How Many Nurse Practitioners Can a Physician Supervise?

How many nurse practitioners can a physician supervise?

The number of nurse practitioners or NPs that need to be supervised by a physician depends on the state. The exact number and conditions are not uniform throughout.

Some states don’t even need the service of physicians in supervising nurse practitioners.

These kinds of states are 33 in number excluding Washington DC. They have no necessity of any collaboration or supervision by physicians.

While that is the case in those states, there are still 18 states that don’t allow the nurse practitioners to take care of patients independently.

This article will give you the straight answer on how many nurse practitioners can a physician supervise in each state.

Along with this requirement for the oversight, there are a handful of other conditions and variations that may arise in different states.

One example of these varied specifications is the number of practitioners that need supervision or that must be supervised by the physician.

The exact number of physicians is not specified by most of the states.

There are exactly 10 states that specify the required number of practitioners that are permitted for a single physician. The accurate ratio is not designated to many states.

However, the states which have been designated a ratio, have certain guidelines that go with their agreement.

For instance, the regulation put forth by Georgia is four, out of the 8 nurse practitioners are permitted for productive-supervision.

Some regulations depend on the full-time or part-time commitment to the nurse practitioner.

Trivial and insignificant as they may seem, they become an obstacle for nurse practitioners who are searching for jobs in states that adhere to certain regulations.

Hence, it becomes a task that needs lots of effort.

Apart from these strict regulations, there is another hassle.

Nurse practitioners that are on-hold for their employment are thrown-out if the one employing doesn’t find any physician to supervise them.

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Let’s dive in deeper to the subject about how many nurse practitioners can a physician supervise.

Does a nurse practitioner need a supervising physician?

A nurse practitioner or NP possesses a lot more administering authority and patient care, unlike a registered nurse.

See also: How to Become a Registered Nurse

However, to do NP practice, they have to collaborate with a delegated physician adhering to state rules.

States of the USA

A nurse practitioner’s need for a physician is totally dependent on state regulations.

Some states do offer autonomy for nurse practitioners, while some are under strict regulations and restrictions.

However, from a medical point of view, supervised nurse practitioners are much more preferable.

This is because they are much capable of handling medicines and providing medical assistance.

By being under the supervision of a physician, the chance of making a mistake is negligibly low.

Physician supervision may be trivial in practice but is significant when the NP has to prescribe medicines.

See also: Can a Nurse Practitioner Prescribe Medication?

They don’t have many requirements or official orders to have the supervision of an experienced physician.

They are frequently known to be in teams or organizations with physicians and are rarely seen independently.

Requirements and specifications that must be met by nurse practitioners

For the nurse practitioners to analyze and diagnose patients, they must be legally certified by the specifications given by the State licensure law’.

See also: Can Nurse Practitioners Diagnose?

If the NPs need to evaluate and communicate the lab tests or diagnostic tests, they must be licensed.

See also: Can Nurses Order Lab Tests?

To provide medical analysis and prescribe medicines to the patients, they must be certified and licensed legally by the Exclusive License Authority by the State Board of Nursing.

The arrangement is offered by the Institute of Medicine and the National Council of State Boards of Nursing.

There are some agreements that the collaboration or supervision team needs to agree upon.

This is called the Collaborative Practice Agreement.

As for nurse practitioners who are under strict regulation by the laws of the state, they must submit a written document.

This is a statement specifying the full-time or part-time practice guidelines and the team’s agreement.

See also: Can Nurses Work Part-Time?

What aspects can be handled by an NP independently under a physician’s supervision?

Until and unless there are any restrictions or regulatory instructions that are laid down by the laws of the state, nurse practitioners who are under a delegated physician’s supervision have the freedom to do the following:

  • Prescribing patients on medications that are accessible to them. (These medications need medical knowledge. NPs are not allowed to handle those medications that are out of their jurisdiction of knowledge.)
  • Conduct and prepare a specific diagnosis on a patient
  • Discharging and admission of hospital patients
  • Arrange the fractured bone or a joint-dislocation
  • Discard or destroy some complex medicines
  • Look into the records and evaluate
  • Patient-care and well-being of the patients
  • Analysis, evaluation and organizing certain lab-examinations and tests
  • Arrangement of tests regarding diagnosis
  • Enquiry and consultation to other specialists
  • Assist and help patients in case of emergency

Now you know the basic fundamentals about how many nurse practitioners can a physician supervise so it’s time to move on to the specific states of the USA.

How many nurse practitioners can a physician supervise in …

Down below you can find the situation that is currently in different states in the USA.

In Georgia?

In Georgia, an agreement with a supervising physician can be made with 8 NPs.

