State law chart: Nurse Practitioner Practice Authority

State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
Alabama An “advanced practice nurse” Yes A collaborative practice agreement is required. N/A A physician may enter into collaborative
is a registered nurse that has agreements with certified registered nurse
gained additional knowledge (Ala. Code Collaborating physician provides direction and oversight and must be practitioners not exceeding a cumulative one
and skills through successful 1975 § 34- available to the NP by radio, telephone, or telecommunications, and must be hundred and twenty (120) hours (3 FTEs) per
completion of an organized 21-81 (3)). available for consultation or referrals from the NP (Ala. Admin. Code 540-X- week. The total number of persons supervised
program of nursing education 8-.08 (1); Ala. Admin. Code 610-X-5-.08 (1)). by or in collaborative practice with a
that prepares nurses for physician shall not exceed one hundred and
advanced practice roles and If the NP is to perform services off site, then the written protocol must specify twenty (120) hours per week (3 FTEs). Ala.
has been certified by the “the circumstances and provide written verification of physician availability Admin. Code 540-X-8-12.
Board of Nursing to engage in for consultation, referral, or direct medical intervention in emergencies, and
the practice of advanced after hours, if indicated.” (Ala. Admin. Code 540-X-8-.08 (3); Ala. Admin.
practice nursing. There shall Code 610-X-5-.08 (3)).
be four categories of advanced
practice nurses: The collaborating physician must be present at least 10% of the NP’s
CRNP, CNM, CRNA, and scheduled hours, and must visit each collaborative practice site at least
CNS. (Ala. Code. Ann. § 34- quarterly. (Ala. Admin. Code 540-X-8-.08 (4); Ala. Admin. Code 610-X-5-
21-81 (3)). .08 (4)).

Written standard protocols must

 specify the specialty practice area of the NP and the collaborating
physician;
 identify all cites where the NP will practice within the protocol;

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State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
 identify the physician’s principal practice site; be maintained at each
practice cite;
 include a formulary of drugs, devices, medical treatments, tests, and
procedures that may be prescribed, ordered, and implemented by the NP;
 include a pre-determined plan for emergency services;
 specify a plan for quality assurance management with established patient
outcome indicators for evaluation of the NP, and include review of at
least 10% of medical records, plus all adverse outcomes (Ala. Admin.
Code 540-X-8-.08 (9); Ala. Admin. Code 610-X-5-.08 (9)).
Alaska (1984) “Advanced nurse practitioner” No N/A None When applying to deliver health care services
means a registered nurse the NP shall submit a written consultation and
authorized to practice in the (12 Alaska referral plan. The plan must describe the
state who, because of Admin. clinical practice characteristics, list the
specialized education and Code method and documentation process for routine
experience, is certified to 44.400) consultations and referrals and describe the
perform acts of medical process for quality assurance to evaluate the
diagnosis and the prescription practice (including a written evaluation of the
and dispensing of medical, quality assurance review with a plan for
therapeutic, or corrective corrective action)
measures under regulations
adopted by the board. (Ala.
Rev. Stat. § 08.68.410 (1)).
Arizona “Registered nurse No NPs must refer a patient to a physician or another health care provider if the None
practitioner” means a referral will protect the health and welfare of the patient and consult with a
registered nurse who: is (A.R.S. § physician and other health care providers if a situation or condition occurs in
certified by the board, has 32-1601 a patient that is beyond the NP’s knowledge and experience. (Ariz. Admin.
completed a NP education (15)(d)(iv); Code R4-19-508)
program approved or Ariz.
recognized by the board and Admin. Scope of practice includes: assessing clients, synthesizing and analyzing data

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State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
educational requirements Code R4-19- and understanding and applying principles of health care at an advanced
prescribed by the board by 508). level; managing the physical and psychosocial health status of clients;
rule; if applying for analyzing multiple sources of data, identifying alternative possibilities as to
certification after July 1, 2004, the nature of a health care problem and selecting, implementing and
holds national certification as evaluating appropriate treatment; making independent decisions in solving
a NP from a national complex client care problems; diagnosing, performing diagnostic and
certifying body recognized by therapeutic procedures, and prescribing, administering and dispensing
the board; has an expanded therapeutic measures, including legend drugs, medical devices and controlled
scope of practice within a substances within the scope of NP practice on meeting the requirements
specialty area. (A.R.S. § 32- established by the board; recognizing the limits of the nurse's knowledge and
1601 (15)). experience and planning for situations beyond the nurse's knowledge,
educational preparation and expertise by consulting with or referring clients
to other health care providers when appropriate; delegating to a medical
assistant pursuant to section 32-1456; performing additional acts that require
education and training as prescribed by the Board and that are recognized by
the nursing profession as proper to be performed by a nurse practitioner.
(A.R.S. § 32-1601 (15)).
Arkansas (1995) “Practice of advanced nurse APRN - No No collaborative practice agreement required for APRNs. N/A Arkansas distinguishes between APRNs and
practitioner nursing” means Registered Nurse Practitioners (RNPs), which
the performance for RNP - Yes RNPs must practice in accordance with protocols developed in collaboration does not require a master’s degree or national
compensation of nursing skills with a practicing physician. These protocols must address: “established board certification, and has not been issued
by a RN who, as demonstrated (Ark. procedures for the management of common medical problems in the practice since 2000.
by national certification, has Admin. setting”; “the degree to which collaboration, independent action, and
advanced knowledge and Code supervision are required”; and “acts including, but not limited to, assessment, Collaborative practice agreement required for
practice skills in the delivery 067.00.5(C)( diagnosis, treatment, and evaluation.” prescriptive authority.
of nursing services. (Ark. 1)) (Ark. Admin. Code 067.00.I (C)).
Code Ann. 17-87-102
(4)(B)(i)).
California "Nurse practitioner" means a Yes. In addition to any other practices that meet the general criteria set forth in N/A
RN who possesses additional statute or regulation for inclusion in standardized procedures developed

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State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
preparation and skills in (Cal. Bus. & through collaboration among administrators and health professionals,
physical diagnosis, psycho- Prof. Code including physicians and surgeons and nurses, standardized procedures may
social assessment, and §2835.7). be implemented that authorize a NP to do any of the following:
management of health-illness (1) Order DME
needs in primary health care, (2) After performance of a physical examination by the nurse practitioner and
and who has been prepared in collaboration with a physician and surgeon, certify disability pursuant
a program conforms to board to Section 2708 of the Unemployment Insurance Code.
standards as specified in (3) For individuals receiving home health services or personal care services,
Section 1484. (16 Code Cal. after consultation with the treating physician and surgeon, approve, sign,
Rules 1480 (a)). modify, or add to a plan of treatment or plan of care.

