By Melanie Balestra, NP, Esq.

I receive an increasing number of questions about what to know and how to start an NP business. From COVID-19 to telehealth, nurse practitioners face a multitude of complicated issues. The following are some of the key considerations I am often asked to address.

Has COVID-19 increased NP scope of practice?  
While other states increased the NP scope of practice, like allowing PNPs to see patients up to 30 years of age, California NPs have no more independence now than they did before the COVID-19 global pandemic. The only enactment made by the State of California allows for a physician to collaborate with more than four NPs for 60 days. It’s important to exercise continued caution in your practice, as the Bureau of Registered Nursing (BRN) will continue to keep a watchful eye on all NP practices as we move through this pandemic. 

Does a group lawyers insurance plan through an employer cover administrative law actions?
It is important to thoroughly read and ask questions anytime an insurance policy is purchased. The group plans that cover legal representation for any type of legal problem usually provide limited compensation for the attorney, and it’s possible to be matched with an attorney that lacks the adequate experience or subject area expertise. For example, I recently received a question from a CANP member stating that she received a BRN complaint and learned after the fact that administrative law cases did not include disciplinary actions. Even though disciplinary actions fall under administrative law, the insurance company declined her representation. The “fine print” matters so always be sure to research the insurance companies and contracts before purchasing insurance.

How can an NP practice telehealth within the limits of the law?  
The NP must be licensed to practice in the State of California and the state where the patient resides. Outside of California, the NP must follow that state’s Nurse Practice Act and laws. For instance, an NP licensed in California can provide care for a patient in Arizona without physician supervision if the NP also is licensed in Arizona. Also noteworthy, California does not require that the first patient visit be in-person as some states do. 

Telehealth has become very popular during the COVID-19 pandemic, and additional regulations related to telehealth likely will be enacted.

Can an NP work as an independent contractor?  
There are situations where NPs can be independent contractors, like when they are providing services for a skilled nursing facility (SNF) that does not have a provider. SNF’s usually do not have NPs work for them as employees. 

The law states that if an independent contractor provides services for a company that provides the same services, one cannot be an independent contractor. (Physicians, attorneys, hairdressers and several other professions are exempt.) This law is a way of getting more people to comply with all the exemptions of a W2 employee, including but not limited to, workers’ compensation, social security, and California disability insurance. The employer will be fined if it is determined that they inappropriately hired an independent contractor. 

One approach does not fit all. There may be exceptions to the law, and each situation may be different, so contacting a knowledgeable attorney before making any final decisions is always the best bet. There may be a bill introduced within the next year exempting health care providers from the independent contractor law, but there is no a guarantee it will pass.  

Many NPs try to incorporate themselves and do so incorrectly. Establishing a business is not just about the law; it’s also about anticipating issues, understanding how the BRN thinks, marketing, social media and much more.  

Stay tuned! CANP is compiling member questions and planning a webinar presentation with members who have established successful businesses. Topics will feature “business basics” what to do and not to do when starting out. Keep an eye out for the announcement.

Melanie Balestra is both an attorney and a nurse practitioner. She is a former President of CANP, and was previously President of the American Association of Nurse Attorneys, which in 2016 honored her with the award for Outstanding Health Law & Compliance Section Member. She has law offices in Irvine and Newport Beach, and continues to work part time as a PNP and Director of Pediatrics at the Laguna Beach Community Clinic.