Nurse Practitioner Scope of Practice: California

Californians have the luxury of sunny weather, year-round glowing tans and probable movie star sightings.  In keeping with their good fortune, let’s kick off this state-by-state scope of practice series by reviewing rules and regulations governing the more than 17,000 NP’s practicing in the The Golden State.

California was among the first states to adopt the nurse practitioner role.  Since this time, California has embraced NP’s as qualified medical providers and falls roughly in the middle of the spectrum of the level of independence it offers to nurse practitioners.

California’s Nurse Practitioner Supervision Laws

Sorry NP’s, nurse practitioners practicing in California are not allowed to go solo.  State law requires that NP’s practice in collaboration with a physician.  Each physician can supervise no more than four drug-prescribing NP’s.  Collaborating physician’s and nurse practitioners must have jointly-developed, written protocols covering all major elements of practice.

In California, a nurse practitioner’s charts do not need to be signed by the supervising physician.  This may, however be required by some insurance carriers.  The collaborating physician does not need to be in direct contact (i.e. the same building) with the NP.  Geographical distance required for supervision is not specifically addressed.  Nurse practitioners practicing in California are allowed to be formally recognized as primary care providers.

California’s Nurse Practitioner Prescribing Laws

The first thing every new nurse practitioner wants to do is prescribe drugs.  Fortunately, in California, NP’s have this privilege…under physician supervision.  Nurse practitioners in California may order, administer, dispense and prescribe medications including schedule II-V controlled substances.  Yes, NP’s in this great state are allowed to prescribe the good stuff– within a collaborative practice agreement.

Unique Educational Requirements for Nurse Practitioners in California

Although nurse practitioners working in California cannot practice independently, they are still a pretty lucky bunch.  NP’s in this sunny state are not required to take the national nurse practitioner certification exam.  Aspiring nurse practitioner’s must complete a master’s degree program approved by the state board of nursing.  Then, NP’s must obtain either a state or national certification.  A word of caution- if you are planning to practice as a nurse practitioner in California, foregoing the dreaded national NP certification exam could affect your ability to bill insurers.

Other NP Scope of Practice Laws

It may seem simple to pronounce someone dead, however NP’s in California are not allowed to sign death certificates.  This must be completed by a qualified MD.  Nurse practitioners in CA may not be able to declare someone dead but they are however allowed to sign handicap parking permits (sorry, must be for actual patients not friends and family).

Nurse practitioners in California have a favorable legal profile compared to many other states.  Although they must be supervised in their practice and prescribing abilities, their capabilities are only minimally limited.  Not to mention, the average salary for NP’s practicing in California is a whopping $96,225.

It is impossible to cover every last letter of the law governing nurse practitioners in California.  If you have any questions regarding your scope of practice, contact the California State Board of Nursing.