A “standardized procedure” is the legal mechanism for RNs and NPs to

perform functions which would otherwise be considered the practice of
medicine. Standardized procedures must be developed collaboratively by
nursing, medicine, and administration in the organized health care system
where they will be utilized. The procedure functions are the diagnosing,
prescribing, and severing or penetrating of tissue functions under the
MPA. The standardized procedure outlines when the nurse is to refer or seek
a second opinion, limitations, required education, settings, how the practice
will be evaluated etc.

Standardized procedures must be developed collaboratively by nursing,

medicine, and administration in the organized health care system where they
will be utilized. Once the physician signs off on the standardized procedure,
nurse and facility (if applicable) the practice is considered independent. The
“standardized procedure” is agency specific and must meet certain
requirements including collaborative development by nursing, medicine and
administration within the agency.
Colorado Advanced Practice Nurse No. (Colo. N/A None An APN may sign an affidavit, certification,
(APN): A master’s prepared Rev. Stat. or similar document that: documents a

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4
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
nurse holding a graduate 12-38-103 patient’s current health status; authorizes
degree in advanced practice (10)). continuing treatment, tests, services, or
nursing who has completed a equipment; or gives advance directives for end
graduate or post-graduate of-life care. Such affidavit, certification, or
program of study in an similar document may not be the prescription
advanced practice Role and/or of medication unless the APN has been
Population Focus, in an granted RXN by the State BON or in conflict
accredited advanced practice with other requirements of law. Such forms
nursing program and has been may include but not be limited to forms for
recognized and included on jury service, school forms, physical exams,
the Advanced Practice utility company forms, CPR directives, and
Registry (APR) by the Board. handicap parking. APNs may place persons
APN Roles recognized by the on mental health holds but may not
Board are NP, CRNA, CNM discontinue the holds. APNs may not place
and CNS. A nurse seeking persons with alcohol or substance abuse
recognition as an APN must problems on Involuntary Commitments and
be academically prepared for may not place persons on mental health
the expanded scope of practice certifications. APNs are authorized to
described as Advanced implement Medical Orders Scope of
Practice Nursing. (Colo. Code Treatment forms which include advanced
Regs 716-1, Ch. XIV (1.2)). directive planning and DNR orders for adults.
Connecticut Advanced nursing practice is Yes – for the For the first 3 years after having been issued a license and no less than 2,000 3 years and no APRNs allowed to certify disability leave,
defined as the performance of first 3 years hours of practice, NPs must perform acts of diagnosis and treatment of less than 2,000 authorize DNR orders, certify involuntary
advanced level nursing and no less alterations in health status in collaboration with a physician. The hours commitment,
practice activities that, by than 2,000 collaboration must address a reasonable and appropriate level of consultation
virtue of postbasic specialized hours of and referral, coverage for the patient in the absence of the APRN, a method to
education and experience, are practice. review patient outcomes and a method of disclosure of the relationship to the
appropriate to and may be patient. The collaborative agreement must be in writing and include the level
performed by an APRN. (Conn. Gen. of schedule II and III drugs that the NP may prescribe and a method to review
(Conn. Gen. Stat. 20-87a (b)). Stat. § 20- patient outcomes. (Conn. Gen. Stat. § 20-87a (b)).

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5
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
87a (b)).
An APRN who has engaged in APRN activities in collaboration with a
physician for a period of no less than 3 years may thereafter, alone or in
collaboration with another health care provider: (i) perform the acts of
diagnosis and treatment of alterations in health status; and (ii) prescribe,
dispense and administer medical therapeutics and corrective measures and
dispense drugs in the form of professional samples.
Delaware A nurse practitioner is a RN Yes – for the APRNs are required to practice under a collaborative practice agreement or N/A When an APRN who has been granted
with advanced nursing first 2 years protocol with a physician for two years and a minimum of 4,000 hours of independent practice comes before the Board
educational preparation who is or 4,000 practice. All APRNs have full practice and prescriptive authority, but full of Nursing for discipline related to a deviation
a provider of primary hours of practice authority does not equate to independent practice. from the standard of care, the Board of
healthcare in a variety of practice. (24 Nursing’s decision must be approved by the
settings with a focus on a Del. Code. After 2 years or 4,000 hours of practice under a collaborative agreement, an Board of Medical Licensure and Discipline.
specific area of practice. Ann. § 1902 APRN can apply to the APRN Committee (a joint committee of the BON and
(b)(1)&(2)). BOM) for independent practice, which is defined as “practice and prescribing
by an APRN who is not subject to a collaborative agreement and works
outside the employment of an established health care organization, health care
delivery system, physician, podiatrist, or practice group owned by a physician
or podiatrist. Independent practice shall be in an area substantially related to
the population and focus of the APRN’s education, and certification.” The
APRN Committee makes recommendations to the BON regarding whether to
grant independent practice.

APRNs granted independent practice shall not be held to any lesser standard
of care than that of a physician providing care to a specific patient condition
or population.
D.C. Certified nurse practitioner: a No. (D.C. N/A None
registered nurse trained in an Code § 3-
educational program and 1206.03 (a)).
certified by a recognized

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6
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
national certification
organization to provide
healthcare services who, when
functioning within the
authorized scope of practice, is
qualified to assume primary
responsibility for the care of
patients. (CDCR 17-5999.1).
Florida “Advanced registered nurse Yes. General supervision by a physician or dentist is required. The degree and N/A An MD may supervise APRNs offering
practitioner” means any method of general supervision, determined by the APRN and the physician or primary care services at no more than 4
person licensed in this state to (Fla. Stat. § dentist must be specifically identified in written protocol and shall be satellite offices in addition to the primary
practice professional nursing 464.012 (3); appropriate for prudent health care providers under similar circumstances. place of practice.
and certified in advanced or Fla. Admin.
specialized nursing practice, Code 64B9- Protocols and the collaborative practice agreement must include the An MD may supervise APRNs offering
including CRNA, CNM, and 4.010 (1)). information listed here: www.flrules.org/gateway/ruleno.asp?id=64B9-4.010. specialty services at no more than 2 satellite
NP. (Fla. Stat. § 464.003 (3)). offices in addition to the primary place of
practice.

