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The scope of practice of advanced practice nurses around America is somewhat different in every state. Each state has a practice act that is laid out by the board of registered nursing in that state.

In California, the Nurses' Practice Act requires the nurse practitioner to work with the collaboration of a physician or surgeon. They must adhere to the standardized procedures which are developed through the collaboration amongst health professionals, administrators, supervising physicians, or surgeons (Spetz & Muench, 2018). In this scenario, the physician or surgeon must take legal responsibility for the nurse practitioners' work of practice. They are required to oversee the nurse practitioner’s quality of care and practice. However, there is always a regulation of communication between the physician and nurse practitioner. This statement is validated by a report done in California asking nurse practitioners to rate how involved in the development of revision of standardizing procedures they were in with their supervising physician. And only 8% reported said they never had a voice in the development of the standardized procedures. In 2017, 72% of nurse practitioners in California reported that their collaborating physicians practiced in the same location they did (Spetz & Muench, 2018).

Prescribing opioid medication in an office-based care setting in California was limited to only physicians up until 2016 when the Comprehensive Addiction and Recovery Act allowed nurse practitioners and physician assistants to obtain waivers so that they can engage in the treatment for opioid use disorders and prescribe opioid medications (Spetz et al., 2019). Although the nurse practitioner has the autonomy to prescribe opioids, it must be done in the supervision of a physician who has obtained a Drug Addiction Treatment Act waiver (Spetz et al., 2019).

The National Council of State Boards of Nursing has developed a Model Act which encourages consistency across states for the scope of practice of advance registered nurses (APRNs) (Toney-Butler & Martin, 2020). This act outlines the scope of practice, which includes: conducting assessments; ordering and interpreting diagnostic procedures; making diagnoses; prescribing, ordering, administering, dispensing and prescribing therapeutic measures; delegating to other team members; and consulting with other disciplines and providing referrals.

          Florida nurse practitioners can be certified in many clinical areas such as acute care, community, and public health, women’s health, family practice, pediatrics. They have full autonomy to diagnose and treat a variety of illnesses and conditions (Toney-Butler & Martin, 2020). In Florida starting July 2020 advanced nurse practitioners have the right to operate primary care practices without the supervision of any physician if they have accumulated at least 3000 hours of experience under physician supervision. Also, they must have a minimum graduate-level course working differential diagnosis in pharmacology (Toney-Butler & Martin, 2020). This bill was signed on March 11 and allows qualified nurse practitioners to independently practice family medicine, general pediatric, and general internal medicine. The nurse practitioners can work now without the supervision of any physician, while in California the ratio of physician supervision to nurse practitioner, is one to four (Spetz & Muench, 2018). California earlier this year progressed to pass a bill that would grant nurse practitioners full autonomy to work without the supervision of a physician. Although the bill has not passed, many movements are trying to make the change happen

References

Spetz, J., & Muench, U. (2018). California nurse practitioners are positioned to fill the primary care gap, but they face barriers to practice. Health Affairs, 37(9), 1466-1474.  https://doi.org/10.1377/hlthaff.2018.0435 (Links to an external site.)

Spetz, J., Toretsky, C., Chapman, S., Phoenix, B., & Tierney, M. (2019). Nurse practitioner and physician assistant waivers to prescribe buprenorphine and state scope of practice restrictions. JAMA, 321(14), 1407.  https://doi.org/10.1001/jama.2019.0834 (Links to an external site.)

Toney-Butler, T. J., & Martin, R. L. (2020, March 27). Florida nursing laws and rules - StatPearls - NCBI bookshelf. National Center for Biotechnology Information.  https://www.ncbi.nlm.nih.gov/books/NBK532859/