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.
