Introduction
Nursing practitioners (NPs) responsibilities and opportunities vary between the states, and while in specific parts of the country, they are independent, the same activities are restricted in others. The scope of practice in California is a specific example of how the limitations severely impact healthcare quality. Practitioners face the demand for following standardized procedures, waste patients’ time waiting for physicians’ feedback for decision-making, and receive continuous education for prescribing medication (Peacock & Hernandez, 2020). This paper aims to explore and discuss Californian NPs’ scope of practice, restrictions, licensure obtaining, and the limitations on the state’s healthcare.
Level of Practice’s Independence
California’s scope of practice for NPs experiences changes now due to the growing demand for increasing their level of independence. AB 890, the Act which expands practitioners’ rights statewide, was passed by the government in 2020 to address the need for skilled personnel to manage the COVID-19 pandemic (Brusie, 2020). California is the state with restricted NPs’ scope of practice, and the limitations are related to different aspects. Practitioners must operate under physicians’ supervision, and the latter has legal responsibility for the former’s decisions (Brusie, 2020). Moreover, they must receive continuing education and furnishing number for making prescriptions and be certified by the Board of Nursing.
Aside from the practicing limits, Californian NPs must work according to the Standardized Procedure Guidelines (SPG). Indeed, SPG establishes the need for physicians’ involvement in certain activities, the methods to evaluate their effectiveness, and describe the algorithms of performance and records keeping (Legal Information Institute, n. d.). For example, secondary care SPG policy describes the type of diseases that demand it and includes a protocol a practitioner is authorized to use (Legal Information Institute, n. d.). In the instruction, the necessary reports to physicians and standardized procedures to assist a patient are described and must be performed.
Prescribing Authority
Californian legislation for NPs has specific requirements developed by the California Board of Nursing for getting authority. Indeed, practitioners must receive a Furnishing License and the DEA Number to prescribe Schedule II controlled substances (Cimiotti et al., 2019). The process to obtain the certification is complex, and even experienced NPs might not receive their license approval. Firstly, a practitioner must apply for getting the APRN Licensure and a Furnishing License, and, to expand prescription for using controlled drugs, the DEA number is necessary. Secondly, NPs must complete a continuing education course developed by the California Board of Nursing. Substances’ use, symptoms to address, and the distinctions between Schedule II type and others are learned in those classes, and a practitioner must attend at least 3 hours of studies to receive the license (Winter et al., 2021). Aside from taking time to complete, the course is paid to start from $250, making getting permission to expand prescription rights less accessible. Lastly, NPs need to make a written request to California’s Board of Nursing with the certificate from continuing education and furnishing license number attached.
Prescribing limitations for NPs in California make it challenging for them to timely provide high-quality care for patients in need. Furthermore, as per the Nursing Practice Act, they must operate under physicians’ supervision, adding unnecessary responsibility to the practitioners (Winter et al., 2021). The restricted authority also reduces access to healthcare because, in the areas where only the NPs are available, the number of prescriptions is limited by furnishing license numbers.
Practice Limitations
California is a state with the restricted practice for NPs because they can only operate under the physician’s supervision. Indeed, a practitioner must sign a formal agreement with a doctor who must review their activities and decisions multiple times every year. Only primary care can be performed without the collaboration of a physician (Cimiotti et al., 2019). However, the COVID-19 pandemic revealed the demand for expanding NP’s practice rights, and California joined the Full Practice Authority (FPA) states, announcing that practitioners would be able to perform fully by 2023 (Brusie, 2020). The need for physician supervision will be eliminated, making independent work possible with additional benefits such as improved quality of care and cost savings.
Restricted scope of practice is a serious challenge for many Californian NPs as it limits their career options, decreases care delivery quality, and negatively influences patient ethics. Indeed, practitioners might not get sufficient feedback or timely assessments from their supervising physician and miss job improvement opportunities as a result (Cimiotti et al., 2019). Then, the time necessary for receiving permission or waiting for doctors to involve might be dangerous for the client’s health and severely impacts the overall facility’s authority (Cimiotti et al., 2019). Lastly, the patient’s autonomy and nonmaleficence are threatened due to the NP’s obligation to involve a physician. The COVID-19 pandemic forced the regulators to take action towards expanding practitioners’ activities due to the need for an urgent reaction to the health challenge the nation faces today.
