Scope-of-Practice Rules for Nurse Practitioners in Pennsylvania: What's Allowed

Pennsylvania still requires nurse practitioners to operate under a physician's supervision — but pressure to change that is growing.

The Collaborative Agreement: What the Law Requires

Pennsylvania is one of a shrinking number of states that require nurse practitioners (NPs) to practice under a formal collaborative agreement¹ with a licensed physician. Under current state law, an NP cannot independently diagnose, prescribe, or manage patient care without that arrangement in place — a requirement that sets Pennsylvania apart from more than two dozen states, including neighboring Connecticut and Massachusetts, that have moved to full practice authority².

A collaborative agreement is a written document outlining the terms under which an NP and a supervising physician work together. It typically specifies the scope of services the NP may provide, the mechanism for physician consultation, and how prescribing authority is handled. In practice, the physician does not need to be physically present — but the agreement must exist and be maintained, and the physician must be available for consultation. For nurse practitioners in rural or underserved areas⁵ of the Commonwealth, finding a willing physician partner is not always straightforward, and the administrative overhead of maintaining these agreements adds cost and friction to practices that can least afford it.

The Pennsylvania State Board of Nursing and the State Board of Medicine jointly regulate NP practice. Prescriptive authority³ — including the ability to prescribe controlled substances — is subject to additional requirements, and NPs must hold a separate certificate to do so under their collaborative framework.

The Legislative Debate

Efforts to move Pennsylvania toward full practice authority have circulated in the General Assembly for years without reaching the governor's desk. Proponents argue the current model creates artificial bottlenecks in care delivery, particularly in rural counties like Centre County where primary-care shortages are acute. Nationally, organizations including the American Association of Nurse Practitioners contend there is a substantial body of evidence showing NP-delivered care is safe and effective across a wide range of primary-care settings.

Efforts to move Pennsylvania toward full practice authority have circulated in the General Assembly for years without reaching the governor's desk.

The opposition has come primarily from physician groups, which argue that collaborative requirements exist to protect patients and ensure appropriate clinical oversight. The Pennsylvania Medical Society has consistently maintained that physician-led team care offers an additional safety layer — especially for complex cases — that full independence would remove.

The debate in Harrisburg has not been purely clinical. Workforce economics are embedded in it. Physician groups have a direct financial stake in how NP practice is structured; collaborative agreements sometimes involve compensation from the NP or the NP's employing practice to the supervising physician. Critics of the current system describe this as a structural barrier that functions more like a market-access fee than a genuine quality mechanism.

The House Professional Licensure Committee has been one of the bodies through which NP scope-of-practice legislation has moved — or stalled. Competing bills have proposed everything from modest modifications to the collaborative requirement to full independent practice authority. None has cleared both chambers.

Where Pennsylvania Stands — and What Could Change

As of 2024, states including Washington State and Colorado have granted NPs full practice authority, joining a growing national consensus reflected in guidance from the Federal Trade Commission, which has characterized restrictive scope-of-practice laws as potentially anticompetitive. West Virginia and Kentucky — states with rural healthcare challenges comparable in some respects to Pennsylvania's — have also made the transition.

For Pennsylvania residents, the practical stakes are real. In communities across rural Pennsylvania and in underserved urban neighborhoods — parts of North and West Philadelphia, pockets of Allentown, Darby in Delaware County — access to primary care is already constrained. Nurse practitioners represent a trained, licensed workforce capable of filling gaps; the question the legislature has not yet resolved is under what terms.

AARP Pennsylvania ↗ has been among the advocacy voices supporting expanded NP authority, framing it as a health-access issue for older Pennsylvanians who rely heavily on primary care. The Pennsylvania State Grange, representing rural communities, has also expressed interest in policies that would bring more providers to agricultural and small-town areas.

The collaborative-agreement requirement will remain in place until the legislature acts. Whether the current session produces movement depends on whether workforce and access pressures finally outweigh the resistance that has shelved similar bills before.