California SB 1451 and Impacts on Independent Nurse Practitioners
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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 with at least one physician.
The BRN confirms that 103 NP applicants have completed their required 3 years, referred to as the “transition to practice,” by submitting a formal attestation from a licensed physician or another 103 or 104 NP. After working for 3 years as a 103 NP, individuals can apply for “104” certification which allows full independent practice without a physician, practice ownership, and medical staff membership. For more information, see Nurse Practitioner Expanded Scope of Practice in California.
Briefly, the attestation process begins after an NP submits a 103 NP application to the BRN. In response, the BRN sends an email to the attesting physician (or 103 NP) identified by the NP, with a request to complete the attestation online. Of note, the attestor must practice in the same clinical specialty as the NP, and they cannot have a familial or financial relationship with the 103 NP applicant.
In 2024, California passed Senate Bill 1451 (SB 1451) which, among other things, further clarifies requirements for NPs to become eligible for 103 NP certification. Specifically, SB 1451 makes several important changes with the intention of facilitating the transition to practice and attestation process:
- The transition to practice requires the equivalent of 3 years (4600 hours) of direct patient care in California within the last five years prior to application. SB 1451 clarifies that those 3 years of practice can be cumulative and non-consecutive.
- SB 1451 clarifies that the minimum 3 years of NP practice can be in any one of the six categories of NP practice (family, adult gerontology, neonatal, pediatrics, women’s health, and mental health), rather than having to be all in one category.
- SB 1451 specifies that the transition to practice attestation signed by the attesting physician or NP does not verify clinical competence or expertise of the applicant, rather that the applicant has completed the minimum required hours of practice in California. Furthermore, SB 1451 immunizes the attesting practitioner from liability for either providing or refusing to provide an attestation, unless they do so fraudulently.
- 103 and 104 NPs are required to advise patients that they are not physicians, and they are required to post written notice of their licensure through the Board of Registered Nursing. However, SB 1451 clarifies that 103 and 104 NPs are not required to specifically inform patients of their right to see a physician.
For physicians who are asked to provide an attestation for a 103 NP applicant, the liability protections afforded under SB 1451 should provide some reassurance- as long as the physician has either personally employed or served as the collaborating physician for the NP applicant, or has reviewed the NP’s employment records and confirmed their completion of the minimum 4600 hours of practice in California. For attesting physicians, MIEC recommends carefully reviewing NP employment records before drafting or signing an attestation and avoiding any statements as to the clinical competence or expertise of the NP to avoid potential liability exposure.