Background

In the United States, patients, particularly low-income individuals and those without health insurance, face limitations in accessing physician-based medical care. At the same time, primary care, including family planning and sexual health services, has never been more important. Increasing nurses’ scope of practice can help provide access to these critical services.

Over the past several decades, advanced practice registered nurses (APRNs) have become an integral part of the health care system. APRNs, including nurse practitioners (NP), certified nurse midwives (CNM), clinical nurse specialists (CNS) and certified registered nurse anesthetists (CRNA), must have at least a Masters degree and are trained to treat a specific patient population. (CRNAs are not analyzed in this brief since they do not regularly provide sexual and reproductive health care.) APRNs provide patient assessments, diagnose diseases and conditions, order tests, prescribe medications and direct patient care. Some states allow APRNs to dispense medications under certain conditions and others permit APRNs to provide drug samples to patients. States vary in how APRNs are licensed: some states allow APRNs to practice independently, others require APRNs to work within a collaborative practice agreement with a physician and other states generally allow APRNs to work independently, but require a collaborative practice agreement with a physician in order to prescribe medications.

In fact, many states have adopted the "consensus model" which provides uniform requirements for APRNs across Some states have also expanded the types of services registered nurses (RN) can provide. Starting in the 1980s, some states authorized RNs to dispense medications, including contraceptives and STI medications, as a way to increase access to medical care for individuals obtaining services at outpatient health clinics, such as health departments or family planning clinics. These laws are in addition to physician orders that delegate duties to RNs.

Highlights

 

Nurses' Authority to Prescribe or Dispense

STATE

AUTHORITY TO PRESCRIBE

AUTHORITY TO DISPENSE

 

Clinical Nurse Specialist

Nurse Practitioner

Nurse Midwife

Registered Nurse*

Clinical Nurse Specialist

Nurse Practitioner

Nurse Midwife

Alabama

 

X

X

Contraception/STI

 

 

Alaska

X

X

X

 

X

X

X

Arizona

 

X

X

 

X

X

X

Arkansas

X

X‡​

X‡​

 

X

X

X

California

X

X‡​

X‡​

Drugsξ​

X

X

X

Colorado

X

X

X

 

Connecticut

X

X

X

 

Delaware

X

X

X

Drugs

X

X

X

Florida

 

X

X

 

 

X

X

Georgia

X

X

X

Drugs

X

X

X

Hawaii

X

X

X

 

X

X

X

Idaho

X

X

X

 

X

X

X

Illinois

X

X

X

 

X

X

X

Indiana

X‡​

X‡​

X‡​

       

Iowa

X

X

X

Contraception

X

X

X

Kansas

X

X

X

 

 

Kentucky

X‡​

X‡​

X‡​

Drugs

X

X

X

Louisiana

X

X

X

 

X

X

X

Maine

 

X

X

 

X

X

X

Maryland

 

X‡​

X‡​

Drugs

X

X

X

Massachusetts

X

X‡​

X

       

Michigan

X‡​

X‡​

X‡​

Contraception

Minnesota

X

X

X

Contraception

X

X

X

Mississippi

 

X

X

 

X

Missouri

X

X

X

 

†Ω

†Ω

†Ω

Montana

X

X

X

Contraception/STI

X

X

X

Nebraska

 

X

X

Contraception/STI

 

 

Nevada

X

X

X

 

X

X

X

New Hampshire

X

X

X

Drugs

X

X

X

New Jersey

X‡​

X‡​

X‡​

 

X

X

X

New Mexico

X

X

X

 

X

X

X

New York

 

X

X

     

X

North Carolina

 

X

X

Contraception

 

X

X

North Dakota

X

X

X

 

X

X

X

Ohio

X

X

X

 

Oklahoma

X‡​

X‡​

X‡​

 

Oregon

X

X

X

Contraception/STI

X

X

X

Pennsylvania

 

X

X

   

X

X

Rhode Island

X

X

X

Contraception

X

X

 

South Carolina

X

X

X

 

South Dakota

 

X

X

   

X

X

Tennessee

X

X

X

 

X

X

X

Texas

X‡​

X‡​

X‡​

 

Utah

X

X

X

       

Vermont

X

X

X

       

Virginia

 

X

X‡​

   

Washington

 

X

X

Contraception

     

West Virginia

X‡​

X‡​

X‡​

       

Wisconsin

X

X

X

 

 

Wyoming

X

X

X

 

X

X

X

TOTAL

37

50

50

16

26- Dispense

11- Samples

29- Dispense

13- Samples

29- Dispense

12- Samples

Contraception: contraceptive methods, some states specify drugs and devices
Drugs: a range of prescription drugs, sometimes limited by a formulary established by the state
STI: drugs to treat sexually transmitted infections, in Montana limited to Chlamydia

*  Generally applies to registered nurse at an outpatient clinic (such as a state health department clinic or a family planning clinic). In Iowa and Washington, the policy applies to a family planning clinic. In Minnesota, for patients who are at least 12 years of age.
  State permits dispensing of samples. Michigan and Missouri allow dispensing of starter doses; Wisconsin allows dispensing of samples if provider is at least 30 miles away from a pharmacy.
  State requires APRN to have a collaborative practice agreement with a physician explicitly for prescriptive authority.
ξ  California has two policies: one allows registered nurses at public clinics to dispense drugs and devices; the other allows registered nurses to dispense contraceptives and administer injections for contraceptives.
 Allows advanced practice registered nurses at Title X clinics to dispense drugs