A Board certified/eligible MD in plastic

surgery or dermatology must supervise
APRNs offering primarily dermatologic or
skin care at no more than 1 satellite office in
addition to the primary place of practice.
Georgia "Advanced practice registered Yes. General supervision and delegation is required pursuant to a protocol N/A Chart review required for all charts where
nurse" means a registered agreement. The protocol agreement must: be between a NP and a physician controlled substances prescribed.
professional nurse licensed (O.C.G.A. who practice in comparable specialty areas, and must:
under this chapter who is 43-34-25).  contain a provision for immediate consultation between the NP and the Protocol agreements define what medical acts
recognized by the board as delegating physician; are delegated to the NP. NPs cannot “employ
having met the requirements  identify the parameters under which delegated acts may be performed by a physician to be their delegating physician”.
established by the board to the NP, including the number of refills that may be ordered, the extent to Radiographic imaging tests can only be

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7
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
engage in advanced nursing which radiographic image tests may be ordered, and the circumstances ordered by NP’s in “life threatening
practice and who holds a under which a prescription drug order may be executed; situations”. A 2009 Cosmetic laser bill
master's degree or other  require documentation by the NP of those acts performed by the NP included APRNs (among other ‘medical
graduate degree from an which are specific to the medical acts authorized by the delegating practitioners’), addressed new provisions
approved nursing education physician; relating to the licensing of cosmetic laser
program and national board  include a schedule for periodic review by the physician of patient practitioners, and changed certain provisions
certification in his or her area records; provide for patient evaluation or follow up examination by the relating to the two levels of cosmetic laser
of specialty, or a person who physician; services licenses. The NP may pronounce
was recognized as an  be reviewed, revised, or updated annually; death, but may not sign the death certificate.
advanced practice registered  be available upon written request by the Board of Nursing; and NPs can be delegated the authority to “sign,
nurse by the board on or  provide that a patient who receives a prescription for a controlled certify and endorse all documents relating to
before June 30, 2006. CRNAs substance pursuant to a nurse protocol agreement shall be evaluated or health care provided to a patient within his or
who graduated from an examined by the physician at least quarterly. her authorized scope of practice”.
approved prior to January 1,
1999, are not required to hold Further, if the authority to prescribe controlled substances is among those A collaborating physician shall not enter into
a master's or graduate degree. delegated to the NP under the written protocol, the protocol must include a collaborative practice arrangement with
(Ga. Code. Ann. § 43-26-3 written provisions regarding the procedure for ordering controlled substances. more than 3 FTE APRNs. This limitation shall
(1.1)). (Ga. Admin. Code 410-13-.01 (g)). not apply to collaborative arrangements of
hospital employees, or population-based
public health services.
Hawaii "Advanced practice registered No. N/A None The board shall grant recognition as an
nurse" means a RN who has advanced practice registered nurse to a nurse
met the qualifications for (Haw. Rev. who has:
advanced practice registered Stat § 457- (1) A current, unencumbered license as a
nurse set forth in this chapter 8.5 (a)). registered nurse in this State;
and through rules of the board, (2) An unencumbered license as a registered
which shall include nurse in all other states in which the nurse has
educational requirements. a current and active license;
(Haw. Rev. Stat. § 457-2 (a)). (3) An unencumbered recognition as an
advanced practice registered nurse or similar

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8
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
designation in all other states in which the
nurse has a current and active recognition as
an advanced practice registered nurse;
(4) Completed an accredited graduate-level
education program [ ] preparing the nurse for
one of the four recognized advanced practice
registered nurse roles;
(5) A current, unencumbered certification of
having passed a national certification
examination that measures role and
population-focused competencies and is
recognized by the board;
(6) Maintained continued competencies
through recertification in role and population-
focused competencies through a national
certification program recognized by the board;
(7) Acquired advanced clinical knowledge and
skills preparing the nurse to provide direct
care to patients through a significant
educational and practical concentration on the
direct care of patients;
(8) Demonstrated a greater breadth of
knowledge, a greater synthesis of data, greater
complexity of skills and interventions, and
greater role autonomy than demonstrated by a
registered nurse;
(9) Been educationally prepared to assume
responsibility and accountability for health
promotion and maintenance and to assess,
diagnose, and manage patient problems

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9
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
through the use and prescription of
pharmacologic and non-pharmacologic
interventions;
(10) Acquired clinical experience of sufficient
depth and breadth to reflect the intended
license; and
(11) Paid the appropriate fees."
(H.B. 79, 27th Leg., Reg. Sess. (Haw. 2013)).

Idaho "Nurse practitioner" means a No. N/A None NPs are allowed to sign death
licensed professional nurse certifications, state disability parking, state
who has graduated from a (IDAPA workman’s compensation.
nationally accredited NP 23.01.01.27
program, passed a qualifying 1 (2)).
examination recognized by the
board, and has current initial
certification or current
recertification from a national
group recognized by the
board. (Idaho Stat. § 54-1402
(1)(c)).
Illinois "Advanced practice nurse" or Yes – but A collaborative practice agreement is required for all clinical practice, None APNs with a collaborative practice agreement
"APN" means a person who: is not for except for practice within a hospital or ambulatory surgical treatment center. must collaborate and consult with their
licensed as a registered practice collaborating physician at least once a month,
professional nurse under the within a The written collaborative agreement shall describe the working relationship but there is no requirement for a face-to-face
Act; meets the requirements hospital or of the NP and the collaborating physician or podiatrist and authorize the meeting.
for licensure as an advanced ASC categories of care, treatment, or procedures to be performed by the NP. The
practice nurse under Section agreement need not describe the exact steps that the NP must take with
15-10 of the Act; except as (225 ILCS respect to each specified condition, disease, or symptom, but must specify
provided in Section 15-25 of 65/65-35. which authorized procedure require the presence of the collaborating

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10
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
the Act, has a written physician as the procedures are being performed.
collaborative agreement with a
collaborating physician in the The collaborative relationship under an agreement shall not be construed to
diagnosis of illness and require the personal presence of a physician or podiatrist at all times at the
management of wellness and place where services are rendered. Methods of communication shall be
other conditions as appropriate available for consultation with the collaborating physician or podiatrist in
to the level and area of his or person or by telecommunications in accordance with established written
her practice in accordance guidelines as set forth in the written agreement.
with Section 15-15 of the Act;
and cares for patients: by
using advanced diagnostic
skills, the results of diagnostic
tests and procedures ordered
by the advanced practice
nurse, a physician assistant, a
dentist, a podiatrist, or a
physician, and professional
judgment to initiate and
coordinate the care of patients;
by ordering diagnostic tests,
prescribing medications and
drugs in accordance with
Section 15-20 of the Act, and
administering medications and
drugs; and by using medical,
therapeutic, and corrective
measures to treat illness and
improve health status. (68 Ill.
Admin. Code 1305.10).
Indiana "Advanced practice nurse" Yes. A collaborative practice agreement is required. The collaborative N/A NPs have the authority to order OT services,

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11
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
means: a NP, CNM, or a CNS agreement must set forth the manner in which the NP and the licensed to sign handicapped driving stickers; an NP is
who is a RN qualified to (Burns Ind. practitioner will cooperate, coordinate, and consult with each other in the a member of the birth registry problems
practice nursing in a specialty Code Ann. § provision of health care to patients. committee. NPs are prohibited from entering
role based upon the additional 25-23-1- into a collaborative practice agreement with a
knowledge and skill gained 19.4 (b)). PA.
through a formal organized
program of study and clinical
experience, or the equivalent
as determined by the board,
which does not limit but
extends or expands the
function of the nurse which
may be initiated by the client
or provider in settings that
shall include hospital
outpatient clinics and health
maintenance organizations.
(Burns Ind. Code § 25-23-1-
1).
Iowa “Certified nurse practitioner” No. N/A None
is an ARNP educated in the
disciplines of nursing who has (655 IAC
advanced knowledge of 7.1 (152).
nursing, physical and
psychosocial assessment,
appropriate interventions, and
management of health care,
and who possesses evidence of
current certification by a
national professional nursing

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12
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
certifying body approved by
the board. (655 Iowa Admin.
Code 7.1).

