Assembly Bill 890, which took effect on January 1, 2023, essentially created two new categories of nurse practitioners.
It recently took Janette Grigg, a family nurse practitioner in Pasadena, six months to be able to secure an appointment with a physician for her annual physical exam. Grigg said as a result of a law – Assembly Bill 890 – the time of waiting for exams will be reduced because nurse practitioners will be allowed to perform them, as well as order lab tests, diagnose ailments, and prescribe medication without the oversight of a doctor.
“The added independence will be a great advantage for patient care. Right now, we’re limited because either the CMA (California Medical Association) or the insurance companies don’t allow most patients to be seen by nurse practitioners,” Grigg told Pasadena Now in December “With this opportunity, insurance is going to have to cover patients to be seen by nurse practitioners and patients will get in quicker. We’ll be able to facilitate. Most recently, Grigg added that the process for nurse practitioners to become independent has been streamlined by the California Board of Registered Nursing (BRN). “It’s (process) in place now and working,” Grigg said.
California’s nursing agency approved rules allowing nurse practitioners to treat patients without physician supervision. The approval, made in November 2022, is one of the last major steps necessary to implement the law, originally fully signed in 2020.
AB 890
AB 890, which took effect on January 1, 2023, essentially created two new categories of nurse practitioners. Starting in January, nurse practitioners who have completed 4,600 hours or three years of full-time clinical practice in California can apply for the first category – 103 NP. This will allow them to work without contractual physician supervision, but only in certain facilities where at least one doctor or surgeon also practices. The idea is that nurse practitioners would still be able to consult a doctor when needed.
104 NP – This second designation will allow nurse practitioners full practice authority without any setting restrictions. Nurse practitioners would be able to open their own medical practice. Given the phased-in approach, eligible nurse practitioners will likely obtain full independence around January of 2026.
Grigg, one of the people who worked towards getting the legislation passed, said the law will allow more nurses to provide more care, especially in the rural areas, and will allow nurses to start seeing patients immediately without the long wait. She noted that being under direct supervision of physicians has sometimes slowed down the delivery of care to patients.
“Primary care can open up, nurse practitioners can lead the way in getting patients in more quickly, getting all the tests and medications and therapies set up that they need done. Then patients will know if they need further care from specialties. So it’s very much a gateway opening up patients to have primary care, which is essential.”
“Every patient should be seen yearly for annual physicals, and those just shouldn’t be so hard to get. And nurse practitioners are very qualified to do annual physicals and set up all the further care appointments that patients will need,” said Grigg.
Of the 31,000 nurse practitioners in California, an estimated 20,000 will be eligible to apply for expanded authority in 2023, according to the California Association of Nurse Practitioners. Cynthia Jovanov, president of the California Association of Nurse Practitioners, said the new law creates an advantage for the communities and patients. “Now there’s more of us out there; we’re not being held hostage by a physician or a clinic that has a three, six month waiting period,” Jovanov said. “Now we could have another source, another clinic that can open up spots to see patients sooner and get the care they need faster. So that there’s not a delay.”
“This bill is not going to impact us negatively; it’s not going to impact our work – it’s actually going to relinquish that mandatory relationship from physicians so that when you are going to see your primary care provider, that the goal is that the insurance company will assign you to a nurse practitioner based on your decision if that’s what you choose to have. And so it gives options. This bill allows patients to have options.”
