Introduction: Nursing practice requires specialized knowledge and skills attained through education and training in accredited institutions. The boards of nursing in each state have their requirements for certification and scope of practice. This essay discusses the scope of practice in the state of California and compares it with that of Florida.
Scope of Practice for The Advanced Practice Nurse (APN) in The State of California
The scope of practice for the advanced practice nurse in California is among the strictest laws in the United States. According to Montague (2020), the regulations require nurse practitioners (NPs) to have a written agreement with the supervising physician and make treatment decisions collaboratively with the physician. Notably, one of the Board of Registered Nursing (BRN) requirements is that NPs should practice under a physician’s oversight and comply with the standardized procedures established via teamwork with various healthcare disciplines such as administrators, surgeons, physicians, and nurse practitioners.
The standardized procedures provide NPs with the ability to do tasks that would otherwise fall under the practice of medicine. Additionally, NPs require accreditation from the BRN for prescribing or ordering medications or devices used in the standardized procedures in California (Montague, 2020). Generally, these supervisory agreements render physicians legally responsible for NP’s practice, and they determine the suitable level of supervision.
The state recently introduced some law changes under AB 890, effective from January 2023, which permits independent NPs’ practice after a transitional supervision period (Montague, 2020). Two categories of NPs created by this law function independently. However, if an NP does not want independent practice or does not meet the qualifications under this law for the two categories, they continue to practice their current agreements. The two categories are under sections 2837.103 and 2837.104 with special schooling, preparation, accreditation, governing requirements (Montague, 2020). This law expands the scope of practice of NPs such that they can practice independently without standardized procedures in any setting. The law allows them to open their own practice.
Comparison to Florida state practice laws for APNs
California compares to Florida in terms of supervision laws in that both states require physicians to supervise NPs. In Florida, a physician supervises NPs in at least four settings, excluding their primary practice setting (Toney-Butler & Martin, 2018). The physician does not have to physically avail themselves at the health setting for consultation but must be available via phone. Additionally, the state requires that patients receive notifications about the availability of physicians at a clinic. The stricter rule applies to speciality clinics where physicians can only oversee nurse practitioners in one health setting in addition to their primary practice settings, and they have to be at most 75 miles apart (Toney-Butler & Martin, 2018).
Also, both states require the nurse to meet certain competency standards to become fully certified to perform tasks within their scope of practice as per the state. Bushy (2019) establishes that registered nurses must demonstrate high competence and accountability in all aspects of practice, including suitable recognition, referrals, consultations, and appropriate interventions when complications arise.
In contrast with California, Florida NP prescribing laws do not allow them to prescribe controlled drugs despite a physician’s supervision. To prevent some practices from circumventing this law, the state created laws that bar NPs from using pre-signed physicians’ prescription forms and their DEA numbers on prescriptions (Toney-Butler & Martin, 2018).
Bushy, A. (2019). Laws and Rules Governing Nursing Practice in Florida. Retrieved from https://www.nursece.com/courses/129-laws-and-rules-governing-nursing-practice-in-florida
Montague A. (2020). Expanding scope of practice for nurse practitioners in California: AB 890 compromises to permit independent practice. California legislative beat. Retrieved from https://sourceonhealthcare.org/expanding-scope-of-practice-for-nurse-practitioners-in-california-ab-890-compromises-to-permit-independent-practice/
Toney-Butler, T. J., & Martin, R. L. (2018). Florida Nurse Practice Act Laws and Rules. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532859/
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