CA NPs. have you seen bill text for AB890?

[thinbluelineRN, MSN, NP]

Wanted to get your thoughts on AB890. Here is a response from AANP.

The California Assembly voted to advance Assembly Bill 890 (AB 890) to the Senate on Tuesday, January 28. AANP has very serious concerns about the effects the bill would have on NP practice and patient care. At this time, AANP cannot support AB 890.

The current version of the bill moves NPs away from core principles and national standards for NP regulation. As amended, the bill moves NP regulation out of the Board of Registered Nursing, creates a new regulatory board that includes physician oversight, regulates NPs by setting, establishes new barriers and would disproportionately impact NP business owners and NP practices.

Here is a more detailed summary of the current version:

The bill does not remove physician supervision and standardized procedures for NP practice from all the necessary statutes that exist in California law. For example, under California law, a pharmacist may only dispense prescriptions written by NPs pursuant to requirements for NP prescribing within a standardized procedure. The current bill does not address this or similar types of issues.

The bill moves regulation of NP practice outside of the Board of Nursing to a new APRN board that includes physician oversight. In 2008 the APRN Consensus Model and over 40 Nursing organizations called for regulation of APRN practice to be exclusively under the state board of nursing. As amended, AB 890 would remove one of the few existing elements where California is currently well-positioned and in alignment with national standards.

AB 890 establishes a minimum transition to practice period of 3-years or 4,600 hours of "additional clinical experience and mentorship provided to prepare a nurse practitioner to practice without the routine presence of a physician and surgeon" for NPs providing patient care functions without standard procedures.

NPs would also be required to hold national NP certification, pass supplemental state examinations if required by the APRN Board, document specific education standards, and practice within physician-linked select settings. NPs who do not meet these criteria would remain under standardized procedures.

NPs outside of the specified physician-linked settings, such as NPs who own their own practices or work in NP offices, would be required to (1) meet the above clinical experience, certification, education and examination requirements, (2) hold an MSN or DNP degree, (3) complete an additional three years in practice beyond the 3-year or 4,600 hours transition period, and (4) have a plan for patient referral to a physician or surgeon. These regulatory burdens on NP businesses will significantly interfere with expanding access, opening new practices and clinics, and inhibit NP-businesses' ability to hire new NPs.

AB 890 would mandate the state to complete an occupational analysis of NP functions and determine whether the competencies required align with competencies tested by national NP certification boards. Based on that analysis, the new APRN Board could develop and require supplemental state examinations prior to authorizing an NP to provide the patient care functions without standardized procedures. This is an unnecessary expense to the state, inconsistent with the APRN Consensus Model, and creates a new barrier. National certification boards already undertake such reviews and align competencies with examination.

Adds new language to establish additional regulation of education program standards and requirements for clinical practice hours.

Require NPs to notify patients that NPs are not physicians or surgeons.

Require NPs use the standard phrase of "enfermera especializada." to describe the NP role to Spanish-speaking patients. Direct translation is "skilled nurse" or "specialized nurse".

Narrows and limits NP voting powers on committees, departments from the prior version of the bill.

Adds the new APRN Board to the peer review and reporting sections of the bill.

The current version of AB 890 does not contain provisions that would exempt or "grandfather" currently licensed NPs from any new education, examination or practice hour requirements developed by the new APRN Board established by the bill.

Across the country AANP is seeing a concerted effort on the part of organized opposition to move NP regulation away from the core principles of the APRN Consensus Model and push for physician regulatory oversight of the NP profession, base permission for an NP to practice on where NPs are employed or a practice setting, establish multiple years of residency-like supervised practice and create additional regulations that target NP businesses. It is concerning to see these elements in the current version of AB 890.

AANP knows that some states are able to make larger changes all at once and other states will need to take smaller, incremental steps. AANP has supported both types of progress. AANP will continue to dialog with our partners on the ground and look for opportunities to champion meaningful change that improves patient access to NP care. We will continue to inform California members of further developments as the bill moves forward.

[Corey Narry, MSN, RN, NP]

I'm not surprised that California would come up with such a proposal that adds regulation and creates just as much bureaucratic red tape as the existing NPA.

California, of course, followed the lead of other states that require NP's to have a minimum transition to practice period before removing the collaboration requirement.

