The scope of practice for advanced practice nurses (APNs) continues to vary widely across the United States, directly influencing nurse practitioner (NP) autonomy, prescriptive authority, and the delivery of care. Not only are there differences between states, new legislation means that the scope of practice is ever-changing. Differences in state regulation play a critical role in determining how effectively NPs can address provider shortages and improve access to care, particularly in rural and underserved communities. A comparison of Georgia and Floridaboth classified as reduced-practice stateshighlights how regulatory frameworks shape NP practice authority and patient access outcomes (American Association of Nurse Practitioners, 2025).
Georgia remains among the most restrictive states for NP practice. Nurse practitioners in Georgia are required to maintain a formal delegation agreement with a supervising physician that explicitly outlines permitted clinical activities. Prescriptive authority is not inherent to NP licensure and must be individually delegated by the physician, including authority to prescribe controlled substances. Importantly, Georgia does not provide any pathway to independent or autonomous NP practice, regardless of clinical experience, specialty certification, or years in practice (National Conference of State Legislatures, 2024).
These constraints significantly limit NP flexibility and may exacerbate healthcare access challenges, particularly in rural areas where physician shortages are a huge problem. The delegation-based model can delay care delivery and restrict the expansion of NP-led services in high-need communities.
Florida, while also categorized as a reduced-practice state, has taken measurable steps toward increasing NP autonomy. Legislative changes enacted through House Bill 607 established a pathway for certain nurse practitioners to practice independently after meeting defined requirements. Eligible NPs must complete at least 3,000 hours of supervised clinical practice and satisfy specified graduate-level educational criteria. Once qualified, they may practice without physician supervision; however, this authority is limited to primary care specialties, including family, adult-gerontology primary care, and pediatric nurse practitioners (AANP, 2025).
Psychiatric mental health nurse practitioners (PMHNPs), acute care NPs, and other specialty practitioners remain excluded from autonomous practice under Florida law. As a result, Floridas regulatory framework creates a tiered system of NP autonomy, granting independence to some specialties while maintaining physician oversight for others.
In contrast, Georgia mandates physician delegation for all nurse practitioners and does not recognize any form of independent practice. Although both states permit NPs to prescribe controlled substances, Georgias prescriptive authority is more restrictive because it is contingent upon explicit physician delegation. While neither state offers full practice authority, Floridas incremental movement toward autonomy suggests a greater potential for future expansion, particularly for specialties such as psychiatric mental health that are critical to addressing nationwide mental health workforce shortages (NCSL, 2024).
These differences reflect broader national debates regarding NP autonomy, healthcare access, and the balance between physician oversight and advanced nursing practice. Georgias model emphasizes structured physician control, whereas Florida has adopted a more selective approach to NP independence. Understanding these distinctions is essential for nurse practitioners planning career advancement, relocation, or specialization, as regulatory environments substantially influence professional scope, practice opportunities, and patient care delivery.
References:
American Association of Nurse Practitioners. (2025). State practice environment.
National Conference of State Legislatures. (2024). Scope of practice laws for nurse practitioners.
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