Proposed Regulations Bring California Nurse Practitioners Closer to an Independent Scope of Practice

In a notice dated September 6, 2022, the California Board of Registered Nursing (BRN) released a Notice of Proposed Action to Article 8, Division 14 of Title 16 of the California Code of Regulations (CCR). The proposed regulations would add sections 1482.3 and 1482.4 of the CCR. 

These regulations have been long-awaited following the passage of Assembly Bill 890 (AB 890) in September 2020. As we previously reported in our Health Care Counsel Blog, AB 890 amended the Nursing Practice Act, broadening the nurse practitioner (NP) scope of practice and allowing for greater NP independence. Specifically, AB 890 created two new categories of NPs under California Business and Professions Code section 2837.103 and 2837.104. The new categories of NPs — referred to as Section 103 NPs and Section 104 NPs — can function independently within a defined scope of practice and without standardized procedures. However, no NP could qualify for these new categories until the BRN issued implementing regulations required by AB 890.

The Proposed Transition-to-Practice Standards

The BRN’s proposed regulations address several AB 890 mandates, including the application process to become a 103 NP or 104 NP, minimum qualification requirements, and certain protocol and notice requirements. 

However, the most anticipated provision in the proposed regulation is the “transition to practice” definition.  

AB 890 requires NPs to complete a “transition to practice” to qualify for the expanded scope of practice as a 103 NP or 104 NP. “Transition to practice” is not defined in statute; rather, the BRN was tasked with defining in regulation minimum transition-to-practice standards. Under the proposed regulations, the “transition to practice” requirement would consist of a minimum of “4600 hours or three full-time equivalent years of clinical practice experience and mentorship” that meets all of the following requirements:

• Completed in California;
   
• Completed within five years prior to the date the NP applies for certification as a 103 or 104 NP;
   
• Completed after certification by the BRN as an NP; and  
   
• Completed in direct patient care in the category in which the NP seeks certification (these categories are defined in section 1481(a) of the existing regulations).

Additionally, to qualify as a 104 NP, the proposed regulations include an additional requirement that the NP has practiced as a 103 NP for at least three full-time equivalent years or 4600 hours in direct patient care.

Next Steps

Because the regulations are not yet final, no NP has been able to meet the qualifications for the expanded scope of practice. Pending their adoption, the release of proposed regulations defining the transition-to-practice standards brings NPs closer to an independent scope of practice in California. 

The BRN is accepting written comments to the proposed regulations, due by November 1, 2022, at 5:00 PM.