However, only 4 NPs can be actively supervised by the physician. A delegating physician and NP have to operate under a protocol.

See also: 5 Rights of Delegation in Nursing

The physician gives the authority to the nurse to carry some medical works with the availability of consultation upon request.

The agreement is between one NP on one physician.


  • The patient’s medical records of the NP must be reviewed by the delegated physician. On-site and quarterly observations are done by the physician.
  • An agreement outline on prescribing specified medicines only.

In Florida?

How many nurse practitioners can a physician supervise in Florida?

Florida needs a written arrangement outlined between physician and NP.

A physician is not permitted to supervise NPs in over 4 offices. This includes the physician’s practice office.


  • Informing patients when physician supervision is not available for NP or not on the premises to direct NP.
  • This is among the 2 states that restrict the prescription of controlled substances by NP even under supervision by a physician.
  • NP and the physician cannot be over 75 miles apart.

In California?

So how many nurse practitioners can a physician supervise in California?

According to California Business and Professions Code section 2836.1(e), a delegating physician can supervise about 4 NPs who can furnish devices or drugs.


  • NPs need a collaborative agreement for practice with a delegated physician.
  • They should have written protocols for primary practice elements.
  • Their charts have to be signed by the delegated physician.
  • NPs can prescribe certain medications.

See also: Can You Be a Nurse With a DUI in California?

In Ohio?

A physician can take up supervision of up to 5 NPs. NPs can prescribe certain medicines.

A Standard Care agreement between NP and physician is made. The services provided by NP are outlined.

Along with this, the chart and performance frequency is reviewed timely. It has to be signed annually.


  • Performance review has to be done yearly.
  • Prescribing practices has to be reviewed half-yearly.
  • Schedule II medications can be prescribed by NPs.
  • A prescription can be given by NP to only patients who have come for a consultation.

In Mississippi?

How many nurse practitioners can a physician supervise in Mississippi then?

A physician can supervise up to three NPs. They can prescribe certain scheduled medicines.


  • A collaborative agreement with a physician consultation
  • Specialty practices according to the protocol created by physician and NP.
  • Each month, charts of NPs are reviewed to at least 10 percent.

In Texas?

How many nurse practitioners can a physician supervise in Texas?

In Texas, NP practice is limited. Under physician supervision, NP can practice within 75 miles of area.

A physician cannot take up supervision of over 4 NPs at a given time.


  • NPs are permitted to prescribe 30-day medicines supply. The prescriptions should include the name, DEA number, address, and phone number of the physician.
  • They are allowed to prescribe certain medicines.

In Oklahoma?

How many nurse practitioners can a physician supervise in Oklahoma then?

A supervising physician can take up to 2 NPs in full-time practice or 4 NPs in total.

Physician supervision is a must when NPs are prescribing certain medicines but not to practice as such.


  • State permission has to be obtained by NPs. The state board of nursing shall permit an NP to prescribe.
  • A collaborative agreement has to be written between NP and supervising physician. A DEA number is provided to NP.

In Illinois?

Last but not least, how many nurse practitioners can a physician supervise in Illinois?

In Illinois, 3 NPs can get into an agreement with a supervising physician. Overall, the physician can have 4 agreements.

An application has to be submitted with the Illinois Division of Professionals.


  • A collaborative agreement is outlined between NP and physician.
  • When NP requests, the physician ought to be available for phone or in-person consultation.
  • Each month physicians should collaborate with NP.
  • NPs can prescribe certain medications while others need physician’s authorization.

Conclusion: How many nurse practitioners can a physician supervise?

NPs or nurse practitioners are given authority to full practice in 21 states of the USA. NPs are licensed to carry their practice and prescribe with no supervision by a physician.

The remaining 29 states have a requirement of physician supervision for NPs to a certain level.

Physician supervision is based on a collaborative agreement written between the physician and the NP. The agreement outlines a nurse protocol that NP has to follow while practicing under physician supervision.

NPs are allowed to prescribe certain medications while other medicines can be prescribed only after a physician’s consultation.

NPs are reviewed timely by the delegated physicians.

Coming to the number of NPs that a physician is permitted to supervise is dependent on the state of the nursing board’s regulations.

The numbers of NPs are clearly outlined in the above article with their supervision policy.

See also: How Can Nurses Influence Policy?

Each supervising physician has to adhere to this number of NPs.

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About Ida Koivisto, BSN, RN, PHN

Ida is both a registered nurse and public health nurse. Her passion is to provide as much valuable information about nursing to the world as possible. In her spare time from work and blogging, Ida loves to work out at the gym and spend time with relatives.