Full Practice Authority for Nurse Practitioners: Everything You Need to Know

Blog Updated on January 9, 2026.

Since the creation of the nurse practitioner (NP) role more than five decades ago, NPs have advocated for full practice authority, which allows them to practice to the full extent of their education, training and certification without physician oversight.

But while NP degree programs and board certifications are consistent and standardized nationwide, NP practice authority still varies by state.

Nurses nationwide are pursuing advanced degree programs so that they can become practitioners.

 

History of the Nurse Practitioner

The need for more primary care health care services first surfaced in 1965 when Medicare and Medicaid expanded their coverage to low-income women, children, the elderly and those with disabilities. With so many new people qualifying for coverage, the nation experienced a shortage of primary care physicians.

Visionaries Loretta C. Ford, EdD, PNP, FAAN and Henry Silver, MD, established the first nurse practitioner program in the United States in 1965. Their program was established as a certification program, but in the early 1970s, it was elevated to a master’s degree program.

A Brief Timeline

• In 1971, Idaho was the first state to recognize nurse practitioners’ scope of practice, which included diagnosis and treatment.
• By 1973, there were more than 65 nurse practitioner programs in the United States, and six years later, the country had 15,000 nurse practitioners.
• The American Academy of Nurse Practitioners was established in 1985.
• By 1989, 90% of NP programs were master’s degree or post-master’s degree programs.
• By the end of the last century, there were more than 63,000 NPs in the United States.
• By 1994, five states had approved full practice authority for NPs.
• In 2013, the American Academy of Nurse Practitioners and the American College of Nurse Practitioners (founded in 1995) joined to form the American Association of Nurse Practitioners (AANP®), the largest, full-service national professional membership organization for NPs of all specialties.
• In 2025, more than 461,0000 NPs practiced in the United States, with an estimated 1.06 billion patient visits each year.

 

Nurse Practitioner Full Practice Authority Adoption

Over the years, states have adopted full practice authority slowly and independently. In 1994, five states — Alaska, Iowa, Montana, New Mexico and Oregon — granted NPs full practice authority.

In 1997, Medicare authorized reimbursement for NP services, thus expanding the number of states willing to approve full practice authority. By the year 2000, 10 states and the District of Columbia were on board.

To date, 27 states, two U.S. territories and the District of Columbia states have granted full practice authority to NPs across the country. Other states and territories have been slower to adopt the model and place restrictions on the NP’s scope of practice, leaving some people in those states with limited access to quality healthcare.

NP Practice Authority Scope

AANP identifies three levels of nurse practitioner practice authority: full practice, reduced practice and restricted practice. These levels define the extent to which nurse practitioners can evaluate patients; diagnose conditions; order and interpret diagnostic tests; and initiate treatment plans, including prescribing medications.

Discussion around nurse practitioner full practice authority continues because scope-of-practice laws and regulations vary by state. Although NP education and certification standards are regulated nationally, each state determines how much independence nurse practitioners have in clinical settings.

As a result, many states continue to examine the role of physician oversight in relation to nurse practitioner scope of practice. These ongoing debates often focus on improving access to care while maintaining high standards of patient safety and care quality.

Full Practice

Nurse practitioner full practice authority allows these professionals to provide primary care to the full extent of their post-graduate education, clinical training and national certification. They can evaluate and diagnose patients, order and interpret diagnostic tests, manage treatments and prescribe medications, including controlled substances.

This model, supported by the National Academy of Medicine and the National Council of State Boards of Nursing, essentially gives NPs authorization to practice and prescribe exactly as a physician does, without supervision.

In addition to the District of Columbia, Guam and the Northern Mariana Islands, the following 27 states grant full practice authority. Some are approved immediately upon licensure, while others require working a set number of hours or years under the supervision of a physician before they are granted full practice authority.

