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Barriers to Practice and the Impact on Health Care

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California is one of the handful of states in the U.S. where state practice and licensure laws restrict the ability of the advance practice nurse to practice to the full extent of their education (State Practice Environment, 2021). At this time, it is necessary to have career long supervision by a physician, in order for the advance practice nurse to provide care (State Practice Environment, 2021).

Currently, residency hours are not required for a nurse practitioner before they are able to practice independently in California, as a NP must be supervised by a physician throughout their career. However, recently, California passed AB890 where nurse practitioners will be allowed to full practice authority through a transition-to-practice process (Governor Signs AB 890 by Assemblymember Jim Wood Providing Full, 2020). This means that all nurse practitioners will be able to evaluate and diagnose patient’s, order and interpret diagnostic tests, initiate and manage treatments, and prescribe medications which include controlled substances (State Practice Environment, 2021).

In an article from Brusie (2020), this bill is scheduled to take effect in January 2023.
Because California presently offers a restricted practice environment for nurse practitioners, there are several barriers a nurse practitioner must face in California. According to research from E. Peterson, MS, APRN, AOCNP (2017), one of the most serious barriers is the limitation to access of medical care to state residents. This is because in California, the advanced practice nurse is not able to function as an independent provider, which limits the APN’s practice and limits access and quality of care delivered to the patient.

Research has connected these restrictions to lower amount of NP’s, less use of primary care services, and an increase in hospitalizations and visits to the emergency department (Spetz, 2018).
Brusie, C. (2020, October 5). California Grants Nurse Practitioners Full Practice Authority by 2023. Nurse.Org. https://nurse.org/articles/california-nurse-practitioners-full-practice/
E. Peterson, MS, APRN, AOCNP, M. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the Advanced Practitioner in Oncology, 8(1). https://doi.org/10.6004/jadpro.2017.8.1.6

Governor Signs AB 890 by Assemblymember Jim Wood Providing Full. (2020, September 30). Official Website – Assemblymember Jim Wood Representing the 2nd California Assembly District. https://a02.asmdc.org/press-releases/20200929-governor-signs-ab-890-assemblymember-jim-wood-providing-full-practice

Spetz, J. (2018, September). California’s Nurse Practitioners: How Scope of Practice Laws Impact Care. California Health Care Foundation. https://www.chcf.org/wp-content/uploads/2018/09/NursePractitionerScopePracticeLaws.pdf
State Practice Environment. (2021, January 1). American Association of Nurse Practitioners. https://www.aanp.org/advocacy/state/state-practice-environment

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