What are the BEST and WORST States to practice as an NP? - page 12

I am speaking primarily from two perspectives here: 1. The degree to which NP's are accepted, recognized, and utilized in that area/state. 2. The degree to which state law recognizes NP's, and... Read More

  1. by   TX RN
    I believe TX is one of 7 (maybe 12) states that requires MD endorsement (supervision) for prescriptive priviliges and limits drug class that NP's are allowed to write for. From some e-mails that I've received from my school and CNAP it appears that TX is pretty restrictive (albeit it's relative to what state you reside in now). Hope that helps.
  2. by   ANPFNPGNP
    Quote from sim236
    Hi. Can someone please tell me how Texas is like for NP's based on earnings and level of independence? Thank You.
    I live in Texas and we are presently fighting for complete independence from physician oversight. We're going after it in urban and rural areas, but the MD lobbyists are fighting us like crazy, but I really feel we'll get it in rural areas. I wonder if there are any states that allow NP's to practice
    independently in rural areas only?

    As far as earnings, it just depends on where you live. I've heard that NP's in Austin are a dime a dozen and make around 65K-70K annually. However, I'm seeing 6 figure salaries in rural areas and in the Houston area. It's all about supply and demand. Hospitalist NP's are in high demand in South Texas and they are all earning >100K. TX is VERY restrictive as far as scope of practice, so you'll need to be an Acute Care NP in order to practice as a hospitalist around here.
  3. by   ANPFNPGNP
    Quote from TX RN
    I believe TX is one of 7 (maybe 12) states that requires MD endorsement (supervision) for prescriptive priviliges and limits drug class that NP's are allowed to write for. From some e-mails that I've received from my school and CNAP it appears that TX is pretty restrictive (albeit it's relative to what state you reside in now). Hope that helps.
    NP's in Texas can write controlled substances (Schedules III-V), but we must have a DEA # tied to a physician in order to do so. However, there are very few NP's who even bother to get a DEA number, because it isn't necessary to have one in order to write prescriptions. I practice in both primary and urgent care and it's very rare that I need to write a controlled substance. I know NP's and PA's who don't have a DEA number, so they just have a protocol set up with their SP and they just call the script into the pharmacy under the doc's name or have the doctor sign it if he's available. In the chart, they indicate that the medication was ordered by the doctor.

    Also, we aren't allowed to write for more than a 30 day supply of a controlled substance nor are we allowed to refill a controlled substance. I actually LIKE it that way, b/c it gives me a way out when a drug seeker is asking for Lortab, etc.

    Another thing, it cost $25.00 to get a TX DPS license and then $550.00 to get a DEA license, so make sure you get your SP to pay for it.
  4. by   NewDeb07
    What is the market like for NP practice in Ohio? Cincinnati, Dayton, or Columbus areas?
  5. by   deb18
    Hi. I am a psych np in north florida. While we have prescriptive ability we cannot write for controlled substances. Reimbursement for nps by 3rd parties is terrible. We are under protocol with an MD. Some physicians are welcoming, some are threatened by us. Florida is very southern when you are north of orlando.
  6. by   JDCitizen
    So whats the theory of better practice? We were told in school the further north the better the practice....

    So I am guessing us folks in the south especially in the so called bible belt have the good-boy league against us.

    Does practice rights/regulations seen to improve north-east or north-west..
  7. by   efy2178
    Iowa does not--NPs in Iowa have full prescription rights.
  8. by   ANPFNPGNP
    Quote from Annegg
    What is NY like for NP's?
    I worked as a RN in NYC and I remember it being tough for NP's b/c there are so many doctors there. It seems that everyone wants to live in the Big Apple, so there really isn't a shortage of physicians.
  9. by   CEOMMOON
    Can you give me more info on NP's in Florida?
  10. by   blahdiboodah
    the american journal for nurse practitioners releases an annual pearson report every february.

    this report lists state-by-state presentation (info on what np titles are used in that state, what education is required, rx authority, etc.) as well as an overview of diagnosing and treating and prescribing by state.

    you may get a pdf download from http://www.webnp.net/ajnp08.html of the pearson report. read it for yourself -- you'll see where nps are restricted and where they have "free reign."

    this was from the 2008 report:

    [font=futura-condensedboldoblique][color=#ffffff]diagnosing and treating [font=futura-condensedbold][color=#ffffff]aspects of np practice

    [color=#ffffff]
    [font=futura-condensedbold][color=#ffffff][font=futura-condensedbold]no requirement for any physician involvement:[font=futura-condensedbold][color=#ffffff]

    [font=futura-condensedbold][font=futura]alaska, arizona, colorado, district of columbia, hawaii, idaho, iowa, kentucky, michigan, montana, new hampshire, new jersey, new mexico, north dakota, oklahoma, oregon, rhode island, tennessee, utah, washington, west virginia, wyoming, maine (after the first 2 years of practice)

    [font=futura-condensedbold][font=futura-condensedbold]prescribing aspect of np practice[font=futura-condensedbold]

    [font=futura-condensedbold]absolutely no requirement for any physician involvement:

    [font=futura-condensedbold]alaska, arizona, district of columbia, idaho, iowa, montana, new hampshire, new mexico, oregon, washington, wyoming, maine (after the first 2 years of practice)

    [font=futura-condensedbold]
    [font=futura-condensedbold]
    [font=futura-condensedbold]hope this helps.
  11. by   hospicenp
    One of the worst states: Florida. Prescriptive authority does not include ANY scheduled drugs, which is a real hassle for me since I work in hospice. We have to file our MD protocol annually. We constantly fight the Florida Medical Association in the legislature, they introduce bills to limit us even further and would get away with it if we aren't vigilant. If it weren't for the particular group I work with, I wouldn't be here.
  12. by   JDCitizen
    Quote from hospicenp
    One of the worst states: Florida. Prescriptive authority does not include ANY scheduled drugs, which is a real hassle for me since I work in hospice. We have to file our MD protocol annually. We constantly fight the Florida Medical Association in the legislature, they introduce bills to limit us even further and would get away with it if we aren't vigilant. If it weren't for the particular group I work with, I wouldn't be here.

    We are right there with you here in GA....
  13. by   ANPFNPGNP
    Quote from hospicenp
    One of the worst states: Florida. Prescriptive authority does not include ANY scheduled drugs, which is a real hassle for me since I work in hospice. We have to file our MD protocol annually. We constantly fight the Florida Medical Association in the legislature, they introduce bills to limit us even further and would get away with it if we aren't vigilant. If it weren't for the particular group I work with, I wouldn't be here.
    I used to work in pain management in TX, where we can write III-V's. Unfortunately, the vast majority of people in PM are on Schedule II's and it was a major hassle tracking down the doctor to get him to sign the scripts. The DEA license was completely useless.

    The majority of NP's I know don't even have a DEA license nor do they want one.

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