Did California Give More Independent Authority to Advanced Practice Nurses?

California recently released proposed regulations to expand the scope of practice for nurse practitioners. What does this mean for advanced practice nurses in the state, and when will they be able to start practicing with greater autonomy?

The pandemic revealed weaknesses in our healthcare system, including our understaffed, undersupported healthcare workforce. Healthcare workers had been sounding the alarm for years. Ultimately, scenes of overflowing hospitals strained by provider illness, quarantine, and burnout grabbed national attention and forced legislatures to take action. 

Over the past two years, many states have changed the legal definition of the scope of practice for advanced practice nurses to help patients access much-needed care. One such law was California’s Assembly Bill 890, enacted in 2020. The law, which aims to expand nurse practitioners’ scope of independent practice and give them more autonomy, will take effect on January 1, 2023. And unlike some pandemic-driven legal changes, this expanded scope of practice will not be temporary; these regulations will govern the practice of nursing in California for the duration. 

Finalizing the New Law: Proposed Regulations

In September 2022, as part of the ongoing regulatory process, the California Board of Registered Nursing (BRN) released its proposed regulations.

The proposed regulations represent the BRN’s suggested legal standards for implementing the new law. Because these regulations have been proposed by the BRN (an administrative agency), they must be vetted by the public through what’s called a notice-and-comment period. In short, the public will have the opportunity to comment upon the proposed changes before they are finalized or before they take effect. 

Comments on the rules are due to the BRN before 5:00 p.m.on November 1, 2022. Once the notice-and-comment period ends, the comments will be reviewed. Then, the regulations could be adopted as proposed or amended to address questions and concerns expressed by stakeholders, so long as the amendments remain closely tied to the law being implemented. At this stage, the proposed regulations will likely be made final. However, significant amendments could trigger another notice-and-comment period.

What Could Be Changing?

As proposed, the regulations would clarify the specific duties that fall within a nurse practitioner’s scope of practice and allow nurse practitioners with certain certifications to perform specific functions without standardized procedures. The proposed regulations would also require those who wish to obtain full practice authority to:

• provide proof of certification by a national, accredited certification organization and complete 4600 hours of clinical practice experience and mentorship in the state of California within the five years preceding the application; 
• prepare a referral plan for complex cases and emergencies within 90 days of receiving certification; and
• post a notice of their title and scope of practice in a conspicuous location and verbally inform all new patients that they are not a physician or surgeon. 

How to Prepare for the 2023 Changes

For now, monitor the progress of the proposed regulations. Once the regulations are made final, review any communications you receive from the BRN and read updates posted on their website. 

Be sure to determine if you are required to adopt new standardized procedures or modify your existing procedures. If nurse practitioners at your practice seek full-practice authority, confirm that they have met all applicable prerequisites and be sure to maintain all documentation to demonstrate compliance. 

Explain the changes to your patients, including obtaining their informed consent to receive expanded scope of treatment from nurse practitioners with full practice authority. Remember that informed consent includes education about risks, benefits, and alternatives.

A patient’s primary care provider should not be changed without first discussing the impact of the change. As proposed, the regulations may also require the practice to post a notice with all nurse practitioners’ titles and scope of practice.

Evaluate your practice’s collaborative or supervision agreements to determine if you need to make adjustments. Determine, too, whether you need to modify nurse practitioners’ supervision obligations over others at the practice. Also, consider whether this will affect the compensation or responsibilities given to nurse practitioners at your practice. If so, update their employee contracts or independent contractor agreements.

Get Legal Support.

If you want help preparing for the change by updating your policies, contracts, or relationships, our partner Erin Jackson maintains an active California practice. You can schedule a free consultation with one of our experienced healthcare attorneys to learn more.

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.