Let’s choose California as the state to compare with Florida regarding the scope of practice for Advanced Practice Registered Nurses (APRNs), specifically Nurse Practitioners (NPs).

The American Association of Nurse Practitioners (AANP) categorizes states into three levels of practice authority for NPs:

1. Full Practice Authority: State practice and licensure laws allow all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. No physician oversight is required.
2. Reduced Practice Authority: State practice and licensure laws allow reduced ability for NPs to engage in at least one element of NP practice. In these states, the law requires a regulated collaborative agreement with an outside health provider (often a physician) in order for the NP to provide patient care, or limits the setting or scope in other ways.
3. Restricted Practice Authority: State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation, or team management by another health provider (e.g., physician) for the NP to provide patient care.

Nurse Practitioner Scope of Practice: California vs. Florida

Florida: Restricted Practice State (with recent changes towards reduced/full for certain NPs)

Florida has historically been a Restricted Practice state for Nurse Practitioners, meaning NPs generally require supervision or a collaborative agreement with a physician for many aspects of their practice, particularly for prescriptive authority.

Key aspects of NP scope of practice in Florida:

• Prescriptive Authority: NPs in Florida must have a supervisory relationship with a physician to prescribe medications, including controlled substances. This typically involves a “supervisory protocol” or “prescriptive authority agreement.” The physician must also be continuously available for consultation.
• Independent Practice: Historically, NPs could not practice independently or open their own clinics.
• Recent Changes (2020 Legislation): Florida has made some legislative changes that moved certain NPs towards a “reduced” or even “full” practice environment, specifically for primary care NPs.
  • As of 2020, certified advanced practice registered nurses (APRNs) who meet specific criteria can apply for independent practice in primary care. These criteria include completing 3,000 hours of supervised practice under a licensed physician within the past five years and completing specific graduate-level coursework.
  • Even with this independent practice in primary care, there can still be nuances and limitations, particularly concerning controlled substances and specific procedures.
• Diagnosis and Treatment: While under a physician’s supervision or within the new independent primary care scope, NPs can diagnose and manage treatments.

California: Evolving from Reduced to Full Practice (with a transition period)

California has traditionally been a Reduced Practice state for Nurse Practitioners, requiring physician supervision or collaboration for elements of their practice. However, recent legislation (Assembly Bill 890, effective January 1, 2023) is moving California towards Full Practice Authority for NPs, but with a crucial transition period.

Key aspects of NP scope of practice in California:

• Pre-AB 890 (Traditional): NPs generally required a “standardized procedure” or “collaborative agreement” with a physician to perform certain functions, including diagnosing, prescribing, and ordering tests. Prescriptive authority for controlled substances also required physician oversight.
• Post-AB 890 (New Era, effective 2023): California is implementing a two-transition process for NPs to achieve full practice authority:
  1. Transition to “NP-18”: NPs can transition to practicing without physician supervision or collaboration in certain settings (e.g., hospitals, clinics, or specific community health centers) after meeting requirements, including:
     • Holding an active California NP license.
     • Completing 3 years of full-time clinical practice (or 4600 hours within 5 years) in good standing, under the supervision of a physician or other experienced NP.
     • Completing a board-approved transition to practice program.
  2. Full Practice Authority (“NP-19”): After practicing as an NP-18 for an additional period (which will be defined by the Board of Registered Nursing), NPs can gain full, independent practice authority, including operating their own practices, without any physician oversight requirements.
• Prescriptive Authority: Once an NP meets the requirements for NP-18, they will have independent prescriptive authority, including for controlled substances.