2
fhea.com Fitzgerald Health Education Associates, Inc., May 2015
care. These collaborative agreements determine an
NP's scope of practice and reduce their ability to en-
gage in at least one element of NP practice.
2
States
with a restricted practice regulatory structure require
NPs to have supervision, delegation, or team-man-
agement by an outside health discipline in order to
provide patient care, restricting their ability to en-
gage in at least one element of NP practice. (See
State Practice Environment map.)
Recent Developments
The first full practice authority laws were adopted
in the 1980s by Alaska, New Hampshire, Oregon
and Washington. Since then, the number of states
with laws giving NPs full practice authority has
risen to 21 (plus the District of Columbia; see
Table). The two most recent additions to the full
practice authority list, Nebraska and Maryland,
illustrate the political wrangling involved in chang-
ing practice laws at the state level. On March 5,
2015, the Nebraska governor signed into law a bill
removing the requirement that NPs maintain ca-
reer-long "collaborative agreements" with physi-
cians as a condition of practice. The bill containing
this measure had been passed by lawmakers in
2014 by a unanimous vote, but it was vetoed by
NP Scope of Practice
Table
Full Practice Authority
Alaska
Arizona
Colorado
Connecticut
District of Columbia
Hawaii
Idaho
Iowa
Maine
Maryland
Minnesota
Montana
Nebraska
Nevada
New Hampshire
New Mexico
North Dakota
Oregon
Rhode Island
Vermont
Washington
Wyoming
Reduced Practice
Alabama
Arkansas
Delaware
Illinois
Indiana
Kansas
Kentucky
Louisiana
Mississippi
New Jersey
New York
Ohio
Pennsylvania
South Dakota
Utah
West Virginia
Wisconsin
Restricted Practice
California
Florida
Georgia
Massachusetts
Michigan
Missouri
North Carolina
Oklahoma
South Carolina
Tennessee
Texas
Virginia
Source: AANP.
2