A state board of nursing is the state-specific licensing and regulatory body that sets the standards for safe nursing care, decides the scope of practice for nurses within its jurisdiction, issues licenses to qualified candidates, and handles any disciplinary actions for nursing practice violations.
All 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands have boards of nursing that collectively represent the member organizations that make up the National Council of State Boards of Nursing (NCSBN).
The NCSBN administers the National Council Licensure Examinations that all state boards require as part of the licensing process:
- Registered Nurses (including advanced practice RNs) – NCLEX-RN exam
- Licensed Practical or Vocational Nurses – (NCLEX-PN) exam
California, Louisiana, and West Virginia each have two boards, one for Registered Nurses (RNs) and one for LPNs or LVNs. One state, Nebraska, has a separate board for advanced practice registered nurses (APRNs).
It’s the role of these boards to determine how advanced practice registered nursing is defined in each state.
How State Nursing Licensure Works
As a nurse or prospective nurse, you probably already have a basic idea of how the licensing process goes. You put in the years it takes to get the required combination of education, experience, and put all the documentation together to prove it. You take and pass the required test for your level of licensure. You probably go through a background check and you fill out an application form that seems like it’s the size of a short novel.
Then you bundle it all up and send it off to the board. In a couple of weeks, they let you know if you forgot to dot any i’s, neglected to submit something, or if your tests scores didn’t come through… or if everything looked good and your license is on the way.
But what happens on the other side of that process? Well, the staff isn’t just sitting around joking about applicants who don’t make the cut.
Instead, they:
- Review and verify your application information and ensure that information goes into the state databases for future reference
- If you have left any portion incomplete or filled it out wrong, they are responsible for contacting you and letting you know how to fix it
- They coordinate with law enforcement agencies to have background checks run on you
- They validate your test scores and ensure you took the appropriate exam for the license you applied for
- If necessary, they may issue a temporary practice permit
- Finally, once all qualifications have been verified and approved, they issue your active license and update databases so other agencies and healthcare services can validate the license
And that’s just the licensing function. Before you even get that far, you might have contacted them with questions and gotten the answers you needed. After licensure, they also follow up on renewals. The board is also responsible for investigating and deciding allegations of misconduct.
It’s a big job, and it makes the profession of nursing the most trusted job in America, year after year.
What Is the Function and Role of Your State Board of Nursing?
Even though all state boards maintain similar licensing standards and voluntarily align themselves under the NCSBN, you might be surprised to learn that there are no national rules for licensing and regulating the practice of nursing.
Each state is responsible for passing their own laws, often called Nursing Practice Acts (NPAs), that establish their own regulations for nurses. The District of Columbia and each U.S. Overseas Territory also has its own nursing board.
The legal language in the NPA lays out the requirements for licensure and defines the scope of nursing practice. But a lot of the details aren’t hammered out.
Instead, the Acts create nursing boards of between 10 and 17 members, usually a mixture of registered, practical, and advanced practice nurses together with members of the public. The boards then put the NPA into practice by setting specific administrative rules and regulations that further define the qualifications for licensure and the scope of practice. Board rules must be consistent with the NPA and can’t supersede NPA mandates.
The board members themselves don’t handle most of the actual work of the board. Instead, they make the big decisions while professional staff handle the paperwork, investigations, and communications required.
Depending on the state, nursing boards may be called commissions, examiners, or registration agencies, but despite the names they all have the same regulatory job.
All boards of nursing are responsible for evaluating applications for nurse licensure, issuing and renewing nursing licenses, and taking disciplinary actions when needed. Other responsibilities that a board of nursing might take on, depending on the state, include:
- Authorizing the use of particular licensing examinations
- Approving nursing education programs that meet established criteria
- Offering advice to the legislature about determining the legal scope of nursing practice in the state
- Regulating nurse aides/nursing assistants and medication aides/assistants working in nursing home and home health care settings
A Short History of State Nursing Boards
Most state nursing boards date back to the early 20th century when the nursing profession was becoming more formal and better recognized. The American Nurses Association (ANA) was established in 1896 and began lobbying lawmakers for recognition and professional standards.
Lawmakers responded by passing some of the first laws regulating nursing. In 1903, North Carolina became the first state in the nation to have a registration process for nurses, paving the way for the RN designation now established in every state. And in doing so, it created the very first nursing board, a Board of Examiners which had discretion to “…issue license without examination to such applicants as shall furnish evidence of competency entirely satisfactory to them.”
