What it’s like to work as an RN, NP, or physician assistant can change drastically from state to state. (Ask a travel nurse!)

Why is this the case? Local laws dictate whether advanced practitioners, such as NPs and PAs, can practice independently of physicians, if and what they can prescribe, and other limitations. Moreover, some states offer staffing requirements and other protections for healthcare workers, but others don’t.

The following list breaks down the states with the most accommodating laws for nurses and PAs, according to Barton Associates.

Nurses

States With the Best Laws for NPs

The Northwest

Washington: Known as one of the best states for NPs to open their own practice, Washington allows full autonomy and the ability for NPs to prescribe medical marijuana to patients.

Oregon: Oregon grants NPs many of the same freedoms as Washington. One restriction: NPs must complete a minimum of 384 hours of practice as an RN before being issued an NP license.

Alaska: NPs in Alaska may begin practicing immediately following graduation from their program.

Idaho: Although Idaho allows autonomous practice and has traditionally been a lenient state for NPs, legislative changes require prospective NPs to complete more schooling before receiving certification. The hope is that increasing required education will help rural areas suffering from physician shortages.

The Northeast

Rhode Island: Since 2008, NPs in Rhode Island have had some prescriptive authority and full autonomy.

New Hampshire: In addition to granting full autonomy, New Hampshire provides temporary licenses to recently-graduated NPs who have yet to complete the national certification exam.

Washington, D.C. Prospective NPs in the District of Columbia can apply for both their RN and NP licenses at the same time.

The Southwest

Arizona: A beaming state for NPs to start their own practice, Arizona’s only restriction is that NPs must practice within their specialty and certification.

New Mexico: Considered one of the best states for NPs to practice in, New Mexico offers a $3,000 tax credit to eligible NPs and other healthcare providers who choose to work in rural areas. For students, some stipend programs in New Mexico will financially support two years of education in exchange for working in underserved areas.

States Where NPs Are Fully Authorized by State Law To See Patients, Provide Diagnoses, and Prescribe

• Alaska
• Arizona
• Colorado
• Connecticut
• Hawaii
• Iowa
• Idaho
• Maryland
• Maine
• Minnesota
• Montana
• North Dakota
• Nebraska
• New Hampshire
• New Mexico
• Nevada
• Oregon
• South Dakota
• Vermont
• Washington
• Wyoming

States Where NPs Have Full Medical Staff Membership

• Kansas
• Massachusetts
• Montana
• North Carolina
• North Dakota
• New Mexico
• Nevada
• New York
• Oregon
• Utah
• Vermont
• Washington
• West Virginia

States Where NPs Have Full, Autonomous Practice (No Physician Involvement Necessary)

• Alaska
• Arizona
• Colorado
• Connecticut
• Hawaii
• Iowa
• Idaho
• Maryland
• Maine
• Minnesota
• Montana
• North Dakota
• Nebraska
• New Hampshire
• New Mexico
• Nevada
• Oregon
• Rhode Island
• South Dakota
• Vermont
• Washington
• Wyoming

States That Recognize NPs As Primary Care Providers

• Alaska
• Arizona
• California
• Colorado
• Connecticut
• Delaware
• Hawaii
• Iowa
• Kentucky
• Massachusetts
• Maryland
• Maine
• Minnesota
• Montana
• North Dakota
• New Hampshire
• New Jersey
• New Mexico
• New York
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• Tennessee
• Texas
• Washington
• West Virginia

States With Laws That Address Nurse Staffing

• California
• Connecticut
• Illinois
• Massachusetts
• Minnesota
• Nevada
• New Jersey
• New York
• Ohio
• Oregon
• Rhode Island
• Texas
• Vermont
• Washington

Physician Assistants

States With the Best Laws for PAs

East Coast

Massachusetts: Massachusetts’s capital city, Boston, offers some of the nation’s most competitive salaries and employment rates for PAs.

North Carolina: Lacking many restrictions that its neighboring states place on PAs, North Carolina is considered a great place to start a modern PA practice. Its capital, Raleigh, offers a high average salary.

Rhode Island: Rhode Island is welcoming to NPs and PAs alike. Although salaries aren’t as competitive as in other states, its laws are highly accommodating of healthcare professionals in general.

Vermont: Practicing in Vermont means full autonomy, scope of practice determined at the practice level, competitive annual mean salaries, and an exciting job market.

Midwest

Michigan: PAs in Michigan are considered full prescribers and aren’t supervised by physicians. Instead, physicians need only “participate.”

Minnesota: Legislation in 2016 removed administrative burdens for PAs and allowed practice in a favorable regulatory environment.

‍North Dakota: With the scope of practice determined on-site and no limit on the number of PAs who can work with a physician, North Dakota offers some of the most autonomy for PAs. It is also a top-paying state.

Far West

Alaska: With more PAs per population than any other state, Alaska has improved its practice laws to create a friendly, regulatory environment that allows PAs to play a significant role in healthcare.

Arizona: Arizona employs an autonomous PA regulatory board, which oversees its PAs’ licensure, investigation, and discipline. It is known for its progressive practice environment.

Wyoming: With the scope of practice determined on-site and prescriber authority, PAs in Wyoming can also complete medical certification of death and prescribe opiate antagonists to patients at risk of overdose.

PAs Have Full Prescriptive Authority Without State-Level Restrictions in All States, Except:

• Arkansas
• Georgia
• Iowa
• Kentucky
• Missouri
• Oklahoma
• West Virginia

A PA’s Scope of Practice Is Determined at the Practice Site in All States, Except:

• Alabama
• Georgia
• Iowa
• Kentucky
• Maryland
• Mississippi
• Oklahoma
• Pennsylvania
• South Carolina
• Virginia
• Washington
• West Virginia
• Wisconsin

All States Have Adaptable Supervision/Collaboration Requirements for PAs, Except:

• Alabama
• Alaska
• Colorado
• Florida
• Idaho
• Iowa
• Kansas
• Kentucky
• Maine
• Mississippi
• Missouri
• Montana
• Nebraska
• Nevada
• Oregon
• Pennsylvania
• South Carolina
• Tennessee
• Virginia
• West Virginia

States Where Physicians Can Practice With an Unlimited Number of PAs

• Alaska
• Arkansas
• Connecticut
• Maine
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Montana
• North Carolina
• North Dakota
• Rhode Island
• Tennessee
• Vermont

Required Break Laws

Federal law does not require employers to allow breaks from work, but many states do, especially to eat a meal. Visit your state’s labor or wage and hour website for more information.

States With Required Break Laws

• California
• Colorado
• Delaware
• Illinois
• Kentucky
• Maine
• Massachusetts
• Minnesota
• New Hampshire
• Nevada
• New York
• North Dakota
• Oregon
• Rhode Island
• Tennessee
• Washington
• West Virginia
• Wisconsin