By Hamdy M. Masri
On August 31, 2021, and again on September 21, 2021, the Nurse Practitioner Advisory Committee, an advisory committee created by the Board of Registered Nursing pursuant to AB 890 (Wood) (Chapter 265, Statutes of 2020), met to discuss the criteria and terms delineated in sections 2837.191, 2837.103, and 2837.104 of the Business and Professions Code. The legislature added these sections in 2020 pursuant to AB 890, which created two new categories of nurse practitioners, referred to as 103 and 104 Nurse Practitioners (NPs), in alignment with the code sections that created the designations. [26:1 CRLR 63–64]. During the meetings, NPAC members set forth the Committee’s purpose: to provide the full Board with recommendations for regulatory language creating licensing requirements for 103 and 104 NPs.
Business and Professions Code section 2837.101 requires the Board to define, through regulation, a minimum transition to practice requirement for 103 and 104 NPs. Business and Professions Code section 2837.103 allows certified 103 NPs to practice without standardized procedures in specified healthcare settings where physicians practice. This provides an opportunity for a new baseline scope of practice that does not require standardized procedure. Certified 103 NPs who earn an additional three years of licensed practice will qualify for a 104 certification. Business and Professions Code section 2837.104 allows 104 NPs to practice without standardized procedures in settings where physicians do not practice. The legislation allows the Board to lower the three-year licensed experience requirement for a nurse practitioner holding a Doctorate of Nursing Practice (DNP) if they elect to do so.
With respect to the minimum transition to practice requirement, NPAC discussed and recommends a grandfathering clause for experienced nurse practitioners and 4,600 hours of mentored practice requirement by a physician or NP. NPAC also recommends an attestation of supervision form [Agenda Item 6.0] and that a clinical competency committee be required to attest to the competency for a 103 NP to practice independently. Additionally, NPAC passed a motion to advise the Board to reduce the three-year requirement for DNPs by an hour-to-hour ratio of inpatient care experience, provided that the experience was in the specified field they are seeking certification in.
Business and Professions Code section 2837.105 requires the Board to request the Office of Professional Examination Services (OPES) to perform occupational analysis of Nurse Practitioners to determine if supplemental examination is necessary and if so to create it. OPES presented updates to NPAC at the September 21, 2021 Committee meeting; they are required to complete their analysis by January 1, 2023.
The Board is behind on its projected notice publication date (projected August 2021), and projected public hearing date (projected September 2021) regarding rulemaking on nurse practitioners’ scope and practice. On October 26, 2021, NPAC will hold an interested parties meeting to take public comment on these topics. NPAC is scheduled to hold its next meeting on November 16, 2021, and the full Board will meet on November 17–18, 2021.