The legal status and regulation of NPs varies significantly from state to state. Twelve states and the District of Columbia allow independent NP prescribing, while the rest require physician collaboration with other limitations (Table 1). Currently, 21 states and the District of Columbia allow some degree of independent practice for NPs, and the rest require collaboration or supervision by a physician (Table 2). Even licensing authority and classification varies by state.
These variations exemplify and exacerbate a growing professional schism. Although many NPs and physicians enjoy successful collaborations, regulatory variations and the professional turf battles that cause this gap threaten to make such collaboration more difficult.
|Prescribe independently, including controlled substances||Alaska, Ariz., D.C., Iowa, Me., Mont., N.H., N.M., Ore., Vt., Wash., Wis., Wy.|
|Prescribe with physician collaboration, including controlled substances||Ark., Calif., Colo., Conn., Del., Fla., Ga., Hawaii, Idaho, Ill., Ind., Kan., Mass., Md., Mich., Minn., N.C., N.D., Neb., N.J., N.Y., Okla., Pa., R.I., S.C., S.D., Tenn., Utah, W. Va.|
|Prescribe with physician collaboration, excluding controlled substances and/or with schedule limits||Ala., Ky., La., Mo., Miss., Nev., Ohio, Tex., Va.|
The credible evidence showing that collaboration improves health outcomes for patients entreats the two professions to put cooperation before professional roles. NPs and physicians should work together to create new models of integrated education and collaborative care with patients as the focus. A combined, sustained effort is urgently needed to permit new policies for redesigning and improving the U.S. health care system.
|Scope of NP Practice||NP practice authorized through State Board of Nursing||NP practice authorized by Boards of Nursing and Medicine/Others|
|Without physician supervision or collaboration||Alaska, Ariz., Ark., Colo., D.C., Hawaii, Iowa, Me., Mich., Mont., N.D., N.H., N.J., N.M., Okla., Ore., R.I., Tex., Utah, Wash., W. Va., Wyo.||NA|
|With physician supervision||Calif., Fla., Ga., Ida., La., Mass., S.C., Wis.||Ala., Miss., N.C., Pa., S.D., Va.|
|With physician collaboration||Conn., Del., Ill., Ind., Kan., Ky., Ohio, Md., Minn., Mo., Neb., Nev., N.Y., Vt.||Tenn.|