NP Scope of Practice Series: California

Key Takeaways

Generally, California is more restrictive for NPs than other states. The state dictates the majority of scope requirements. In California, NPs are unable to practice beyond the typical RN scope.

They have standardized procedures to perform overlapping medical functions. Only in specific situations and with specific authorizations can an NP perform medical functions beyond standard RN scope.

The state of California is a highly desired travel destination, especially as a locum tenens nurse practitioner. With sunny skies, endless beaches, and the always possible celebrity sighting, traveling to California is a no-brainer. To prepare for your potential assignment in California, we have provided everything you need to know. This includes information about the state-specific NP scope of practice laws.

Can Nurse Practitioners Practice Independently in California?

California previously restricted access to NP care. Physicians and NP had to enter a collaborative agreement for one or more elements of NP practice.

• The California NP collaborative agreement highlighted the areas in which NPs could practice.

Through Assembly Bill 890 (AB 890), California is now shifting to allow NPs to have full practice authority. Governor Gavin Newsom signed AB 890 in 2020. It created two new categories of NPs, 103 NPs and 104 NPs.

• 103 NPs work at locations with at least one practicing physician and surgeon. NPs do not need supervision but they can only work where they are practicing.
• 103 NPs can apply for 104 NP certification after at least three years. These NPs have full practice authority and can practice independently, without supervision.
• The California Board of Registered Nurses expects NPs to gain full practice authority by 2026.

Medical Staff Membership: Reduced

Under AB 890, nurse practitioners qualify for medical staff membership since 2023.

• This is specifically for 104 NPs, who will be able to vote at department/committee meetings.
• Regular NPs or 103 NPs may not qualify for medical staff membership.

Autonomous Practice: Reduced

In California, NPs work with supervising physicians as opposed to entering a collaborative agreement.

• Supervising physicians assume responsibility for the care provided.
• AB 890 is phasing out the nurse practitioner-supervising physician agreement in California.

Primary Care Provider: Full

State statutes and/or Administrative Code recognizes nurse practitioners as primary care providers.

• This allows the NP to see more consistent patients and takes the workload off the physician(s).

Nurse Practitioner Salary: $161,540

The Bureau of Labor Statistics reports that the annual mean wage for nurse practitioners was $161,540 as of May 2023.

Independently Prescribe Schedule II Drugs: Full

NPs can prescribe controlled substances in California. Prescribing medication is a crucial part of patient care.

• Some examples of schedule II drugs are oxycodone, fentanyl, and hydromorphone.

Order Physical Therapy: Reduced

Nurse practitioners can make referrals for physical therapy depending on the specifications of their collaborative relationship.

• This ensures patients will receive necessary treatment without seeing multiple healthcare providers first to get approval.
• Physicians may still have oversight on physical therapy orders by NPs.

Sign Death Certificates: Restricted

Nurse practitioners cannot sign death certificates. Only a licensed physician can sign death certificates.

Sign Disabled Person Placard Forms: Full

Nurse practitioners can sign disabled person placard forms.

• According to the AANP, “NPs know the challenges and frustrations of bureaucratic paperwork delays. Recognizing NP signatures on forms reduces costs and promotes efficient, timely care, and patient choice.”

POLST/POST/MOLST/MOST/COLST: Full

NPs may sign POLST forms in California.

• POLST, or Physician Orders for Life-Sustaining Treatment, is a medical form that travels with the patient. They are for communicating your wishes as medical orders.

Editor’s Note: This article was originally written by Chris Keeley in January 2020. It was updated by Desirae Sin in May 2024 to reflect current information.

Want to learn more about locum tenens with Barton Associates? Reach out to us today and one of our representatives will get in touch!