More boards followed, and exams became a part of the process. Eventually, licensing become mandatory in 1935 and the titles of Registered Nurse and Licensed Practice Nurse became legally protected, applying only to nurses recognized by nursing boards.
How Does APRN Independent Practice Differ By State?
Just as every state has its requirements for RN licensing, each state also sets its own requirements for licensing APRNs. They determine the legal scope of practice for APRNs and establish the APRN roles and titles recognized in the state.
Variations in state laws for APRNs creates confusion for both nurses and patients. A coalition of nursing organizations led by the NCSBN have developed a Consensus Model for APRN Regulation to standardize both licensing requirements and the scope of practice for advanced practice nurses nationwide. NCSBN and other organizations continue to actively lobby for state legislatures to incorporate it.
To date, 18 states have fully adopted the model into their laws, but most state boards of nursing have adopted at least some part of the NCSBN’s APRN Consensus Model. As of July, 2021, nursing boards in 37 states plus the District of Columbia allow APRNs to independently prescribe certain drugs. According to the American Association of Nurse Practitioners (AANP), 24 states offer full independent practice authority to diagnose and treat patients without direct physician oversight or a collaborative agreement in place. This widespread trend to adopt the consensus model strongly suggests that additional state boards of nursing will soon tailor their regulations to match this model.
COVID-19 May Have Changed The Rules For Advanced Practice Nurses Forever
The COVID-19 pandemic hit the American healthcare system like a Mack truck. Hospitals were swamped with patients; infected healthcare providers had to quarantine, putting even more pressure on those who remained to deliver services. In an industry that was already running short of doctors, there was suddenly a critical need for advanced practice providers to shore up the gaps.
State legislatures, insurers, and federal agencies like the Centers for Medicare and Medicaid Services scrambled to put in place emergency rule changes to allow APRNs and other providers more latitude to practice independently. Not only were the shortages of healthcare professionals during the pandemic a major driver of these policies, but so were the limitations on existing collaborative practice agreements that assumed a level of supervision that just wasn’t possible remotely.
As of July 2021, 18 different states had temporarily suspended or waived practice agreement requirements to cope with COVID-19 according to AANP. Thirteen of those suspensions remained in force.
Having demonstrated in all those states and more (no exemptions were necessary in states already offering full practice authority) that they are fully capable of handling major healthcare emergencies, it’s a good bet that APRNs will have a stronger hand next time they ask state legislatures for independent practice and prescriptive authority.
State-by-State Guide to Nursing Boards, APRN Acts, and Independent Practice Rules
This list is not reflective of temporary emergency authorizations put in place in response to the COVID-19 pandemic. The definitions for independent practice and prescriptive authority we use to evaluate each state reflect those of the National Council of State Boards of Nursing:
- Independent practice – Nurse practitioners are not required to have a written collaborative agreement, active supervision, or conditions for practice
- Prescriptive authority – APRNs are authorized to independently prescribe pharmacologic and non-pharmacologic therapies beyond perioperative and periprocedural periods of treatment.
Various levels of independent practice and prescriptive authority may be allowed in certain states. For example, state law may allow advanced practice nurses to prescribe only under a collaborative agreement with a physician, but grant independent practice for everything else. These variations are also noted here.
Alabama
- Independent Practice for CNS
- Licensing for CRNA and CNM/CRNP, but Not Independent Practice and Limited Prescriptive Authority
- Alabama APN Scope of Practice
Alaska
- Independent Practice and Prescriptive Authority for All APNs: CNP, CRNA, CNS, CNM
- Alaska APN Scope of Practice
- CNP: Article 4 Sections 430 and 440
- CRNA: Article 5
Arizona
Arizona State Board of Nursing
- Independent Practice and Prescriptive Authority for All APNs: CNP, CRNA, CNS, CNM