Kansas “Advanced registered nurse Yes. Collaborative practice is required. N/A

practitioner” or “ARNP”
means a professional nurse (K.A.R. 60- Each NP shall function in an expanded role to provide primary, secondary,
who holds a certificate of 11-101). and tertiary health care in the NP's category of advanced practice. Each NP is
qualification from the board to authorized to make independent decisions about advanced practice nursing
function as a professional needs nursing needs of families, patients, and clients, and medical decisions
nurse in an expanded role, and based on the authorization for collaborative practice with one or more
this expanded role shall be physicians. Any NP who interdependently develops and manages the medical
defined by rules and plan of care for patients or clients is required to have a signed authorization
regulations adopted by the for collaborative practice with a physician(s) who is licensed in Kansas. This
board in accordance with regulation shall not be deemed to require the immediate and physical
K.S.A. 65-1130. (Kan. Ann. presence of the physician. Each NP shall be directly accountable and
Stat. 65-1113 (g)). responsible to the consumer.

The authorization for collaborative practice must be jointly developed and

signed by both the NP and the physician(s) and be reviewed annually.
Kentucky "Advanced practice registered No. N/A None Consultation and collaboration are required
nurse" means a NP, CRNA, for situations outside the APRNs SOP.
CNM, or CNS, who is (201 KAR APRNs can certify cause of death, CDLs.
licensed to engage in advance 20:057).
practice registered nursing
pursuant to KRS 314.042 and
certified in at least one
population focus. (Ky. Rev.
Stat. Ann. 314.011 (7)).
Louisiana Nurse practitioner who is an Yes A collaborative practice agreement is required to perform medical

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13
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
APRN educated in a specified functions. The collaborative agreement must include: the availability of the
area of care and certified (46 LAC collaborating physician or dentist for consultation or referral, or both;
according to the requirements XLVII § methods of management of the collaborative practice, which shall include
of a nationally recognized 4513 (B)). clinical practice guidelines; and coverage of the health care needs of the
accrediting agency such as the patient during any absence of the NP, physician, or dentist. (La. Rev. Stat.
ANA’s American Nurses 37:913 (9)).
Credentialing Center, National
Certification Corporation for
the Obstetric, Gynecologic
and Neonatal Nursing
Specialties, or the National
Certification Board of
Pediatric NPs and Nurses, or
as approved by the board and
who is authorized to provide
primary, acute, or chronic care
as an APRN acting within his
scope of practice to
individuals, families, and other
groups in a variety of settings
including, but not limited to,
homes, institutions, offices,
industry, schools, and other
community agencies. (La.
Rev. Stat. 37:913 (1)(d)).
Maine "Certified nurse practitioner" Yes – for Supervision required for the first 24 months of practice. Supervision can be 24 months
means a registered first 24 under:
professional nurse who has months of  a licensed physician;
received post-graduate practice  a NP practicing in the same practice category who will provide oversight
education designed to prepare for the NP; or

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14
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
the nurse for advanced (Code Me.  as an employee of a clinic or hospital that has a medical director who is a
practice registered nursing in a R. 02-380, licensed physician.
specialty area in nursing that Ch. 8)
has a defined scope of practice “Supervising nurse practitioner” means a certified nurse practitioner who
and has been certified in the qualifies as an advanced practice registered nurse who has: (A) Completed 24
clinical specialty by a national months of supervised practice in accordance with subsection 2-A; (B)
certifying organization Practiced as an APRN for a minimum of 5 years in the same specialty; (C)
acceptable to the Board. (Code Worked in a clinical health care field for a minimum of 10 years; and (D)
Maine R. 02 380 008 § 1 (B)). Been approved by the advanced board.
Maryland “Nurse practitioner” means an Yes – For A nurse practitioner must consult and collaborate with a physician or nurse None NPs may sign death certificates and
individual who (1) Is licensed the first 18 practitioner for the first 18 months of practice. handicapped parking certification; issue
by the Board to practice months of emergency DNR orders; verify that an under-
registered nursing; and practice. aged female may get married if she is
(2) Is certified by the Board to pregnant or has just delivered a child; and sign
practice as a NP. (Ann. Code (Ann. Code birth certificate for hospital births. The NP
Maryland Section 8-101(K)). Maryland must specify the exact laboratory or diagnostic
Section 8- procedures to be performed along with the
“Practice as a nurse 302(b)(5)). documentation of proof of education, training
practitioner” means to and competency for performing each specific
independently: (1) Perform an procedure if these specific skills are acquired
act under subsection (N) of after the formal NP program.
this section; (2) Conduct a
comprehensive physical
assessment of an individual;
(3) Establish a medical
diagnosis for common chronic
stable or short–term health
problems; (4) Order, perform,
and interpret laboratory tests;
(5) Prescribe drugs as

© 2017 American Medical Association. All rights reserved.

15
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
provided under § 8–508 of this
title; (6) Perform diagnostic,
therapeutic, or corrective
measures; (7) Consult and
collaborate with, or refer an
individual to, an appropriate
licensed physician or any
other health care provider as
needed; and (8) Provide
emergency care. (Ann. Code
Maryland Section 8-101(L)).
Massachusetts “Nurse engaged in prescriptive Yes These guidelines must: specifically describe the nature and scope of the NP’s N/A
practice” means a nurse with: practice; describe the circumstances in which physician consultation or
(a) authorization to practice in (244 CMR referral is required; describe the use of established procedures for treatment of
the expanded role; (b) a 4.22 (1)). common medical conditions that the nurse may encounter; and include
minimum of 24 contact hours provisions for managing emergencies. (244 CMR 4.22 (2)).
in pharmacotherapeutics
which are beyond those
acquired through a generic
nursing education program;
and (c) valid registration(s) to
issue written or oral
prescriptions or medication
orders for controlled
substances from the MDPH in
accordance with M.G.L. c.
94C, § 7(g) and, where
required, by the U.S. DEA.
(244 Code Mass. Regs. 4.05).
Michigan None given. No N/A None NPs may perform state mandated physical

© 2017 American Medical Association. All rights reserved.

16
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
examinations.

