California Scope of Practice

Advanced Practice Columnist / Guide · Aug 8, 2014

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.

chouxpastry · Aug 9, 2014

thanks for the reply, juan! i should have thought about the nature of inpatient care before asking my questions the recent discovery of a comparative wheel of state to state scope of practice laws plus input from seasoned NP have induced a bit of anxiety as to what the future holds. and while i've also noticed that the lines can "soften" so to speak under the careful supervision of a trusting physician, i don't want to count on being as lucky to find said physician(s). moreover, the institution i've had the pleasure of doing my rotations at is also unfortunately NP-unfriendly (placing additional limitations on its currently employed NPs...what i fear reflects CA's NP scope of practice laws). should i continue to worry? or is all this anxiety unnecessary?

Advanced Practice Columnist / Guide · Aug 9, 2014

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.

chouxpastry · Aug 10, 2014

interesting...the institution i'm speaking of is indeed a nice magnet private Southern California hospital. but apparently the opposite may also be true in other areas of california? it does seem like it all then depends on where you work. do you think it would be prudent to ask these questions in an interview?

Advanced Practice Columnist / Guide · Aug 11, 2014

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.

chouxpastry · Aug 11, 2014

thanks again, juan. the scenario what you described is exactly what happened to an acquaintance of mine - promised one thing, given another. well...guess i'll just have to do some research when the time comes.

coast2coast · Aug 17, 2014

In the outpatient setting, not at all. Inpatient really depends on the culture of the hospital, the specific service, and how much experience they have utilizing NPs. I have seen extreme opposites in SoCal for inpatient services, from micro-managed scut monkeys to ICU supervisors.

jessram · Dec 18, 2014

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?

chouxpastry · Dec 24, 2014

thanks for the reply, coast2coast :) and sorry for my late reply, I completely missed your post. It appears that you have quite some insight into the SoCal np market. I would love to pm you about this topic if that's ok with you :)

Advanced Practice Columnist / Guide · Dec 24, 2014

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.