California Expands Nurse Practitioner Practice Authority

• An estimated 20,000 nurse practitioners will be eligible to apply for the first phase of expanded authority in California by 2023.
• Expanded nurse practitioner practice authority increases access to two of California's most needed services: primary care and mental healthcare.
• California's expansion of practice authority and high salary may not be enough for nurse practitioners who can get full-practice authority in many of the surrounding states.

Nearly 45% of Californians do not have enough access to primary care providers, according to Let's Get Healthy California. The expansion of nurse practitioner (NP) practice authority in California allows nurse practitioners to open their own practices or join existing practices in rural communities without worrying about physician agreements or physician-to-nurse-practitioner ratios. This expansion could increase access to healthcare for many Californians.

Dive into how California's expanded NP authority affects NPs in the state and nationally.

What This Means for Nurse Practitioners in California

Assembly Bill 890, signed by California Governor Gavin Newsom in 2020, gives nurse practitioners in California a pathway to full-practice authority. The law can go into full effect in January 2023 because the Board of Registered Nursing finalized the steps NPs will take to gain full-practice authority.

Beginning in January 2023, NPs who have completed 4,600 hours or three years of full-time clinical practice in the state of California will be eligible to apply for the first category of California's new expanded practice authority.

NPs can gain full-practice authority in two phases:

1. During the first phase, NPs work without physician supervision for three years at certain practices where a physician or surgeon also practices. The first phase allows NPs to practice independently, but they can consult a physician if needed.
2. After those three years, nurse practitioners gain full-practice authority without any restrictions. Nearly two-thirds of California's NPs could gain full-practice authority by 2026.

Nurse practitioners with full-practice authority can practice within the complete scope of their NP license without a supervising physician. They can:

• Diagnose patients
• Order tests
• Prescribe medications
• Perform physical exams

Full-practice authority under this law or any other law does not give NPs any additional duties outside of an NP license's scope of practice. Full-practice authority also does not remove the need for providers to collaborate with one another.

In fact, collaborating with physicians and other healthcare providers is part of the training to be an NP. For many NPs who choose to practice independently within a practice with other healthcare providers, collaboration will still play a major role.

What This Means for Nurse Practitioners Across America

Primary care and psychiatric mental health are the first and fourth most popular NP specialties, and they are also two of the services California needs the most providers.

• By 2028, California will have a 50% shortage of psychiatrists.
• By 2030, California will need between 78,000-103,000 primary care providers. Half of those will need to be advanced practice providers.

Granting nurse practitioners full-practice authority allows them to open their own practices in underserved areas without having to get a supervising physician. The expansion of practice authority also allows current practices to hire more NPs without meeting a physician-to-nurse-practitioner ratio. More nurse practitioners can lead to:

• Fewer wait times and delays
• Increased access to care
• Improved patient outcomes

California offers nurse practitioners the highest average annual salary in the country, according to the U.S. Bureau of Labor Statistics data from December 2022. However, the high average salary, $151,830 annually, and relaxed restrictions on practice authority may not be enough to attract the 4,100 primary care practitioners California needs.

Other western states such as Nevada, Oregon, and Arizona all offer NPs full-practice authority. Some have suggested that NPs may value the higher independence over the higher salary, which means California may still struggle to draw NPs away from their neighboring states to their underserved neighborhoods.

However, this new bill may start a trend of states loosening their restrictions on nurse practitioners' practice authority. States may wait to see if California successfully increases access to care with this bill before they follow suit. If California sees increased access to mental health and primary care in underserved areas, areas with more than 2,000 people for every one primary care provider, other states may pass similar laws so their residents can have increased access to needed health services.