1. Alaska
2. Arizona
3. Colorado
4. Connecticut
5. Delaware
6. Hawaii
7. Idaho
8. Iowa
9. Kansas
10. Maine
11. Maryland
12. Massachusetts
13. Minnesota
14. Montana
15. Nebraska
16. Nevada
17. New Hampshire
18. New Mexico
19. New York
20. North Dakota
21. Oregon
22. Rhode Island
23. South Dakota
24. Utah
25. Vermont
26. Washington
27. Wyoming

Reduced Practice

Some states’ practice and licensure laws reduce the capacity of the NP’s role in at least one area of their practice. As defined by AANP, some “state laws require a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice.”

In addition to American Samoa, Puerto Rico and the U.S. Virgin Islands, the following 12 states allow NPs to practice with reduced authority:

1. Alabama
2. Arkansas
3. Illinois
4. Indiana
5. Kentucky
6. Louisiana
7. Mississippi
8. New Jersey
9. Ohio
10. Pennsylvania
11. West Virginia
12. Wisconsin

Restricted Practice

In restricted practice states, licensure laws require “career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care,” according to AANP. This means that NPs can only treat patients under the supervision of a physician.

Eleven states allow NPs to practice with restrictions, with those restrictions varying by state:

1. California
2. Florida
3. Georgia
4. Michigan
5. Missouri
6. North Carolina
7. Oklahoma
8. South Carolina
9. Tennessee
10. Texas
11. Virginia

 

NP Practice Authority and Veterans Affairs

In December 2016, the Department of Veterans Affairs (VA) granted NPs permission to practice independently without physician supervision, overriding state laws.

AAPN released a statement supporting the VA’s decision: “AANP applauds this move to provide our nation’s veterans with direct access to the health care services of NPs and other APRNs and encourages the VA to include our CRNA colleagues.”

NP Practice Authority Expands Its Scope

This was a big win for the full practice authority movement; the VA is the nation’s largest employer of nurses, which includes nearly 6,000 NPs. It serves 9.1 million veterans each year.

 

The Growing Need for Full Practice Authority

There are many compelling reasons for states to adopt nurse practitioner full practice authority legislation. Nurse practitioners represent a highly trained, experienced and readily available workforce that can help address growing healthcare demands. Their advanced education and clinical training prepare them to deliver high-quality, patient-centered care across a wide range of settings.

Granting full practice authority allows RNs who become NPs to practice to the full extent of their skills, which can significantly improve access to primary and preventive care, particularly in rural, underserved and primary care shortage areas. By reducing unnecessary regulatory barriers, states can more effectively leverage the nurse practitioner workforce to expand healthcare access, improve continuity of care and support better patient outcomes.

An Aging Population

The U.S. population is aging rapidly, and the health care needs of older adults are increasing. As of recent estimates, more than 61 million Americans are age 65 or older, accounting for roughly 18% of the total U.S. population. This share continues to grow as life expectancy increases and birth rates decline.

By 2030, approximately 1 in 5 Americans is expected to be 65 or older, representing about 71 million people nationwide. Population projections indicate that the number of older adults will continue to rise for decades, potentially reaching between 80 and 95 million by mid-century.

This demographic shift has significant implications for healthcare systems, long-term care services and workforce demand, increasing the need for accessible primary and preventive care across the country.

Supply and Demand

As demand for healthcare continues to grow, the supply of primary care physicians is struggling to keep pace. Recent workforce analyses project a substantial shortfall of doctors in the United States over the next decade. According to the Association of American Medical Colleges (AAMC), the nation could face a shortage of between 37,800 and 124,000 physicians by 2034, with primary care specialties among those most affected. This reflects rising healthcare needs, an aging population and persistent challenges in recruiting clinicians to primary care roles.

At the same time, a significant portion of the current physician workforce is nearing retirement age. Nearly 1 in 3 active physicians is age 65 or older, meaning that a wave of retirements could further reduce the number of practicing clinicians in the coming years.

Compounding the issue, fewer medical graduates are choosing careers in primary care. Despite an increase in residency positions, many go unfilled or are taken by graduates pursuing other specialties, leaving gaps in family medicine, internal medicine and pediatrics.

