• Justin Hein

Governor Signs Law Permitting Nurse Practitioners to Work Without Physician Supervision

AB 890 passes with support from CANP but against wishes of the CMA.

On September 29, 2020, Governor Gavin Newsom signed AB 890 by Assemblymember Jim Wood (D-Santa Rosa) into law after it passed through both houses of the California Legislature with broad bipartisan support. AB 890 allows Nurse Practitioners to work without physician supervision. Twenty-two states and Washington, D.C. already allow nurse practitioners to work independently, and legislation similar to AB 890 is also being considered in Texas.

Current California law requires nurse practitioners, who hold masters or doctorate degrees in nursing and additional certification beyond a regular nursing degree, to always operate under a doctor’s supervision. The measure allows nurse practitioners to practice independently in 2023. This independent practice would include specified functions without standardized procedures, including ordering, performing, and interpreting diagnostic procedures, certifying disability, and prescribing, administering, dispensing, and furnishing controlled substances. Nurse practitioners would have to operate under a doctor’s supervision for a minimum three-year transition period before embarking on their own practices.

Gov. Newsom’s signature represented the culmination of a fight that has spanned several legislative sessions, pitting doctors groups against those that want to expand nurse practitioners’ ability to treat patients. California Medical Association (CMA) President Peter N. Bretan, Jr., M.D.,stated the following in response:

We are deeply disappointed that Gov. Newsom signed AB 890. 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. ... California still has a critical shortage of health care providers – including physicians – and AB 890 will do nothing to change the need for California to educate and train more physicians, nurses and other medical professionals.

The American Medical Association (AMA) also staunchly opposed the bill, urging Gov. Newsom to veto it. AMA Executive Vice President and CEO James L. Madara, MD, had sent a letter to Gov. Newsom similarly explaining that the bill “will not expand access to care in rural and underserved areas, increases overall health care costs and threatens the health and safety of patients in California."

The Association of American Physician and Surgeons (AAPS) had set up an online tool to tell Gov. Newsom to veto the bill.

On the other side, the California Association for Nurse Practitioners (CANP) organized the effort to support the bill and celebrated its passing and signing into law.

Throughout the legislative process, the CANP team worked tirelessly to bring to the forefront the severe and growing provider shortage in California and the important role NPs play in closing the health care gap by delivering quality health care for millions of Californians. We proudly led and activated the 80-plus member Close the Provider Gap coalition that provided research-based messaging and compelling details to lawmakers, the media, and the public about the many merits of this law.

The CANP also notes that there is still work to be done on the law, as it organizes the Nurse Practitioner Advisory Committee to advise on writing the implementing regulations.

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