- Arizona APRN Scope of PracticeArticle 5 (page 36)
Arkansas
Arkansas State Board of Nursing
- Licenses CNP, CNS, CRNA, and CNM With Collaborative Agreement
- Independent Practice Authority Available After Initial Collaboration
- Collaborative Agreement Required With Limited Prescriptive Authority
- Arkansas APRN Scope of Practice
California
California Board of Registered Nursing
- Independent Practice, but No Independent Prescriptive Authority for CRNA
- Licensing for CNP, CNM, and CNS but No Independent Practice or Prescriptive Authority
- California APN Scope of Practice
Colorado
- Independent Practice and Prescriptive Authority for All APNs: CNP, CNRA, CNM, CNS
- Colorado APN Scope of Practice (Article 255, Page 620)
Connecticut
Connecticut Department of Public Health
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CNRA, CNM, and CNS
- Connecticut APRN Scope of Practice
Delaware
- Independent Practice and Prescriptive Authority for CNP, CNS, and CRNA
- Independent Practice, but No Prescriptive Authority for CNM
- Licensing for CNS, but No Independent Practice or Prescriptive Authority
- Delaware APRN Scope of PracticeSection 1935
District of Columbia
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CNRA, CNM, and CNS
- DC APRN Scope of PracticeSubchapter VI page 37
Florida
- Licensing for APRN roles CNP, CRNA, and CNM, but No Independent Practice or Prescriptive Authority
- Independent Practice for CNM, CNS, and CNP but No Prescriptive Authority
- Florida APRN Scope of Practice
Georgia
- Licensing for All APRNs: CNP, CRNA, CNM, and CNS, but No Independent Practice or Prescriptive Authority
- Georgia APRN Scope of Practice Decision Tree
Hawaii
- Independent Practice and Prescriptive Authority for All ARPNs: CNP, CNRA, CNM, and CNS
- Hawaii APRN Scope of Practicepage 89-42
Idaho
State of Idaho Board of Nursing
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CNRA, CNM, and CNS
- Idaho Advanced Practice Registered Nurse Compact
Illinois
Illinois Department of Financial & Professional Regulation – Nursing
- Licensing for APN roles CNP, CNS, CRNA, and CNM, but No Independent Practice or Prescriptive Authority
- Illinois APN Collaborative Agreement
Indiana
Indiana State Board of Nursing
- Licensing and Limited Prescriptive Authority for APN roles CNP, CNS, CRNA, and CNM, but No Independent Practice
- Indiana APN Collaborative Agreement Example
Iowa
- Independent Practice and Prescriptive Authority for All ARNPs: CNP, CNRA, CNM, and CNS
- Iowa ARNP Scope of Practice
Kansas
- Independent Practice for CRNA, but No Prescriptive Authority
- Licensing for CNP, CNM, and CNS, but No Independent Practice or Prescriptive Authority
- Kansas APRN Scope of Practice
Kentucky
- Independent Practice for All APRNs: CNP, CRNA, CNM, and CNS, but No Prescriptive Authority
- Kentucky APRN Scope of Practice
Louisiana
Louisiana State Board of Nursing
- Licensing and Limited Prescriptive Authority for APRN roles CNP, CNS, CRNA, and CNM, but No Independent Practice
- Louisiana APRN Scope of Practice
- Louisiana APRN Collaborative Practice Agreement
Maine
- Independent Practice and Prescriptive Authority for CNP and CNM
- Independent Practice for CNS, but No Prescriptive Authority
- Licensing for CNRA, but No Independent Practice or Prescriptive Authority
- Maine APRN Scope of Practice
Maryland
- Independent Practice for CNP and CNS, but No Prescriptive Authority
- Independent Practice and Prescriptive Authority for CNM
- Licensing for CRNA, but No Independent Practice or Prescriptive Authority
- Maryland APRN Scope of Practice: CNP, CNM, CNS, CRNA
- Maryland CRNA Collaborative Agreement
Massachusetts
Massachusetts Board of Registration in Nursing
- Independent Practice and Prescriptive Authority for CNM, CNP, and CRNA
- Licensing for CNS in Psych/Mental Health Only, with No Prescriptive Authority
- Massachusetts APRN Scope of Practice
Michigan
- Licensing for APRN Roles CNP, CNM, CNS with Independent Practice
- CRNA Licensing But No Independent Practice or Prescriptive Authority
- Other APRNs Have Prescriptive Authority for Nonscheduled Drugs
- Michigan APRN Scope of Practice
Minnesota
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CRNA, CNM, CNS
- Minnesota APRN Scope of Practice
Mississippi
- Licensing, but No Independent Practice or Prescriptive Authority for APRN roles: CNP, CRNA CNM
- Mississippi APRN Scope of PracticeTitle 30, Part 2840
Missouri
- Licensing for APRN roles CNP, CRNA, CNM, and CNS but No Independent Practice or Prescriptive Authority
- Missouri APRN Prescriptive Authority Form
Montana
