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Can an FNP Prescribe Medication? Yes, but It's Complicated

Trailblazers / Can an FNP Prescribe Medication? Yes, but It's Complicated
Can an fnp prescribe medication? a picture of an FNP listening to a patient.
August 4, 2022

Family nurse practitioners (FNPs) fulfill a vital role in the American healthcare system, but can an FNP prescribe medication? Yes! In fact, FNPs can prescribe medication in all 50 states. The extent of their prescriptive authority is fully dependent upon the approved state regulations in which they are employed. Therefore, every nurse practitioner — no matter their particular specialty — must maintain keen awareness of the legalities and practice limitations related to their license.

NP Practice Authority

As mentioned above, one crucial aspect of a nurse practitioner’s scope of practice are the state-based regulations to which all NPs must adhere, including the prescribing of medication. So, to answer the question, can an FNP prescribe medication? The answer is yes, but it’s a bit complicated as it varies state by state.

According to the American Association of Nurse Practitioners (AANP), practice authority is defined as follows:

Full practice:

State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing (from AANP.org).

  • Alaska
  • Arizona
  • Colorado
  • Connecticut
  • Delaware
  • Guam
  • Hawaii
  • Idaho
  • Iowa
  • Maine
  • Maryland
  • Massachusetts
  • Minnesota
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Mexico
  • North Dakota
  • Northern Mariana Islands
  • Oregon
  • Rhode Island
  • South Dakota
  • Vermont
  • Washington
  • Washington, DC
  • Wyoming

Reduced practice:

State practice and licensure laws reduce the ability of NPs to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice (from AANP.org).

  • Alabama
  • American Samoa
  • Arkansas
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Mississippi
  • New Jersey
  • New York
  • Ohio
  • Pennsylvania
  • Puerto Rico
  • U.S. Virgin Islands
  • Utah
  • West Virginia
  • Wisconsin

Restricted Practice:

State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care (from AANP.org).

  • California
  • Florida
  • Georgia
  • Michigan
  • Missouri
  • North Carolina
  • Oklahoma
  • South Carolina
  • Tennessee
  • Texas
  • Virginia

* States and territories are divided according to their current practice standings as of June 10, 2022.

The Prescribing of Medication

Here are three states to reference as examples of the three levels of NP practice authority regarding the prescribing of medication:

Full prescriptive authority:

In Iowa, NPs enjoy full practice authority and the ability to prescribe medications, including controlled substances. The following description is taken from the Iowa State Legislature website:

“Prescriptive authority” is the authority granted to an ARNP registered in Iowa in a recognized

nursing specialty to prescribe, deliver, distribute, or dispense prescription drugs, devices, and medical gases when the nurse is engaged in the practice of that nursing specialty. Registration as a practitioner with the Federal Drug Enforcement Administration and the Iowa board of pharmacy examiners extends this authority to controlled substances. ARNPs shall access the Iowa board of pharmacy examiners website for Iowa pharmacy law and administrative rules and the Iowa Board of Pharmacy Examiners Newsletter.

Reduced prescriptive authority:

In Kansas, where NPs practice with reduced authority, the Kansas State Legislature website says:

An advanced practice registered nurse may prescribe drugs pursuant to a written protocol as authorized by a responsible physician. Each written protocol shall contain a precise and detailed medical plan of care for each classification of disease or injury for which the advanced practice registered nurse is authorized to prescribe and shall specify all drugs which may be prescribed by the advanced practice registered nurse. Any written prescription order shall include the name, address and telephone number of the responsible physician.

The advanced practice registered nurse may not dispense drugs, but may request, receive and sign for professional samples and may distribute professional samples to patients pursuant to a written protocol as authorized by a responsible physician.

In order to prescribe controlled substances, the advanced practice registered nurse shall: (1) Register with the federal drug enforcement administration; and (2) notify the board of the name and address of the responsible physician or physicians. In no case shall the scope of authority of the advanced practice registered nurse exceed the normal and customary practice of the responsible physician.

An advanced practice registered nurse certified in the role of registered nurse anesthetist while functioning as a registered nurse anesthetist under K.S.A. 65-1151 through 65-1164, and amendments thereto, shall be subject to the provisions of K.S.A. 65-1151 through 65-1164, and amendments thereto, with respect to drugs and anesthetic agents and shall not be subject to the provisions of this subsection.

Restricted prescriptive authority:

In Tennessee, physicians have a authority over nurse practitioners, including the prescribing of medications. The website of the National Conference of State Legislatures provides the following information:

Physician supervision is required. The physician has control and responsibility for prescriptive services rendered by the NP.

NPs may prescribe Schedules II-V controlled substances upon receiving a certificate of fitness from the State Board of Nursing and adoption of physician supervisory rules. Schedules II-IV may only be prescribed after consultation with the physician.

Take aways: a changing prescriptive landscape

Simply put, the answer to the question can an FNP prescribe medication? will vary from state to state, but one thing is certain: a nurse practitioner’s prescriptive authority is built on a shifting landscape which depends on a given state’s legislation. . In this regard, it is highly likely that prescriptive authority and NP independence will expand over time.

Thus, it is beneficial for both current and prospective nurse practitioners to remain aware of the practice authority regulations in their state of employment. Also, try to capitalize on opportunities to advocate for changes in legislation. This could have a large impact on advancing an NP’s scope of practice.

Finally, if you feel like you have what it takes to become an FNP, whether you’re already an RN or a nurse in pursuit of a BSN, check out United States University’s FNP program where tuition is only $375 a month.

Keith Carlson, BSN, RN, NC-BC is a nurse, holistic career coach, writer, podcaster, and keynote speaker. Keith has conducted more than 2,000 coaching sessions with nurses from all walks of life, and his podcast, The Nurse Keith Show, reaches nurses throughout the world with fascinating interviews and messages of inspiration and career strategy. He lives and works in beautiful Santa Fe, New Mexico.