The Impact: No Physician Supervision for Advanced Practitioners in CA (2024)

The Impact: No Physician Supervision for Advanced Practitioners in CA (1)

The Impact of Having No Physician Supervision for Advanced Practitioners in California

New data was just released within the state of California. We have the latest news on the impact of Advanced Practitioners not needing to have physician supervision moving forward! Keep reading to find out more!

New year, new rules: In November, California set new standards for advanced nurse practitioners. How will this impact California FQHCs and the NPs, doctors, and other clinical staff that serve in these facilities?

Why was the California Nurse Practitioner New Rule Necessary?


Before the November ruling, California was one of 22 states restricting Nurse Practitioners by requiring them to work within a physician’s oversight. The problem? The research shows the quality of NP care is just as good as the quality of physician care. These laws needlessly restricted our highly-qualified NPs from working to the top of their license. The California Health Care Foundation says, “A large body of research has linked such restrictions to a lower supply of NPs, poorer access to care for state residents, lower use of primary care services, and greater rates of hospitalization and emergency department visits.”

The new ruling is widely viewed as favorable. Advanced care nurses have long been viewed to expand the healthcare safety net, particularly in rural areas and to the underserved. This new ruling is a cost-effective way for FQHCs and other community healthcare providers to stretch limited resources at a time when staffing shortages still plague these communities.

What the New Rule for CA NPs Says


Advanced nurse practitioners are now allowed to work without physician oversight. The 2022 ruling was the final implementation of the 2020 Assembly Bill 890 scope of practice law for nurse practitioners. The hold up in the implementation of this ruling was that the Board of Registered Nursing had to determine how NPs would transition into their new role. Would additional testing be needed? Certifications?

The new law creates two NP categories. Beginning in January 2023, NPs who completed 4,600 hours or three years of full-time clinical work in the State of California can apply to work without physician supervision. However, the facility must have at least one practicing doctor or surgeon on-site. Cal Matters says, “The idea is nurse practitioners would still be able to consult a doctor when needed.”

After an additional three years within that group setting, NPs can apply for full practice authority with no restrictions related to the facility in which they operate. This second category puts most existing NP populations in California on a path toward full independence by 2026. According to Cal Matters, approximately 20,000 NPs will be eligible to apply for the expanded phase two authority by 2023.

What the Expanded CA NP Rules Mean to FQHCs


This new approach is a boon to the FQHC community in several ways:

  • The expanded scope of practice will likely attract more NPs to California.
  • The ruling allows FQHCs to hire more NPs without meeting doctor-to-nurse practitioner ratios.
  • The law could shore up staffing shortages. While it may be a finger on the dam crack, having more NPs is both cost-effective and patient-forward for the FQHC community.
  • Ultimately, the rule may increase access to care for our underserved populations.

Expanding the NP scope of practice is a win/win for our community. UHC Solutions is proud to represent California FQHCs in their efforts to attract more clinical and administrative talent. If you’re an advanced practice nurse looking to apply your skills, we can help! We partner exclusively with community healthcare organizations in their efforts to attract and hire the best industry talent. Call us to find out more.

The Impact: No Physician Supervision for Advanced Practitioners in CA (2)

The Impact: No Physician Supervision for Advanced Practitioners in CA (3)

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The Impact: No Physician Supervision for Advanced Practitioners in CA (2024)

FAQs

The Impact: No Physician Supervision for Advanced Practitioners in CA? ›

The California Health Care Foundation says, “A large body of research has linked such restrictions to a lower supply of NPs, poorer access to care for state residents, lower use of primary care services, and greater rates of hospitalization and emergency department visits.” The new ruling is widely viewed as favorable.

Do NPs in California need a supervising physician? ›

The 104 NP license provides the maximum independence for NPs in California. Here's what it entails: Unrestricted practice: With a 104 NP license, you can practice independently in any setting, without geographical limitations. You don't need a collaborating physician on-site.

