The Nurse Practitioner profession is guided by a myriad of licensing and practice guidelines. Many of these dictates are established by state legislation and range from full to restricted practice limits. This legislation varies considerably depending on your chosen state of practice and can greatly impact your clinical autonomy levels.‌ If you are an NP looking for a new career opportunity, it is essential to know what a state's practice restrictions are before accepting a new job to ensure the best fit. To help you make the best decision consider these states with the highest and lowest Nurse Practitioner autonomy levels.

Nurse Practitioner Autonomy

Advanced Practitioner supervision is a hotly contested area in medicine today. Some medical professionals believe that AP's need comprehensive supervision when it comes to their clinical practice while others disagree. Despite recommendations promoting NP practice autonomy from both the National Council of State Nursing Board and Institute of Medicine, many states still require comprehensive Physician oversight. Nurse Practitioners working in these states are required to have Physicians oversee the diagnostic, prescriptive and treatment aspects of their medical practice.

NP Autonomy

States With Highest Nurse Practitioner Autonomy Levels

While some states follow a restrictive Nurse Practitioner regulation model, the majority permit NP's to work without restrictions or Physician oversight. This freedom promotes higher levels of autonomy for Nurse Practitioners that choose to practice in these states:

NP Autonomy

Consider Federal Employment for Increased Practice Autonomy

Nurse Practitioners looking for higher levels of practice autonomy may also want to consider employment with the Veterans Administration (VA). As of 2016, the VA allows Nurse Practitioners to practice without Physician oversight(1).This new policy increases NP autonomy while reversing former restrictions limiting veteran access to NP's at their facilities.