5 Worst States for Nurse Practitioner Practice

States are increasingly passing laws allowing nurse practitioners more freedom in their practice. Some legislators are even running marketing campaigns attempting to lure NPs from other states within their boarders on the basis of more favorable scope of practice legislation. But, some states lag behind in the NP independent practice movement (ahem, Deep South, we're looking at you). 

Which states fall notoriously short when it comes to granting nurse practitioners freedom in their practice?

1. Florida

If you want to work in healthcare, Florida should be at the bottom of your list of dream destinations. Yes, the Sunshine State may have palms, sun, and sand, but state laws may make your day job a less than illuminating experience. 

Florida's nurse practitioner supervision laws are among some of the strictest in the nation. State law requires that nurse practitioners work under the supervision of a physician when it comes to practice and prescribing. Even when working within a physician supervision agreement, NPs practicing in Florida are not allowed to prescribe controlled substances. This is a major setback, especially considering the state is facing a significant shortage of primary care providers. 

2. Alabama

With the highest rate of obesity in the nation and over 25 percent of its residents smokers, you would think Alabama could use nurse practitioners more than ever. Unfortunately, the state's legislators don't feel the same. Not only must nurse practitioners work in collaboration with a physician, the physician must be physically on site with the NP ten percent of the time. 

Prescribing laws in Alabama are similarly strict for nurse practitioners. NPs working in Alabama may only prescribe Schedule III, IV and V medications limiting their utility in certain settings. 

3. North Carolina


While known for its predictably strong college basketball teams, laws concerning NPs in North Carolina are far from a slam dunk. Like our prior two picks, nurse practitioners practicing in North Caorlina must work in collaboration with a physician. Not only does North Carolina require a collaborative agreement with an MD, nurse practitioners are also restricted within this arrangement. For example, nurse practitioners may only refill certain controlled substances a limited number of times. Complex rules and regulations when it comes to prescribing and supervision limit NPs ability to practice in the Tar Heel State. 

4. Georgia

The last state to grant nurse practitioners the ability to prescribe, Georigia still lags perilously behind when it comes to scope of practice laws. NPs practicing in the Peach State are not allowed to prescribe Schedule II controlled substances. Nurse practitioners in Georgia must also practice under a so called "delegating physician". Georgia may be one of the fastest growing states in the nation, but it's view of nurse practitioners remains limited.  

5. Oklahoma

Oklahoma is as all-American as they come. Famous for cowboys, Tornado Alley, and outlaws, the Sooner state has an adventurous spirit. Unfortunately, these ideals do not extend to laws governing nurse practitioners. NPs practicing in Oklahoma are prohibited from prescribing Schedule II controlled substances not to mention, they must be supervised by a physician in order to prescribe. Sorry Sooner's, the NP scope of practice in Oklahoma leaves something to be desired. 

While the West might be best when it comes to nurse practitioner scope of practice laws, the South presents a pretty sorry picture. How do scope of practice laws in your state affect your practice?


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To all you Physicians out there. You are full of shit!! I was a FT floor (IMC/ICU) RN for over 25 years before becoming a NP. After graduation, I was hired by a dirtbag MD, who had 35-40 patients scheduled a day-for me to see, while he would go off on golf trips, cruises and traveled around the world. He never gave a crap about his patients, who were mostly poor and uneducated, and non English speaking. He was not always accessible by phone. I had to go on Uptodate, or call physician friends, if I had any concerns. I probably made the office over $3000.00 a day, as I also did Derm & advanced wound care. My pay was $375.00 a day after taxes. THIS IS WHY YOU SHs REFUSE TO GIVE AUTONOMY TO NPs IN CALIFORNIA. You don't want to give up your cozy, little money train. DISGUSTING!!! Can't wait to leave Commiefornia!!!!! and the 3rd Reich AMA.

marylou buttocks

As a APRN / FNP student. I am a Nurse, I never wanted or even considered to be a doctor. My dream was nursing. The connections, heart to heart and being able to take care of a person holistically is what motivates me as a bedside nurse , manager of team and even an instructor. I have worked with many phenomenal physicians, NP /PA's Nurses and CNA's. We as a cohesive team is what patient care is all about. I have a lot to learn, I never compare my self to a "doctor" or will ever " mislead" anyone into thinking that is what I am as a future NP (god willing). I will do my best to apply myself, knowledge, and know when to recognize when my abilities or the ability to treat a patient requires physician treatment / collaboration or referral. I think when you take a step out of your "titles" or "ego" for that fact,you can see that WE ARE ALL HUMAN, WE ARE ALL INTERCONNECTED and OUR KNOWLEGDE, SKILLS and EXPERIENCES ARE UNIQUE and when we can put the best talents out there to better serve our patients then that is what truly matters. Practice with competence, evidence, humility and compassion. MD's stop bashing our NP's they are here to take care of patients to provide a service to our community. Learn to appreciate them and know that the knowledge of the MD is not with any competition as we learn from you, grow with you as a fundamental TEAM. I decided to advance my role not try to take over yours and it's not as simple as "well you should have just gone to medical school then". I went to nursing school because you (MD) believe it or not I wouldn't have had it any other way!


