By Dorsey Griffith
Contributing Writer
AB 890, by Assembly Member Jim Wood, which allows California nurse practitioners to practice to the full extent of their expertise and training, has passed, and now the process of developing regulations to enable its implementation begins. While AB 890 was successful in making the most significant policy change, that NPs in California may work without physician supervision, the bill could not address many details, which will be clarified through regulations and subsequent legislation.
CANP held a virtual town hall for members on Nov. 12 during which experts summarized the bill, and CANP President Patti Gurney followed up by meeting with the California Board of Registered Nursing (BRN) to present the Association’s immediate needs and recommendations, including establishment of the board’s NP Advisory Committee and further clarification of the transition to practice provisions. The bill’s key provisions are contained in an overview created by the CANP.
In summary, AB 890 creates two new categories of NPs to function independently within a defined scope of practice without standardized procedures. Under current California law, standardized procedures are documents agreed to by nurses, health systems, physician groups or other administrative entities that authorize NPs to diagnose, treat, and manage health conditions. For shorthand, the two categories are being referred to as 103 NP and 104 NP.
The 103 NP is an NP who works in an integrated setting, which could be an authorized clinic, health facility, medical group, home health agency or hospice facility in which one or more physician practice. NPs must meet several requirements, including: hold a national certification; take a supplemental exam if applicable; provide NP education documentation; and completion of a transition to practice (TTP) in California. Two settings exempt from this group are state hospitals and correctional facilities. This provision goes into effect Jan. 1, 2021; however, AB 890 requires the BRN to promulgate regulations to clarify the TTP and how it may be applied to NPs who have been practicing in California. The intent of Assembly Member Wood is that the TTP only applies to new graduates, licensed after Jan. 1, 2021.
The 104 NP is an NP eligible to practice independently without standardized procedures outside the settings described for the 103 NP. To be a 104 NP, the NP must meet all the 103 NP requirements and hold a valid and active RN license and master’s degree in nursing or other related clinical field, or a doctoral degree in nursing. The 104 NP must have practiced in good standing for at least three years, not inclusive of the TTP. 104 NPs can open their own practice upon completion of the requirements. This provision goes into effect Jan. 1, 2023.
The board must first establish the NP advisory committee to advise and make recommendations to the board as the implementation process moves forward.
Applications to serve on the committee were accepted until Dec. 4. The advisory board will be made up of four NPs, two physicians with experience working with NPs, and a public member. Gurney said candidate interviews will take place in late December so that the committee can be in place by January 2021.
The Association actively encouraged its board members to reach out to physicians and NPs to apply to be part of the committee with the intent of achieving diversity of representation, not only in terms of race and ethnicity, but also practice areas, Gurney said.
Acknowledging fears that physician groups opposed to AB 890 will try to influence how AB 890 is ultimately implemented, Gurney stressed that there are good safeguards in place against undue control of the process. The process will include required public comment periods. The Committee will be advising the BRN; the BRN will have ultimate authority regarding enacting regulatory changes.
Most significant among the regulations to be promulgated are those on the transition to practice, which is a period of time during which NPs work under supervision and is defined under AB 890 as three full-time equivalent years or 4,600 hours. The intent of the transition to practice is to support newly licensed and graduated NPs, those who enter practice after January 1, 2021. The BRN regulations will further clarify this intent.
Gurney told the BRN that CANP stands ready to help enact those regulations so experienced NPs are not delayed in their ability to work without standardized procedures, adding that because every proposed regulation must go through a prescribed process, implementation of the bill will take some time.
“As the process unfolds over the next few months — both with the formulation of regulations and with clean-up legislation introduced during the next legislative cycle — it’s even more important that NPs join CANP to be involved in the process every step of the way” Gurney said.
CANP will provide members with regular updates and other implementation information on the website and in Connections.