Nurse Practitioner Expanded Scope of Practice in California

Published on: February 16, 2023

Beginning in 2023, certified nurse practitioners can apply to practice independently in California.  Assembly Bill 890, which was signed into law in September 2020, went into effect on 1/1/23.  The law created two new categories of Nurse Practitioners (NPs) that can function within a defined scope of practice without standardized procedures.

The California Board of Registered Nursing (BRN)recently released the application on February 2^nd, so nurse practitioners are now able to apply for expanded scope of practice.

The two new Nurse Practitioner categories and their requirements are as follows:

103 NP

• Works under the provisions outlined in Business and Profession Code Section 2837.103
• Works in a group setting (a clinic, hospital, or medical group) with at least one physician and practices without standardized procedures within the population focus of their National Certification
• Must complete a 103 NP application: see https://rn.ca.gov/applicants/ad-pract.shtml#103np
• The following criteria must be met:

1. 1. Has been certified as an NP by the California Board of Registered Nursing.
   2. Holds a National Certification in a recognized population focus consistent with 16 CCR 1481 by a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and recognized by the Board.
   3. Has completed a transition to practice within the category of your National Certification in California of a minimum of three full-time equivalent years of practice or 4600 hours within 5 years of the date of your application.

104 NP

• Works under the provisions outlined in Business and Professions Code Section 2837.104
• May work independently outside of a group setting, including owning their own practice, and practices without standardized procedures within the population focus of their National Certification
• Must work as a 103 NP in good standing for at least 3 years
• Must complete a 104 NP application (implementation is pending in 2026)

Importantly, the above requirements mean that NPs are not automatically permitted to practice without standardized procedures; they must first apply to the BRN and receive certification to practice as a 103 NP.  Given the 3-year practice requirement, the BRN will not begin certifying 104 NPs until 2026.

As noted above, NPs must complete a “transition to practice” before qualifying as a 103 NP.  “Transition to practice” refers to additional clinical experience and mentorship provided to prepare an NP to practice independently. This includes, but is not limited to, managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice.

The transition to practice eligibility requirement is defined as 4600 hours or three full-time equivalent years of clinical practice experience and mentorship that are:

• Completed in California.
• Completed within five years prior to the date the applicant applies for certification as a 103 NP.
• Completed after certification by the Board of Registered Nursing as an NP.
• Completed in direct patient care in the role of an NP in the category in which the applicant seeks certification as a 103 NP.

The BRN verifies the transition to practice by contacting the physician who oversaw and provided the mentorship during the transition to practice period and asking the physician to complete an attestation.  The attesting physician must be competent in the same specialty area or category in which the NP is seeking certification as a 103 NP.

NPs can apply to work as a 103 or 104 NP in one of the six categories defined under 16 CCR 1481(a) in which they obtained their national certification.  The categories are as follows:

1. Family/individual across the lifespan
2. Adult-gerontology, primary care, or acute care
3. Neonatal
4. Pediatrics, primary care, or acute care
5. Women’s health/gender-related
6. Psychiatric-Mental Health across the lifespan

For NPs who hold additional specialty certification, it is important to note that expanded scope of practice only applies to the above national certification categories and not to specialty practice.  With respect to specialty practice, the BRN indicated that it is open to future discussions and potential rulemaking action(s) to address the inclusion of specialty practice areas within 16 CCR 1481(a).

Under the new law, 103 and 104 NPs may perform the following functions without standardized procedures in accordance with their education and training:

• Conduct an advanced assessment.
• Order, perform, and interpret diagnostic procedures.
• For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient.
• A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).
• Establish primary and differential diagnoses.
• Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
  • Diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources.
  • Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
  • Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
• After performing a physical examination, certify disability.
• Delegate tasks to a medical assistant.

The law requires 103 and 104 NPs to refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of a patient is beyond the scope of the education and training of the nurse practitioner.

The law requires 103 and 104 nurse practitioners to post a physical notice in a conspicuous location stating that the nurse practitioner is regulated by the Board of Registered Nursing.  The notice should state the following:

NOTICE
Nurse Practitioners are licensed and regulated by the Board of Registered Nursing
(916) 322-3350
www.rn.ca.gov

For more information on working with advanced practiced providers, and laws and regulations in other states, see The Use of Advanced Practice Providers in a Medical Practice.