October 13, 2020
Area(s) of Interest: Advocacy Scope of Practice
On September 29, 2020, Governor Gavin Newsom signed AB 890 into law changing the rules of physician supervision of nurse practitioners (NPs) for two newly created classifications of NPs.
"We are deeply disappointed that Gov. Newsom signed AB 890,” California Medical Association (CMA) President Peter N. Bretan, Jr., M.D., said in a statement on the bill’s signing. “AB 890 will do nothing to change the need for California to educate and train more physicians, nurses and other medical professionals. CMA will continue to fight to ensure that every California patient – regardless of race, economic or regional background – has access to a physician.”
There are many steps left before AB 890 is implemented, and CMA will remain engaged in the regulatory process.
To ensure that CMA members understand the potential effects of this bill, CMA has published a new fact sheet titled AB 890: An Overview for Physicians.
The fact sheet lays out the two new NP classifications – Section 103 NPs and Section 104 NPs – the new rules and criteria of those designations, and some of the processes that will still have to undergo regulatory structuring and review before the new law is implemented, including a new “transition to practice” requirement, and a review of additional education and examination requirements.
Under AB 890, new thew classifications are as follows:
- Section 103: NPs who meet certain educational and training requirements and are thereby authorized to perform specified functions without standardized procedures if they are practicing in a facility with a physician.
- Section 104: Section 104 NPs are permitted to work in a setting without a practicing physician if they meet additional requirements, including a master's degree in nursing or in a related clinical field and three years of practice in good standing as a nurse practitioner in addition to the transition to practice three-year requirement.
AB 890 directs the California Board of Registered Nursing to determine various standards and requirements including the definition of a “transition to practice,” the analysis of the nurse practitioner board certification, the addition of further necessary educational components and exams, and the establishment of an advisory committee that will make recommendations on matters relating to nurse practitioners, including education, appropriate standard of care and pending disciplinary actions. The new law specifies that the committee will have seven members – two of whom must be physicians with demonstrated experience working with NPs – four qualified NPs, and one public member.
The bill does not prohibit physician supervision and leaves room for interpretation regarding the role supervision can still play in the physician-NP relationship. Even if an NP who is authorized to practice as a Section 103 or 104 NP chooses to practice without standardized procedures, some degree of physician oversight or involvement is permitted, and in some cases required, by the new statute. It should also be noted, existing NPs are not impacted by AB 890 and must continue practicing under standardized procedures.
The requirement that a physician practice in settings where a Section 103 NP practices implies a physician oversight function. Further, the law requires that Section 104 NPs practicing outside of these settings consult with a physician pursuant to "individual protocols" and under other specific circumstances including at the patient’s request.
Significant provisions of AB 890 are ambiguous and necessitate additional clarification and guidance. The implementation of these provisions requires some level of physician involvement and, while not specified in the law, likely requires input and guidance from the Medical Board of California. CMA will remain actively engaged in the developments of these new policies and will continue to advocate for the betterment of the medical profession and access to quality and affordable care which we unequivocally believe keeps the physician as the central figure on the continuum of care.
Click here to see the new fact sheet on AB 890.