Three states delivered three different versions of the same policy fight this year, over whether nurse practitioners can practice without a supervising physician, highlighting unstable ground even as the overall trend keeps moving toward independence.
A pandemic-era waiver in New Jersey had let NPs practice without joint protocol agreements, and on March 30, Gov. Mikie Sherrill signed Senate Bill 2996, permanently eliminating the joint protocol requirement for NPs with more than 5,000 hours of licensed clinical experience — with hours worked under the lapsed waiver counting toward that threshold. The law applies specifically to primary care and behavioral health settings; NPs in other specialties remain under existing collaborative requirements.
In New York, the state’s Nurse Practice Modernization Act, which allows NPs with more than 3,600 hours of practice experience to work independently of a supervising physician, was set to sunset July 1. The FY2027 state budget extended it another four years, to July 1, 2030, which averts a mandatory return to collaborative agreements for thousands of NPs, though the law remains temporary rather than permanent.
Oklahoma’s version of the fight played out as an open veto battle. Gov. Kevin Stitt vetoed a bill expanding NP independent prescriptive authority, citing patient-safety concerns about NP training relative to physicians. The legislature overrode the veto in June 2025. Under the resulting law, effective November 2025, NPs with 6,240 hours of supervised prescriptive experience can prescribe medications, including Schedules III through V controlled substances, without a physician’s co-signature.
The three states show independent practice authority advancing nationally, but not smoothly. For multistate practice groups and health systems operating across state lines, the practical result is the same regardless of the mechanism. Physician-supervision requirements for NPs are shifting on a state-by-state timeline that can change with a single legislative session, veto override or budget bill.
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