Nurse Practitioners Win Their Battle For Practice Expansion In Light Of COVID-19

California’s nurse practitioners will be able to provide patient care with less supervision from medical doctors under a bill signed by Gov. Gavin Newsom Tuesday.

Supporters of the move say these providers — who have more education and training than registered nurses— are crucial to reducing the state’s long-standing health care worker shortage, which experts say has become even more apparent during the COVID-19 pandemic.

As it stands, nurse practitioners must have a written agreement with a physician and must collaborate with them on treatment decisions, though the doctor does not always need to be there in-person to supervise. Nurses argue this model is cumbersome and slows down patient care. 

Ileana Meza, a nurse practitioner who works at the Los Angeles County + University of Southern California Medical Center, says she can’t perform simple steps like ordering a wheelchair for a patient unless a physician is available to approve it. 

She says she has had to ask patients to return to the office to see a physician after she has found a concerning growth during an exam. But the new law, she says, will make her care more efficient because she’ll be able to perform procedures to remedy such cases herself.

“Not only will it stop the patient from having to come back, we can utilize that slot for someone else to have access to care,” she said. 

She says she would still consult physicians and other team members when there’s something she needs help with.

“It’s not like I am going to now start doing brain surgery,” she said. 

Under the bill, the nurses will be able to independently diagnose patients, order and interpret tests, manage treatment, and prescribe medications.

More than half of states give nurse practitioners full scope of practice. At the start of the COVID-19 pandemic, five states removed legal barriers that restricted the nurses’ practice.

Proposals to expand the role of nurse practitioners in health care has come up three times in California since 2013, according to Andrew Acosta, spokesperson for the California Association for Nurse Practitioners.

“Ideally what we’ll see in a few years is nurse practitioners with their own clinics being able to open in rural parts of California or even inner city areas to provide primary care for folks who, at the moment, can’t get in to see a doctor because doctors aren’t taking them,” he said.

The effort has failed in the past due to opposition from physician groups, such as the California Medical Association (CMA) , which said patient care would be compromised if only managed by a nurse practitioner. 

The CMA released a statement that physicians were disappointed Newsom signed the most recent bill.

“We strongly believe that physician-based care is the model that ensures the greatest patient safety and highest quality care for all Californians, regardless of income,” the statement reads.

“While proponents of AB 890 have said this legislation will help increase access to care, the data we have seen from other states that have eased supervision of nurse practitioners has not shown any meaningful improvement in access to care in underserved communities.”

Many experts believe nurse practitioners are key to filling in the health care workforce. A report authored by a commission of California health scholars, hospital administrators and educators in 2019 listed an expanded role for  nurse practitioners as one of 10 priorities for easing shortages of medical professionals. 

Deb Bakerjian, a UC Davis clinical professor and nurse practitioner, said COVID-19 may have impacted the way lawmakers think about the issue.

“They maybe see the need for nurse practitioners to be able to practice more readily, because of the demand for care,” she said. 

But there were also many compromises made during the legislative process, she said. One of the amendments involves adding three years of working under physician supervision before a nurse practitioner goes out on their own.

“In prior years, we were really going for full practice authority and we didn’t get it,” she said. “So this is not a full practice authority bill, and that might be the reason why it passed.”

The bill does not fully take effect until January 2023.