AB890: Forthcoming Changes to NP Practice

Ron Billano Ordona, DNP, FNP-BC
President, Northern California Chapter 
Gerontological Advanced Practice Nurses Association

AB890: Forthcoming Changes to NP Practice 

The focus and motivation of a good number of 2020 legislation, both State and Federal, was the COVID-19 mitigation. With the threat of a surge and a healthcare system in crisis, legislators introduced several bills in the California Legislation this session to address the state’s response to the public health emergency (PHE). Some of these bipartisan bills included making sure essential workers have access to personal protective equipment (PPE) such as AB 275 (Pan), which will require health care facilities, e.g., hospitals and nursing homes, to maintain a 45-day surge capacity stockpile of PPE; as well as, AB 2537 (Rodriguez) similarly passed requiring hospitals to maintain a 3-month PPE stockpile.  

According to the Capitol Advocacy group (2020), expanding access to healthcare providers was another legislative priority this year, including AB 890 (Wood), which allows nurse practitioners (NPs) to practice without the supervision of a physician. It was the predominant scope of practice discussion this session involving healthcare provider groups, hospitals, labor, and other groups and physician groups. It is the first nurse practitioner independent practice bill that made it to and was signed into law by the Governor of California. Similarly, SB 1237 (Dodd), which allows nurse-midwives to practice independently in normal childbirth cases, made it to the Governor and was likewise signed into law.

Governor Newsom approved numerous bills in the healthcare space in September, ranging from minimum personal protective equipment (PPE) requirements, the scope of practice expansions, and expanded mental healthcare coverage. Other noteworthy bills signed by the Governor included (Capitol Advocacy, 2020): 

  • AB 1710 (Wood), which will expand the ability of pharmacists to conduct the COVID- 19 vaccine. 
  • SB 803 (Beall), which creates statewide standards for peer support specialists. 
  • SB 852 (Pan), which takes steps to implement Governor Newson’s idea to create a generic state prescription drug label by contracting with manufacturers. 
  • SB 855 (Wiener) will expand health care coverage for mental health and substance abuse treatment.  

AB 890 (Wood) was signed into law by Governor Newsom on September 29, 2020, and will be in effect on January 1, 2021. There are many more details of the law to be promulgated with the rule-making by the Board of Registered Nursing (BRN) that follows thereafter.  

NPs Practicing Without Standardized Procedures or Physician Supervision

AB 890 provides two avenues within which NPs can practice without standardized procedures and physician supervision: a setting-specific practice and an RN/NP-owned practice.  

Setting-Specific Practices

The scope of practice without standardized procedures will go into effect in 2021, but only after the BRN creates regulations required by AB 890 (2020) and the following provisions are met:

  1. The NP has passed a national NP board certification examination;
  2. The Department of Consumer Affairs, Office of Professional Examination Services (OPES) will complete an occupational analysis of NPs performing the functions in the scope of practice statute and will possibly create an exam to cover aspects of the scope of practice statute if the national NP board certification exams do not cover them;
  3. The NP must hold or maintain national certification from a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and those national certifications need to be recognized by the BRN;
  4. The NP provides documentation that the educational training was consistent with standards that have already been established by the BRN and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement in the new law.
  5. The NP must complete a California-based transition to practice (TTP) of three full-time equivalent years or 4600 hours, in which the regulations governing this TTP will be formulated by the BRN. Experience obtained before January 1, 2021, may count towards the TTP if those experiences meet the requirements established by the BRN.

If the NP completes the identified steps above and works in one of the six settings or organizations, the NP can practice without standardized procedures or physician supervision. Any of the following settings that have one or more physicians and surgeons in practice:

  • A clinic.
  • A health facility except for state hospitals or correctional treatment centers.
  • A medical group practice, including a professional medical corporation, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that provides health care services.
  • A home health agency.
  • A hospice facility.

NPs in Nursing Corporations

Currently, NP’s can create nursing corporations (Business & Professions Code Sections 2775-2781).  On Jan 2, 2023, an NP that meets all of the requirements outlined in the scope of practice without standardized procedures in a setting-specific practice will be able to practice independently with an additional three years of practicing in good standing (i.e., no discipline against the NP’s BRN RN license or NP certificate) in a setting-specific practice, for a total of six years (i.e., three years in TTP + 3 years practicing in good standing), to practice as an independent NP outside the setting-specific practices.  

Medical Staff Membership and Voting Rights 

This legislation allows the NP to serve on organized medical staff and hospital committees and adhere to all applicable medical staff bylaws in healthcare facilities. 

In setting-specific practices, the NP shall be eligible to attend the department's meetings to which the NP is assigned. The NP shall not vote at the department, division, or other meetings unless the vote is regarding the determination of NP privileges with the organization, peer review of the NP clinical practice, whether a licensee’s employment is in the best interest of the communities served by a hospital, or the vote is otherwise allowed by the applicable Medical Staff bylaws.

When an NP in a nursing corporation is eligible to join an organized medical staff after January 1, 2023, the NP will be eligible for voting rights at all department, divisions, or other meetings.

Referrals and Elevation of Care

An NP shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of a patient is beyond the scope of the NP's education and training. This is already an ongoing practice for NPs. NPs and other healthcare professionals cross-refer to each other, such as, to a specialist Cardiology clinic for uncontrolled hypertension or Physical Therapy and Occupational Therapy in the Skilled Nursing Facility (SNF) setting for evaluation of a safe discharge.

For NPs in Nursing Corporations, NPs in SNFs

Most NPs practicing in SNFs will fall under the category of NPs practicing within a setting-specific group; hence, they will not require standardized procedures and physician supervision after the BRN creates regulations starting in 2021. If the SNF NPs wish to create a nursing corporation, they will then practice as an independent individual NP or NP group in 2023, under certain conditions.  Currently, NPs must contract with an individual physician or with physician groups because the regulations governing SNFs requires that a physician may not delegate a task when the regulations specify that the physician must perform it personally, which includes the initial comprehensive visit in a SNF during which the physician completes a thorough assessment, develops a plan of care, and writes or verifies admitting orders for the resident. The Medicare regulation indicates that the physician may not delegate this initial comprehensive visit in a SNF. Non-physician practitioners may perform other medically necessary visits before and after the physician’s initial comprehensive visit (Centers for Medicare & Medicaid Services, 2013).


NPs being able to practice without standardized procedures and physician supervision will allow a more efficient SNF workflow. Physician colleagues will also benefit from the lessened workload and paperwork reduction. The streamlining of workflow in the SNF will benefit the facility and, more importantly, the patients in the long-term.

AB 890 is a significant step forward for NPs in California.  NPs in California have been working for over 20 years to get full practice authority.  While there are still regulatory rules that need to be created, NP practice now have the statute for full practice authority.


  • AB 890 Nurse practitioners: scope of practice: practice without standardized procedures (2020). https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB890
  • Business and Professions Code Div 2, Chap 6, Art 3.5, Sec 2775-2781 (1981). http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=BPC§ionNum=2775
  • Capitol Advocacy. (2020). California end of session update: Governor's actions (Capitol Advocacy Bulletin, Issue 76) [Policy brief].
  • Capitol Advocacy. (2020). California legislative session adjourns: Focus shifts to the Governor (Capitol Advocacy Bulletin, Issue 74) [Policy brief].
  • Centers for Medicare & Medicaid Services. (2013). Physician delegation of tasks in Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs) (Ref: S&C: 13-15-NH) [Memorandum]. CMS.
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