The state will be the 29th to allow nurse practitioners to practice without a physician. Show
California nurse practitioners (NPs) will be able to strike out on their own without physician supervision soon after Gov. Gavin Newsom signed a law opposed by various physician groups. According to a report in The Sacramento Bee, the law, which goes into effect in 2021, will allow NPs to practice independently beginning in 2023 after having operated un a physician’s supervision for three years. Under current regulations NPs must always operate under a physician’s supervision. This brings the total number of states which allow NPs to practice without doctor supervision to 29, The Bee reports. The California Medical Association (CMA) opposed the law, titled AB 890, and after Newsom signed it President Peter N. Bretan, Jr., MD, released a statement expressing disappointment in its passage. “We strongly believe that physician-based care is the model that ensures the greatest patient safety and highest quality care for all Californians, regardless of income,” he says in the statement. “And while proponents of AB 890 have said this legislation will help increase access to care, the data we have seen from other states that have eased supervision of nurse practitioners has not shown any meaningful improvement in access to care in underserved communities.” Bretan says that the legislation has many steps to go before it is implemented and that the CMA intends to remain engaged in the regulatory process. “While the Bureau of Registered Nursing will play an important role, the implementation of key provisions of the bill will require physician involvement and will likely require input and guidance from the Medical Board of California,” he says. “CMA will be engaged throughout the regulatory process to ensure that patients’ interests, including the timely access to a physician, are protected in the implementation of AB 890." Since the inception of the first nurse practitioner (NP) education program in 1965, men and women in the profession have experienced great success and heated opposition. Physician organizations have openly opposed the use of nurse practitioners as primary care providers, claiming that educational gaps render NPs unsafe and unqualified to care for patients independently. Even though the decades-old debate continues, research has proven time and again that nurse practitioners are indispensable primary care providers with the ability to treat a wide variety of conditions. Moreover, the Kaiser Family Foundation (KFF) indicates that 58 million Americans live in areas in which the supply of primary care physicians doesn’t meet federal standards with the appropriate ratio of providers to patients. The gap is widening as legislation expands access to medical care, and the Association of American Medical Colleges (AAMC) predicts the physician shortage could reach up to 139,000 physicians by 2033. Nurse practitioners are gaining independence and establishing autonomy as they provide medical care without the oversight or management of a physician. What Is Scope of Practice for Nurse Practitioners?The American Nurses Association (ANA) defines scope of practice as the “services that a qualified health professional is deemed competent to perform, and permitted to undertake — in keeping with the terms of their professional license.” The three types of practice regulations for NPs are: FULL: NPs can prescribe, diagnose, and treat patients without physician oversight. Nurse practitioners who operate in full-practice states are also allowed to establish and operate their own independent practices in the same way physicians do. REDUCED: NPs can diagnose and treat patients but need physician oversight to prescribe medications. RESTRICTED: NPs need physician oversight to prescribe, diagnose, and treat patients. Nurse Practitioner Scope of Practice by StateScope of practice guidelines for advanced nursing professions vary by state. Currently, 22 states and the District of Columbia have approved “full practice” status for nurse practitioners, a provision that allows them to assess, diagnose, interpret diagnostic tests, and prescribe medications independently. Kaiser Health News reports that Alaska, New Hampshire, Oregon, and Washington were the first states to offer expanded scope of practice NPs in the 1980s; more rural states, mainly those with physician shortages, followed in the 1990s. Note: The following scope of practice designations are accurate as of April 28, 2021.  Full-Practice Authority States
Reduced Authority States
Restricted Authority States
Expanding Nurse Practitioner Practice StatusIn 2010, full practice status became the recommended model by the Institute of Medicine and the National Council for State Boards of Nursing. Not all states, however, are on board with the measure; 27 continue to mandate reduced or restricted practice regulations for nurse practitioners. While the guidelines for reduced and restricted practice regulations are slightly different depending on location, both require NPs to have either a signed collaboration agreement with a physician or direct oversight from a physician. Not all states require the physician to be physically present or even in the same building with the NP during patient care, but they should be available by phone or email. Despite aggressive opposition from the medical community, new and changing legal policies indicate that lawmakers are looking closely at the NP’s role in expanding coverage to underserved areas and easing the burden on the dwindling number of primary care physicians who remain — calling the NP role “necessary for long-term health care.” More than 20 states expanded NPs’ practice ability through legislation or regulation in 2013, according to the 26th Annual Legislative Update from The Nurse Practitioner. Several states have also approved new legislation for NPs that empowers them to sign death certificates and formal health records. With the approval of SB 61 in 2017, South Dakota became the latest state to pass legislation allowing nurse practitioners to practice independently. Additionally, states aren’t the only entities moving to dismantle practice barriers: In 2016, the U.S. Department of Veteran Affairs (VA) issued a proposal that would “permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.” Communication and Collaboration in the FutureHealth care leaders from nursing and medicine fields agree that there should be more conversations addressing the independence of NPs. Both sides concur that the NP role is vital to the health and delivery of medical care in this nation, but neither can agree on the best way to achieve the goal. As both sides hold strongly to their convictions, there is sure to be more debate — and potentially more autonomy — for nurse practitioners. Additional Career Resources:
Citation for this content: Nursing@Simmons, the online FNP program from the Simmons School of Nursing Can nurse practitioners practice on their own in California?AB-890 Nurse practitioners: scope of practice: practice without standardized procedures. With the passage of AB 890 the Nurse Practitioner may be able to practice independently once certain provisions have been met. All Nurse Practitioners will not meet the provisions outlined within AB 890 by January 1, 2023.
Does a nurse practitioner need a supervising physician in California?California's Nurse Practitioner Supervision Laws
Sorry NP's, nurse practitioners practicing in California are not allowed to go solo. State law requires that NP's practice in collaboration with a physician. Each physician can supervise no more than four drug-prescribing NP's.
When can nurse practitioners practice independently in California?In 2022, California Senate pro Tempore Toni Atkins introduced SB 1375, which clarifies the TTP requirement by specifying that an NP with at least three full-time equivalent years or 4,600 hours of experience can practice independently.
Is California a restricted state for NP?California is 1 of 22 states — and the only western state — that restricts NPs by requiring them to work with physician oversight.
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Can nurse practitioners practice independently in california
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