California Nurse Practitioners Granted the Right to Practice Independently


After years of lobbying by nurse practitioners in California, a bill allowing them to practice without being under medical practitioners’ supervision was signed into law on 29 September. The law will come into effect in 2023.

Under the new legislation, nurse practitioners will join those in 40 other US states, which allow for either full or partial autonomous practice. They have welcomed the development they believe will significantly contribute to providing health care services, especially primary health care for low-income and underserved rural communities.  

Nurse practitioner lobbying

California is the US state with the largest population and a survey in 2014 showed that there were only around half the number of primary care doctors available compared to federal recommendations.

Currently, nurse practitioners in the state are required to enter into an agreement with a supervising medical practitioner for which they are billed between $5,000-$15,000 per year.

Previous bills for full practice authority, in 2013 and 2015, had failed. With strong lobbying for nearly two years by a coalition headed by the California Association for Nurse Practitioners, both California legislature houses passed Assembly Bill 890 with an overwhelming bipartisan majority.


Lawmakers and lobbyists believe that the COVID-19 pandemic contributed to the eventual success of the bill. It highlighted the shortage of healthcare providers in primary health care and changed the health care landscape.

However, as in the past, the medical profession, and especially the California Medical Association, had vehemently opposed the bill. Despite extensive research-based evidence supporting nurse practitioners’ quality of care, they argued that the law would compromise patient safety. The new California law for nurse practitioners contains various restrictions which were a concession to the strong doctors’ lobby.

California nurse practitioner legislation

In terms of the law, the Board of Registered Nursing in California has to appoint a commission to oversee its implementation of the legislation and specify the minimum standards. Nurse practitioners from other states might be required to pass additional testing.  

Upon completing the educational requirements to qualify as a nurse practitioner and obtaining national certification, nurse practitioners in California will have to transition to practice. This means that they will have to work a minimum of three full years under the supervision of a medical practitioner. Furthermore, the law states they will be required to notify their patients that they are not physicians or surgeons.

The American Association of Nurse Practitioners stated that the California legislation was one of the most restrictive policies on nurse practitioners’ autonomous practice. California nurse practitioners, however, have welcomed the new law and believe that it would go a long way towards reducing shortages of primary health care providers


Frieda Paton is a registered nurse with a Master’s degree in nursing education. Her passion for nursing education, nursing issues and advocacy for the profession were ignited while she worked as an education officer, and later editor, at a national nurses’ association. This passion, together with interest in health and wellness education since her student days, stayed with her throughout her further career as a nurse educator and occupational health nurse. Having reached retirement age, she continues to contribute to the profession as a full-time freelance writer. In the news and feature articles she writes for Nurseslabs, she hopes to inspire nursing students and nurses on the job to reflect on the trends and issues that affect their profession and communities - and play their part in advocacy wherever they find themselves.
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