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Nurse Practitioners in California – Essayfount

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Nurse Practitioners in California

Each state has a legislative and a regulatory stance on issues affecting advanced practice within its jurisdiction (Phillips, 2016).

One identified barrier to California Nurse Practitioner practice is scope-of-practice regulations requiring a supervising physician with written procedures governing the nurse practitioner’s practice (Spetz and Muench, 2018).

California has eventually joined the roster of Full Practice Authority (FPA) states, granting nurse practitioners full practice authority. The authority was granted by California’s governor Gavin Newsome, who passed bill AB-890 into legislature earlier this week. The bill was approved on September 29th and the move makes California the 23rd state in the U.S. to offer FPA to its nurse practitioners when it goes into effect in January 2023. The American Association of Nurse Practitioners (AANP) explains that the designation means that NPs practicing in those states do not have to partner with a physician and do not have oversight by the state’s medical board (like doctors do). FPA sees NPs as fully independent practitioners under their own umbrella–they’re not doctors, so they don’t follow doctors’ rules for oversight, but they can practice independently. Along with increased access to care, the AANP also lists these additional benefits to having full practice authority NPs:

· Streamlined care. Allowing FPA removes the delay in care that can occur when an NP must consult or work with a physician to deliver necessary care.

· Cost savings. NPs are more cost-effective in general, but FPA also avoids unnecessary service duplication.

· Upholds patient autonomy. Some patients prefer to work directly with NPs, and may even feel more comfortable sharing health care concerns with primary care NPs.

In California’s case, the bill outlines exactly how FPA will be granted and run through the California Board of Nursing. It requires the board to define the minimum standards necessary for a NP to transition to independent practice, and once that has been met, the NP can perform specific functions that include “ordering, performing, and interpreting diagnostic procedures, certifying disability, and prescribing, administering, dispensing, and furnishing controlled substances.”

I support the new California law pertaining to Transition to Practice (TTP) for California’s Nurse Practitioners which provides authorization for NPs to practice to the fullest extent of their education and training following an additional three years of practice beyond the TTP in all other settings (Phillips, 2020).


Nurse Practitioners in Nebraska

There are four Advanced Practice Registered Nurse (APRN) groups described by the Consensus Model for APRN regulations. Nurse Practitioners or NPs are one set of this group. An RN that has completed a graduate or post-graduate program to prepare themselves for practice within one of the roles may be called an APRN. Nurse Practitioners are one of these groups of APRNs (Joel 2018). In the state of Nebraska, a Nurse Practitioner has full practice authority as of 2015. They are able the most diverse group with approved certification for licensure in Nebraska. Nurse Practitioners are licensed to practice, then they can become certified in a specialty area. Approximately half of the NPs with certifications were in family practice (Nebraska DHHS 2019).

Nurse Practitioners in the state of Nebraska are required to practice a 2,000-hour transition-to-practice period in which they are supervised by a licensed MD or NP before they can enjoy their full practice authority. Nebraska requires a minimal level of a Masters’ degree to practice as an NP. They are encouraged to have a doctorate. They are also required to carry liability insurance, register for a DEA number, and have board certification in order to practice (Phillips 2021).

As a Nurse Practitioner in the state of Nebraska, there are several barriers to overcome. One is the increased need for healthcare by an increasingly aging population, and a decreasing primary care workforce, especially those in a specialty field (Hoebelheinrich 2019). Not all Physicians or other health care workers understand the extent of the nurse practitioners’ scope of practice. NPs can conduct a face-to-face evaluation of a patient, but due to Medicare regulations, they are not authorized to admit patients to nursing facilities or to do an initial certification for hospice care. Nebraska is a rural area, with Medicare regulations, for an NP to own an independent practice inhibits their ability for payment (Barnes 2018, Holmes 2019). I would consider all of these to be additional barriers to independent practice as a Nurse Practitioner.

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