This imbalance between supply and demand has made it increasingly difficult for patients, especially in rural and underserved communities, to access timely primary care, highlighting the need for expanded roles for nurse practitioners, physician assistants and other health care professionals to help meet the nation’s growing needs.

Underserved Populations

Access to primary care remains a significant challenge across the United States. Recent federal data show that nearly 74 million Americans live in areas designated as primary care Health Professional Shortage Areas (HPSAs). These are communities where the supply of primary care providers isn’t sufficient to meet the population’s basic healthcare needs.

These shortages are especially common in rural and underserved urban areas, where residents may face long wait times, limited appointment availability or the need to travel long distances for care. Approximately 1 in 5 people in the United States live in a region affected by a primary care provider shortage, limiting access to preventive services and routine medical care.

Although an HPSA designation is based on provider-to-population ratios, it doesn’t fully capture the strain communities experience. Many regions continue to struggle with recruiting and retaining health care professionals, underscoring the growing need for expanded access to primary care services nationwide.

Chronic Disease Management

Another major reason for expanding nurse practitioner full practice authority is the growing strain on the healthcare system caused by increasing patient complexity and chronic disease.

More Americans are living with multiple chronic conditions such as diabetes, heart disease, obesity and respiratory illnesses. Managing these conditions requires ongoing monitoring, patient education and preventive care rather than episodic treatment. Nurse practitioners are trained to provide this type of comprehensive, continuous care, often spending more time with patients and focusing on health education and prevention.

Granting full practice authority allows NPs to manage chronic conditions independently, improve care coordination, and reduce unnecessary emergency room visits and hospitalizations. This not only improves patient outcomes but also helps relieve pressure on overcrowded healthcare systems, making care more accessible and efficient overall.

The Opioid Crisis

The opioid epidemic remains a significant public health challenge in the United States, even as recent data show signs of improvement. In 2023, an estimated 105,000 people died from overdoses, and approximately 76% of those deaths involved opioids, including synthetic opioids such as fentanyl. While preliminary data from 2024 indicate a notable decline in overdose deaths compared with the previous year, opioids continue to account for the majority of fatal overdoses nationwide.

Primary care professionals play a critical role in addressing this crisis by identifying substance use disorders, providing early intervention, prescribing medications for opioid use disorder and coordinating ongoing care. 

However, shortages of primary care providers (PCPs) leave many individuals without access to timely treatment and support. These shortages are especially pronounced in rural areas, where residents are far more likely to live in communities with limited primary care access, making it harder to receive addiction treatment and preventive services when they’re most needed.

 

The Good News: NPs Can Fill the Gap

The need for full practice authority is paramount so that NPs can fill the PCP gap.

While the pool of PCPs is shrinking, the number of NPs is growing. There were more than 461,000 licensed nurse practitioners in the country as of 2024.

According to the U.S. Bureau of Labor Statistics, nurse practitioner jobs are expected to increase by 40% between 2024 and 2034. This provides a great deal of growth potential for the profession and for you personally.

NP Practice Authority and Full Practice Authority Adoption

Recent analyses show that states with full practice authority have seen significant growth in nurse practitioner practice locations compared with more restrictive states. 

States that have adopted full practice authority also tend to attract and retain more NPs overall. This trend suggests that allowing nurse practitioners to practice independently not only enhances access to care but may also encourage more professionals to enter and remain in the workforce, especially in underserved and rural communities where primary care needs are greatest.

 

The Benefits of Full Practice Authority for Patients

States that see the value of extending practice authority to the fullest extent allow NPs to practice and prescribe drugs without physician oversight.

Improved Access

Full practice authority improves access to care, especially in underserved areas. States with full practice authority are more likely to have NPs working in rural and underserved areas than states with more restrictions.

Full practice authority streamlines care and provides access right when it’s needed. Having to consult with a physician creates delays in care and can leave some patients with unmet needs.

Patient Satisfaction

Full practice authority protects patients’ rights to see their health care providers of choice by removing anti-competitive licensing restrictions. Studies have shown that integrating APRNs into clinical care improves patient satisfaction scores and can lead to improved outcomes and patient retention.

