Essential State-by-State Guide: Nurse Practitioner Prescriptive Authority

A Nurse Practitioner (NP) is really just an Advanced Practice Registered Nurse, with responsibilities beyond the standard care offered by a Registered Nurse. This individual medical professional can offer a range of additional services and care options, including but not limited to screenings and referrals, diagnostic and treatment, physical exams, health and wellness counseling, and prescriptions for medications (with some possible restrictions based on the state requirements).

What Does Prescriptive Authority Mean?

The Nurse Practitioner’s prescriptive authority refers to the ability to prescribe medication. Nurse Practitioners can prescribe medication in all 50 states, although the independence with which they can prescribe drugs, medical services or devices can vary depending on the state.  The prescriptive authority for Nurse Practitioners is essential for healthcare practice and service. That prescriptive authority provides quality and cost-effective healthcare for patients who are in need of fast, reliable, and accessible care in their communities.

The Nurse Practitioner prescriptive authority has been around since New Mexico first approved it in 2002, which was soon followed by approvals in Louisiana, Illinois, Iowa, and Idaho. The American Association for Nurse Practitioners (AANP) recommends that NPs not be restricted, but rather that they are allowed to prescribe medications, devices, medical equipment, supplies, and other healthcare services for patients, with oversight by the state board, as well as the training, education, and certification credentials.

Why is it Important for Nurse Practitioners to Be Able to Prescribe Medication?

The prescribing privileges for Nurse Practitioners include a range of responsibilities for diagnostic, interpretation of results, counseling, exams, etc.  A Nurse Practitioner can pursue a number of additional specialties and certifications in Women’s Health, Neurology, and Cardiology, although there are other concentrations that are available in Nursing and specifically for Nurse Practitioners.

A Nurse Practitioner prescribing authority is an important development. Nurse Practitioners step up to provide services to patients in growing numbers, according to the American Association of Nurse Practitioners (AANP). The idea of a nurse being trained to a level where he or she would be able to offer primary care services has been around since ~1965, when Dr. Henry Silver and Loretta Fox joined forces to develop a certification program. In the intervening decades, the program has evolved and grown. More than 270,000 Nurse Practitioners (NPs) are now licensed to practice in states across the US.  Each of the NPs sees an average of 24 patients every day, which takes on an enormous amount of healthcare coverage. It helps to address the huge demand for primary care that was already evident in 1965. The job outlook is at 26%, higher than the average for career opportunities in the US.

It’s essential that Nurse Practitioners (NPs) be allowed to prescribe medications because they fill an essential role in offering primary care services to populations that may not otherwise have the same access to reliable and cost-effective healthcare or medical services, particularly in rural and underserved communities and in high-population areas. NPs have received advanced training, and they often have additional specializations and certifications that allow them to provide comprehensive care options and treatment to the populations that they serve.

What is the Difference Between Practicing Under a Doctor and Practicing Independently?

A Nurse Practitioner prescriptive authority is regulated by the state boards of Nursing. The prescribing authority is licensed and regulated to promote public safety. But the question is: Can an APRN prescribe medication? The APRN is recognized and able to prescribe medicine, based on the authority granted to him or her by the laws of their licensing state as well as the state board of Nursing. For each state and particular individual’s situation, it’s important to keep up-to-date on the current status of prescriptive authority and licensure.

A Nurse Practitioner prescribes drugs, including controlled substances, with and without the collaborative support of a physician. With the growth of job opportunities for Nurse Practitioners, the role has taken on ever-greater responsibilities in providing high-quality care and prescriptive authority. The role of NPs is important since they are fully authorized to offer healthcare services in rural and underserved areas, which would not otherwise have the level of community medicine or prescriptive medical services available.

