Abstract
Keywords
Nurse practitioners (NPs) play a crucial role in worker health and safety. Within the workplace context, occupational health NPs (OHNPs) have duties related to preventive health care, employee health assessment, and policy and regulatory compliance (González-Caballero, 2024). Importantly, prescribing medication, including controlled substances such as opioids, is a core component of an OHNP’s job. Yet, state regulations govern NP prescribing authority, creating ambiguity about restrictions, especially for controlled substances. OHNPs have acknowledged this concern. In our most recent study, which included 10 OHNPs, a participant noted, “You have to understand the legalities and the regulatory stuff and all the things that go into occupational health . . .” (P9) (Rosemberg et al., 2026).
Prescriptive authority varies widely across states and professions. Physicians, dentists, NPs, and physician assistants (PAs) all prescribe medications. Each professional discipline has its own practice scope. For example, dentists can prescribe oral health-related medications, and can prescribe opioids for oral pain if they are registered with the Drug Enforcement Administration (DEA) (American Dental Association, n.d.; Zhang & Patel, 2026). NPs and PAs have similar practice scopes; however, there is divergence. PAs must have a legal relationship with a physician to practice and prescribe, and state regulations govern their prescribing authority (Zhang & Patel, 2026). While NPs’ scope of practice is also dictated by state rules and regulations, unlike PAs, they can practice and prescribe autonomously in some states.
NPs must have a thorough understanding of their state’s practice policies and regulations. Currently, there are 12 states where NPs have reduced practice, 11 with restricted practice, and 27 with full practice authority (American Association of Nurse Practitioners [AANP], 2026). Restricted practice states require all activities to occur under the supervision of a physician, including prescribing authority (AANP, 2026; Zivian Health, 2026). In reduced-practice states, NP prescribing scope is dictated by state law or board regulations and may require physician approval. In full practice states, NPs and primary care physicians (PCP) have equal authority to diagnose and treat patients (AANP, 2026).
In many instances, such as with worker populations in rural settings, OHNPs may be the only healthcare provider workers see. In such settings, OHNPs may provide both occupational and primary care. However, barriers in state regulations can delay care. Many workers often cannot miss work to see multiple providers. These delays can prompt unnecessary emergency room visits for pain management due to deterioration in their condition. Consequently, OHNPs may not be aware when a worker is prescribed a controlled substance, potentially affecting workplace safety. OHNPs must be vigilant in the care and complete a thorough history to ensure consideration of controlled substances. Given ethical concerns, such as Health Insurance Portability and Accountability Act (HIPAA) compliance, clear communication, and worker consent are critical. Workplace injuries are common, and when controlled substances are involved in the employee’s existing interdisciplinary care plan involving multiple healthcare providers, OHNPs must consider workplace safety, regulatory compliance, and employee health when making care decisions. The OHNPs can coordinate interdisciplinary care with multiple healthcare providers, especially when controlled substances are involved; these medications can influence mental and physical capacity to maintain safe work behaviors.
Overall, there are significant knowledge gaps surrounding OHNPs’ practice in restricted, reduced, and full practice states. Additionally, fragmented communication points to broader inconsistencies in healthcare. Increased interdisciplinary collaboration among healthcare providers is essential for optimizing care for workers.
The protocol for the interview data noted in this document was approved by a University’s Institutional Review Board.
Footnotes
Conflict of Interest
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Rosemberg is the Current Topics editor and was not involved in the reviewing process.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Julianne Armijo receives funding from a Predoctoral Fellowship Training Grant (T32 NR016914).
Ethical Approval
The protocol for the interview data noted in this document was approved by the University of Michigan Institutional Review Board (HUM00246047).
Artificial Intelligence
Authors declare that the content, ideas, results, discussion, and conclusions presented are the sole responsibility of the author.
