What are the BEST and WORST States to practice as an NP? - page 10

by Roland 171,905 Views | 215 Comments

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 grants them autonomy, and... Read More


  1. 0
    Quote from meagain716
    I found this site which explains NPs prescribing privileges by state http://www.medscape.com/viewarticle/440315

    It was published in 2002, so some of it might have changed, but it gives you a general overview of how NPs are perceived in terms of what they're allowed to prescribe.
    Thanks for posting that again, meagain716 (first posted on page 5).

    Hope to have an updated one soon.
  2. 0
    Washington seems like a pretty good state to practice in. I just shadowed a NP in independant practice for a day to see what the work enviroment was like. He worked with three other NP's in a family care practice and was working without a collaborating physician. Seemed like there was high job satisfaction in that practice overall. I've also had the priveledge of interviewing NP's who work in critical care in the hospital and never realized until recently that there are many NP's used by hospitals here. I think WA is favorable for NPs.
  3. 0
    Quote from platon20
    Thats not what I call "independent practice"

    What are the states that allow total unmitigated, independent practice? By this I mean myself as an NP can open up a full blown clinic, no MD signature EVER, and I NEVER have to consult with an MD for ANY REASON. No collaboration agreement, no supervision, nothing. Where are these states because thats where i want to move
    MOVE TO NEW MEXICO!
  4. 0
    Quote from suzanne4
    Sorry, but you are wrong.
    Psychologists do not have prescribing priv., the med order has to come from the psychiatrist, or they can make a recommendation to the PMD, but they cannot write the Rx.
    Pharmacists do not write prescriptions, they can take a verbal order. But they cannot prescribe medication that needs a prescription.
    Physical Therapists can not write a medication prescription, they can order devices for patient, or order treatments, but they cannot order medications.
    Chiropractors in most states do not have prescriptive authority, and if they do, it is severely restricted.
    PSYCHOLOGISTS IN NEW MEXICO HAVE PRESCRIPTIVE AUTHORITY! I don't know about the other specialties mentioned...
  5. 0
    Quote from SueBee RN-BSN
    In Missouri the PA's are in danger, and the CNM can't fully practice any longer. Even the CRNA in limited.

    What I find to be bigeat shame of all is that nurses give their power to these doctors.
    Missouri is one of the worst, and this year I thought it might turn for the better, but not only did the CS law not pass, but 2 laws passed that further restricts NPs in Missouri. What a joke!!!

    Too bad I had to leave my home state. I find it much better in KS. I hope all NPs leave Missouri. I say if they want it all to themselves, fine, let them have it. There's not enough docs to go around and then they'll be kicking themselves in the a$$. PCP docs will see their work load explode and specialists will see their profit margins plummet as they don't have a NP to keep the clinic moving while they are in surgery anymore. All this for a brainless turf war. Amazing...
  6. 0
    Quote from platon20
    OK, are you saying that I can move to New Mexico as an NP, open and run my own clinic, and that I DONT have to have a collaboration agreement with a doctor? I dont have to consult with him, I dont have to have him review charts even once?

    These are the places i'm looking for. 100% independence. NO collaboration agreement, all sched 2 drugs, zero consultation with MD, zero chart review zero cosignatures.
    Yes Yes Yes That is exactly what I am saying. I have a FNP friend that just bought her own building, & has her own independent practice. New Mexico is one of the Best Places to open your own clinic, no need to have MD collaborate or review charts with full prescriptive, The local hospitals also grant you admiting privildges .
    PM me & we can discuss more. Sorry I just got a link to this thread 4 just 4 months late!!
  7. 0
    Quote from mmwelch
    I will begin a direct entry NP program this fall in Boston. However, I will be returning to my home state of Illinois when I am finished, or shortly there after. I was wondering why everyone says Illinois is so bad? There are no reasons given, just that it is no good.
    I am not an APN in Illinois but one of my best friends is and her husband is a doctor. She told me that Illinois is not desirable to APNs because the AMA (American Medical Assoc. ) is located in CHicago and has a strong hold on trying to limit the use of APNs. Her husband is very supportive of her degree and career choice and they are likely not going to stay in Illinois because of her limitations in Illinois. They are considering moving to Colorado.
  8. 0
    Quote from cgfnp
    Missouri is one of the worst, and this year I thought it might turn for the better, but not only did the CS law not pass, but 2 laws passed that further restricts NPs in Missouri. What a joke!!!

    Too bad I had to leave my home state. I find it much better in KS. I hope all NPs leave Missouri. I say if they want it all to themselves, fine, let them have it. There's not enough docs to go around and then they'll be kicking themselves in the a$$. PCP docs will see their work load explode and specialists will see their profit margins plummet as they don't have a NP to keep the clinic moving while they are in surgery anymore. All this for a brainless turf war. Amazing...

    Thanks for the heads-up, although I was kinda hoping it was the other way between KS and MO since KS doesn't license acupuncturists unless they are a MD/DO with NO TRAINING, but MO has had a descent scope for some time.

    Is there any website to get updates on the legistlative initiatives for MO NPs?
  9. 0
    I would have to say that I disagree with manna. I don't know specifically what you are referring to in regards to Mississippi, but it is not a bad place to work as an NP.

    I used to work there and know many NP's. Mississippi has very strong lobbying for NP's and they get paid ok considering the region of the country that it is in. Now I can't argue with what one physician says or doesn't say but I can assure you that not all physicians feel that way.

    Perhaps this MD does not like NP's - I'm ok with that, however MD's usually don't like NP's for one of two reasons.

    1. They are an older physician and think that everyone that can diagnosis and treat should go through the same education that they had to go through.
    or
    2. They are a younger breed of physicans perhaps insecure and see NP's as a threat to them and their job.

    Of course this is just my 2 cents worth- I do think this is a good topic to talk about b/c it allows people to make better judgements about where they are going to move, live, and practice.

    Kevin
  10. 0
    Quote from mec65
    All MD's in MS are not threatened by NP's as this sounds. I am currently in the NP program at MUW and I have had a good relationship with those I have worked with in clinical! The NP's I know are working fairly autonomously with an MD available for collaboration. NP's in MS have prescriptive rights and can obtain a DEA for authority to write anything their patients may need. Evidence-based practice serves as the guide for safe, sound practice!


    I totally agree with you- Sure you will have MDS that may or may not like NPs - SO WHAT - By the way I am originally from MS and MUW is awesome- I know an NP who went there. Good Luck to you - I am in the NP program at UCI (University of Cal. @ Irine)


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