Minnesota "Advanced practice registered Yes – for A collaborative practice agreement with a physician or APRN is required 2,080 hours An APRN certified in mental health may act
nurse," means an individual first 2,080 only for the first 2,080 hours of clinical practice. as an examiner to place a patient on
licensed as a RN by the board hours of emergency hold for care and treatment and to
and certified by a national practice. A NP must practice for at least 2,080 hours, within the context of a petition the court for retention for treatment;
nurse certification collaborative agreement, within a hospital or integrated clinical setting where they may also act as a ‘Health Officer’ for
organization acceptable to the (Minn. Stat. APRNs and physicians work together to provide patient care. The NP shall purposes of taking an individual into custody
board to practice as a CNS, § 148.211). submit written evidence to the board with the application, or upon completion for transport to a treatment facility. APRNs
CRNA, CNM, or NP. (Minn. of the required collaborative practice experience. A collaborative agreement are now listed as one of the providers able to
Stat. § 148.171 (3)). is a mutually agreed upon plan for the overall working relationship between a diagnose AD/HD.
NP and one or more physicians or APRNs that designates the scope of
collaboration necessary to manage the care of patients. The NP and
collaborating physician(s)/APRN(s) must have experience in providing care
to patients with the same or similar medical problems.

Mississippi An "advanced practice Yes. A collaborative practice agreement is required. N/A

registered nurse" is a person
who is licensed or holds the (Miss. Code Collaborative relationships must include a formal quality assurance/ quality
privilege to practice under this §§ 73-15-5, improvement program consisting of: review by the collaborative physician of
article and who is certified in 73-15-20). a sample of charts that represent 10% or 20 charts, whichever is less, of
advanced practice registered patients seen by the NP every month; NP maintenance of a log of charts
nurse or specialized nursing reviewed; and a face-to-face meeting once per quarter. Physicians are
practice and includes CNM, prohibited from entering into collaborative agreements with APRNs whose
CRNA, and NPs. (Miss. Code practice location is over 75 miles from the physician’s primary office. (Board
§ 73-15-5). Rule 1.3)
Missouri "Certified nurse practitioner", Yes A collaborative practice agreement is required. The collaborative practice Limit of 3 FTEs per collaborating physician.
a registered nurse who is arrangements must address:
currently certified as a NP by (20 CSR NPs must work with the collaborating
a nationally recognized 2200-4.200).  the geographic distance between the NP and the physician; physician for 1 calendar month before the NP

© 2017 American Medical Association. All rights reserved.

17
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
certifying body approved by  methods of treatment and authority to administer, dispense, or prescribe can work at a site without the presence of the
the board of nursing. (Mo. drugs; and physician.
Rev. Stat. § 335.016 (7)).  include guidelines for consultation and referral.

The physician must be immediately available for consultation at all times,

either personally or via telecommunications. The collaborating physician
must review the work and records of the NP at least once every 2 weeks.
(CPA checklist at http://pr.mo.gov/nursing.asp).

The use of a CPA by an APRN who provides health care services that include
the diagnosis and initiation of treatment for acutely or chronically ill or
injured persons shall be limited to practice locations where the collaborating
physician, or other physician designated in the CPA, is no further than 50
miles by road, using the most direct route available, from the collaborating
APRN if the APRN is practicing in federally designated health professional
shortage areas (HPSAs). Otherwise, in non-HPSAs, the collaborating
physician and collaborating APRN shall practice within (30) miles by road of
one another. The provision of the above specified health care services
pursuant to a CPA shall be limited to only an APRN. (20 CSR 2200-4.200
(2)(B)).

An advanced practice registered nurse (APRN) providing nursing services

under a collaborative practice arrangement under section 334.104 may
provide such services outside the geographic proximity requirements of
section 334.104 if the collaborating physician and advanced practice
registered nurse utilize telehealth in the care of the patient and if the services
are provided in a rural area of need. Telehealth providers shall be required to
obtain patient consent before telehealth services are initiated and ensure
confidentiality of medical information.
(H.B. 315, 97th Gen. Assem., Reg. Sess., 2013 (Mo. 2013)).

© 2017 American Medical Association. All rights reserved.

18
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
Montana "Advanced practice registered No. (Mont. N/A None
nurse" means a registered Code Ann.
professional nurse who has 37-8-409
completed educational (1)).
requirements related to the
nurse's specific practice role,
in addition to basic nursing
education, as specified by the
board pursuant to 37-8-202.
(Mont. Code Anno. § 37-8-
102 (1)).
Nebraska Nurse practitioner means a RN Yes – for A collaborative practice agreement is required only for the first 2,000 hours 2,000 hours
certified as described in first 2,000 of practice under the supervision of a physician or nurse practitioner.
section 38-2317 and licensed hours of
under the APRN Practice Act practice. 38-2315. Nurse practitioner; functions; scope.
to practice as a NP. (N.R.S.A. (3)(a) A transition-to-practice agreement shall be a formal written
38-2312). (Neb. Rev. agreement that provides that the nurse practitioner and the supervising
Code §§ 38- provider practice collaboratively within the framework of their respective
2314.0138- scopes of practice.
2322 (1)). (b) The nurse practitioner and the supervising provider shall each be
responsible for his or her individual decisions in managing the health care of
patients through consultation, collaboration, and referral. The nurse
practitioner and the supervising provider shall have joint responsibility for
the delivery of health care to a patient based upon the scope of practice of
the nurse practitioner and the supervising provider.
(c) The supervising provider shall be responsible for supervision of the
nurse practitioner to ensure the quality of health care provided to patients.
(d) In order for a nurse practitioner to be a supervising provider for
purposes of a transition-to-practice agreement, the nurse practitioner shall
submit to the department evidence of completion of ten thousand hours of

© 2017 American Medical Association. All rights reserved.

19
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
practice as a nurse practitioner which have been completed under a transition
to-practice agreement, under a collaborative agreement, under an integrated
practice agreement, through independent practice, or under any combination
of such agreements or practice, as allowed in this state or another state.
(4) For purposes of this section:
(a) Supervising provider means a physician, osteopathic physician, or
nurse practitioner licensed and practicing in Nebraska and practicing in the
same practice specialty, related specialty, or field of practice as the nurse
practitioner being supervised; and
(b) Supervision means the ready availability of the supervising provider
for consultation and direction of the activities of the nurse practitioner
being supervised within such nurse practitioner's defined scope of practice.

Transition-to-practice agreement means a collaborative agreement between a

nurse practitioner and a supervising provider which provides for the delivery
of health care through a collaborative practice and which meets the
requirements of section 38-2322.
Nevada “Nurse practitioner” means a No. N/A None (except
registered nurse who has for prescribing
completed an organized (N.A.C. controlled
formal program of training for 632.237) substances –
qualification to practice in a see
specialized area of nursing. prescriptive
(N.A.C. 632.061). authority
chart)
New Hampshire "Advanced practice registered No. N/A None
nurse'' means a RN currently
licensed by the board under (R.S.A. 326-
RSA 326-B:18. (N.H.R.S. B:11).
326-B:2 (I)).

© 2017 American Medical Association. All rights reserved.

