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Thinking of earning your nurse practitioner degree? Becoming a family nurse practitioner is an exciting way to build on your experience as a Registered Nurse so you can do more for patients. One of the major appeals of a career as an FNP is the opportunity to have more authority as a primary care practitioner.

However, as you’re probably aware, the exact amount of additional authority varies from state to state. Each state defines the scope of nursing care within its own nurse practice laws. Roughly speaking, there are three kinds of states for nurse practitioners: restricted practice, reduced practice, and full practice.

As you prepare to enroll in a family nurse practitioner program, it’s worth understanding the differences between these three categories so that you understand ahead of time what steps you’ll need to take after obtaining your license.

Restricted Practice States

The American Association of Nurse Practitioners (AANP) tracks the status of nurse practitioner practice in each state. According to the AANP’s current map[i], twelve states, including heavily populated states such as California, Texas, and Florida, are restricted practice states. In these states, family nurse practitioners have more scope of practice than an RN, but need to operate under the supervision of an MD or a hospital in order to treat patients.

If you become an FNP in a restricted practice state, you will not be able to set up a private practice. Prescriptions, tests, and referrals you make will require sign-off from your supervising authority.

Reduced Practice States

In a reduced practice state, FNPs have more authority to treat patients independently, but still need to be affiliated with an MD or hospital in order to provide certain services. The exact services that require collaboration with a physician will vary from state to state. Most reduced practice statutes focus their attention to a nurse practitioner’s authority to prescribe or administer certain types of medicines, such as opiate pain killers.[ii]

If you work in a reduced practice state, you will need to develop a written practice agreement with your collaborating physician. This document will outline which treatments you can perform independently and which require sign-off from the physician. As of 2014, eighteen states, including New York, New Jersey, and Illinois, were reduced practice states.[iii]

Full Practice States

The remaining twenty states of the union are full practice states. In these states, family nurse practitioners operate completely independent of an MD. Their scope of practice still has limits placed on it, but they can freely make referrals to other specialists.

In full practice states, nurse practitioners can offer comprehensive primary care services from their own independent practices. If they choose, FNPs in these states also have the option of working in a collaborative group with other practitioners, including physicians.

A Full Practice Future?

The Institute of Medicine and National Council of State Boards of Nursing both recommend extending full practice authority for nurse practitioners to all states. This recommendation is timely: demand for primary health care is rising as millions of new patients join the ranks of the insured, and there is a limited supply of physicians.

Nurse practitioners are capable of providing many of the services offered by MDs, and to a comparable standard of quality[iv]. So if you don’t yet live in a full practice state, the chances are that you soon will, thanks to the law of supply and demand.


[i] http://www.aanp.org/legislation-regulation/state-legislation-regulation/state-practice-environment
[ii] http://www.medscape.com/viewarticle/440315
[iii] http://www.aanp.org/images/documents/state-leg-reg/stateregulatorymap.pdf
[iv] http://ebn.bmj.com/content/5/4/121.full