Accelerating Impact: How to Support Nurse Practitioners in Expanding Access to Care

California’s Assembly Bill 890 — which was passed in September 2020 — allows nurse practitioners (NPs) who meet certain criteria the authority to practice without physician supervision. At the time of writing, the law is scheduled to go into effect in 2023.

AB 890 presents opportunities to increase access to health care for Californians, especially those served in the safety net and those who live in rural and underserved areas. This issue brief explores the driving factors and the challenges to implementing AB 890 and expanding NP services in the state from the perspective of NPs, health care leaders, and policy experts. Policymakers, health plans, NPs, communities, and leaders in safety-net settings can use this issue brief to understand how they can support NP practice in the wake of the passage of AB 890.

Key recommendations include:

• Promote understanding of NP practice. More exposure to NPs and messaging toward the public and community leaders that reinforces the quality and safety of NP practice could help address a general lack of understanding about NPs and their role in health care.
• Remove remaining practice barriers. These include hospital policies limiting NP privileges and leadership roles, NP practices not being allowed to apply for rural health clinic designation, NPs not being able to be laboratory directors in order to offer lab services in their own clinics, and telehealth regulations.
• Increase awareness of nurse-managed health centers. With the implementation of AB 890, new nurse-managed centers not affiliated with academic health centers could supplement or become affiliated with Federally Qualified Health Centers in the provision of primary care.
• Provide education and supports for NPs. If California NPs are to expand access to health care services, particularly in areas where practices do not already exist, they need to have business knowledge and skills to find funding and run their own businesses or expand practices within institutions. NPs need the skills to manage complex institutional, financial, billing, compliance, human resources, and marketing issues.