant to change.

Quality control: States may restrict NP practice to maintain quality control over healthcare delivery. By requiring supervision or collaboration, they aim to ensure that NPs are working within their competencies and following best practices.

Political and regulatory factors: The influence of medical associations and lobbying efforts can play a significant role in shaping state regulations. These organizations often advocate for physician supervision requirements.

Economic factors: Allowing NPs full practice authority may change the economics of healthcare delivery, which can be a concern for some stakeholders. So there may be financial interests in maintaining the status quo.

Education and training differences: Some argue that there are differences in the educational background and training between physicians and NPs, which justify differential scopes of practice. However, NPs are educated and trained to provide primary and specialty care, often with a focus on a holistic, patient-centered approach.

It's important to note that opinions on this matter vary widely and there is ongoing debate and research regarding the extent of NP scope of practice. 

Which states are FPA licensure states?

As a result of these debates and varying interests, NP scope of practice regulations continue to evolve, with some states expanding their practice authority while others maintain limitations. 

Below are the states that grant FPA, allowing NPs to practice independently without a collaborative practice agreement or supervision from a physician to provide medical services: 

  • Alaska

  • Arizona

  • Delaware

  • Hawaii

  • Idaho

  • Iowa

  • Kansas

  • Kentucky

  • Maryland

  • Massachusetts

  • Montana

  • Nevada

  • New Hampshire

  • New Mexico

  • North Dakota

  • Oregan

  • Rhode Island

  • Utah

  • Washington

  • West Virginia

  • Wyoming

However, there are still some states that maintain a few restrictions (not including prescribing) and only allow NPs to practice independently after a certain period of time specified by the state. These states include:

  • Arkansas

  • California

  • Colorado

  • Connecticut

  • Florida

  • Illinois

  • Maine

  • Minnesota

  • Nebraska

  • New Jersey

  • New York

  • South Dakota

  • Vermont

  • Virginia

And finally, there are the few remaining states that never allow NPs to practice independently without a collaborative practice agreement or supervision:

  • Alabama

  • Georgia

  • Indiana

  • Lousianna

  • Michigan

  • Mississippi

  • Missouri

  • North Carolina

  • Ohio

  • Oklahoma

  • Pennsylvania

  • South Carolina

  • Tennessee

  • Texas

  • Wisconsin

Why is FPA Important?

One of the main benefits of FPA is its ability to increase access to care. Since FPA gives NPs the ability to practice independently, this allows them to practice anywhere and bring care to underserved areas without having to worry about supervision. FPA laws and expanding access to care is especially important amid the nation’s shortage of primary care providers. 

FPA also streamlines care and allows patients to receive timely care without long wait times. Full Practice Authority removes delays and allows Nurse Practitioners to provide services at point of care. It also reduces cost by eliminating unnecessary repetition of care visits and orders. 

Powering the expansion of access to care

Looking to expand your practice to FPA states and help continue to break down access to care barriers? Consider joining OpenLoop’s clinician network!

Our easy-to-use, HIPAA compliant technology was designed with clinicians top-of-mind for seamless scheduling, patient visits and note charting. With 6,000+ providers already in our clinician network, you can tap into the OpenLoop advantage too with:

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Interested in expanding your reach as a nurse practitioner? Learn more about our clinician network!