Even in urban areas, a Nurse Practitioner can help to cover a range of services both with prescriptive authority but with a wide range of other diagnostic care, testing, and treatment options for heavily impacted clinics and community medical centers. Part of the reason NPs fill this role is that their salaries are often lower than a medical doctor, so it may be more likely that the non-profit organization or otherwise budgetary-challenged small community can better afford to hire them. NPs are meeting the needs of patients in the evolving non-traditional settings that are popping up all over the US in an effort to address the shortage in physicians as well as the demands based on the needs of a growing and aging population.

Beyond the obvious reasons for NP involvement in the care and treatment of patients, there’s a difference in how an NP treats his or her patients. In general, they pursue a more holistic approach for the patients they serve. This approach can take on a more consultative or counseling-focused focus. It’s more in keeping with the often more integrated approach that the Nursing profession has with the care and treatment of a patient. It can also involve discussions and counseling on lifestyle choices and other factors that are affecting the overall health and wellness of the patient.

Are There Limits to What an NP Can Prescribe?

What medications can Nurse Practitioners prescribe? Nurse Practitioners can prescribe medications, with varying layers of physician oversight. Some states support reduced, restricted, and full-practice authority. Nurse Practitioners (NPs) can prescribe antibiotics, birth control, as well as other non-controlled substances, in all 50 states.

There’s the question: What drugs can a Nurse Practitioner prescribe? As a highly educated and experienced medical professional, a Nurse Practitioner can prescribe antidepressants like Prozac and Zoloft. Under Alaska Nursing Statutes, Nurse Practitioners (NPs) must submit an application to prescribe control substances (Schedule II-V). The Indiana Nurse Practice Act restricts prescriptive authority with the requirement of an agreement in collaboration with a physician and a Controlled Substances Registration (CSR). Nurse Practitioner narcotics prescribing is authorized in 23 states without collaboration or a doctor’s oversight.

The care of a Nurse Practitioner is considered comparable to that of a doctor. While the care and prescribing authority of a Nurse Practitioner is important, it is not meant to replace doctors, but rather to work collaboratively together. The Nurse Practitioner controlled substance prescribing medications must include the DEA registration number. For Schedule II and II drugs, the Nurse Practitioner is authorized to prescribe a 30-day dosage supply.

With the ongoing opioid crisis, the focus on the prescriptive authority and ethical ramifications have taken center stage. NPs may be in the best position to advocate for their patients, with a full understanding and evaluation of the current and needed pain management, particularly with a background in Pharmacology. Ongoing education and follow-up are always needed for the NPs to continue to understand their roles as an advocate for their patients. NPs offer the level of education directly to their patients that should help mitigate oversight and misinformed prescriptive authority.

What are the States that Allow an NP to Prescribe Independently?

The Nurse Practitioner prescribing laws by state vary based on collaborative practice, full authority, or required supervision. The Nurse Practitioner prescriptive authority by state includes collaborative or reduced practice in Alabama, Arkansas, Delaware, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Mississippi, New Jersey, New York, Ohio, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, and Wisconsin.  The states with prescribing rights for Nurse Practitioners with full authority with state licensure include Alaska, Arizona, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, Washington, and Wyoming.

The Nurse Practitioner prescriptive authority by state requiring supervision and a collaboratively written prescription includes California, Florida, Georgia, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas. The restrictions on prescriptive authority are controversial. While the American Association for Nurse Practitioners (AANP) point to the years of safe, reliable, and cost-effective service that NPs have offered to their patients, some states do not allow full-practice authority. So, NPs are required to rely on physicians to fully support their patients’ prescriptive needs.

State restrictions and authorizations for the prescriptive authority of Nurse Practitioners under the law and state boards are in a state of evolution. The prescriptive authority of Nurse Practitioners can be somewhat contentious based on the position that some physicians’ groups take on the topic, but the trend is moving toward greater authority, as NPs continue to fill the gaps in care availability and necessity. More than 58 million Americans face the side effects of the shortage of inadequate physician availability in their communities. With their growing importance in health and medical care, nearly 50% of NPs now have hospital privileges that allow them to order specialty services as part of the quality of care.

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