20
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
New Jersey "Advanced practice nurse" No. N/A None NPs are authorized to determine cause of
means a person who holds a death and execute death certification if NP is
certification in accordance (N.J. Stat. patient’s primary caregiver.
with section 8 or 9 of Ann. 45:11-
P.L.1991, c.377 (C.45:11-47 49 (a)).
or 45:11-48). (N.J. Ann. Stat.
§ 45:11-23 (1)(d)).
New Mexico "Certified nurse practitioner" No N/A None NPs are authorized to declare death and sign
means a RN who is licensed death certificates, and to certify disability for
by the board for advanced (N.M.S.A. purposes of handicapped parking passes.
practice as a NP and whose 61-3-23.2
name and pertinent (B)(2)).
information are entered on the
list of NPs maintained by the
board. (N.M.A.S. § 61-3-3
(E)).
New York None given. Yes A collaborative practice agreement is required. The practice protocol must N/A NPs may write home health personal aid
reflect current accepted medical and nursing practice and must be filed with services, may act as medical inspector in
(139 the department within 90 days of the commencement of practice. (139 3,600 hour school districts, may order respiratory
N.Y.C.L.S. N.Y.C.L.S. § 6902 (3)(d)). Protocols must identify the area of practice to be requirement therapy, may obtain limited test site permits
§ 6902). performed by the NP in collaboration with the physician; reflect accepted for NPs to be under CLIA, may declare an emergency in
standards of nursing and medical practice; include provisions for case exempt from relation to ordering utilities turned back on
management, including diagnosis, treatment, and appropriate record keeping written after “shutoff” action, and may prescribe non
by the NP; and may include such other provisions as are deemed to be practice patient specific orders (i.e. certain
appropriate. (N.Y.C.R.R. § 64.5 (c)). agreement and immunizations; anti-anaphylactic agents; PPD
protocol tests; and rapid HIV tests). NPs are granted
The collaborative agreement must include provisions for: referral and requirements. authority to sign death certificates.
consultation; coverage for absences of either the NP or the collaborating
physician; resolution of disagreements between the NP and the collaborating No physician shall enter into practice
physician regarding matters of diagnosis and treatment; the review of a agreements with more than 4 nurse

© 2017 American Medical Association. All rights reserved.

21
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
representative sample of patient records every 3 months by the collaborating practitioners who are not located on the
physician; record keeping provisions and any other provisions jointly same physical premises as the collaborating
determined by the NP and the physician to be appropriate. (N.Y.C.R.R. § 64.5 physician.
(b); Board website (http://www.op.nysed.gov/prof/nurse/)/ APN application;
139 N.Y.C.L.S. § 6902 (3)(c)).

Nurse practitioners practicing for more than 3,600 hours are exempt
from requirements for written practice agreement and written practice
protocols. Instead, these NPs must have collaborative relationships with
one or more licensed physicians qualified to collaborate in the specialty
involved or a hospital that provides services through physicians. The NP
must complete and maintain a form to which the NP shall attest, that
describes such collaborative relationships. “Collaborative relationship”
means that the NP shall communicate, whether in person, by telephone or
through written (including electronic) means, with a licensed physician
qualified to collaborate in the specialty involved or, in the case of a
hospital, communicate with a licensed physician qualified to collaborate in
the specialty involved and having privileges at such hospital, for the
purposes of exchanging information, as needed, in order to provide
comprehensive patient care and to make referrals as necessary. Such form
shall also reflect the nurse practitioner's acknowledgement that if
reasonable efforts to resolve any dispute that may arise with the
collaborating physician or, in the case of a collaboration with a hospital, with
a licensed physician qualified to collaborate in the specialty involved and
having privileges at such hospital, about a patient's care are not successful,
the recommendation of the physician shall prevail.
North Carolina "Nurse Practitioner" or means Yes. (21 A collaborative practice agreement is required. During the first 6 months of collaborative
a currently licensed RN N.C.A.C. practice, the NP and primary supervising
approved to perform medical 36.0804). Requirements for collaborative practice agreements: physician must hold monthly quality
acts consistent with the nurse's improvement process meetings. Subsequently,

© 2017 American Medical Association. All rights reserved.

22
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
area of nurse practitioner  the NP and primary or back-up supervising physician must be meetings must be held at least every 6 months.
academic educational continuously available to each other for consultation by direct
preparation and national communication or telecommunication;
certification under an  the agreement must be signed by both parties and maintained at each
agreement with a licensed practice site;
physician for ongoing  the agreement must be reviewed at least yearly;
supervision, consultation,  must include the drugs, devices, medical treatments, tests, and procedures
collaboration and evaluation that may be prescribed, ordered, and performed by the NP;
of medical acts  must include a pre-determined plan for emergency services; and
performed. Such medical acts  the NP and the physician must develop an ongoing quality improvement
are in addition to those nursing process that includes a written plan for evaluating the quality of care
acts performed by virtue of provided, a plan for improving outcomes, and scheduled meeting
RN licensure. (21 N.C.A.C. between the NP and the physician at least every 6 months.
32M.0101 (4)).
North Dakota "Advanced practice registered No N/A None
nurse" means an individual
who holds a current license to (N.D.A.C.
practice in this state as an 54-05-03.1-
APRN. (N.D.C.C. 43-12.1-02 03.2).
(1)).
Ohio “Certified nurse practitioner” Yes NPs may, in collaboration with one or more physicians or podiatrists, N/A NPs have hospital admitting privileges.
means a RN who holds a valid provide preventive and primary care services, provide services for acute
certificate of authority issued (O.R.C. illnesses, and evaluate and promote patient wellness within the nurse's
under this chapter that 4723.43 nursing specialty, consistent with the NP’s education and certification, and in
authorizes the practice of (C)). accordance with rules adopted by the board.
nursing as a NP in accordance
with section 4723.43 of the When a NP is collaborating with a podiatrist, the NP’s scope of practice is
Revised Code and rules limited to the procedures that the podiatrist has the authority to perform.
adopted by the board of
nursing. (O.R.C.A. 4723.01 The NP must enter into a “standard of care arrangement” with one or more

© 2017 American Medical Association. All rights reserved.

23
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
(J)). physicians or podiatrists who practice in a specialty that is the same as, or
similar to, the nurse’s nursing specialty. (O.R.C. 4723.1 (A)). The
requirements for a standard of care arrangement are outlined in O.R.C.
4723.431.

The physician or podiatrist must be continuously available to communicate

with the clinical nurse specialist or certified nurse practitioner either in person
or by radio, telephone, or other form of telecommunication. (O.R.C. 4723.01
(L)(1)).
Oklahoma "Advanced practice nurse" No N/A None
means a licensed RN who: has
successfully completed a (Ok. Stat.
formal program of study Ann. §
approved by the Board which 567.3a (6)).
is designed to prepare
registered nurses to perform in
an expanded role in the
delivery of health care; is
nationally certified by an
appropriate certifying body,
recognized by the Board; and
has received a certificate of
recognition from the Board.
(Okla. Stat. Ann. 567.3a (5)).
Oregon “Nurse practitioner” means a No N/A None Supervised practice is required for reentry.
RN who has been certified by
the board as qualified to (O.A.R.
practice in an expanded 851-050-
specialty role within the 0005 (5)).
practice of nursing. (O.R.S.

