California NP's

TheOldGuy · Apr 6, 2013

The thing is, with both CMA and CNA opposing, this bill doesn't have a chance. Someone asked "what is wrong with this state?" - I think the question is "what is wrong with nursing?"! Nursing is like a pot of crabs on the stove - when one tries climbing out, the others pull it down.....

CNA/NNU want to be in control and if they aren't then they oppose things. They get involved in areas that have nothing to do with nursing (eg gay marriage - Projections Inc Blog), and don't really promote the development of nursing as a profession.

This bill does everything we would want - and the timing is perfect. Kudos to Hernandez. Too bad its going nowhere - and it will be years before the issue is brought up again. CANP has no juice - They didn't propose it. They didn't champion it. They aren't out lobbying for it. They aren't trying to generate public support for it. It took an OD (Hernandez) to bring this bill forward, and he's all by himself.

myelin · Apr 6, 2013

this is so depressing. Guess I'm moving when I graduate.

Advanced Practice Columnist / Guide · Apr 7, 2013

But if they were still NP's that were employees of a hospital or larger healthcare organization, couldn't they still be members of the union? I understand if they are in independent practice and owning their own clinic that partaking of the union might not make sense

That is true in theory. Many hospital based NP's in CA are union members (UCSF, Stanford, Kaiser in the Bay Area). If this bill becomes law, there's no stopping these hospitals from changing the employment arrangement from a hospital employee to a contract status with the medical group like physicians if the NP's are going to be independent. There are NP's where I work who are non-union already. I think unions like to have the numbers...it strengthens their power to negotiate. Is the opposition a way to stick out for NP's best interests? no, it does protect the union from losing membership.

Advanced Practice Columnist / Guide · Apr 7, 2013

If you're a CANP member, you would have already gotten an email about this bill. The next step is for the Senate's Business, Professions, and Economic Development Committee to look at the bill. There are nine senators in that committee: Corbett, Padilla, Wyland, Yee, Price, Block, Hill, Emmerson, and Galgiani. A form letter has been emailed to CANP members and all one has to do is fill in one's name and information on the form and a message is sent automatically to the senators. Unfortunately, I can not post a link to that letter because it shows my personal information on the link.

Is it OK to be pessimistic and do nothing about this bill? On one hand, the nursing union in California have offered no support and the physician's group through the CMA is just laughing at this move by the union. The physician lobby need not make a statement it seems - the non-support of CNA speaks for itself. Unions have a strong lobby and the current California legislature favors having the unions on their side. The overwhelming argument in support of this bill is it will greatly help with the Affordable Care Act by making patient access to primary care services more streamlined. Senator Ed Hernandez has been an NP ally. He is responsible for the law that eliminated physician supervision as a requirement for NP's obtaining a Furnishing License.

TheOldGuy · Apr 7, 2013

I'm not saying to do nothing....I'm just saying that I don't think the bill has a snowball's chance in you know where. I'm still up for trying though!

I am very frustrated with CANP and am no longer a member. Sending an email to CANP members with a form letter is hardly lobbying! A couple of years ago I went to their lobbying day event - what a joke! I spoke with them at that time about scope of practice. They were totally intimidated by the all out effort that CMA made the last time this issue came up.

In the states that have been successful in expanding scope of practice (and as you know California doesn't even have a defined scope!), a concerted effort involving letter writing, media advertisement, and boots on the ground lobbying was necessary.

Advanced Practice Columnist / Guide · Apr 19, 2013

Update:

CNA/NNU no longer lists SB 491 as a bill they are opposing. They are, however, not listing it as a bill they are supporting either.

California Legislation | National Nurses United

myelin · Apr 20, 2013

Interesting. A step forward?

Advanced Practice Columnist / Guide · Apr 20, 2013

Not really sure, committee hears the bill on Monday, April 22.

Advanced Practice Columnist / Guide · May 16, 2013

Update:

SB 491 successfully passed two senate committee hearings but the hurdle is far from over. The real test is when it is heard by the full California Senate on May 31. As of the current time, only CANP is active in pushing this bill forward. They are asking for assistance for NP colleagues in California to write letters to their senators or join the CANP as a member.

Advanced Practice Columnist / Guide · May 30, 2013

From CANP:

Senate Bill 491 (Hernandez) was passed by the State Senate on May 28. The proposal to remove practice barriers for nurse practitioners in California, allowing them to work autonomously without physician supervision, will now move to the State Assembly for consideration.

The measure was approved by a Senate Floor voice vote of 22-12 (see the final individual vote tally). In response to concerns raised by a number of Senators, Senator Hernandez agreed to consider a number of amendments on the Assembly side. CANP will continue to engage in these discussions along with other stakeholders.

Many thanks to the thousands of CANP members and allies who utilized our Grassroots Action Center to send nearly 15,000 messages of support to Senators during the bill’s progression through the upper house. The process will begin anew next month, when the bill is referred for its first Assembly policy committee hearing. Stay tuned for details on how you can play a role in advocating on behalf of this crucial legislation.

...if you are a practicing NP in CA, you have a role in helping push this bill forward. We all work with physicians and many of them receive messages from their professional organization spreading fears of how this bill would affect their practice. Have a strategy explaining how an environment where NP's practice without formal requirement in the law for supervision would be like. It has been positive in states where NP's are independent and it shouldn't be different in CA.

TheOldGuy · May 30, 2013

WOW! I am shocked, amazed and happy to have miscalculated!!

We're not completely there yet but.....! There are indications that Hernandez is looking to amend the bill to require NPs to be affiliated with a medical group/HMO....in essence replacing one barrier to practice with another....if you feel that is not a good thing then please share your concerns with Sen Hernandez...and your assemblyman.....!

LuxCalidaNP · Aug 2, 2013

UPDATE! The CANP has released this most recent updates to the amendments before this gets voted on in Assembly on Aug. 6th:

Under the first pathway, NPs who are nationally certified and have at least two years of physician supervised experience prior to the bill’s enactment date will be able to practice autonomously if they are working in a community clinic, hospital, skilled nursing facility, or medical group.
Under the second pathway, NPs who are nationally certified and have at least three years of physician supervised experience prior to the bill’s enactment date will be able to practice autonomously if they are working in settings other than those described in the first pathway. NPs practicing under this pathway must maintain a current list of licensed health care providers most often used for the purposes of obtaining information or advice.
What do ya think, ya'll?