Given California's shortage of primary care providers, nurse practitioners ("NPs") are increasingly being asked to fill gaps in provider coverage. With that background, Governor Newsom signed Assembly Bill 890 ("AB 890") into law in 2020. AB 890 allows NPs to practice with expanded independence under certain conditions. Although nearly two years have passed since AB 890 was enacted, regulatory and legislative delay have prevented full implementation of the law.
But that's expected to change soon. The Board of Registered Nursing anticipates the law will be fully implemented on or before January 1, 2023. So while no NPs are currently eligible for expanded practice authority, medical staffs would be well-advised to take proactive steps now to update their policies before the law becomes operational.
Overview of AB 890 and Current Status
AB 890 creates two new categories of advanced practice registered nurses ("APRNs") that can function within defined scopes of practice without "standardized procedures" previously required in the Nursing Practice Act. The law defines education, training, and national certification requirements for APRNs, and also expands medical staff governance rights for APRNs.
NPs are currently not eligible to practice under AB 890. The Board of Registered Nursing must first promulgate implementing regulations before NPs are eligible for expanded practice. On the legislative side, two bills have been introduced to clarify AB 890's application and expedite the process for APRN eligibility. Though both bills made have made headway 2022, neither bill has been approved by the Legislature or signed into law by the Governor.
Nonetheless, the Board of Registered Nursing believes it's on track to adopt implementing regulations for AB 890 by January 1, 2023.
Medical Staff Governance and Procedures Under AB 890
With AB 890's full implementation on the horizon, now is good time for medical staffs to make sure they're prepared. AB 890 touches on three core areas for medical staffs: scope of practice guidelines, medical staff governance, and peer review. Below outlines items that medical staffs should consider addressing in the months to come.
A. Scope of Practice Guidelines
Under federal law and Joint Commission accreditation standards, medical staffs must make credentialing recommendations based on objective criteria and in accordance with state law, including scope of practice laws and medical staff bylaws, rules, and regulations. AB 890 expands the scope of practice for APRNs, making them eligible for privileges and credentialing previously beyond their licensure. Medical staffs should begin reviewing their credentialing processes and standards in their bylaws, rules, and regulations to bring them in line with AB 890's practice expansion for APRNs.
B. Medical Staff Governance
AB 890 grants ARPNs expanded opportunities to participate in medical staff governance. Their participation in governance isn't required, but each medical staff has some leeway to involve ARPNs within certain parameters. All the same, medical staffs should review their bylaws and consider updates on (1) NP eligibility to serve on medical staff and hospital committees, (2) ARPN eligibility to attend department meetings, (3) ARPN rights to vote at department meetings, and (4) ARPN eligibility for medical staff membership.
C. Peer Review Discipline
Finally, AB 890 makes certain adverse actions against ARPNs reportable to the Board of Registered Nursing under Business & Professions Code section 805. While 805 reports usually trigger formal peer review hearing rights, AB 890 doesn't extend those same hearing rights to ARPNs. Instead, medical staffs can provide more simplified hearing procedures for disciplined ARPNs. Because of the substantial litigation risk in not providing a hearing, medical staffs should review their peer review policies to make sure they provide adequate procedure for APRNs subject to 805 reports.
Medical staffs that wait to update their policies and procedures to comply with AB 890 may find themselves behind the eight ball come January 2023. We encourage medical staffs to be proactive and work with counsel to identify appropriate updates to scope of practice policies, medical staff governance provisions, and peer review procedure.
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