© 2017 American Medical Association. All rights reserved.

24
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
678.010 (6)).
Pennsylvania Certified Registered Nurse Yes A collaborative practice agreement is required. N/A
Practitioner is a professional
nurse licensed in this (P.A.C. § “Collaboration” is defined as a process in which a NP works with one or
Commonwealth who is 21.251). more physicians to deliver health care within the scope of the NP’s expertise.
certified by the Board in a The collaborative agreement must include provisions regarding: the
specialty and who, while immediate availability of the physician through direct communication, radio,
functioning in the expanded telephone, or telecommunications; a predetermined plan for emergency
role as a professional nurse, services; and the physician’s availability to the NP on a regularly scheduled
performs acts of medical basis for referrals, review of the standards of medical practice incorporating
diagnosis or prescription of consultation and chart review, drug and other medical protocols within the
medical therapeutic or practice setting, periodic updating in medical diagnosis and therapeutics, and
corrective measures in co-signing records when necessary to document accountability by both
collaboration with a physician parties.
licensed to practice in this
Commonwealth and in
accordance with the act and
this subchapter. Nothing in
this subchapter is to be
deemed to limit or prohibit a
professional nurse from
engaging in those activities
which constitute the practice
of professional nursing as
defined in section 2 of the act
(63 P. S. § 212). (P.A.C. §
21.251).
Rhode Island "Certified nurse practitioner" No N/A None
is an advanced practice nurse
utilizing independent (Gen. L. R.I.

© 2017 American Medical Association. All rights reserved.

25
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
knowledge of physical § 5-34-44).
assessment, diagnosis, and
management of health care
and illnesses. The practice
includes prescriptive
privileges. Certified nurse
practitioners are members of
the health care delivery system
practicing in areas including,
but not limited to: family
practice, pediatrics, adult
health care, geriatrics, and
women’s health care in
primary, acute, long-term, and
critical care settings in health
care facilities and the
community. Certified nurse
practitioners may be
recognized as the primary care
provider or acute care provider
of record.(R.I. Gen. Laws 5-
34-3 (4)).
(1) “Advanced
practice registered nurse”
(APRN) is the title given to an
individual licensed to practice
advanced practice registered
nursing within one of the
following roles: certified nurse
practitioner (CNP), certified

© 2017 American Medical Association. All rights reserved.

26
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
registered nurse anesthetist
(CRNA) as defined in chapter
5–34.2, or certified clinical
nurse specialist (CNS), and
who functions in a population
focus. An APRN may serve as
a primary or acute care
provider of record.
South Carolina "Nurse Practitioner" means a Yes General supervision and delegation is required pursuant to protocol. The N/A
RN who has completed an requirements for written protocols can be found in S.C. Code Ann. § 40-33-
advanced formal education (S.C. Code 34(D)(1)).
program at the master's level Ann. §§ 40-
acceptable to the board, and 33-20 (41), The physician must be in near proximity and is able to be contacted either in
who demonstrates advanced 40-33-34 person or by telecommunications or other electronic means to provide
knowledge and skill in (C)(1)). consultation and advice to the nurse practitioner, certified nurse-midwife, or
assessment and management clinical nurse specialist performing delegated medical acts. When application
of physical and psychosocial is made for more than three NP's, CNM's, or CNS's to practice with one
health, illness status of physician, or when a NP, CNM, or CNS is performing delegated medical acts
persons, families, and groups. in a practice site greater than 45 miles from the physician, the Board of
NPs who perform delegated Nursing and Board of Medical Examiners shall each review the application to
medical acts must have a determine if adequate supervision exists. (S.C. Code Ann. § 40-33-20 (52)).
supervising physician or
dentist who is readily
available for consultation and
shall operate within the
approved written protocols.
(S.C. Code Ann. § 40-34-20
(41)).
South Dakota “Nurse practitioner," a Yes – for the A collaborative practice agreement with a physician, nurse practitioner, or 1,040 hours of
(2017) provider duly authorized under first 24 nurse midwife is required for the first 1,040 hours of clinical practice. collaboration

© 2017 American Medical Association. All rights reserved.

27
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
this chapter to practice the months and with a
specialty of nurse practitioner 1,040 hours physician, NP,
as defined in § 36-9A-12. of practice or NM.
(S.D.S.A. § 36-9A-1 (5)).
(S.D. Stat.
Ann. § 36-
9A-3)).
Tennessee Nurse Practitioner means a Yes TCA 63-7-123(b) (1) requires that a nurse who has been issued a license to N/A The only mention of diagnose in the nurse
Tennessee licensed RN with a practice as a nurse practitioner (NP) must file a notice with the board, practice act is in TCA 63-7-103(b) where it
master's degree or higher in a (TCA § 63- containing the name of the NP, the name of the licensed physician having states that the practice of an RN does not
nursing specialty and has 7-123(b)(1); supervision, control and responsibility for prescriptive services rendered by include acts of medical diagnosis except to the
national specialty certification Tenn. Rules the nurse practitioner and a copy of the formulary describing the categories of extent such acts may be authorized by TCA
as a NP. (TCA § 63-7-126). and Regs legend drugs to be prescribed and/or issued by the nurse practitioner. 63-1-132, 63-7-123, and 63-7-207. The
0880-06- relevant section of TCA 63-1-132 requiring
.02) The supervision regulations for physicians, Tenn. Rules and Regs 0880-06- the director to provide the board of pharmacy
.02, Clinical Supervision Requirements, require the NP’s supervisor to be with the names of all NP’s authorized to write
available for consultation at all times, have protocols in place with the nurse prescriptions was repealed in 2010. TCA 63-
practitioner, develop clinical guidelines in collaboration with the NP to 7-123 requires that a nurse practitioner have a
include a method for documenting consultation and referral, review 20% of supervising physician for prescriptive services
charts every 30 days, and make an on-site visit every 30 days. rendered by the NP. TCA 63-7-207 sets out
the powers of the nursing board to establish
the qualifications for a NP to write
prescriptions.
Texas “Advanced practice nurse” No. N/A. N/A
means a RN approved by the
Board to practice as an APRN (T.A.C. § However, a physician who delegates to a nurse practitioner must follow
on the basis of completion of 221.13 (c)). certain statutory protocols for quality review and assurance. Texas
an advanced educational Occupations Code 157.051.
program. The term includes a
NP, CNM, CRNA, and CNS.

© 2017 American Medical Association. All rights reserved.

