Case Studies

State Approaches to Scope of Practice: Advanced Practice Registered Nurses

January 1, 2015


Joseph W. Thompson, MD, MPH
President & CEO


Advanced practice registered nurses (APRNs) are “nurses who have gained additional knowledge and skills through successful completion of an organized program of nursing education that certifies nurses for advanced practice roles as certified nurse practitioners, certified nurse anesthetists, certified nurse midwives, and clinical nurse specialists.” Although a variety of nuances exist, there are generally three approaches (Figure 1) used by states to regulate the relationship between physicians and advanced practice registered nurses (APRNs) as it relates to diagnosis and treatment: Requirement for physician supervision, requirement for written documentation of physician involvement, and no requirement for physician involvement.

This report goes over different state approaches to regulation between physicians and APRNs as well as state regulation of APRN prescriptive authority.