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What is Nurse Practitioner Authority? Learn More About NP Jobs

As concerns grow amid the data reports of the areas experiencing shortages of primary care health professionals, the healthcare industry is pushing for more full-practice authority states for nurse practitioners. Learn about the scope of practice for a nurse practitioner (NP), the three levels of nurse practitioner authority, their differences, and more about NPs today.

What is a Nurse Practitioner's Scope of Practice?

It's important to clarify that NPs are not the same as physicians. This is due not only to their education and training but also to their scope of practice. According to the American Association of Nurse Practitioners (AANP), the NP's scope of course:

"... includes, but is not limited to, assessment; ordering, performing, supervising and interpreting diagnostic and laboratory tests; making diagnoses; initiating and managing treatment, including prescribing medication and non-pharmacologic treatments; coordinating care; counseling; and educating patients, their families, and communities...They may also serve as health care researchers, interdisciplinary consultants, and patient advocates."

NPs are authorized to practice only within their licensed specialty, which may be: primary health, family, adult gerontology, psychiatrypediatrics, orthopedics, neonatal, and oncology.

What is Nurse Practitioner Authority?

Each state has laws that govern an NP's scope of practice, meaning what they can and cannot do as independent clinicians. This is typically referred to as NP practice authority or state practice environment. Across the states and territories of our country, NP practice authority varies and can be categorized into three groups: full practice authority, reduced practice authority, and local practice authority

In the restricted practice category, NPs must have physician supervision for the entirety of their scope of practice and are not independent practitioners. As of December 2022, there are 12 states which have restricted NP practice authority.

In the reduced practice category, NPs are more independent than in restricted states; they typically require physician supervision for medication prescriptions. They cannot run an independent medical practice but can work independently in a practice run by a physician. There are currently 16 states with reduced practice authority for NPs.

In the entire practice authority category, there are currently 28 states (the District of Columbia is part of the 28). This category is precisely as it sounds. NPs can work to the full extent of their scope of practice without physician supervision/collaboration. It should be noted that some of the states in this category require a few years of experience under physician supervision first. 

Latest States to Join the Full Practice Authority State Roster

Because of the pandemic, several states have enacted emergency measures providing NPs full authority but only for a limited time. Many states are reaching the end of those temporary agreements. This year has seen two states join the entire practice authority category, and we may see more next year. 

New York was one such state, and on April 9, 2022, the New York Governor signed a bill that would make full authority a permanent measure. 

On April 19, 2022, the Kansas Governor signed a bill removing NP practice restrictions. Rural areas of the Midwest state are experiencing primary healthcare shortages, and this move will improve accessibility to healthcare.

Other states with temporary waivers on NP authority restrictions, such as Pennsylvania and Indiana, may see legislation in the next year as organizations advocate so that communities won't face challenges accessing healthcare once again.

How to Become a Nurse Practitioner (NP)

Nurse Practitioners (NPs) often serve as primary health care clinicians in a similar capacity to physicians. The education and training of an NP are different from that of a physician. Nevertheless, their ability to provide primary health care services in communities makes them more vital now than ever as our country faces a severe physician shortage. So how does one become an NP?

Becoming an NP starts with becoming a licensed registered nurse (RN) and holding a bachelor of science in nursing (BSN) degree. Following a few years of work experience, you can enter a graduate program for NPs. Many NPs work in primary health, but specialization is becoming more common among advanced practice nurses. Just as RNs must be licensed to practice, so too must NPs. NP licensure can be attained through the American Academy of Nurse Practitioners Certification Board or the American Nurses Credentialing Center.

What is the Average Salary for an NP?

According to the U.S. Bureau of Labor and Statistics (BLS), in 2021, NPs earned an average of $118,040 for the year or $56.75 an hour, although, as a whole, earnings vary widely across the states. Some top-paying work settings for NPs include Home Health Care Services, Psychiatric and Substance Abuse Hospitals, and Outpatient Care Centers.

As you can see, NPs tend to earn salaries above the national average, and while they don't have all the authority of physicians, they don't have all of the medical school debt either. The time and financial costs should be considered if you're investigating the pros and cons of becoming a nurse or a physician.

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Booher, RN
Blog published on:
December 9, 2022

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