28
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
(T.A.C. § 301.152 (a)).
Utah None given. No N/A

(Utah Code
Ann. 58-
31b-102
(13)).
Vermont "Advanced practice registered Yes – for the Graduates with fewer than 24 months and 2,400 hours of licensed active 2,400 hours
nurse" means a licensed first 24 advanced nursing practice in an initial role and population focus shall have a and 2 years of
registered nurse authorized to months and formal agreement with a collaborating physician or APRN) collaboration
practice in this state who, 2,400 hours with a
because of specialized of practice APRNs who obtain a subsequent certification in an additional role and physician or
education and experience is population focus shall have a formal agreement with a collaborating APRN
endorsed to perform acts of (V.S.O. 26- physician or APRN for no fewer than 12 months and 1,600 hours.
medical diagnosis and to 28-1613)
prescribe medical, therapeutic
or corrective measures under
administrative rules adopted
by the board. (Vt. Stat. Ann. §
1572 (4)).
Virginia "Advanced practice registered Yes NPs are required to practice as part of patient care teams, which are defined N/A In the event a physician who is serving as a
nurse" means a registered as a multidisciplinary team of health care providers actively functioning as a patient care team physician dies, becomes
nurse who has completed an (18 V.A.C. unit with the management and leadership of one or more patient care team disabled, retires from active practice,
advanced graduate-level 90-30-120 physicians for the purpose of providing and delivering health care to a patient surrenders his license or has it suspended by
education program in a (A)). or group of patients. the Board, or relocates his practice such that
specialty category of nursing he is no longer able to serve, and a NP is
and has passed a national Physicians shall not serve as a patient care team physician on a patient care unable to enter into a new practice agreement
certifying examination for that team at any one time to more than six nurse practitioners. with another patient care team physician, the
specialty. "Nurse practitioner" NP may continue to treat patients without a
means an APRN who is jointly Each member of a patient care team shall have specific responsibilities related patient care team physician for 60 days,

© 2017 American Medical Association. All rights reserved.

29
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
licensed by the Boards of to the care of the patient or patients and shall provide health care services provided the NP continues to prescribe only
Medicine and Nursing within the scope of his usual professional activities. Nurse practitioners those drugs previously authorized by the
pursuant to § 54.1-2957. practicing as part of a patient care team shall maintain appropriate practice agreement with such physician and to
(Virginia Code § 54.1-3000) collaboration and consultation, as evidenced in a written or electronic practice have access to appropriate physician input in
agreement, with at least one patient care team physician. NPs who are complex clinical cases and patient
CRNAs shall practice under the supervision of a licensed doctor of medicine, emergencies and for referrals. The Boards
osteopathy, podiatry, or dentistry. Collaboration and consultation among NPs shall grant permission for the NP to continue
and patient care team physicians may be provided through telemedicine as practice under this subsection for another 60
described in § 38.2-3418.16. Practice of patient care teams in all settings shall days, provided the NP provides evidence of
include the periodic review of patient charts or electronic health records and efforts made to secure another patient care
may include visits to the site where health care is delivered in the manner and team physician and of access to physician
at the frequency determined by the patient care team. input.

"Collaboration" means the communication and decision-making process

among members of a patient care team related to the treatment and care of a
patient and includes (i) communication of data and information about the
treatment and care of a patient, including exchange of clinical observations
and assessments; and (ii) development of an appropriate plan of care,
including decisions regarding the health care provided, accessing and
assessment of appropriate additional resources or expertise, and arrangement
of appropriate referrals, testing, or studies.
"Consultation" means the communicating of data and information,
exchanging of clinical observations and assessments, accessing and assessing
of additional resources and expertise, problem-solving, and arranging for
referrals, testing, or studies.
Washington An "advanced registered nurse No N/A None NPs may sign accident reports and certify
practitioner" is a RN who has time loss for Labor and Industry claims.
had formal graduate education (WAC 246- Psychiatric NPs are authorized to admit, and
and has achieved national 840-300). manage the care of patients who are
specialty certification for the involuntarily detained in hospitals and mental

© 2017 American Medical Association. All rights reserved.

30
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
NP, CRNA, or CNM role. A health treatment centers; they may also
nurse with this preparation provide legally mandated evaluations for
may qualify as an ARNP as hearings related to issues such as whether
described in WAC 246-840- there is reason not to allow a patient’s right to
300. (WAC § 246-840-010 refuse medications. The Department of Labor
(1)). and Industries added psychiatric ARNPs to its
list of approved providers. ARNPs were
included as primary care providers in
legislation that requires Medicaid, Basic
Health and the Public Employees Benefits
Board programs to include provisions in
contracts that encourage broad
implementation of primary care health homes
(Senate Bill 5394).

West Virginia The practice of “advanced No N/A None APRNs can sign death certificates.
practice registered nurse” is a
RN who has acquired (W.Va.
advanced clinical knowledge Code § 30-
and skills preparing him or her 7).
to provide direct and indirect
care to patients, who has
completed a board-approved
graduate-level education
program and who has passed a
board-approved national
certification examination. An
APRN shall meet all the
requirements set forth by the
board by rule for an advance

© 2017 American Medical Association. All rights reserved.

31
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
practice registered nurse
which shall include, at a
minimum, a valid license to
practice as a CRNA, CNM,
CNS, or CNP.
Wisconsin “Advanced practice nurse Yes Advanced practice nurse prescribers shall work in a collaborative N/A
prescriber’’ means an APRN relationship with a physician. The collaborative relationship is a process in
who has been granted a (Wis. which an APRN is working with a physician, in each other's presence when
certificate to issue prescription Admin. necessary, to deliver health care services within the scope of the practitioner's
orders under s. 441.16 (2), Code N 8.10 professional expertise. The APRN and the physician must document this
Stats. (Wis. Adm. Code N (7)). relationship
8.02 (2)).
Wyoming "Advanced practice registered No N/A None
nurse" means a nurse who:
May prescribe, administer, (Wy. Stat.
dispense or provide Ann 33-21-
nonprescriptive and 120 (a)(i)).
prescriptive medications
including prepackaged
medications, except schedule I
drugs as defined in W.S. 35-7-
1013 and 35-7-1014; Has
responsibility for the direct
care and management of
patients and clients in relation
to their human needs, disease
states and therapeutic and
technological interventions;
Has a master's degree in
nursing, or an APRN specialty

© 2017 American Medical Association. All rights reserved.

32
State (incl. year Definition of Nurse Physician Details Supervised Additional notes
independence Practitioner involvement practice hours
granted, if required for required
applicable) diagnosis & before
treatment? autonomy
or has completed an accredited
APRN educational program
prior to January 1, 1999; and
Has completed an advanced
program of study in a specialty
area in an accredited nursing
program, has taken and passed
a national certification
examination in the same area
and has been granted
recognition by the board to
practice as an APRN. (Wyo.
Stat. § 33-21-120 (a)(i)).
030117

© 2017 American Medical Association. All rights reserved.

33