Obtaining Licensure Process in California
NPs must certify for advanced practice through the California Board of Registered Nursing for working at the state’s healthcare facilities. Furthermore, they must apply for additional prescriptive authority, complete continuing education courses, and gain sufficient experience submitted by a physician (Winter et al., 2021). Most of the national certification programs are approved by the Board, and having at least a master’s degree is necessary for obtaining licensure. The documentation for applying to become certified includes forms verifying an NP’s completion of the educational program, clinical experience and competencies, and the curriculum of the completed courses (Winter et al., 2021). Besides, obtaining licensure $75 fee exists in California and must be paid before applying for the certification. Once approved, practitioners do not need to renew their status because it automatically happens with the RN license update.
Certification and Education Requirements for Licensure
Licensure for NP’s in California has comprehensive certification and education requirements to follow before applying to the Board of Registered Nursing. Indeed, a practitioner must pass the national board exams and have a certificate from an educational institution with an accreditation from the National Commission for Certifying Agencies or the American Board of Nursing Specialties (The Department of Health Care Services [DHCS], 2021). Besides, NPs must check the recent regulations to clarify how their educational level and curriculum comply with the Board’s requirements.
Restrictions’ Impact
California is a state with restrictive practices, yet it is moving towards providing NPs with independence by 2023. Today, the existing limits create a massive challenge for the state because they decrease the accessibility to high-quality healthcare and disrupt practitioners’ operations. For instance, patient care has been severely impacted due to the restrictions in San Francisco during the emerging COVID-19 pandemic. Indeed, NPs who worked in the emergency departments could only provide the most basic and primary care, while prescribing or diagnosis statements required a physician’s approval (DHCS, 2021). These obligatory aspects took time, crucial for patients who needed help or transportation to other units.
The pandemic significantly impacted the way NPs perform in Californian healthcare facilities because of the demand for expanding their practice. Emergency departments at most organizations were used for primary care, and practitioners who worked there could not complete their work without physicians’ involvement (Cimiotti et al., 2019). Furthermore, the growing stream of new patients with infectious diseases and other issues forced many NPs to make decisions without supervisors, putting themselves at risk of losing their licenses.
The state has a sufficient number of clinics, and primary care is available for most citizens; however, the more complicated types of treatment are strictly limited by NPs’ practice regulations. Furthermore, patient access to healthcare varies between the areas: the central one has the most developed and well-equipped departments, while rural parts experience deficiency in the workforce, tools, and medication (Winter et al., 2021). California’s decision to update the regulations towards becoming the FPA state by 2023 is reasonable, considering the massive challenges the facilities and patients face due to the limits of NPs’ working abilities.
Restrictions and Healthcare Disparities
In a restrictive state such as California, NPs frequently provide care primarily for patients without insurance or under the Medi-Cal program who cannot afford a higher-standing physician’s assistance. The clients of that socioeconomic status represent healthcare disparities based on their age, race, gender, and prevalence of specific diseases. For example, hypertension (HBP) is a significant challenge, and its statistics for different race representatives vary (DHCS, 2021). DHCS (2021) states that “in both the California and Medi-Cal population, African Americans/Blacks were more likely to report ever being diagnosed with HBP” (p. 4). The established practice regulations for NPs severely impact the access to basic healthcare for the mentioned groups.
Conclusion
An NP must evaluate the scope of practice in the state they select because of the limitations and specialized licensing conditions at the legislative level. California is a state with restricted conditions, and although it updated the laws to establish independence, today, written collaboration with a physician, continuous education, and standardized procedures following are obligatory. The regulations severely impact healthcare quality as they decrease access to essential services and complicate addressing the disparities.
References
Brusie, C. (2020). California grants nurse practitioners full practice authority by 2023. Nurse.org. Web.
Cimiotti, J. P., Li, Y., Sloane, D. M., Barnes, H., Brom, H. M., & Aiken, L. H. (2019). Regulation of the nurse practitioner workforce: implications for care across settings. Journal of Nursing Regulation, 10(2), 31-37. Web.
Department of Health Care Services. (2021). Health disparities in the Medi-Cal population. Web.
Legal Information Institute (n. d.). Sec. 1474 – Standardized Procedure Guidelines. Web.
Peacock, M., & Hernandez, S. (2020). A concept analysis of nurse practitioner autonomy. Journal of the American Association of Nurse Practitioners, 32(2), 113-119. Web.
Winter, S., Chapman, S. A., Chan, G. K., Duderstadt, K., & Spetz, J. (2021). Nurse practitioner role and practice environment in primary and in nonprimary care in California. Medical Care Research and Review, 78(6), 780-788. Web.