The longtime effort in California to expand the scope of unsupervised care by nurse practitioners (NPs) is beginning to take form. AB 890 by Assemblyman Jim Wood (D-Eureka) went into effect on January 1, 2021. As described on the Assemblyman’s official web page: “This bill will allow nationally certified nurse practitioners, after completing specific transition requirements, to practice to the full scope of their license independent of physician oversight. Twenty-two other states allow full practice authority of nurse practitioners. Increasing the number of primary care health care practitioners will increase access to care for many more people in California, especially in underserved and rural areas.”
It should be noted that Assemblyman Wood represents a very rural part of the state and that the full implementation of AB 890 will come in tiers as the new law requires additional training and certification.
Traditionally, the Nursing Practice Act has provided for the certification and regulation of nurse practitioners by the Board of Registered Nursing (BRN). Existing law authorizes the implementation of standardized procedures for a nurse practitioner to perform certain acts.
The Nurse Practitioner Advisory Committee (NPAC) was established by AB 890 to advise and give recommendations to the BRN Practice Committee, which will then report to the full Board. BRN staff are in the process of drafting AB 890 regulations and are prioritizing transition to practice regulations.
The Board, by regulation, is required to define minimum standards for nurse practitioners to transition to practice independently and expand their scope of care. AB 890 created two different categories of NPs, defined by the settings in which they practice and named for the section of the state code in which the law resides. Each category has different requirements the NP must complete before being allowed to practice without physician supervision. The two categories are:
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 his or her own practice. The option for NPs to practice in these settings begins January 1, 2023. The new statute requires the Board to issue that certification to a nurse practitioner who meets additional specified education and experience requirements.
The ultimate outcome will establish a new category of nurse practitioners who meet certain education, experience, and certification requirements to perform specified functions without standardized procedures, including ordering, performing, and interpreting diagnostic procedures, certifying disability, and prescribing, administering, dispensing, and furnishing controlled substances.
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: www.rn.ca.gov/consumers/meetings.shtml.
Gabriela Villanueva is CAP’s Government & External Affairs Specialist. Questions or comments related to this article should be directed to GVillanueva@CAPphysicians.com.