Better Health Outcomes

People who have regular access to routine and preventive healthcare tend to be healthier. Expanding NP practice authority to the fullest, thereby allowing NP independence, can increase the frequency of routine checkups, improve care quality and decrease emergency department visits by patients.

A 2023 review of systematic reviews found that NP care is equal to physician care in numerous settings. 

State Health and Full Practice Authority

States with full practice authority rank higher than reduced or restricted authority states in overall health, outcomes, care quality and access to care.

 

Full Practice Authority Is Cost-Effective

One of the long-standing arguments for full practice authority is the cost efficiency of training nurse practitioners compared with physicians. Recent data show that the average total tuition and fees for a nurse practitioner master’s program typically fall in the range of about $35,000 to $65,000, though costs vary by school and program length. In contrast, the class of 2025 paid an average of $228,959 for a four-year medical degree, according to data compiled by the Education Data Initiative. 

This stark difference in education expense means that preparing a nurse practitioner requires significantly less financial investment than training a physician, making the pathway a more accessible option for many aspiring clinicians while still producing highly capable primary care providers.

Cost Savings Now and in the Future

There’s strong evidence that nurse practitioner-led care can match or improve key cost and utilization outcomes compared with physician-led care. A systematic review of research published through 2023 found that care provided by nurse practitioners was as effective as physician care and was associated with similar or lower rates of hospitalizations, emergency department visits and length of stay in many settings. Studies also report no consistent disadvantage in outcomes when nurse practitioners deliver primary care, suggesting that quality of care remains equivalent across these measures.

Recent modeling suggests that expanding nurse practitioner practice authority in states could generate substantial economic benefits. For example, analyses project that removing unnecessary scope-of-practice restrictions could lead to notable reductions in primary care costs and improved access to care, particularly in underserved and rural communities.

Collectively, this evidence supports the idea that broad use of nurse practitioners, combined with full practice authority, has the potential to reduce health care spending while preserving quality of care and improving access for patients.

Advance Your Degree and Increase Your Salary

U.S. News & World Report lists nurse practitioner jobs with a median income of $126,260.

Even more impressive, it cites the role of nurse practitioner as #1 in the 100 Best Jobs of 2025 for these reasons:

• It pays well.
• It’s challenging.
• It matches your talents and skills.
• It offers room for advancement.
• It provides a satisfying work-life balance.
• It’s in demand.

Beyond the benefits of becoming an FNP, you can join the growing number of NPs who are championing legislation for increased NP practice authority in states that are reluctant to change.

 

Full Practice Authority: The Future Is Now at Walsh University Online

Increased primary care demand for an aging population, rising health care costs and limited access to care are reshaping the healthcare landscape. The good news is that with change comes opportunity.

You are in the unique position to grow your skills as a nurse and become a leader in service to others.

The online MSN degree program from Walsh University is more flexible and affordable than similar programs and is accredited by the Commission on Collegiate Nursing Education and the Higher Learning Commission.

WUO graduates have above-average pass rates on the AANP Certification Board Exam.

Competitive tuition rates and flexible financial aid are some of the perks of an online education at Walsh University.

Other benefits include:

• A placement coordinator will provide you with a preceptor and sites for your clinicals.
• You’ll gain 600-700 clinical hours.
• You’ll connect with a fully engaged faculty of experienced nurses.
• You’ll benefit from small class sizes.
• Dedicated and proactive support will help you succeed.

Learn about the various online MSN degree specializations offered by Walsh University, such as Family Nurse Practitioner (MSN-FNP), Nurse Educator (MSN-NE) and Psychiatric Mental Health Nurse Practitioner (MSN-PMHNP). For working RNs who already hold a master’s degree, we also offer a Post-Graduate FNP Certificate and a Post-Graduate PMHNP Certificate program.

With one of the most affordable tuition rates and assistance in finding preceptors through Walsh’s many local clinical partnerships, there’s no need to put achieving your dreams on hold.