The Board of Registered Nursing voted, at its last meeting, to issue proposed regulations implementing AB 890 (2020), which changes the physician supervision requirements for two newly created classifications of nurse practitioners (NPs). These regulations set minimum standards for “transition to practice” requirements for NPs seeking to practice without physician supervision. NPs can elect, but are not required, to transition to these new classifications.

These new NPs—commonly referred to as the 103 and 104 NPs—would be allowed to perform certain functions without standardized procedures and physician supervision. The AB 890 statute requires the Board of Registered Nursing (BRN) to create regulations that set minimum standards for the transition to practice requirements for candidates seeking certification as a 103 or 104 NP.

The California Medical Association (CMA) has stayed actively engaged in the regulatory process to ensure that physician voices are heard and that patient safety remains a top priority. CMA has submitted multiple comments throughout the process, including most recently submitting formal comments on the proposed AB 890 regulations.

Currently, all 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.

CMA appreciates that the newly adopted regulations clarify that the clinical practice experience required to become a 103 or 104 NP must be completed in the five years prior to the date the NP applies for the new certification. CMA also appreciates that clinical practice experience must be in direct patient care in the category the NP seeks certification. However, CMA remains concerned that the nursing board has chosen to recognize work experience completed prior to passage of the regulations, as this clinical experience was not directly in preparation for independent practice.

Throughout the regulatory process CMA has urged BRN to require a supplemental examination with a clinical component, and true to the statute, additional clinical experience and mentorship regardless of preexisting practice experience. CMA appreciates the physician leaders who participated throughout the process and voiced their concern at the BRN meeting.

While the BRN issued the proposed regulations without clearly articulated and comprehensive education and training requirements and standards, CMA will continue to monitor and advocate for stronger regulations that protect patients.

For more details, see CMA’s comments.