There are advantages for NPs who work in states with the largest scope of practice. These states allow NPs to work at the highest level of care without the supervision of a collaborating physician.

NPs should consider independent practice authority and prescriptive privileges because it allows for professional autonomy and improves access to care, especially in marginalized communities and rural areas.

In these states, nurse practitioners can practice at the top of their licenses:

• Alaska
• Arizona
• Washington D.C.
• Idaho
• Iowa
• Minnesota
• Montana
• New Hampshire
• New Mexico
• North Dakota
• Oregon
• Rhode Island
• Washington
• Wyoming

According to the American Association of Nurse Practitioners, states that offer full practice authority allow NPs to "evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing."

For example, NPs in Alaska have prescriptive, controlled substance, and dispensing authority. NPs practicing in states with reduced or restricted authority can only prescribe medications with permission and sign-off from a doctor.

But even full-practice authority states have additional laws and requirements.

What full-authority NPs are allowed to do under their license varies by state. For example, NPs in New York must have written practice agreements with collaborating physicians unless they have met 3,600 clinical experiences. Other states allow NPs to practice without a collaborating physician and prior clinical experience outside the required amount in their NP programs.

Full-practice authority states recognize that NPs are providing high-quality care to patients. They know the need to improve access to care for the most vulnerable communities. For reduced and restricted states to become full-practice authorities, legislation must be passed. 

The states with the most job opportunities can attract NPs starting their careers or looking for a change. These states can offer job security, professional retention and development, higher pay, and improved health care outcomes. However, NPs should be aware that states with the highest projected job growth may not be the states with the highest number of openings for NPs.

It's important to explore job opportunities and demand for NPs before making a decision. For example, states with the highest demand for NPs, according to Clarke, may signify job dissatisfaction.

"High turnover typically means low job satisfaction. The less turnover or fewer openings means higher job satisfaction," Clarke says. 

According to the BLS, NPs earned a mean annual salary of $124,680 in 2022 or an average hourly wage of $59.94. However, NPs can make up to $2-$16 more if they work in the top 10 states with the best salaries for NPs.

When deciding to work in a certain state, it's important to consider the cost of living and salary potential. NPs should feel comfortable negotiating their salaries and incorporating the cost of living expenses, which include housing, food, and transportation, into their contracts.

If an NP has difficulty finding a salary that fits their needs, choosing between working in a hospital versus an outpatient center may be the deciding factor. NPs who work for a hospital make significantly more than those in outpatient centers.

For example, New Mexico NPs who work in the hospital make an annual average salary of $151,313. In contrast, outpatient NPs make $144,104 annually when their salaries are adjusted for New Mexico's cost of living.

Another factor that we examined is purchasing power. For example, NP salaries in Iowa and New Mexico can purchase 10% more goods than the national average. 

Our list of the best states to work as an NP was determined using a weighted average ranking comprised of nine different metrics, including the scope of practice, NP average hourly salary, state purchasing power, outpatient NP average annual salary adjusted for cost of living, hospital NP annual average salary adjusted for cost of living, projected job growth, projected NP job openings per year, NPs currently employed, and pre-pandemic job satisfaction.

The salary index score is a simple average of the average hourly salary index, the average annual salary for outpatient NPs adjusted for the cost of living index, and the average annual salary for hospital NPs adjusted for the cost of living index. The opportunity index is an average of each state's projected NP annual openings index and current NP employment index.

Sources include Projections Central, the Bureau of Labor Statistics, American Association of Nurse Practitioners, BEA Regional Price Parity, Health Resources and Services Administration (HRSA) Nursing Workforce Dashboard, American Medical Association's State law chart: Nurse Practitioner Prescriptive Authority from 2017, and The U.S. Department of Justice's Mid-Level Practitioner Controlled Substance Authorization by State Guide, which was last updated in 2022

Nurse practitioner practice authority was taken from the American Association of Nurse Practitioners. Prescriptive authority was taken from the American Medical Association's State law chart: Nurse Practitioner Prescriptive Authority from 2017 and The U.S. Department of Justice's Mid-Level Practitioner Controlled Substance Authorization by State Guide, which was last updated in 2022.

Projected NP job openings per year and projected job growth were taken from Projections Central's data for 2020-2030. Purchasing power was the 2021 regional price parity from the BEA Regional Price Parity in each state. NPs currently employed and average hourly salary were collected from Bureau of Labor Statistics data from 2022. NP salary data for New York is from 2021 because 2022 data was unavailable.

The purchasing power tells NPs how much more or fewer goods and services they can buy with their paycheck in their state compared to the national purchasing power. Each state's average outpatient NP salary and average NP salary were multiplied by the purchasing power to get the outpatient NP salary and hospital NP salary in each state adjusted for cost of living.

Job satisfaction was measured by what percentage of NPs in each state reported being "extremely satisfied" with their role, according to the Health Resources and Services Administration (HRSA) Nursing Workforce Dashboard, which, at the time of publication, uses 2018 data. Since this data was collected, NP job satisfaction has been affected by the COVID-19 pandemic, and the HRSA has not released more recent data on how the pandemic affected job satisfaction among NPs.

In several states, as much as 24% of NPs did not report their job satisfaction to the HRSA. The sample size in some states, like Wyoming and Montana or North and South Dakota, was so small that the data from two states were reported together. When that occurred, the same percentage was used for both states.

This story was produced by NurseJournal and reviewed and distributed by Stacker Media.