State Licensure and Certification: Myths and Realities

Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC, FNAP

You are completing your nurse practitioner education, likely one of the most challenging tasks you have ever undertaken. Now, NP certification and licensure loom in your future. You probably have spoken to a number of certified and practicing NPs about these issues. Much of the information they share is helpful. However, there is also a good deal of inaccurate information circulating. Here are some common myths and realities about these important subjects.

Myth: Once I am nationally certified, I am also licensed to practice as an NP.

Reality: In nearly all states, achievement of national certification is one of a number of requirements to obtain a license as an NP. NP licensure is handled at the state level through the board of nursing. Information about the NP practice act in your state can be obtained by contacting your state board of nursing. Links to all of these state agencies can be found at Practice Information by State on the American Association of Nurse Practitioners (AANP) website.

Myth: Once I am a certified NP and licensed to practice in one state, I will be able to practice in every state.

Reality: NP licensure is handled at the state level, and regulations vary from state to state. As a result, you must meet the requirements for, and obtain a license in, every state in which you practice.

Myth: From state to state, NP practice acts are quite similar.

Reality: State NP practice acts differ significantly in a number of ways. For example, in some states, an NP must have a physician collaborator to practice. In an increasing number of states, NPs have full practice authority, without a requirement for physician collaboration. In certain states, state law mandates third-party reimbursement to NPs (the rate of reimbursement can vary significantly). While NPs have the authority to prescribe controlled substances in all states, the prescriptions permitted range from schedules II through V in some states to schedules III through V only in others. Keep in mind that in order to prescribe controlled substances, NPs must obtain a federal Drug Enforcement Agency (DEA) registration number. However, the requirements NPs must meet to obtain a DEA number also vary from state to state. Make sure you are aware of the scope of NP practice and particulars of the NP practice act in each state in which you are licensed.

Myth: My state doesn’t require national certification to get an NP license, so I don’t need to take the NP boards.

Reality: Only California and New York allow NPs to practice without certification. Interestingly, these states are among the top in the nation for number of NPs. Even in California and New York, the days of practicing without certification are past because virtually all third-party insurers and NP employers require certification. The result is that many non-certified NPs are now seeking the same documentation of professional achievement as the nation’s certified NPs.

Not having NP certification is quite professionally limiting. Without certification, moving from state to state and continuing to practice can be difficult or impossible. In addition, since most employers require certification, changing jobs can be challenging. As additional specialty certifications become available, likely employers will require this further documentation of clinical expertise. For example, an increasing number of employers require FNPs who practice in emergency care to acquire and maintain emergency NP (ENP) certification. Fitzgerald offers certification exam prep courses and resources for the following NP specialties:

Myth: Once I am licensed, I can practice as an NP.

Reality: You must first be credentialed with your employer organization before you can begin working for your employer as an NP. Credentialing is a process that involves the verification of education, licensure, certification, and reference checks. It is used by organizations and agencies to ensure that their healthcare providers meet all necessary requirements and are appropriately qualified. Credentialing can take up to three months to complete because of the amount of paperwork involved. Typically, however, credentialing paperwork can be started 30 days before you begin work, and often a practice manager will guide you through the process. Fitzgerald’s comprehensive, current, and convenient courses and resources will help you successfully prepare for certification in your specialty, an essential step in becoming a licensed, practicing NP.