NP · pathways
Where Nurse Practitioners need a physician, and for how long
Read this as demand: the third group is where physician agreements are permanent.
Full practice authority (18)
Independent from licensure. A physician relationship is optional here.
Conditional independence (21)
Authority arrives after a transition period the statute defines. The conditions below are the feed's summary; each state page has the full rule and its source.
| State | Conditions for independent practice |
|---|---|
| Arkansas | ≥6,240 hours of practice under a collaborative practice agreement (or equivalent out-of-state prescriptive-authority practice); Full Independent Practice Credentialing Committee (FIPCC) approval — active unencumbered CNP license and prescriptive-authority certificate, 2 recommendation letters, $150 application fee |
| California | '103 NP' tier (Bus. & Prof. Code §2837.103): national NP board certification + a 'transition to practice' of ≥3 full-time-equivalent years OR ≥4,600 hours of direct patient care within the preceding 5 years (need not be consecutive, per SB 1451 (2025)) — unlocks practice without standardized procedures, but only within a group practice setting that includes ≥1 physician; '104 NP' tier (Bus. & Prof. Code §2837.104): after ≥3 years practicing as a 103 NP in good standing (Board may reduce this for DNP holders) — unlocks fully independent practice outside any group/physician-integrated setting, including hospital medical staff privileges |
| Connecticut | ≥3 years licensed and practicing as an APRN (prior collaboration with an out-of-state physician may count toward this, per §20-87a(2)(B)); ≥2,000 hours performing advanced-practice nursing activities in collaboration with a physician during that period (§20-87a(3)) |
| Delaware | ≥2 years of collaborative practice; ≥4,000 hours of clinical practice with a physician or experienced APRN in the same role/population focus |
| Florida | ≥3,000 clinical practice hours under physician supervision, completed within the 5 years immediately preceding registration (§464.0123(1)); 3 graduate-level semester hours (or equivalent) in differential diagnosis, within the preceding 5 years; 3 graduate-level semester hours (or equivalent) in pharmacology, within the preceding 5 years; Active, unencumbered APRN license under §464.012; no disciplinary action under §456.072/§464.018 within the preceding 5 years; Registration with the Florida Board of Nursing (Fla. Admin. Code R. 64B9-4.020) |
| Illinois | ≥4,000 hours of clinical practice under a written collaborative agreement after first attaining national certification; ≥250 hours of continuing education/training; a notarized full-practice-authority attestation filed with IDFPR |
| Kentucky | ≥4 years prescribing nonscheduled legend drugs under a CAPA-NS in good standing exempts the NP from further CAPA-NS requirements (KRS 314.042); ≥4 years prescribing controlled substances under a separate CAPA-CS in good standing exempts the NP from further CAPA-CS requirements |
| Louisiana | LA Admin. Code tit. 46 §7911.A.5 references an exemption from the collaborative practice agreement requirement after a threshold of prior collaborative-practice experience — secondary sources give conflicting hour figures (1,000 vs. 2,080 hours) and this research pass could not confirm the correct figure or exactly what authority the exemption confers (full independent diagnosis/prescribing vs. a narrower administrative exemption) — verify against LSBN rule text before relying on this for a compliance decision. |
| Massachusetts | 2 years of supervised practice under mutually-agreed guidelines with a Qualified Healthcare Professional (244 CMR 4.07), OR ≥3 years of independent-practice authority already held in another state/territory; submission of a Board attestation — independence is not automatic upon hitting the threshold |
| Maryland | 18 months of mentorship (available consultation/collaboration) from a Maryland-licensed physician or NP with ≥3 years' clinical experience — ONLY required for an NP never previously certified in Maryland or any other state; an NP already certified elsewhere is exempt from this mentorship entirely and practices independently from initial MD certification |
| Maine | 24 months of supervised practice under a licensed physician, a qualifying supervising NP (≥5 years as an APRN in the same specialty, ≥10 years in a clinical health care field, Board-approved), or employment by a clinic/hospital with a physician medical director |
| Nebraska | ≥2,000 hours of practice under a transition-to-practice, collaborative, integrated, or independent-practice arrangement (or combination), completed in Nebraska or another state |
| New Jersey | practicing within a qualifying population focus — family/individual across the lifespan, adult-gerontology, pediatrics, women's health, or behavioral health; >5,000 hours of licensed, active advanced nursing practice within that population focus; providing primary or behavioral healthcare (not general obstetrics, and not elective aesthetic/cosmetic services) |
| Nevada | ≥2,000 hours of practice under a collaborative agreement with a Nevada-licensed physician, submitted with the application for prescribing registration to the Board of Pharmacy |
| New York | ≥3,600 hours of practice as a certified NP (in NY, another state, or federal/VA/Armed Forces/PHS service); Below that threshold: a written practice agreement AND written practice protocols with a physician qualified in the NP's specialty are required |
| Oklahoma | ≥6,240 hours of supervised clinical practice, then Board of Nursing approval of independent prescriptive authority (H.B. 2298, eff. Nov. 1, 2025) |
| South Dakota | ≥1,040 practice hours as a licensed CNP (or CNM); until then, a written collaborative agreement with a physician OR an already-independent CNP/CNM (SDCL 36-9A-4(5)) — the collaborator need not be a physician |
| Virginia | equivalent of ≥3 years full-time clinical experience — § 54.1-2957(I) itself only says 'as determined by the Boards,' but 18VAC90-30-86 defines full-time as 1,800 hours/year, i.e. 5,400 hours total (confirmed directly against the regulation text; a commonly-repeated secondary-source figure of ≈4,500 hours appears to be an error propagated across NP-advice sites); attestation from a patient care team physician who supervised the experience, or (per H.B. 971, eff. 7/1/2024) an 'attesting nurse practitioner' who has held autonomous-practice status ≥3 years |
| Vermont | ≥2 years and ≥2,400 hours of practice under a collaborative agreement (≥1,600 hours over ≥12 months if adding a second APRN certification) |
| Wisconsin | ≥3,840 hours of professional RN practice over ≥24 months (shortfall against 24 months, if any, is added to the APRN-role requirement below); ≥3,840 hours of advanced practice in the NP's Recognized Role while working with a physician or dentist immediately available for consultation, over ≥24 months |
| West Virginia | for prescribing specifically: ≥3 years in a documented collaborative relationship with granted prescriptive authority, then Board of Nursing approval to prescribe without an ongoing collaborative agreement |
Supervision required (13)
No experience- or hours-based pathway. The physician agreement lasts for the life of the practice.