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CRNA, CNM, and CNS
- Montana APRN Scope of Practice
Nebraska
Nebraska Department of Health & Human Services – Nursing
- Independent Practice and Prescriptive Authority for CNP, CNM and CRNA
- Independent Practice for CNS, but No Ability to Prescribe
- Nebraska APRN Scope of Practice
Nevada
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CRNA, CNM, and CNS
- Nevada APRN Scope of Practice
New Hampshire
New Hampshire Board of Nursing
- Independent Practice and Prescriptive Authority for CNP, CRNA, and CNM
- New Hampshire APRN Scope of Practice
New Jersey
- Licensing for CNP, CNM, and CNS, but No Independent Practice
- Licensing for CRNA, but No Independent Practice or Ability to Prescribe
- New Jersey APN Scope of Practice Page 52
New Mexico
New Mexico Department of Health (For CNM Licensing)
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CRNA, CNM, and CNS
- New Mexico APRN Scope of Practice
New York
New York State Office of the Professions – Nursing
New York State Office of the Professions – Midwifery
- Licensing for CNP and CNS, but No Independent Practice or Prescription Authority
- Licensing for CNM Under Board of Midwifery but No Independent Practice or Prescriptive Authority
- Scope of Practice and Sample Collaborative Agreement for CNP
North Carolina
North Carolina Board of Nursing
- Independent Practice for APRN roles CRNA and CNS, but No Ability to Prescribe
- Licensing for APRN roles CNP and CNM, but No Independent Practice or Prescriptive Authority
- North Carolina APRN Scope of Practice
North Dakota
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CRNA, CN, and CNS
- North Dakota APRN Scope of Practice
Ohio
State of Ohio Board of Nursing
- Licensing for All APRNs: CNP, CRNA, CNP, and CNS, but No Independent Practice or Prescriptive Authority
- Ohio APRN Scope of Practice Decision Making Model
Oklahoma
- Independent Practice for APRN roles CRNA, CNP, CNM, and CNS, but No Prescriptive Authority
- Oklahoma Decision Making Model for Scope of Nursing Practice Decisions
Oregon
- Independent Practice and Prescriptive Authority for APRN roles CNP, CNM, CRNA, and CNS
- Oregon CNP Scope of Practice Decision Algorithm
Pennsylvania
Board of Medicine (CNM Licensing)
- Licensing for CNP and CNM but No Independent Practice or Prescriptive Authority
- Pennsylvania CNP Scope of Practice
Rhode Island
State of Rhode Island Department of Health – Nursing
- Independent Practice and Prescriptive Authority for APRN roles CNP, CNS, and CRNA
- Rhode Island Scope of Practice Decision Tree
South Carolina
South Carolina Board of Nursing
- Licensing for All APRNs: CNP, CRNA, CNM, and CNS, but No Independent Practice or Prescriptive Authority
- South Carolina Scope of Practice Decision Tree
South Dakota
- Independent Practice and Prescriptive Authority for APRN roles CNP and CNM
- Licensing for APRN roles CRNA and CNS, but No Independent Practice or Prescriptive Authority
- South Dakota CNP Collaborative Agreement
Tennessee
- Licensing for All APRNs: CNP, CRNA, CN, and CNS, but No Independent Practice
- APNs Can Apply for Prescriptive Authority if They Have Taken the Required Pharmacology Classes, but Limited Independence
Texas
- Licensing for All APRNs: CNP, CRNA, CN, and CNS, but No Independent Practice
- Texas APRNs Can Apply for Prescriptive Authority
- Texas APRN Scope of Practice
Utah
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CRNA, CNM, and CNS
- Utah APRN Nurse Compact
Vermont
- Independent Practice and Prescriptive Authority for All APRNs: CNP, CRNA, CNM, and CNS
- Vermont APRN Scope of Practice
Virginia
- Independent Practice and Prescriptive Authority for CRNA
- Licensing for APRN Roles CNP, CNS and CNM, but No Independent Practice or Automatic Prescriptive Authority
- CNP Can Apply for Prescriptive Authority
- Virginia APRN Scope of Practice
Washington
Washington State Department of Health Nursing Commission
- Independent Practice and Prescriptive Authority for All ARNPs: CNP, CRNA, CNM, and CNS
- Washington State ARNP Scope of Practice
West Virginia
- Independent Practice and Prescriptive Authority for APRN roles CRNA, CNP, CNM and CNS
- West Virginia APRN Scope of Practice
Wisconsin
- Independent Practice for APNP Roles CNP, CRNA, and CNS, but No Prescriptive Authority
- Licensing for CNM, but No Independent Practice or Prescriptive Authority
- Wisconsin APNP Scope of Practice
Wyoming
Wyoming State Board of Nursing
- Independent Practice and Prescriptive Authority for APRN Roles CRNA, CNM, CNP and CNS
- Wyoming APRN Scope of Practice
