California faces a statewide shortfall for primary care providers. Mid-range forecasts indicate the state would need about 4,700 additional primary care clinicians in 2025 and about 4,100 additional primary care clinicians in 2030 to meet demand.
One of the top recommendations to solve this problem from the California Health Workforce Commission, representing thought leaders from business, health, employment, labor and government, after it spent a year looking at how to improve California’s ability to meet healthcare workforce demands, was to allow full practice authority for Nurse Practitioners.
The California Legislature responded in 2020 by passing AB 890 which was signed by Governor Gavin Newsom. This law created two new categories of Nurse Practitioners (NPs) that can function within a defined scope of practice without standardized procedures. These new categories of NPs are:
– – 103 NP – Works under the provisions outlined in Business and Profession Code Section 2837.103. This NP works in a group setting with at least one physician and surgeon within the population focus of their National Certification
– – 104 NP – Works under the provisions outlined in Business and Professions Code Section 2837.104. This NP may work independently within the population focus of their National Certification.
Previously, although Nurse Practitioners have had more clinical independence than Registered Nurses, California law limited their extended scope of practice to implementation of standardized procedures with physician oversight.
AB 890 required that the California Board of Registered Nursing pass appropriate implementation regulations before the law would go into full effect. The Board conducted widespread outreach and engagement prior to developing the proposed regulatory language to implement AB 890. Extensive and frequent input was received from Board members, advisory committee members, and community stakeholders.
The regulatory language to implement AB 890 has been approved by the Office of Administrative Law on December 30, 2022, and went into effect January 1, 2023. While they do not significantly extend or alter the current NPs scope of practice, the new categories do have additional authority to work without standardized procedures.
All NPs who wish to practice without standardized procedures, must apply to the BRN for a special certification before they can do so. This new authority is not automatically granted to all NPs in California on January 1st.
The law requires a licensee to first work as a 103 NP in good standing for at least 3 years prior to becoming a 104 NP. Consequently, the Board is only able to certify 103 NPs at this time and will not be able to certify 104 NPs until 2026.
According to Business and Profession Code Section 2837.103, the following criteria must be met to become a 103 NP:
– – Has been certified as an NP by the California Board of Registered Nursing.
– – Holds a National Certification in a recognized population focus consistent with 16 CCR 1481 by a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and recognized by the Board.
– – Has completed a transition to practice within the category of their National Certification in California of a minimum of three full-time equivalent years of practice or 4600 hours within 5 years of the date of an application.
An estimated 20,000 nurse practitioners will be eligible to apply for the first phase of expanded authority Nurse Practitioners who meet the requirements for either pathway under AB 890 will have the authority to undertake the following specified functions:
– – Conduct an advanced assessment;
– – Order, perform, and interpret diagnostic procedures;
– – Order diagnostic radiologic procedures and utilize the findings or results in treating a patient;
– – Establish primary and differential diagnoses;
– – Certify disability after physical examination;
– – Delegate tasks to a medical assistant; and
– – Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including controlled substances, among other pharmacological and non-pharmacological interventions.
The legislation elevates the need to reexamine intersecting statutes, regulations, payer policies, clinical agency operations, interprofessional team structures, health care finance, and employment relationships and align them to fully realize the goals and intent of AB 890.
Accordingly, the California Health Care Foundation published its study: Aligning Nurse Practitioner Statutes in California. The research team reviewed a comprehensive, but not exhaustive, list of California statutes that govern heal- ing arts practitioners and identified opportunities for better alignment between existing laws and new leg- islation or regulatory action.
Labor Code § 3209.10 (a). authorizes NPs functioning pursuant to standardized procedures and acting under the review or supervision of a physician and surgeon, to provide medical treatment in the workers’ compensation insurance program.