Autonomous nurse practitioners in Florida frequently practice outside their legal scope of primary care: a cross-sectional study.

Abstract

Nurse practitioner (NP) organizations have advocated for expanding the NP scope of practice as a means of meeting the increasing demand for primary care services. Florida enacted the NP unsupervised practice of medicine (UPM) as part of House Bill 607 in July 2020, with the stipulation that autonomous NPs practice within primary care. The objective of this study was to determine the extent to which autonomous NPs in Florida have limited their scope of practice to primary care. We obtained a database of the population of autonomous NPs in Florida on 27 August 2024 from the Florida Department of Health, which contained a total of 11 925 NPs. Between November 2024 and February 2025, we randomly sampled 464 autonomous NPs across the state of Florida, ultimately reaching 328 autonomous NP practices. Of the 328 autonomous NP practices reached, 128 NPs were working in primary care, and 6 NPs were working in non-clinical roles. The remaining 194 autonomous NPs were working clinically in non-primary care settings, with the top five most common being (i) cosmetic and non-standard medical/surgical practices such as antiaging, IV hydration, vitamin infusions, hormonal therapy, and supplements (n = 53), (ii) psychiatry/addiction medicine (n = 53), (iii) emergency/urgent care (n = 20), (iv) inpatient medicine (n = 13), and (v) cardiology (n = 9). Our study provides strong evidence that many autonomous NPs in Florida have established specialty practices and other services not within the legal scope of practice of Florida law. Stricter enforcement of NP practice within the scope of training and legislation is needed.