The California Medical Association (CMA) and its members continue to engage with state regulators over the implementation of a new state law (AB 890 – Wood) that gives nurse practitioners (NP) the ability to practice without standardized procedures and protocols.

Earlier this month, the Board of Registered Nursing’s (BRN) Nurse Practitioner Advisory Committee held an Interested Parties meeting. Dozens of physicians offered oral and written testimony emphasizing the need for a continued focus on patient safety and provider training as the BRN develops pathways for expanding NP practice authority. The BRN is tasked with creating rules and regulations for the new categories of nurse practitioner created by the new law. 

Throughout this process, CMA will continue to focus on the BRN’s responsibility to prioritize patient safety as it works to implement AB 890.

Currently, nurse practitioners are required to practice with physician supervision, but the level of supervision can vary depending on training and experience and across practice settings and specialties. As nurse practitioners are given more authority to practice without direct physician supervision, the state should protect patients by ensuring that NPs may provide care only in areas for which they have demonstrated completion of specified education, clinical training and competency milestones. CMA will continue to call on our physician members to use their voices to let the BRN know that NPs need to meet additional clinical training requirements to safely provide high-quality patient care in the absence of physician supervision.

NPs who choose to practice without physician supervision should be required to meet additional specified competency milestones within a structured transition to practice, beyond the current requirements for NPs practicing with physician supervision, and similar to the framework in which physicians are evaluated during postgraduate training.

This means creating new standards that require measurable demonstration of NP competency to practice without physician supervision. Allowing NPs to count any past work experience toward meeting the transition-to-practice requirement without establishing clear competency standards that evaluate their ability to care for patients without physician supervision will put patient safety at risk. Currently, there is tremendous diversity in quality of and participation in NP training programs. By ensuring robust competency standards, we can protect California patients.

If you have any additional questions about AB 890 or its implementation, please contact Juli Portola at jportola@cmadocs.org.