New California Rules Will Allow Nurse Practitioners to Practice Without Physician Supervision

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New California Rules Will Allow Nurse Practitioners to Practice Without Physician Supervision

California’s nursing agency just approved rules that will allow nurse practitioners to treat patients without direct physician supervision.  This vote is one of the last major steps necessary to fully implement a 2020 law that will allow nurse practitioners to practice more freely.  Nurse practitioners, who have advanced degrees and training, currently must enter into a written agreement with a physician who oversees their work with patients. Earlier this year, Governor Newsom also signed into law Senate Bill 1375, which authorizes Nurse Practitioners to provide reproductive care and first trimester abortions without doctor supervision.

With the passage of AB 890, a Nurse Practitioner may be able to practice independently once certain provisions outlined within AB 890 have been met.  Until those conditions are met, a Nurse Practitioner must continue to operate using Standardized Procedures (i.e. working under a physician’s supervision), the mechanism for Nurse Practitioners to perform functions considered the practice of medicine.

A Nurse Practitioner’s transition to independent practice must include, among other things, a minimum of three (3) full-time equivalent years of practice or 4600 hours, and must practice within the limits of their knowledge, experience and national certification and have practiced in good standing.  Then, a Nurse Practitioner may practice in limited settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner, without standardized procedures.

Furthermore, a Nurse Practitioner who is practicing independently, must then consult and collaborate with other healing arts providers based on the clinical condition of the patient to whom health care is provided and establish a plan or referral of complex medical cases and emergencies to a physician and surgeon or other appropriate healing arts providers.

These new rules will expand access care in California at a time when workforce shortages plague just about every corner of health care.  Nurse Practitioners are a cost-effective way of bringing more primary care providers to communities that need them, particularly in rural areas.  Although California’s transition requirements to independent Nurse Practitioners will be among the most robust in the country, it has not occurred without opposition, especially with the California Medical Association (“CMA”).  During legislative debate, the CMA said that Nurse Practitioners have less training than physicians, so allowing them to practice independently could lessen the quality of care and even pose a risk to patients and that in theory, Nurse Practitioners would be able to open their own medical practice (read:  in competition with the physician).

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