6 Best States for Nurse Practitioner Practice

Dreaming of opening your own clinic? Or, perhaps you are tired of handing the red tape associated with practicing as a nurse practitioner? Laws regulating NP practice vary significantly between states and can affect what your job looks like on a day to day basis. For example, some states require NPs to work within a certain radius of an overseeing physician and others regulate nurse practitioner's prescribing abilities. One state's laws may permit you to open your own clinic with ease while another's could have you jumping through hoops.

Regardless of your reasons for seeking independence in your practice, living in a nurse practitioner friendly state can certainly give you more room to grow in your NP career. Which states fare best when it comes to nurse practitioner scope of practice laws?

1. Washington State

Residents of Washington State have an overall liberal mindset. You can't visit Seattle, after all, without seeing a some blue hair and a few wannabe rockers pining away for the 90's. This independent mindset extends to nurse practitioners practicing in the state. Physician involvement is not required in practice or prescribing for NPs living in Washington State. Furthermore, Washington was the first state, and remains one of the few in the nation, that currently allows nurse practitioners to prescribe medical marijuana.

 

2. New Mexico

New Mexico's Governor, Susana Martinez, is a big fan of nurse practitioners so the state has scope of practice laws to match. NPs practicing in New Mexico may practice and prescribe independently of physician oversight. Not only are New Mexico's laws regulating nurse practitioners among the most favorable in the nation, the state is actively recruiting NPs to its ranks. Recently, New Mexico implemented an ad campaign in neighboring Texas encouraging nurse practitioners to relocate to neighboring New Mexico where scope of practice laws are more favorable. As an added bonus, New Mexico also offers NPs practicing in rural areas a $3,000 tax credit.

 

3. Oregon

Oregon has long recognized the value of nurse practitioners to healthcare. For example, the state began allowing NPs to prescribe controlled substances as early as 1979. Nurse practitioners working in Oregon may both practice and prescribe without physician oversight. Aspiring NPs should note that in Oregon, new nurse practitioners are required to have at least 384 hours of registered nursing experience outside of the academic setting in order to obtain a nurse practitioner license, a requirement not held by most other states.

 

4. Alaska

Like Oregon, Alaska has a rich history of supporting nurse practitioners. Alaska began adapting scope of practice laws granting NPs more freedom as early as the 1980's and hasn't looked back since. Physician involvement in diagnosing, treating, and prescribing for patients is not required for nurse practitioners practicing in Alaska. Furthermore, new NPs may begin practicing immediately upon graduation, even while certification exam results are pending. This allows for a smooth transition from education to practice.

 

5. New Hampshire

"Live free or die", New Hampshire's state motto rings true for nurse practitioners practicing in the state. Like all other states on our list, New Hampshire does not require physician supervision or collaboration in practice or prescribing when it comes to NPs. The state also has a provision for newly graduated nurse practitioners allowing a temporary license to practice before sitting for the national certification exam. This gives new nurse practitioners a seamless transition from education to practice.

 

6. Arizona

Arizona completes our list of most nurse practitioner friendly states. Nurse practitioners working in Arizona enjoy the freedom to practice and prescribe independently. Within this freedom, however, state law specifies that NPs must practice only within their area of certification, they should not "exceed the limits" of their advanced practice specialty.

Overall, west is best when it comes to nurse practitioner scope of practice regulations. Five of the top six most favorable states for NP practice lie in the western half of the country. While these states stand out above others when it comes to offering nurse practitioners freedom in their practice, more and more states are jumping on the NP independence bandwagon. Soon, we could see all 50 states mirroring the practice and prescribing laws of the nation's most nurse practitioner friendly locales.

 

You Might Also Like: Legislative Lash Out- NP Scope of Practice Laws in the News

 

Comments

I love what I do and have few complaints. My 1st NP position was in South Carolina in 1994. (Yup you heard that right. I was born in the Jurassic period.) I had 13 years experience in advance practice as a Maternal-Child Clinical Specialist, focusing in Pediatrics prior to completing a postgraduate family nurse Practitioner certificate program at UT, Knoxville. I had the advantage of extensive experience prior to becoming a FNP. I am concerned about NPs who enter practice with limited to no past experience as a nurse.

URGENT CONCERN: Assigning new grads or NPs who are uncomfortable, requiring additional training straight into practice often w a full schedule of patients. Worse yet, new grads assigned to work solo and manage the staff.

AN EXAMPLE
I had a clinical preceptor who (for my FNP program) completed a BS to Masters. (FNP) program at Vanderbilt in TN. During my FNP practicum roles were often reversed. She asked me how to do many things, including removal of sutures on a little but mighty little boy. She’d never done that before. I felt compassion for her. She was a new RN and a new NP at the same time.

MY MANTRA
“Know what you know and know what you don’t know.” Don’t let anyone bully you into doing something you are not qualified to do! A prudent action is to provide basic care and contact the physician to consult, evaluate, or transfer care to a more experienced NP. Offer to take one of her patients in return.

Scope of Practice
What does “out of your scope of practice” mean? ANA and your state BON have position papers that define scope of practice for your state.. Go to their website.

CONCERNS
I have observed new NP grads with limited clinical experience confidently accepting new patients with multiple uncontrolled complicated chronic and acute medical, psychological and social problems. I shook my head thinking “what are you doing?” Start with the basics and expand from there. With 15 yrs experience as a NP to draw upon, I still collaborate with a physician from time to time. It can be a great learning opportunity . There is no shame in collaboration and asking questions.

