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Industry insider insights from the professionals at UHC Solutions.

The Impact of Having No Physician Supervision for Advanced Practitioners in California

New data was just released within the state of California. We have the latest news on the impact of Advanced Practitioners not needing to have physician supervision moving forward! Keep reading to find out more!

New year, new rules: In November, California set new standards for advanced nurse practitioners. How will this impact California FQHCs and the NPs, doctors, and other clinical staff that serve in these facilities?

Why was the California Nurse Practitioner New Rule Necessary?

Before the November ruling, California was one of 22 states restricting Nurse Practitioners by requiring them to work within a physician’s oversight. The problem? The research shows the quality of NP care is just as good as the quality of physician care. These laws needlessly restricted our highly-qualified NPs from working to the top of their license. The California Health Care Foundation says, “A large body of research has linked such restrictions to a lower supply of NPs, poorer access to care for state residents, lower use of primary care services, and greater rates of hospitalization and emergency department visits.”

The new ruling is widely viewed as favorable. Advanced care nurses have long been viewed to expand the healthcare safety net, particularly in rural areas and to the underserved. This new ruling is a cost-effective way for FQHCs and other community healthcare providers to stretch limited resources at a time when staffing shortages still plague these communities.

What the New Rule for CA NPs Says

Advanced nurse practitioners are now allowed to work without physician oversight. The 2022 ruling was the final implementation of the 2020 Assembly Bill 890 scope of practice law for nurse practitioners. The hold up in the implementation of this ruling was that the Board of Registered Nursing had to determine how NPs would transition into their new role. Would additional testing be needed? Certifications?

The new law creates two NP categories. Beginning in January 2023, NPs who completed 4,600 hours or three years of full-time clinical work in the State of California can apply to work without physician supervision. However, the facility must have at least one practicing doctor or surgeon on-site. Cal Matters says, “The idea is nurse practitioners would still be able to consult a doctor when needed.”

After an additional three years within that group setting, NPs can apply for full practice authority with no restrictions related to the facility in which they operate. This second category puts most existing NP populations in California on a path toward full independence by 2026. According to Cal Matters, approximately 20,000 NPs will be eligible to apply for the expanded phase two authority by 2023.

What the Expanded CA NP Rules Mean to FQHCs

This new approach is a boon to the FQHC community in several ways:

  • The expanded scope of practice will likely attract more NPs to California.
  • The ruling allows FQHCs to hire more NPs without meeting doctor-to-nurse practitioner ratios.
  • The law could shore up staffing shortages. While it may be a finger on the dam crack, having more NPs is both cost-effective and patient-forward for the FQHC community.
  • Ultimately, the rule may increase access to care for our underserved populations.

Expanding the NP scope of practice is a win/win for our community. UHC Solutions is proud to represent California FQHCs in their efforts to attract more clinical and administrative talent. If you’re an advanced practice nurse looking to apply your skills, we can help! We partner exclusively with community healthcare organizations in their efforts to attract and hire the best industry talent. Call us to find out more.


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