I am talking from a patient's perspective, and from a future healthcare provider trying to decide which path to take. There is not a whole profession superior and better than the other. There are individuals in each profession that are great, and do a better job than many of the people in the "superior" or "inferior" professions. There are individuals in each profession that are so horrible that you wonder how they are still there. There are doctors who think they are so superior that they fail to see their errors and take patients lives or ruin patient's lives in the process. A lot of doctors do things that should cost their license, but they keep practicing because anyone who decides to report them might lose their job/license instead, or reports go ignored. They continue practicing until they take one or more lives or someone sues the hospital. There are nurses that have horrible bedside manners, and/or do things that put patients at risk, and even kill patients. There are PAs that pretend they know everything, and order unrelated exams, missing the actual diagnosing, and putting people at risk. There are also doctors, nurses, and PAs, that are selfless, and are mature enough not to argue about who is superior or inferior and work as a team with their coworkers to give the best care to their patients. There are doctors that understand that other healthcare providers are needed, and that without them, patients would not survive/recover. They understand that those providers are as important as them, and are not inferior, but just have a different role in the patient care. As a patient I've had horrible doctors, ok doctors, and great doctors. I had a bad experience with a PA, and a great experience with a NP. I know enough to say that not all PAs are bad, and not all NPs are good. I also understand that doctors don't know everything, and I shouldn't blindly believe everything a doctor says, and accept every treatment they give. A patient's care is a team work, everyone should be involved, including the patient. Doctors are not dictators who have the only say and everyone has follow others, and nurses are not followers that are only there to follow doctors' orders without a say. Good healthcare providers know their limits, but also speak up when something doesn't seem right, and put patient's well being first. They also admit when they are wrong, and when to ask for help.


Stop belly aching about the awful nurse practitioners who make mistakes - EVERYONE MAKES MISTAKES, MDs included! No one is perfect, it comes down to the individual provider. Some of you can put down NPs all you want, but who helps train your precious doctors when they're in school and don't know which end of a needle goes in the patient? NURSES & NURSE PRACTITIONERS! I've stopped doctors from making medication errors too many times to count. It comes down to the training, education, work experience and individual ability to admit you don't know something and finding a resource for help when you need it. I have no problem telling a patient I'm not sure of something and want to do research before I proceed, or referring them to a specialist when an issue is beyond what can or should be handled by a primary care practitioner. Many people prefer to see nurse practitioners because NPs tend to be kinder to their patients and can actually demonstrate to their patients that they care about them as individuals and want to help them be their healthiest selves. I chose not to go to med school because I didn't want to lose my ability to have compassion - most MDs I've come across are so full of themselves they treat patients like peasants who have been granted the honor of being treated by them; that might have a little something to do with the NP trend. Not everyone thinks being a doctor is such hot crap- get over yourselves.


For those quoting studies where np's provide superior care that is more cost effective please reread your studies critically. These are highly flawed studies.

It is called an advanced nursing degree, not a medical degree. Stop faking and portraying to the public that you can practice medicine independently. If you want to do that, go to medical school! How egotistical can you be to put such lies out there? Recognize your limitations and stop pretending to be physicians.

Anonymous and c...

I will stay in AZ...the pay is really high and we can practice on our own if we like.


@ Dr. Kel.

Blah, blah, blah Dr. Kel!! If you were an actual doctor you wouldn’t have time to be on here bashing NP’s. Why don’t you just report the NP’s and PA’s from your everyday practice if there are so many diagnostic errors with inappropriate medication use resulting in deleterious medication complications and side effects? Maybe you’re making errors yourself!! Just because whatever the NP’s and PA’s decided to do for their patient is not what you would have done, doesn’t make it wrong!!!! We are all practicing medicine with a strong emphasis on practicing!!!! There is no exact answer all the time. The main focus should be the patient not how much shade can be thrown at the “midlevels”!!! Get a life!!!

NP south

Wow, West coast I will stay. No one is trying to be a medical doctor. Rest assure when their shortage starts impacting care they will loosen their antiquated restrictions so NPs can practice their full scope


Given that a nurse practitioner with 30 years of experience cost my wife and I our first child, I may not be sympathetic to please for "less supervision..." There is a profound difference in training and that cannot be denied, ignored or wished away. Every day, in my practice, I see referrals from NPs and PAs who have made significant diagnostic errors. These errors have lead to inappropriate medication use which has then resulted in deleterious medication complications and side effects... all of which arose from basic errors in medical decision making. I know I am not the only physician seeing this trend. If a self-delcared "professional" does not have the wisdom to understand when s/he is practicing beyond their scope of training.... well, I guess that is what trial lawyers are for.

Dr Kel

Mississppi definitely should be added to the worst list. First year new graduates need work 720 supervised hours by a MD to get DEA license. Meanwhile, new NPs need meet up with a Board site visitor every two months and your supervising MD must meet with the site visitor every three months to discuss your performance. NPS are treated like step children especially new graduates in MS. I am on my way out, heard NPs in D. C. Oregon and VA are in much better place and can seeing patients and prescribe independently without Physician on site

Doomed in MS