California Nurse Practitioners Achieve Independent Practice Authority...Almost
For the California nursing community, patience is truly a virtue. It has now been two years since AB 890 - an act granting independent practice authority to Nurse Practitioners (NPs) - was signed into law. However, despite the monumental win, adoption has yet to occur. The good news for NPs across the state is that the waiting game may soon be over, as the CA Board of Registered Nursing (BRN) has submitted a Notice of Proposed Action to governing bodies for final approval.
How Did We Get Here?
In one of the most stringent Corporate Practice of Medicine (CPOM) and scope of practice states, California legislators recognized a serious shortage of healthcare providers during the Covid-19 pandemic and voted to join twenty-six other states across the country that have authorized some level of expanded practice authority to NPs. Like many states that made the jump to independent practice, this change did not come without its share of controversy. Headwinds from the Medical Board of California resulted in a 2015 version of the bill being shot down. Opponents of the bill argued that quality of care issues arise when medical decisions are left to non-physicians. For that very reason, California NPs historically have had to adhere to strict collaboration arrangements to ensure proper oversite by physicians. However, data showed that given the immense population across the state, less than half of Californians will have access to a physician by the year 2030. Realizing the impending crisis, AB 890 was born.
California BPC §2837.103 allows for independent practice without “standardized procedures” in a number of healthcare settings once an NP has completed three years or 4600 hours of “transition to practice.” BPC §2837.104 goes a step further to allow for an NP to practice independently in settings outside of a healthcare facility if the NP meets all the requirements of §2837.103, as well as: (i) holds a valid CA registered nursing license, (ii) has a master’s or doctorate in nursing, and (iii) has practiced in good standing for at least three years, which does not include the transition to practice timeframe.
What’s the Hold-Up?
When passed into law two years ago, the BRN was tasked with creating additional guidance on implementation and rollout. The BRN was required to form a Nurse Practitioner Advisory Committee (NPAC), and to put parameters around what “transition to practice” includes and how to govern disciplinary action, amongst other matters. As anyone familiar with navigating legislative enaction can attest, finding agreement amongst various agendas is no easy task. It seems however that AB 890 is in the final stretch and will find official adoption on January 1, 2023 or sometime soon thereafter.
Of course, like any new regulation, the journey to adoption is just one step in an ongoing process. Once in place, NPs will have to ensure they have procedures and protocols implemented in the practice to minimize liability. It is imperative that NPs be armed with a suite of documentation, from patient intake and privacy forms to proper employment and contractor agreements for those whom are planning to staff up to accommodate the influx of business. If you are an NP preparing for independent practice in the new year, talk with legal counsel as soon as possible to ensure your practice is legally-sound.
With years of experience in nursing law, Marti Law Group is here to help providers ensure the long-term success of their practice. Let us help with business and legal matters through Value Based Pricing or membership, while you focus on providing exceptional patient care. Call us at (860) 552-7770 or email firstname.lastname@example.org for more.
 https://www.aanp.org/advocacy/state/state-practice-environment  Joanne Spetz & Ulrike Muench, California Nurse Practitioners Are Position to Fill the Primary Care Gap, But They Face Barriers to Practice, 37 Health Aff. 1466, 1466 (2018).