It is often challenging to stand your ground, refusing to accept tasks that are “out of your scope of practice” or procedures for which you “lack training and expertise”. Do not refuse care. Simply ask to observe the next several procedures. Follow-up by asking to be trained in the procedure and any other other areas you lack expertise. These actions demonstrate initiative and a desire to learn. Otherwise you run the risk of being labeled “a slacker”, “lazy” or “not carrying your share of the load.”
Most practices use “schedulers” to answer calls, take messages and schedule patients. They are unable to triage calls, perform acuity rating or a detail report of the nature of the illness/ complaint. Remote scheduling without NP input can lead to significant mis-matching of patient and provider expertise, especially for new NPs.
There is no place for shaming providers who know their limits. However all providers need to seek out training in areas you lack expertise. No one can know everything but it is everyone’s responsibility to learn. I realize it is a real challenge to stand your ground. It is better than a lawsuit.

RESPECT
NPs spoke of getting no respect. I agree. At times it is maddening. If possible work 1:1 with a physician (sponsoring or supervising physician) you like and nurture collaboration.
Respect is earned. The benefits of collaboration are revealed over time. Collaboration includes seeking to know the physician and allowing the physician to know you. This can be accomplished while maintaining your privacy. Learn the practices and routines of your partner. , Demonstrate your knowledge and expertise by providing excellent care, following accepted practice guidelines. These actions reassure the physician. This is how mutual respect and trust develop.

MISOGYNY
Misogyny is maddening. Misogyny effects every human blessed with the XX chromosome. I hate it. Our patriarchal society and its inherent stupidity brings tears to my eyes far too often. Women are a force to be reckoned with. Claim your power and act. Vote. Join a women’s group for social action. Some change has occurred but nowhere near enough. Don’t despair. When you feel enraged, depressed or hopeless turn to the women on your right, left, in front or behind you for support. We all live it. Together we will create change.

I love what I do. Your lfe is what you make it. My cup is half full, not half empty. Thank you for allowing me to share. Create yourself a great life!

Dawn P LantzPhD...

I have my DNP and am still a "mid-level," because I did not do Med school, do a surgical residency, or all of the other residencies that MDs or DOs must do. I note that previous comments that are tired of whining and crying have mostly been made by men. Too many women have entered the nursing arena looking to meet their own "need to be needed," and whine and cry anytime the focus is not on them. When you whine and cry all you do is show your own weaknesses and vulnerabilities. Do what you are trained to do with confidence and let what you know speak for you. Karen

Karen Bugaj

Thanks for posting the states that are NP friendly!

Rhita Bax

NP is midlevel education. You still have a PhD. PhD is the highest a nurse can be before making a decision to change her job role. Don't be upset about it... Get a PhD.

Debra

stop your crying....makes you look silly.

FNP

Stop whining! Yes, mid-level is used across this nation and especially where a supervising provider must be present. If you don't like the term then change it. I am sick of nurses crying and whining across the entire span of nursing from working too hard, not being appreciated, having to give baths, not having a tech, having to count their anesthesia cart, and then not knowing that the slightest detail missed could be an opportunity missed to rescue. Sometimes I am embarrassed by my profession. We want the highest pay to have a 2 year preparation or MSN/DNP and then gripe about "tech versus nurse or NP versus physician." Who cares? It is nursing and it serves you and others well. If you don't like it, take action and join your professional organization and encourage slackers to get out or do better. When nurses refuse to carry out basic care and do not know the meaning of verifying orders, documenting well and its importance, giving a good handoff, assessing fully, including family in care, being compassionate instead of worrying how much time they have to spend talking to the patient, then many do not need to be in this profession at any level. The better the experience/encounter a patient has when dealing with an NP, the more public support we will have when seeking scope of practice changes from government. Currently, I work with CRNAs and FNPs that are being as rude and derogatory to patients as many physicians used to be. Nursing is losing ground as the compassionate profession in many ways and I am beginning to see why. Pay is important but practicing to our full ability and demonstrating pride in providing excellent, compassionate care should be job one. DNP, FNP, Ga.

Gene

Arizona should NOT be on this list. They may have no restriction but their board prosecutes nurses for anything and everything violating due process rights. The governor is absolutely useless. It's a politically driven and discriminating state which is reflected massively at the BON. They revoke licenses for a cyberbullying. This female nurse was stalked by a male who made sexual advances and they believed HIM. What a CROOKED state. Don't ever think about working in this state. ANYONE.... YOU ARE AT RISK FOR THIS TARGETING.

MB

I agree with the comments regarding the site name using 'Midlevel'. Consider that at NP's we have obtained the highest degree available in our field of practice. That is not midlevel.

MG

Wow, as a nursing professional with over 20 years of primary care under my belt and looking to begin an NP program, the comments crying about being called a mid-level provider bother me. Face it, an NP or PA is a step above education and practice freedoms than an RN or LVN, but a step below a physician in education and practice freedoms. The term says nothing about the level of care that is provided, hopefully all level of practitioners strive to provide top level care to their patients. It is simply a reference to where in the education and practice freedoms the NP or PA resides when looking at the total care cycle. The attitude that it is belittling to be consider a mid-level provider is exactly why nurses in particular are not running healthcare and actually fixing the issues that plague our healthcare system.

Bill

Idaho should have been on your list. We have no physician oversight, completely practice independently (own clinic), and prescribe schedules II-V. Our state also has always supported us. I agree that the name has to go!

Brittany

Pages