I'm also not surprised that California proposes a separate APRN board with physicians on the panel. That's a concession made so that physicians would feel invested in this bill and not oppose it.

Also, I'm not sure what the correct Spanish translation for NP is. There must not be a word for it in Spanish. I have had an interpreter introduce me to a patient in similar ways which went something like "enfermero especializado en ciudados intensivos". I think roughly, that translates as critical care nurse or nurse specialized in critical care.

[Lienio Desouza, DNP, NP]

There is no correct translation for NP in Spanish. The word practitioner in Spanish is “medico” so the right translation would be “ enfermero medico”.

[FullGlass, BSN, MSN, NP]

I got an email from CANP that they are not going to support this bill. Personally, I'm ok with requiring a certain number of hours of practice before granting FPA because there are very few NPs who go through a residency. I think 2 to 3 years is reasonable.

I don't mind some MD involvement on a board regulating NPs, but the bill not says 50% will be MDs and I'm against that. I also think the BON should pick the MDs.

What is really bad about this bill is the idea of possibly having additional exams or whatever just for California NPs to get FPA. I am totally against that, We have a national exam and that is good enough.

[Lienio Desouza, DNP, NP]

I agree 10% with you.

[FullGlass, BSN, MSN, NP]

2 hours ago, Lienio Desouza said:

I agree 10% with you.

Only 10% ?

[Corey Narry, MSN, RN, NP]

Apparently CANP do support the bill: https://canpweb.org/advocacy/grassroots-resource-center/

Groups opposing are: CMA (big surprise!), CA BRN and CNA/NNU (our current BON and the CA Nursing Union because of the provision to create a separate Board of APRN).

The proposed APRN board will include 4 NP's, 3 Physicians and/or Surgeons, and 2 members of the public.

The bill now goes to the CA senate after the CA assembly passed it in January 27, 2020!

[Lienio Desouza, DNP, NP]

I meat to say 100%

[Alleson Clarens]

The changes to this bill (890) are so very disappointing. How have other states made the transition? What has been the most frustrating for me as a board certified NP in CA is the complete misconception and misleading definition of “MD supervision.” All opposing groups focus on the dangers of removing the MD supervision but do not clarify what this is. In my experience the MD signs a collaborative agreement and standardized protocols. And that is it!! I have never had any supervising MD actually see any of my patients or have any interest/idea how I am managing their care. By signing the collaborative agreement the MD is obligated to be available by phone if the NP decides to call. I don’t believe the public is aware of this fact or lawmakers either. The AMA makes it sound like the MD is providing direct supervision and has some impact on patient care. And no one mentions that the MD can collect $30,000 per year for each NP they supervise.. up to 4 NPs. That’s $120,000 per year for agreeing to be available by phone if the NP should decide to call. Would getting this information out help our cause? Thoughts? Comments?

[db2xs]

On 2/21/2020 at 7:42 AM, Lienio Desouza said:

There is no correct translation for NP in Spanish. The word practitioner in Spanish is “medico” so the right translation would be “ enfermero medico”.

Since there is no Spanish translation for NP, I usually introduce myself as the "practicante de salud" which isn't great either, but I feel that using "enfermero medico" is confusing or misleading. I read a suggestion that we should introduce ourselves as "un/a enfermero/a calificada para trabajar de doctora/medico" or "un/a enfermero/a calificada para ejercer la medicina." So many goddang words though! Argh ...

[umbdude, MSN, APRN]

On 4/10/2020 at 2:55 PM, Alleson Clarens said:

And no one mentions that the MD can collect $30,000 per year for each NP they supervise

Is it normally that high across all settings and states? I thought you only need that if you're not working under the same group as the supervising physician (e.g., you have your own practice, but need supervision on paper).

[Alleson Clarens]

In CA NPs must have an MD to practice in any capacity. We must have standard protocols and a collaborative agreement with MD. MD is allowed to collaborate/supervise up to 4 NPs at one time. I’ve seen NPs paying anywhere from $500 to $5000 for MD to sign on. I worked for a large corporation that paid my collaborating MD $30,000 per year for each NP and he always had 4! Another was private practice and he kept 60% of all my billing. Pretty good incentive to keep NPs from gaining independent practice.