What are the barriers to APN in California? ›

Perceived barriers to practice are lack of prescriptive authority, lack of support from physicians, reimbursem*nt difficulties, and lack of public awareness. Current barriers to nurse practitioner practice in California are similar to national barriers discovered in 1992 data.

Why shouldn't NPs have full practice authority? ›

NPs are essential members of the physician-led care team, but they are plainly not trained to practice independently. They are not required to undergo years of medical residency training and get only 500–720 hours of clinical training, compared with the 10,000–16,000 hours that physicians receive.

Does California NPA require the Aprn to have a collaborative agreement with a physician? ›

Sorry NP's, nurse practitioners practicing in California are not allowed to go solo. State law requires that NP's practice in collaboration with a physician.

Can an NP own a medspa in California? ›

Generally, NPs can own and operate a medical spa, but there are important regulations to consider. California law requires that medical spas, which provide medical services, operate under the supervision of a licensed physician.

Can physician assistants practice independently in California? ›

Can physician assistants practice independently in California? No, PAs in California must have a practice agreement with at least one licensed physician.

What are the challenges of APN? ›

The challenges in APN education encompass various domains, including regulatory barriers, limited faculty resources, inadequate clinical training opportunities, technological limitations, and the need to align curricula with changing healthcare landscapes.

Which of the following has been a barrier to APNs? ›

Which of the following has been a barrier to advanced practice nurses (APNs)? Denial of claims from third-party payers has been a barrier for advanced practice nurses (APNs) and is based upon misinformation. An advanced practice nurse (APN) is caring for an elderly client with mildly elevated blood pressure.

Is California a restricted state for NP? ›

Beginning in 2023, certified nurse practitioners can apply to practice independently in California. Assembly Bill 890, which was signed into law in September 2020, went into effect on 1/1/23.

Do physicians respect NPs? ›

I can say with confidence most physicians, particularly those that hire nurse practitioners, treat NP's with respect. Our scope of practice is different than that of physicians but as a nurse practitioner I know my boundaries and abide by them.

Why is NPs flawed? ›

While NPS provides a quick and easy metric, it is often criticised for being overly simplistic and providing only a surface-level understanding of customer satisfaction. It focuses on the likelihood of recommendations but may miss the intricacies of the customer experience.

Why is NPs outdated? ›

NPS is Not a Good Predictor of Growth or Customer Behavior

The simple question – “How likely are you to recommend us?” doesn't capture the multifaceted nature of customer satisfaction. It only captures one aspect – how many customers will recommend your product or service to others.

What are the barriers to NP practice in California? ›

Most nurse practitioner (65%) respondents in California are providing primary care. Perceived barriers to practice are lack of prescriptive authority, lack of support from physicians, reimbursem*nt difficulties, and lack of public awareness.

Can a nurse practitioner prescribe medication without a doctor in California? ›

Nurse Practitioners vs.

Registered nurses in California typically do not have the authority to prescribe medications independently. Their primary responsibilities lie in administering medications prescribed by physicians, monitoring patient responses, and providing essential nursing care.

Do nurse practitioners need to be board certified in California? ›

Applicants are expected to hold a valid RN license to practice in California, have completed a board-approved postgraduate nurse practitioner preparatory program, and obtained national certification from board-approved national certifying agencies.

What are the requirements to be a NP in California? ›

(1) Hold a valid and active registered nursing license issued under this chapter. (2) Possess a master's degree in nursing, a master's degree in a clinical field related to nursing, or a graduate degree in nursing. (3) Satisfactorily complete a nurse practitioner program approved by the board.

Can nurses do Botox independently in California? ›

Botox Laws in California

Only physicians may perform this procedure. Physician assistants and registered nurses may also inject Botox but only under a physician's supervision.

Which states can NP practice independently? ›

Nurse Practitioners can practice independently in the 27 states with full practice authority: Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, ...

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