Independent Practice State

As I consider which states I plan on obtaining new licenses in, I am thinking about only getting licenses in states that allow independent practice for nurse practitioners. Here are the reasons why:

1. Respect: No one is calling me a ‘mid-level’. In states where nurse practitioners can practice autonomously, we are seen equally to physicians. When we are seen at an equal playing field, no one is using that term (mid-level), I despise. When I worked in Washington State before, a state that supports full practice authority for nurse practitioners, I felt respected.

2. Licensing process is easier: States that require nurse practitioners to have protocols in place or a supervising physician make the licensing process more difficult. Sometimes I have to provide a protocol before they even grant me my nurse practitioner license, which is ridiculous. Other times I have to show proof that I prescribed medications at a previous job, or obtain a letter from my supervising physician.

3. Freedom: In independent practice states I’ll be able to order home health and sign orders for my patients in need. I’ll be able to prescribe all kinds of medications without the pharmacist requesting the name of the physician I work under. I’ll be able to spend less time wondering if that’s something I am authorized to do and assume it is.

4. Better pay: States that value nurse practitioners have already progressed to allowing full practice authority. As a result, these states will typically pay nurse practitioners well. This is because other states use the term ‘mid-level’ to explain why nurse practitioners aren’t paid as well as their peers (physicians), even when doing the same work.

Some states that are considered to be independent practice states for nurse practitioners may have different stipulations. For instance, working in Washington was the ideal full practice autonomy state to work in. On the other hand, although Maine is also an independent practice state, the licensing process was still a bit tedious. I had to have a previous supervising physician confirm that I was supervised over 2 years or more, prior to them giving me an independent license. In addition, some home health agencies do not allow nurse practitioners to authorize home health orders, which I find strange. So keep in mind that the 23 states with nurse practitioner practice autonomy are not all equal.