It’s About Time: The California Board of Registered Nursing Proposes the First Updates to Nurse Practitioner Regulations in 30 Years

Although the changes do not affect the NP scope of practice, they do reflect an attempt to modernize the BRN’s regulatory approach toward NP certification. The public may send written comments on the proposed changes to the BRN by September 19, 2016. The BRN also will hold a public hearing on the proposed amendments on September 19, 2016, at 9:00 a.m., in Sacramento.

The proposed regulatory changes reflect an updated approach to NP qualifications, certification, and education, as they amend regulations that have not been updated since 1986. According to the BRN’s Initial Statement of Reasons, the amendments’ primary purpose is to ensure that NP education programs meet standards that will appropriately prepare students to practice safely and competently. To that end, the proposed regulations would, for the first time, increase the regulatory requirements for NP programs located within California. In addition, the regulations would update and provide greater detail as to the requirements that any BRN-approved program (in-state or out-of-state) would have to meet. Other proposed changes include revised and updated definitions, including a new definition for “primary care” that is more expansive and better reflects the approach to care in a “population health” environment.    

Very notably, and in what may be a disappointment to many NPs and others in the health care industry, the regulations do not alter the NP scope of practice in the state. Almost half the states in the United States allow NPs to practice independently; however, in California, the NP scope of practice is the same as that for registered nurses who are not NPs. California NPs are permitted to perform tasks that otherwise constitute the practice of medicine only under some level of supervision by a physician, using a standardized procedure adopted by the supervising physician or the facility where the NP practices.  

Scopes of practice are defined by statute and can be changed only by the California legislature.  Last year, a bill in the California Senate attempted to amend the NP scope of practice, allowing NPs to practice independently in certain settings. The bill died in committee, opposed by the California Medical Association and the California Academy of Family Physicians. So, although the BRN cannot change the NP scope of practice through regulation, the current proposed regulatory amendments seem to reflect a recognition that the role of NPs has broadened significantly in recent years, as NPs become more involved in providing and directing (under supervision) primary and acute care to patients in an increasingly wide-ranging set of environments.