Nurse Practitioner Scope of Practice: California

Californians have the luxury of sunny weather, year-round glowing tans and probable movie star sightings.  In keeping with their good fortune, let's kick off this state-by-state scope of practice series by reviewing rules and regulations governing the more than 17,000 NP's practicing in the The Golden State. 

California was among the first states to adopt the nurse practitioner role.  Since this time, California has embraced NP's as qualified medical providers and falls roughly in the middle of the spectrum of the level of independence it offers to nurse practitioners.  

California's Nurse Practitioner Supervision Laws

Sorry NP's, nurse practitioners practicing in California are not allowed to go solo.  State law requires that NP's practice in collaboration with a physician.  Each physician can supervise no more than four drug-prescribing NP's.  Collaborating physician's and nurse practitioners must have jointly-developed, written protocols covering all major elements of practice.  

In California, a nurse practitioner's charts do not need to be signed by the supervising physician.  This may, however be required by some insurance carriers.  The collaborating physician does not need to be in direct contact (i.e. the same building) with the NP.  Geographical distance required for supervision is not specifically addressed.  Nurse practitioners practicing in California are allowed to be formally recognized as primary care providers. 

California's Nurse Practitioner Prescribing Laws

The first thing every new nurse practitioner wants to do is prescribe drugs.  Fortunately, in California, NP's have this privilege...under physician supervision.  Nurse practitioners in California may order, administer, dispense and prescribe medications including schedule II-V controlled substances.  Yes, NP's in this great state are allowed to prescribe the good stuff- within a collaborative practice agreement. 

Unique Educational Requirements for Nurse Practitioners in California

Although nurse practitioners working in California cannot practice independently, they are still a pretty lucky bunch.  NP's in this sunny state are not required to take the national nurse practitioner certification exam.  Aspiring nurse practitioner's must complete a master's degree program approved by the state board of nursing.  Then, NP's must obtain either a state or national certification.  A word of caution- if you are planning to practice as a nurse practitioner in California, foregoing the dreaded national NP certification exam could affect your ability to bill insurers.

Other NP Scope of Practice Laws

It may seem simple to pronounce someone dead, however NP's in California are not allowed to sign death certificates.  This must be completed by a qualified MD.  Nurse practitioners in CA may not be able to declare someone dead but they are however allowed to sign handicap parking permits (sorry, must be for actual patients not friends and family).

Nurse practitioners in California have a favorable legal profile compared to many other states.  Although they must be supervised in their practice and prescribing abilities, their capabilities are only minimally limited.  Not to mention, the average salary for NP's practicing in California is a whopping $96,225.  

It is impossible to cover every last letter of the law governing nurse practitioners in California.  If you have any questions regarding your scope of practice, contact the California State Board of Nursing.

 

Comments

It seems like the author of this blog does not seem to like the idea of “Nurse Practitioners”

FYI, not all NEW NP’s would want to do initially is prescribe medications. Yes, we are privileged to prescribe all THE GOOD STUFF because we studied hard and are certified for it. And oh!! not to mention, we are not sorry to only sign for parking permits of ACTUAL PATIENTS and NOT FRIENDS and FAMILY.

Terry

Erin,

you said an NP can have their own practice in california as long as they have a collaborating psychiatrist/doctor. However I am concerned as I just read this on Medscape by Carolyn Buppert:
For nurse practitioners (NPs) in California, practice ownership is a bit more complicated than in other states. California has 2 potential forms of corporation: a nursing corporation and a medical corporation. Both have disadvantages. In a nursing corporation, any name or names under which the company renders professional services must contain the words "nursing" or "registered nursing."[1] A medical corporation must be at least 51% owned by a physician.[2]

and according to the medical board:
The following types of medical practice ownership and operating structures also are prohibited:

Non-physicians owning or operating a business that offers patient evaluation, diagnosis, care and/or treatment.

help?

Anonymous

Is there legislature pending to give the right to NP's to practice autonomously as they can in Colorado and Arizona and many other states? If so, any hunch on when the legislature is slated to get passed?

Robert

Hi Margaret,

Yes! You always need to document when you perform a procedure. 

Erin Tolbert

In Acute Care Hospitals, Does an NP' have to document when they perform a procedure such as intubation after they have met their competency?

Margaret

Hi Jennifer,

The collaborating MD must be licensed in CA if collaborating with an NP practicing and licensed in CA. 

Erin Tolbert

Can the collaborating MD be licensed in another state?

askbotanica@gmail.com

Jennifer

Hi D, 

Nurse practitioners in California can own their own practices. But, they are still required to have a formal relationship with a collaborating physician as well as abide by all other state scope of practice laws. 

Erin Tolbert

Can nurse practitioners own their own practice in California or is the most they can own is 49%? Thanks

D

Hi Erin,

Thank you for this tidbit of info! I am currently in the process of my MSN for FNP. I live in California and I've been looking for something a little less muddled than the official documentation found through the California BRN website (yikes!)... Thank you!

Carlo