Transition to Practice for California’s Nurse Practitioners: Lessons from Other States

Editor’s note: Read an interview with the author of this brief, Susanne Phillips, where she illuminates how California can expedite independence for nurse practitioners. 

The signing of AB 890 (Wood) in September 2020 opened the pathway for nurse practitioners (NPs) in California to treat patients without physician supervision. This change has the potential to improve access to health care for millions of state residents, particularly those most impacted by health care provider shortages. ¹

NPs will be authorized to practice to the fullest extent of their education and training following a transition-to-practice (TTP) period of no less than three full-time equivalent years or 4,600 hours in specified settings. Additionally, NPs will be authorized to practice to the fullest extent of their education and training following an additional three years of practice beyond the TTP in all other settings.

California’s Board of Registered Nursing (BRN) is in the process of promulgating regulations that will further specify details of the TTP period. This regulatory process is a critical next step on the path to the implementation of AB 890.

Some helpful lessons for California might be gleaned from other states that have adopted TTP periods. In balancing the desire to expand the health care workforce while ensuring NPs provide safe, high-quality care, states often define the critical elements of the transition to practice in statute and leave only administrative details for regulation. This minimizes the chance of relegislating the policy issues or slowing down implementation when drafting the regulations.

This brief seeks to support the regulatory process in California by:

• Shedding light on how transition to practice has played out in others states around the country
• Sharing the existing evidence on how full practice authority (FPA) and TTP periods for NPs affect patients’ access to care and outcomes
• Providing an update on where California currently stands in developing its regulations to define its TTP period for NPs

Though more research is necessary, evidence to date does not demonstrate that care has improved as a result of a required TTP. As such, a TTP period that is seamless and minimizes barriers to practice could best serve California policymakers’ goals of improving access to health care for state residents impacted by provider shortages.

1. “Bill History: AB-890 Nurse Practitioners: Scope of Practice: Practice Without Standardized Procedures” (2019–20), 2020 Cal. Stat. ch. 265. ↩︎