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Here’s an overview of the Nurse Practitioner (NP) laws in each state regarding collaborative agreements and the number of NPs per supervising physician versus states where NPs can practice independently:
Full Practice States (Independent Practice)
In these states, NPs can evaluate, diagnose, interpret diagnostic tests, and initiate treatment plans, including prescribing medications without a supervising physician.
1. Alaska
- Independent practice
- No collaborative agreement required
2. Arizona
- Independent practice
- No collaborative agreement required
3. Colorado
- Independent practice
- No collaborative agreement required
4. Connecticut
- Independent practice after three years and 2,000 hours of collaboration with a physician.
5. Hawaii
- Independent practice
- No collaborative agreement required
6. Idaho
- Independent practice
- No collaborative agreement required
7. Iowa
- Independent practice
- No collaborative agreement required
8. Maine
- Independent practice after 2 years of supervision or collaboration.
9. Montana
- Independent practice
- No collaborative agreement required
10. Nevada
- Independent practice after two years or 2,000 hours of supervised practice.
11. New Hampshire
- Independent practice
- No collaborative agreement required
12. New Mexico
- Independent practice
- No collaborative agreement required
13. North Dakota
- Independent practice
- No collaborative agreement required
14. Oregon
- Independent practice
- No collaborative agreement required
15. Rhode Island
- Independent practice
- No collaborative agreement required
16. South Dakota
- Independent practice after 1,040 hours of collaboration with a physician.
17. Vermont
- Independent practice
- No collaborative agreement required
18. Washington
- Independent practice
- No collaborative agreement required
19. Wyoming
- Independent practice
- No collaborative agreement required
20. District of Columbia (D.C.)
- Independent practice
- No collaborative agreement required
Reduced Practice States
NPs have reduced ability to engage in at least one element of NP practice and need a collaborative agreement or supervision for certain practice elements such as prescribing medications.
1. Alabama
- Requires a collaborative agreement for prescribing
- No specified physician-to-NP ratio
2. Arkansas
- Requires a collaborative agreement
- No more than 6 NPs per supervising physician
3. Illinois
- Requires a collaborative agreement for certain practices
- No more than 5 NPs per supervising physician
4. Kentucky
- Requires a collaborative agreement for prescribing
- No limit on NP-to-physician ratio
5. Louisiana
- Requires a collaborative agreement
- No specified physician-to-NP ratio
6. Mississippi
- Requires a collaborative agreement
- No more than 4 NPs per supervising physician
7. New Jersey
- Requires a collaborative agreement for prescribing
- No specified physician-to-NP ratio
8. Ohio
- Requires a collaborative agreement
- No more than 5 NPs per supervising physician
9. Utah
- Requires a collaborative agreement for prescribing
- No more than 4 NPs per supervising physician
10. West Virginia
- Requires a collaborative agreement for the first 3 years of practice
- No specified physician-to-NP ratio
Restricted Practice States
In these states, NPs are required to have physician oversight for diagnosing, treating, and prescribing medications. They need to collaborate with or be supervised by a physician.
1. California
- Requires physician oversight for most practice aspects
- No more than 4 NPs per supervising physician
2. Florida
- Requires physician oversight for most practice aspects
- No more than 4 NPs per supervising physician
3. Georgia
- Requires a collaborative agreement
- No more than 4 NPs per supervising physician
4. Missouri
- Requires a collaborative agreement
- No more than 3 NPs per supervising physician
5. North Carolina
- Requires a collaborative agreement
- No more than 4 NPs per supervising physician
6. Oklahoma
- Requires a collaborative agreement
- No more than 6 NPs per supervising physician
7. South Carolina
- Requires a collaborative agreement
- No more than 3 NPs per supervising physician
8. Tennessee
- Requires a collaborative agreement
- No more than 4 NPs per supervising physician
9. Texas
- Requires a collaborative agreement
- No more than 7 NPs per supervising physician
10. Virginia
- Requires a collaborative agreement for the first 5 years of practice
- No more than 6 NPs per supervising physician
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