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Revised bill on NPs' scope of practice advances in Calif. Assembly

Amendments spur AANP opposition

NEW YORK — A narrower version of a bill that would expand nurse practitioners’ scope of practice, as well as a bill that would expand the role of pharmacists, advanced in a California Assembly this week.

Senate Bill 491 by Ed Hernandez, D-West Covina, would establish independent practice for NPs, enabling them to perform all tasks and functions consistent with their education and training. Specifically, SB 491 would authorize NPs to practice to a fuller extent of their education and training, which includes diagnosing patients, performing therapeutic procedures, prescribing drugs and devices and making independent decisions in treating health conditions.

After failing to gain enough support in the Assembly’s Business, Professions and Consumer Protection Committee last week, Hernandez offered a water-down version of the bill.

The revised bill, which was passed by the Assembly on Tuesday, allows NPs to operate independently only in a hospital, clinic or other group setting. It removes a trail to independent practice without physician oversight after more than 6,000 hours of supervised practice.

The revision of the bill prompted The American Association of Nurse Practitioners to swing from support to opposition of the bill.

"The original legislation supported by AANP would have significantly improved healthcare delivery and increased access to care for millions of Californians by providing patients with full and direct access to nurse practitioner services. Unfortunately, recent amendments to SB 491 in the California Assembly Business, Professions and Consumer Protection Committee have dramatically changed the bill to a point where the state would not only retain the status quo, but impose added barriers to patients and the provider community,” stated AANP presidents Angela Golden and Kenneth Miller in a prepared statement.

"The amended bill would make it a crime for nurse practitioners to ‘supplant’ physicians and continue to require unnecessary oversight, negating workforce gains contained in the prior bill. These changes undermine the very heart of the legislation's original objectives, creating additional, unnecessary regulatory roadblocks just as national health care reform is necessitating that the industry streamline care delivery models. California would remain one of the most restrictive states for nurse practitioners in the nation. For these reasons, AANP has no choice but to actively oppose the revised bill,” the statement continued.

Expressing its support of the original legislation, the California Association for Nurse Practitioners stated that up to 7 million more Californians will enter the healthcare system with the implementation of the Affordable Care Act, putting significant pressure on an already strained delivery system. There are roughly 17,000 NPs licensed in California.

There are currently 17 states that allow NPs to practice at the full extent of their training and education with independent practice.

According to a Wall Street Journal report, proposed legislation that would grant NPs full practice authority also is pending in Pennsylvania, Michigan and Massachusetts. Meanwhile, a bill in New Jersey would give NPs autonomy after two years of collaboration with a physician or other advanced-practice nurse.

Hernandez is also the author of SB 493, which expands the scope of service for pharmacists, including independently administering some vaccines and providing certain nicotine replacement drugs and hormonal contraceptives.

The bills now move to the Assembly Appropriations Committee.

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