California is the only Western state with the red color of the practice environment. This means that nurse practitioners (NPs) are prohibited from providing care to patients without the supervision of a physician. What is more, in such states, the work experience of NPs does not matter because the NP requires the control of another health care provider as long as he or she has this status.
In contrast, NPs in the states with the green color of the practice environment are allowed to examine and diagnose patients, interpret the analysis results, appoint treatment, and prescribe medications. The primary reason for the concern on Californian restricted practice is that NPs could fill the gap in the primary care that is evident from the lack of physicians, but the state law prohibits experienced nurses from this (Spetz & Muench, 2018). Fortunately, in two years, the law that enables Californian NPs who satisfy requirements to practice independently will come into force.
The concept of prescriptive authority refers to the authority of a NP to give drug prescriptions to the patients. In California, NPs could prescribe medications that are related to their practice area. Additionally, when a NP appoints Schedule II and Schedule III substances such as morphine, methadone, ketamine, and anabolic steroids, to name but a few, such prescriptions should be controlled by their supervisors, i.e., physicians.
The standardized procedures requirements for Californian NPs emphasize that they should fit the education, training, and experience requirements and clearly state what nurses are allowed and not allowed to do. For instance, according to the Board of registered nursing (1998), NPs could “provide care for patients with acute conditions” and “furnish non-controlled drugs and devices to essentially healthy patients” (p. 8). The standardized procedures are essential because the imposition of restrictions, obligations, and requirements on nurses guarantees the high quality of patient care.
Board of registered nursing (1998). An explanation of standardized procedure requirements for nurse practitioner practice. Department of Consumer Affair.
Spetz, J., & Muench, U. (2018). California nurse practitioners are positioned to fill the primary care gap, but they face barriers to practice. Health Affairs, 37(9), 1466-1474.