APRN Scope of Practice defines the practice limits for an Advanced Practice Registered Nurse (APRN). The two principal areas of practice engagement are Practice Autonomy and Prescriptive Authority.
Practice Autonomy is the degree of ability to practice independent of physician oversight. Prescriptive Authority is the degree of independence in writing prescriptions and the type of treatments or medications prescribed.
Practice Autonomy and Prescriptive Authority are classified as Independent, Collaborative, or Supervised and are listed here in decreasing order of independence:
- Independent – The ability to act independently. No Physician relationship is required.
- Collaborative – Requires a written collaboration agreement with a Physician.
- Supervised – Requires supervision by a Physician.
- Not Recognized – APRN practice is not recognized or licensed by the state.
These Scope of Practice rules apply to the following APRN roles: Certified Nurse Midwife (CNM), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), and Nurse Practitioner (NP).
In the case of Nurse Practitioners, Independent practice is also referred to as Full Practice Authority (FPA).
States may establish two additional areas of practice engagement for Nurse Practitioners (NPs). These are Signature Authority and Hospital Admitting Privileges. Signature Authority denotes the authorization to sign documents such as Death Certificates, Handicap Parking Permits, and Workers’ Comp Claims. Hospital Admitting Privileges are permitted in a few states and with a limited number of hospitals.
Employers may establish Scope of Practice rules that are more restrictive than the state permits. For example, a state may allow an NP to practice Independently. However, a hospital in that state may require all NPs in their employ to be subject to physician supervision. A different hospital may require physician supervision for newly graduated NPs but allow experienced NPs to practice Independently if permitted by the state.
Rules of APRN Scope of Practice do not apply to other advanced nursing careers, including Clinical Nurse Leader (CNL), Nurse Educator (NE), and Nursing Administration and Healthcare Leadership.
Each state has statutes and administrative codes under which an Advanced Practice Registered Nurse may practice. The following Color-Coded Maps and Sortable Lists illustrate the difference in Scope of Practice rules between states.
Certified Nurse Midwife (CNM)
Certified Registered Nurse Anesthetist (CRNA)
Clinical Nurse Specialist (CNS)
