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What it will mean for health care when California’s nurse practitioners get more freedom under new law

About nurse practitioners

What do they do?

Nurse practitioners provide a full range of primary, acute and specialty health care services:

• Ordering, performing and interpreting diagnostic tests such as lab work and X-rays

• Diagnosing and treating acute and chronic conditions such as diabetes, high blood pressure, infections and injuries

• Prescribing medications and other treatments

• Managing patients' overall care

• Counseling

• Educating patients on disease prevention and positive health and lifestyle choices

What kind of education do they need?

NPs must be a registered nurse, hold a bachelor’s degree in nursing, complete an NP-focused graduate master degree or doctoral nursing program, and successfully pass a national NP board-certification exam.

Source: American Association of Nurse Practitioners

What happens when there isn’t a family doctor in the house? Most likely, a nurse practitioner can help.

Whether it’s writing prescriptions, ordering tests or offering treatment options for patients with chronic conditions like diabetes, NPs perform much of the same work as family doctors.

But there’s a catch: NPs haven’t had the freedom to practice without a doctor’s supervision.

That will soon be changing, thanks to Assembly Bill 890, legislation authored by Assemblymember Jim Wood, D-Santa Rosa, designed to allow NPs to practice on their own. There are many provisions to the legislation, including NPs qualifying only after having worked for three years under a doctor’s supervision. But in its entirety, AB 890 will give NPs more autonomy than ever before. Gov. Gavin Newsom on Sept. 29 signed the bill into law, which will take effect on Jan. 1, 2023.

“For the past decade, there have been multiple attempts in the Legislature to make this change,” Wood said in a Sept. 29 press release announcing his bill had been signed into law. “During that time, it became obvious to me that we have a serious shortage of primary care physicians, so I dove into the issue – the need, the research and what other states have done – in order to come up with an appropriate process that can improve access to quality health care, especially in rural and underserved areas.”

California will join more than two dozen other states that already allow nurse practitioners more freedom when treating patients, he noted.

AB 890’s main opposition throughout the years has come from the California Medical Association, which advocates for physicians. Among the group’s gripes is its long-held position that allowing NPs to work without a physician on-site would result in a lower standard of care.

Specialized care

Nurse practitioners first came onto the scene in 1965, with their role and education levels evolving over the years. Today, an NP must be a registered nurse, hold a bachelor’s degree in nursing, complete an NP-focused graduate master degree or doctoral nursing program, and successfully pass a national NP board-certification exam, according to the American Association of Nurse Practitioners.

NPs focus on managing people’s health conditions and preventing disease. They often specialize in treating one segment of the patient population, be it pediatrics, adults or geriatrics. NPs with advanced certification may add a subspecialty, such as dermatology, cardiovascular health, women’s health or oncology, according to the association.

Passionate about the profession

Surani Hayre-Kwan, a nurse practitioner who since 2002 has practiced at Russian River Health Center in Guerneville, has had her eye on the profession since she was a child.

“I had always wanted to be a nurse practitioner,” Kwan said, recalling the NP who treated her while growing up in Marysville, in Yuba County. “I just fell in love with her as a provider. She was so warm and approachable. I learned how to spell ‘nurse practitioner’ even when I was 10 because I wanted to be (one).”

Kwan has been a registered nurse for 26 years, and a nurse practitioner for 18 of those years. She also works in management at Sutter Health, serving as director for professional practice and nursing excellence.

Kwan, who completed her advanced studies at Sonoma State University, has been involved with the California Association for Nurse Practitioners since her college days. She is a past president, and has served on the board of directors and on the policy committee. She was eager to see AB 890 become law.

“We have been working on practice issues for decades, looking at the option to remove standardized procedures, which is a really an administrative restriction on our practice,” Kwan said. “I always like to explain to the press and to legislators that nurse practitioners are not trying to do anything beyond what we're trained to do, ever. I am not a physician. I've never been a physician, and I have no interest in being a physician.”

Exemplary work

Every year, Wood and other Assembly members in the state honor someone from their district who stands out for their service to the community.

This year, Wood named Kwan “Woman of the Year” for his district.

“Today, I’m recognizing your commitment, compassion and dedication to providing high-quality health care as a nurse practitioner to individuals living in the North Bay area,” Wood told Kwan during a Sept. 10 presentation in front of her clinic. If this were any year other than 2020, Kwan would have been honored at a luncheon and event at the state Capitol.

About nurse practitioners

What do they do?

Nurse practitioners provide a full range of primary, acute and specialty health care services:

• Ordering, performing and interpreting diagnostic tests such as lab work and X-rays

• Diagnosing and treating acute and chronic conditions such as diabetes, high blood pressure, infections and injuries

• Prescribing medications and other treatments

• Managing patients' overall care

• Counseling

• Educating patients on disease prevention and positive health and lifestyle choices

What kind of education do they need?

NPs must be a registered nurse, hold a bachelor’s degree in nursing, complete an NP-focused graduate master degree or doctoral nursing program, and successfully pass a national NP board-certification exam.

Source: American Association of Nurse Practitioners

But she was quite fine just being recognized.

“I was totally shocked when he sent me a letter notifying me that I had been selected,” Kwan said. “It was completely unexpected.”

At what cost?

Among the reasons for the growing national shortage of primary care physicians is there aren’t enough new ones to replace the “significant percentage” of those retiring, Wood said. Rather, medical students are increasingly opting to specialize in one area of medicine because the income is higher, he noted.

Primary care physicians in California earn an average of $195,000 per year, while specialists bring home $284,000, according to Medscape’s 2019 physician compensation report.

Nurse practitioners, on the other hand, earn an annual income between $110,000 to and $125,000, depending on factors that include years of experience and level of education and certification, according to the nurse practitioner association.

“It’s actually more affordable to hire nurse practitioners,” Kwan said. “We cost less money, and we deliver very high-quality care.”

For these reasons and more, business coalitions, including the Bay Area Council, have supported giving more authority to NPs.

Good business sense

“From our members’ perspective, nurse practitioners practicing to the full extent of their training is sort of a win for everyone,” said Patrick Kallerman, research director at the Bay Area Council Economic Institute. “Our members are big buyers of health insurance for their employees, and they also want the best for their employees.”

Kallerman said research studies the institute conducted both last year and in 2014 found that giving full practice authority to nurse practitioners increases access and quality, and controls costs.

“So when you get down to brass tacks, which businesspeople often do, that's the bottom line and it's good for everyone,” he said.

Cheryl Sarfaty covers tourism, hospitality, health care and education. She previously worked for a Gannett daily newspaper in New Jersey and NJBIZ, the state’s business journal. Cheryl has freelanced for business journals in Sacramento, Silicon Valley, San Francisco and Lehigh Valley, Pennsylvania. She has a bachelor’s degree in journalism from California State University, Northridge. Reach her at cheryl.sarfaty@busjrnl.com or 707-521-4259.

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