BOX 3-1*

Variation in State Licensure Regulations

Several states permit APRNs to provide a broad list of services, such as independently examining patients, ordering and interpreting laboratory and other tests, diagnosing and treating illness and injury, prescribing indicated drugs, ordering or referring for additional services, admitting and attending patients in a hospital or other facility, and directly receiving payment for services. In other states, however, those same APRNs would be prohibited from providing many of these services. The following list provides examples of restrictions that APRNs face in states that have adopted more restrictive scope-of-practice regulations. These restrictions could greatly limit the ability of APRNs to fully utilize their education and training.

Examination and Certification

A nurse may not examine and certify for:

  • worker’s compensation;

  • department of motor vehicles (DMV) disability placards and license plates and other DMV testing;

  • excusal from jury service;

  • mass transit accommodation (reduced fares, access to special features);

  • sports physicals (she may perform them, but cannot sign the forms);

  • declaration of death;

  • school physicals and forms, including the need for home-bound schooling;

  • clinician order for life-sustaining treatment (COLST), cardiopulmonary resuscitation (CPR), or do not resuscitate (DNR) directives;

  • disability benefits;

  • birth certificates;

  • marriage health rules;

  • treatment in long-term-care facilities;

  • involuntary commitment for alcohol and drug treatment;

  • psychiatric emergency commitment;

  • hospice care; or

  • home-bound care (including signing the plan of care).

Referrals and Orders

A nurse may not refer for and order:

  • diagnostic and laboratory tests (unless the task has been specifically delegated by protocol with a supervising physician),

  • occupational therapy,

  • physical therapy,

  • respiratory therapy, or

  • durable medical equipment or devices.


*This box draws on Safriet (2010).

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