Nurse Practitioners' Path to Independence

With its passage in 2020, AB 890 created a pathway to greater independence for nurse practitioners (NPs).

Traditionally, the Nursing Practice Act regulated the scope of practice of nurse practitioners by the Board of Registered Nursing (BRN).

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AB 890 also establishes a Nurse Practitioner Advisory Committee tasked with providing the BRN with recommendations on nursing education requirements, standard of care, and discipline. The Committee is currently focused on defining minimum standards for NPs looking to transition to independent practice and expand their scope of care.

Starting January 1, 2023, certified NPs who meet additional training requirements may practice independently without standardized procedures. At this time, the Department of Consumer Affairs is conducting physician surveys to assess what additional requirements may be needed for those NPs who will be practicing independently. Physicians are a crucial part of this process to establish a new category of independent NPs who can practice without standardized procedures. These independent NPs will have the ability to provide services traditionally performed by physicians — ordering and performing diagnostic procedures, certifying disability status and prescribing, administering and dispensing controlled substances.

AB 890 created two different categories of NPs, defined by the settings in which they practice. Each category has different requirements the NP must complete before being allowed to practice without physician supervision.

Category 103 NPs – Work in a Collaborative Setting

Practice Setting-103 NPs work in practice settings in which there is a collaborative medical team, such as clinics, medical group practices, home health agencies, and hospice facilities. Correctional treatment centers and state hospitals are exempt from this law and NPs at those facilities will continue to practice under standardized procedures.

Category 104 NPs – NPs in Their Own Practice

Practice Setting-104 NPs work in practice settings outside of those defined in Section 103, which means that an NP can open an independent practice.

The current regulatory process must address and establish the standards and requirements for NPs to practice independently.

In the current legislative cycle, AB 852 has been introduced to provide clarification and technical changes to the new category of independent NPs. It also adds the new independent NPs to pharmacy definitions for prescribers.

AB 852 includes not only “technical and clarifying changes,” but also major provisions:

Authorizing independent NPs to perform provider-performed microscopy procedures.

Authorizing independent NPs for the use of a self-screening tool that will identify patient risk factors for the use of self-administered hormonal contraceptives by a patient, and, after an appropriate prior examination, the ability to prescribe, furnish, or dispense, self-administered hormonal contraceptives to the patient.

Adding independent NPs to the list of existing providers that may prescribe topical medications for occupational therapy.

Clarifying that NPs are not authorized to independently administer, monitor, or order the administration of general or deep sedation.

Making the following changes to the independent NP physician consultation requirements:

a) Consultation must be obtained as specified in the "practice protocols" rather than the "individual protocols."

b) Defines "practice protocols" as a written document that includes, but is not limited to, a description of the manner of communication with and availability of the consulting physician or physicians and any specialized circumstances under which the nurse practitioner is to communicate in a timely manner with a consulting physician concerning the patient's condition.

c) Clarifies that NP consultation with a physician and surgeon alone does not create a physician-patient relationship and that the NP is solely responsible for the services they provide.

 

d) Requires consultation if a problem is not resolving as anticipated after ongoing evaluation and management of the situation, rather than immediately.

Clarifying that an NP must refer a patient experiencing acute decompensation if not consistent with the progression of the disease and corresponding treatment plan and corrects a drafting error.

Adding independent NP offices as a place respiratory care may be practiced.

Adding independent NPs to various dispensing and prescription definitions in pharmacy law.

Adding independent NP staff committees, peer review bodies, and societies to the exclusion for legal discovery in the Evidence Code.

AB 852 has passed out the Assembly and is awaiting policy committee hearing in the Senate.

The regulatory process to determine additional training and certification requirements is now currently taking place. These meetings are open and public comment via telephone is encouraged. If you are interested, you can find the NPAC meeting schedule here: https://www.rn.ca.gov/consumers/meetings.shtml  

 

Gabriela Villanueva is CAP’s Government and External Affairs Analyst. Questions or comments related to this article should be directed to GVillanueva@CAPphysicians.com.