Knowledge Library

California SB 1451 and Impacts on Independent Nurse Practitioners

Among the new legislation in California that went into effect in 2025, one law includes some important changes that are likely to further stimulate the growth of independent nurse practitioners (NPs) in California. In 2023, the California Board of Registered Nursing (BRN) began accepting applications for a certification that allows experienced NPs to practice without the need for standardized procedures that outline scope of practice.  The new designation, known as a “103” NP, requires NPs to have worked in good standing in California for at least 3 years and requires independently practicing 103 NPs to work in a group setting...

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Patient’s Migraine History Biases Diagnosis in ED

This case study was made available to MIEC through our partnership with CRICO. It was originally written by Margaret Janes, JD,RN, CRICO. Description A 41-year-old woman presented to the ED with a headache; she was treated and discharged within three hours with a diagnosis of migraine. Later the same day, she had an acute event. A CT revealed a subarachnoid hemorrhage from a ruptured aneurysm. Key Lessons Each provider owes it to the patient to make an independent assessment. Effective bias can narrow a clinician’s judgment and consideration of a patient’s complaints. Clinical Sequence A 41-year-old woman with a history...

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Passive Response to Mother’s Status During Labor

This case study was made available to MIEC through our partnership with CRICO. It was written by CRICO Staff. Description A newborn died shortly after her birth, which was complicated by prolonged labor and a delayed diagnosis of chorioamnionitis. Key Lessons Determination for consultation in-person versus remote should be criteria-based. Prolonged labor without significant progress must trigger assessment by a (clinical) third-party. Unresolved concerns (e.g., maternal fever, fetal tracings, stagnant dilation) have to be regularly assessed and the care plan adjusted accordingly. Clinical Sequence A morbidly obese 26-year-old in the 41st week of her first pregnancy was admitted to Labor...

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Opioid Treatment For Sleep Disorder Did Not Consider Patient’s Overall Medication Risks

This case study was made available to MIEC through our partnership with CRICO. It was written by Barbara Szeidler, RN, BS, LNC, CPHQ, CPPS, CRICO Description A 38-year-old woman with a history of suicide attempts and an Ativan prescription from her psychiatrist, dies of an overdose after being prescribed Oxycodone by a sleep specialist. Key Lessons Patients with complex histories and needs benefit from ongoing coordination among caregivers. Selection of opioids for treatment requires patient-specific clinical scrutiny. When prescribing opioids, assessing the risks of all medications the patient may be taking, and close monitoring, is critical to patient safety. Clinicians...

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Enhancing Patient Safety through Data Literacy

This resource was made available to MIEC through our partnership with Candello. It was written by Hannah Tremont, MPH Data literacy involves the ability to read, understand, create, and effectively communicate data-driven insights. Based on a global Qlik report with insights collected from more than 1,200 C-level executives and 6,000 employees, 89 percent of C-level executives expect their team members to be able to explain how data has been used to inform their decisions, yet only 11 percent of employees are fully confident in their ability to read, analyze, and communicate data. Health care organizations are increasingly prioritizing data literacy...

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