For the past decade there has been multiple attempts to award full practice authority to Nurse Practitioners in California. On September 29, 2020, AB290 was signed into law by Gavin Newsom and Assembly member Jim Wood (D-Santa Rosa) finally making full practice authority a reality. The serious shortage of primary care physicians was the main driving force catapult this law in order to improve access to quality healthcare.
“A significant percentage of physicians are over retirement age and new physicians are not keeping up with the need,” said Wood. “Of course, we can increase funding for medical residencies and loan repayment programs, and I have always supported those, but the reality is it’s not only an expensive solution but the number of residency programs will never be enough to meet the current and future need in California.”
A majority of physicians practice a specialty where incomes are usually higher. Nurse Practitioners are often found working in underprivileged rural areas. “Quality of Primary Care by Advanced Practice Nurses: A Systematic Review,” have concluded that nurse practitioners provide care of comparable quality as physicians, even when practicing without physician oversight.
On February 19, 2019 a final report was released by the California Future Health Workforce Commission which addressed the states shortages of primary care and behavioral health providers. The expansion of the Nurse Practitioner role was on the top 10 list. More than 80 organizations supported AB 890, including individual physicians.
The History Of The Nurse Practitioner Profession
Currently, there are more than 290,000 licensed nurse practitioners in the United States. Back in 1965, the United States expanded their Medicare coverage to include low income women, children and the elderly. At this time the US was experiencing a physician shortage particularly in urban areas servicing children.
Loretta Ford, EdD, PNP, FAAN and Henry Silver MD were called to action and founded the first NP program in 1965 at the University of Colorado. It became a master’s degree program in the early 1970’s. The U.S. federal government contributed money to NP education in 1987 and spent $100 million.
Although the NP profession continued to grow, Nurse Practitioners did not have full provider status in the eyes of the federal government and were not eligible for reimbursement. NP’s continued to fight to legitimize their profession. The role of the Nurse Practitioner has become important as more patients are covered by The Affordable Care Act and more states grant NP’s full practice authority. Today, 82.9% of full-time NPs are accepting Medicare patients and 80.2% are accepting Medicaid patients.
The term “Full Practice” means state practice and licensure law provides for all Nurse Practitioners to evaluate patients, perform diagnostic tests, initiate and manage treatments, including prescribing medications under the exclusive licensure authority of the state. Full practice authority varies in every state and due to tireless legislative advocacy, the state practice environments are constantly evolving.
What Nurse Practitioners Offer
Along with increased access to care, the AANP also lists these additional benefits to having full practice authority NPs:
- Streamlined care. Allowing FPA removes the delay in care that can occur when an NP must consult or work with a physician to deliver necessary care.
- Cost savings. NPs are more cost-effective in general, but FPA also avoids unnecessary service duplication.
- Upholds patient autonomy. Some patients prefer to work directly with NPs and may even feel more comfortable sharing health care concerns with primary care NPs.
California is the 23rd state in the U.S. to offer full practice authority to its Nurse Practitioners when it goes into effect in January 2023. AB290 requires the California Board Of Registered Nurses to define the minimum standards for an NP to transition to independent practice and once that has been met the NP can perform specific functions “ordering and performing and interpreting diagnostic procedures certifying disability and prescribing, administering, dispensing and furnishing controlled substances.” Full practice authority details vary from state to state. It’s best to contact the local boards of nursing to find out more regarding practice, prescriptive licensure, Practice acts and other details.
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