The Nurse Will See You Now: Nurse Practitioners Win Partial Autonomy in California

Nurse practitioners, who have more training and experience than registered nurses, are fighting for their right to treat patients with more autonomy in the workplace. Currently, nurse practitioners in California, among other states, must get approval from a licensed physician before administering treatment, but they argue this extra administrative step can slow down the caregiving process. Nurse practitioners must have a physician on hand, whether remote or in person, at all times in order to see patients.

Giving nurse practitioners the authority to expand their practice and treat patients on their own could help speed up the treatment process while increasing the number of providers and treatment centers across the country. However, doctors and physicians typically argue that this could endanger patients, considering nurse practitioners don’t have as much experience and training as physicians.

The coronavirus pandemic has intensified this fight, especially in California, where medical providers can be scarce. As the disease continues to ravage communities across the country, NPs say now is the time to expand their authority, so they can treat patients quickly and effectively without looping a doctor into the process.

California is the latest state to give NPs full scope of practice, but nurse advocates say the bill, AB 890, doesn’t go far enough.

Nurse Practitioners Fight for Full Authority

Currently, more than half of all states have laws on the books that give nurse practitioners full authority in the workplace, including Washington, Oregon, New Mexico, Arizona, parts of New England, and a few Midwestern states.

For NPs living in states with restrictions in place, the coronavirus crisis has been an administrative and logistical nightmare. They have had to get doctors to sign off on the smallest clinical changes even as the number of positive cases continued to climb.

When COVID-19 hit earlier this year, five states quickly removed legal and administrative barriers to give nurse practitioners full authority over their patients, including Kentucky, Louisiana, New Jersey, New York, and Wisconsin.

The move was praised by the American Association of Nurse Practitioners. AANP President Sophia Thomas, DNP, APRN, FNP-BC, PPCNP, FNAP, FAANP, said at the time:

“We have been hearing from frontline NPs in states with outdated regulations that it’s often easier to volunteer in other states than to serve in their own communities. In fact, some are being recruited away from the states they currently reside and practice in more inclusive practice environments, leaving patients at risk of little to no access to care. It’s more urgent than ever that the remaining governors act decisively to eliminate these needless barriers to care and unleash the potential of their state’s NP workforce to combat this pandemic.”

However, California, which is known as one of the most progressive states in the country, had still not passed such a bill, even as the state became a hotspot for COVID-19.

A Partial Victory for CA NPs

Six months into the pandemic and California looks as if it’s finally come around. According to Andrew Acosta, spokesperson for the California Association for Nurse Practitioners, proposals that would give NPs more authority in the workplace have come up three times in the state legislature since 2013.

Since then, it has become a divisive issue across the state. One of the bill’s main opponents has been the California Medical Association (CMA), a network of doctors and physicians. The group says patient care would suffer if NPs had full authority over their patients. They argue that these administrative hurdles are in place to protect patients.

According to a statement released by the group, “We strongly believe that physician-based care is the model that ensures the greatest patient safety and highest quality care for all Californians, regardless of income,” the statement reads.

They go on to say, “While proponents of AB 890 have said this legislation will help increase access to care, the data we have seen from other states that have eased supervision of nurse practitioners has not shown any meaningful improvement in access to care in underserved communities.”

The battle between NPs and doctors can also come down to gender. The overwhelming majority of NPs are women, while most doctors are male.

Many healthcare and public policy experts believe that giving NPs more authority in the workplace is one of the best ways to shore up the nation’s healthcare workforce, especially as older providers continue to retire in mass amid the pandemic.

Now, NPs may finally have their day in the sun. Governor Gavin Newsom signed the bill, AB 890, into law last Tuesday.

But There’s a Catch

After a long, arduous negotiating process, the bill doesn’t go as far as some would like. For one, it’s not expected to take effect until January 2023, likely long after the coronavirus has come and gone. It won’t make much of a difference on the ground anytime soon, but NPs can start planning for the day when they can see patients without physician supervision.

There’s another problem. NPs must work under physician supervision for at least three years before going off on their own.

Deb Bakerjian, a UC Davis clinical professor and nurse practitioner, says COVID-19 made it easier to pass this kind of legislation, but there were roadblocks and concessions along the way.

She commented, “In prior years, we were really going for full practice authority and we didn’t get it,” she said. “So, this is not a full practice authority bill, and that might be the reason why it passed.”

Hopefully, more states will help nurse practitioners unlock their full potential. The pandemic has shown us just how valuable providers can be. With expanded authority, many NPs would be able to go out into the field and set up their own practices, especially in rural, low-income neighborhoods where access to care can be scarce. 

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