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Key Takeaways
- California has three NP practice pathways.Traditional NPs can continue practicing under standardized procedures, while qualifying 103 and 104 NPs can practice without standardized procedures in specified circumstances.
- 104 NP certification allows qualifying NPs to practice independently.A 104 NP can practice without standardized procedures outside a group setting, including in independent practice, but remains subject to California’s scope-of-practice and consultation, collaboration, and referral requirements.
- Independent practice authority is only one part of starting an NP practice.NPs must also address business structure, ownership, contracts, professional liability, practice policies, and other legal and regulatory requirements.
Understanding California Nurse Practitioner Practice Authority
California nurse practitioners have several options to practice without standardized procedures under Assembly Bill 890 (AB 890). The law created two additional categories of nurse practitioners, commonly called 103 NPs and 104 NPs, with different requirements and practice settings.
A 103 NP can practice without standardized procedures in certain group settings, while a 104 NP can practice without standardized procedures outside of a group setting. The traditional nurse practitioner practice model remains available as well.
For nurse practitioners considering independent practice, understanding the differences between these pathways is the first step.
What Changed for California Nurse Practitioners?
California enacted AB 890 in 2020, creating two new categories of nurse practitioners who can practice without standardized procedures in specified circumstances. The California Board of Registered Nursing (BRN) subsequently adopted regulations implementing the law.
California now has three primary pathways for NP practice:
- Traditional NPs can continue practicing under standardized procedures
- 103 NPs can practice without standardized procedures in specified group settings
- 104 NPs can practice without standardized procedures outside of a group setting, including in an independent practice
The 103 and 104 designations are optional. An NP can continue practicing under standardized procedures even after obtaining one of these certifications, and an employer may require an NP to work under standardized procedures.
California’s Three NP Practice Options
California’s NP practice framework now includes three pathways, each with different requirements and limits on where and how an NP can practice.
Traditional NP Practice
The traditional NP practice model remains available in California. An NP who does not obtain 103 or 104 certification can continue practicing under standardized procedures.
Standardized procedures establish the functions an NP may perform in a particular practice setting and the circumstances under which those functions may be performed.
103 NP Practice
A 103 NP can practice without standardized procedures in specified group settings where at least one physician and surgeon practices with the NP. This provides greater autonomy than the traditional NP model but does not create independent practice authority.
To qualify as a 103 NP, an applicant generally must:
- Hold California NP certification
- Hold national certification from a qualifying national certifying organization
- Complete at least three full-time-equivalent years or 4,600 hours of transition-to-practice experience in California within the five years before applying
- Complete the required experience after receiving California NP certification and in direct patient care within the applicant’s area of national certification
104 NP Independent Practice
A 104 NP can practice without standardized procedures outside a group setting, including in independent practice. If an NP plans to establish a separate practice, additional legal requirements may apply, including requirements related to business structure, ownership, contracts, and practice operations. These issues are separate from the NP’s authority to practice independently.
Before applying for 104 NP certification, an NP generally must practice as a 103 NP in good standing for at least three full-time-equivalent years or 4,600 hours of direct patient care.
What Does California NP Independent Practice Authority Not Change?
The 104 designation allows qualifying NPs to practice without standardized procedures outside of a group setting, but it does not eliminate California’s other requirements governing NP practice.
A 104 NP cannot practice beyond the NP’s education, training, knowledge, experience, or national certification. California law also requires 104 NPs to comply with specified consultation, collaboration, and referral requirements based on the patient’s clinical condition.
Independent practice authority also does not eliminate the need for appropriate contracts, policies, business structures, or other compliance measures.
NPs working with physicians or other healthcare professionals should distinguish independent practice authority from other professional relationships and legal requirements.
California’s NP practice rules have changed significantly, but independent practice authority comes with specific requirements and limitations. Jackson LLP advises nurse practitioners and other advanced practice providers on the legal requirements affecting their scope of practice, professional relationships, and independent practice. Book your free attorney consultation with us today.
Patient Notification Requirements for 103 and 104 NPs
California imposes patient notification requirements on 103 and 104 NPs. Practices should incorporate these requirements into their policies and patient-facing materials.
Except in specified facilities operated by the California Department of Corrections and Rehabilitation, a 103 or 104 NP providing healthcare services must prominently post a required notice in a location accessible to the public. The NP must also verbally inform all new patients, in a language understandable to the patient, that the NP is not a physician and surgeon.
What Does Independent Practice Mean for California NPs?
For NPs who qualify as 104 NPs, independent practice authority means they can provide services without standardized procedures outside of a group setting. It does not, however, change the limits of their professional scope or eliminate other California requirements that apply to NP practice.
An NP considering independent practice should confirm that the services they plan to provide fall within their education, training, experience, and national certification. If the NP plans to establish a separate practice, additional legal considerations such as business structure, ownership, and contracts may also apply.
California NPs have more options for independent practice, but determining what those options allow requires a close look at the applicable state requirements. Jackson LLP advises nurse practitioners on the legal issues affecting their practice and professional relationships. We provide complimentary consultations. Reach out today to get started.
This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.
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Frequently Asked Questions About California Nurse Practitioner Full Practice Authority
Can nurse practitioners practice independently in California?
Yes, qualifying nurse practitioners can practice independently in California as 104 NPs. A 104 NP can practice without standardized procedures outside of a group setting, subject to California's scope-of-practice and other legal requirements.
What is a 103 NP in California?
A 103 NP is a California nurse practitioner who meets the requirements for practicing without standardized procedures in specified group settings. A 103 NP must meet California's education, national certification, and transition-to-practice requirements and work in an eligible group setting that includes at least one physician and surgeon.
What is a 104 NP in California?
A 104 NP is a nurse practitioner certified to practice without standardized procedures outside of a group setting. A 103 NP generally must practice in good standing for at least three full-time-equivalent years or 4,600 hours before qualifying to apply for 104 NP certification.
Can a 104 NP open an independent practice in California?
Yes. California law allows a 104 NP to practice without standardized procedures outside of a group setting, including through an independent practice. The NP must still practice within the limits of their education, training, knowledge, experience, and national certification and comply with applicable consultation, collaboration, and referral requirements.
Do California nurse practitioners still need standardized procedures?
Not necessarily. Traditional NPs continue to practice under standardized procedures, while qualifying 103 and 104 NPs may practice without standardized procedures in the settings authorized by law. Even a 103 or 104 NP may continue practicing under standardized procedures, and an employer may require them.
How long does a California NP have to practice before becoming a 104 NP?
A 103 NP generally must practice in good standing for at least three full-time-equivalent years or 4,600 hours of direct patient care before applying for 104 NP certification. However, certain doctoral education hours may count toward this requirement. NPs considering independent practice should confirm they meet current California certification and practice requirements.
