California Scope of Practice

I'd have to start by saying that working in an in-patient setting, particularly in critical care at an academic setting in my case, would automatically make it so that I'm always going to be part of a team that includes physicians and daily collaboration is inevitable if not completely necessary given the patient acuity. However, I don't feel relatively restricted in my practice in this setting.

The law in California requires Standardized Procedure that can include as much detail as possible in terms of scope of clinical activities the NP performs. Also remember that in any state you go to, independent practice or not, provider privileges given to in-patient NP's are governed by Medical Staff Boards who make these policies. The medical staff leadership in our institution is quite supportive of non-physician provider inclusion and has been known for fostering interdisciplinary collaboration between providers so I think I'm lucky in that regard.

I'm sure there are extreme cases on the opposite sides of the autonomy spectrum. I've not worked anywhere else other than my current employer but have co-workers who have experience in other institutions in California. One co-worker did say that the environment is not as NP friendly in a previous setting (a posh, Magnet-designated, private hospital in Southern California) and this was also in a critical care role. Other co-workers' experience in critical care in two other Northern California institutions (both private hospitals but one is university affiliated) is mixed (private non-university affiliated = NP friendly, private university affiliated = has NP's but very restricted in role). There are in-patient NP's from California posting at a yahoogroup for Acute Care NP's and CNS' and it seems like it all depends on where you work.

You could ask these questions during an interview but it's also a good idea to get the lowdown from NP's on the team (if that's possible). Iv'e heard of colleagues who were promised that they would be trained to do this and that during an interview and came to find out later on the job that there was so much scut work and so little time to actually learn anything.

Hi Juan,

I've noticed you're very knowledgeable about NP practice in California. I am a FNP student graduating in August 2015 and I was considering moving to Southern Cali. I was reading about the furnishing license law in Cali and I was hoping you could explain a little more about that. If I were to get a job offer in Cali and I already obtained my California RN license and my NP national certification could I accept the offer and start working immediately? Am I allowed to work without the furnishing license?

You won't be able to work as an NP without an NP license from the California Board of Registered Nursing. National certification does not grant you practice privileges in the state but is certainly a step you will need to get an NP license.

You also can not furnish (California politically-correct speak for "prescribe") without a Furnishing License. I would accept the job offer with the agreement that they will hold the position for you while you wait for the frustratingly long time California processes your application for the required licenses.