Regulation of Nurse Practitioners: Who's in Charge?

If there's one thing we can all agree on, it's that as nurse practitioners we practice in a muddied legal space. State laws governing NPs differ across the county. In some states these laws put the Board of Nursing over nurse practitioners. In other states the Board of Medicine regulates NPs. Who's in charge in your state?

The way you are regulated as a nurse practitioner carries significant implications for your practice. Because nurse practitioners have a unique place in healthcare, operating with the background of a nurse and the roll as one who diagnoses, treats, and prescribes, NPs often find a disconnect in how the regulatory process works. If, for example, the Board of Nursing regulates NPs in your area then RN's and LPN's will have authority to make decisions when it comes to the discipline of NPs. They make make decisions in regards to the responsible prescribing behaviors of nurse practitioners while they do not themselves have experience prescribing medication.

In the same vein, regulation by the Board of Medicine comes with it's own set of problems. Physicians and physician organizations are notoriously against allowing nurse practitioners to work without MD supervision. On the upside, physicians are often more understanding when it comes to disciplinary action concerning nurse practitioners as their day to day role looks similar to that of an NP. 

Recently, I had the opportunity to chat with Alex Fisher, a healthcare law attorney who works with nurse practitioners in Nashville, Tennessee. Her work with NPs has given her some valuable insights into nurse practitioner regulatory systems and how these affect NP practice. So, I invited her to share her thoughts with MidlevelU readers. Here's what she had to say.


If you find yourself facing disciplinary action as a nurse practitioner have questions about how you are regulated, Alex Fisher can be reached at or (615) 251-5594. She's happy to help!


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