Scope of Practice in California

California is a restricted practice state for nurse practitioners (NP) in which NP need to collaborate with a physician or surgeon. An NP is allowed to order drugs or devices under the supervision of a physician, which does not mean the physician has to be present at the time, but they must have a standardized procedure in place, and the physician must be available by phone during the patient’s examination (Nurse Practitioners, 1977). In California, a physician can not supervise more than four NP at one time, and I found this interesting as I did not know there was a limit to the number of NP that the same physician could supervise. This is something to be aware of when applying for jobs in the future and looking for physician collaboration.

Changes are being made to the scope of practice for NP in California. Beginning January 1, 2023, NP who meet specific requirements will work more independently and without a standardized procedure. A NP must be in good standing for at least three full-time years of practice or 4600 hours and must still practice in an organization where a physician is present but will no longer need a standardized procedure with a physician (California Board of Registered Nursing, 2021). These changes break down the barriers that NP currently encounter in California and pave the way to more independent practice.

Licensing in California

After graduation, a person must apply to take the PMHNP exam with the American Nurses Credentialing Center (ANCC) and pay the appropriate fees. Part of the application process with the ANCC is requesting the validation of education form and official transcripts to be sent by the academic institution to the ANCC. ANCC will process and review the application and grant authorization for the applicant to test, which can currently take up to three weeks (American Nurses Credentialing Center, 2021).

To obtain a license as an Advanced Practice Registered Nurse (APRN) in California, a person must possess an active California registered nurse license. The applicant must fill out an application for nurse practitioner certification and pay the appropriate fees. This application and the process can be found on the California board of registered nursing website at https://www.rn.ca.gov. The academic institution must complete the verification of nurse practitioner academic program form and send official transcripts to the board of nursing. The ANCC then needs to submit the verification of nurse practitioner certification by national organization form. For an NP to prescribe drugs or devices in California, a nurse practitioner furnishing number application form must be completed along with paying another fee. Then the academic institution must also complete the advanced pharmacology course verification form. These two application processes must be completed to be licensed as a PMHNP with the ability to prescribe in California.

NP Prescriptive Authority in California

NP can order Schedule II through Schedule V controlled substances in California, but this can be limited based on the standardized procedure agreed upon between the NP and the physician (Nurse Practitioners, 1977).  NP in California that prescribe controlled substances must also be registered with the United States Drug Enforcement Administration (DEA) and complete continuing education (Nurse Practitioners, 1977). NP in California can apply for a DEA license online in the category of a mid-level provider and pay a fee of $888 for three years (Drug Enforcement Administration Diversion Control Division [DEADCD], 2020). Before applying for a DEA license in California, an NP must meet the state requirements of having a collaborative agreement in place (DEADCD, 2020). California uses the Controlled Substance Utilization Review and Evaluation System (CURES) to monitor prescriptions dispensed and prevent abuse and diversion of medications (State of California Department of Justice, 2021). NP in California must register for access to CURES when they are issued a DEA license.

References

American Nurses Credentialing Center. (2021). Psychiatric-Mental Health Nurse Practitioner certification (PMHNP-BC). https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/

California Board of Registered Nursing. (2021). Advanced practice information. https://www.rn.ca.gov/forms/pubs.shtml#adv.

Drug Enforcement Administration Diversion Control Division. (2020). Registration. https://www.deadiversion.usdoj.gov/drugreg/index.html

Nurse Practitioners, Cal. Business and Professions Code § 2834 – 2837 (1977). https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=BPC&division=2.&title=&part=&chapter=6.&article=8.

State of California Department of Justice. (2021). Controlled substance utilization review and evaluation system. https://oag.ca.gov/cures

It is good to learn that California is granting NPs full practice authority next year. I believe that physician collaboration is important for NPs to learn from and become proficient in their chosen field. Becoming a master of a craft requires tutelage from an experienced mentor. I found the bill that opens the door to California NPS: Assembly Bill 890.

The “transition to practice” period makes sense to me rather than allowing NPs to practice independently straight out of school. However, I find the requirement to continue to practice with a physician or surgeon without standard procedures vague and needs clarification. What would their role be and how would one document this relationship?  (California Board of Registered Nursing, 2021).

I was under the impression that physicians need to be in close proximity with the NP or within the same facility and needed to sign off on a percentage of their charts but did not find any laws or rules to support this for California. By contrast, Mississippi stipulates 75 miles and 10% of charts reviewed per year (California Healthcare Foundation, 2018).

Regards,

Stephen Lowe

References

California Board of Registered Nursing. (2021). AB-890 Nurse practitioners: scope of practice: practice without standardized procedures. Retrieved from https://www.rn.ca.gov/practice/ab890.shtml

California Healthcare Foundation. (2018). California’s nurse practitioners: How scope of practice laws impact care. Retrieved from https://www.chcf.org/wp-content/uploads/2018/09/NursePractitionerScopePracticeLaws.pdf

I’m debating on relocating to either California or Maryland within the next 3 years and the information you have provided is helpful. Knowing that the California NPs cannot write prescriptions without having a supervising physician (scopeofpracticepolicypractice.org) your information on the fact that the supervising physician does not need to be present to supervise is useful information. I was also, unaware that there is a limit to the number of NPs the physician can supervise. This is different in Maryland since there the NPs only need to collaborate with a physician or another NP for eighteen months before being on their own (American Association of Nurse Practitioners, 2020).

References

American Association of Nurse Practitioners. (2020).

            http://www.aanp.org/advocacy/state/state-practice-environment.

Scope of Practice Policy (n.d.). Nurse Practitioners Overview. Retrieved from            https://scopeofpracticepolicy.org/practitioners/nurse-practitioners/

California practice authority is similar to my home state Virginia. Both states have restrictive practice authority that required collaboration with a license physician for five years to be able to practice independently. States with restricted practice are currently facing shortage of psychiatrist , by allowing full practice authority PMHNP may increase access to services in those states . State limitation on PMHNP may restrict the ability of an PMHNP to do so. The state of Virginia likewise allow PMHNP to  prescribe schedule I I-V drugs under the supervision of a license psychiatric under the prescription monitoring program. In the US the role of the nurse practitioner was implemented to meet the growing demand of the US population  , thus , there is need for NP to overcome barriers to full practice authority to meet  the ever growing population. The ANA is committed to the monitoring and advocacy for legislative and regulatory changes to NP scope of practice with the aim to of removing practice barriers for NP and improving access to care (ANA, 2018). Great post. Thanks for contributing. 

References

Delaney, K. R., Drew, B. L., & Rushton, A. (2019). Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey. Journal of the American Psychiatric Nurses Association25(2), 146–155. https://doi.org/10.1177/107839031877787

Widmer, J. C. (2021). Nursing Advocacy and the ANA-PAC. Nursing News45(3), 16–17.

American Psychiatric Nurse Association (APNA). https://www.apna.org

American Nurse Association (2018). Nursing scope of practice

American Association of Nurse Practitioners, (2020), State practice environment . https://www.aanp.org/advocacy/State/state-practice-environment

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