SECTIONS 2834-2837 - California Statutes

BUSINESS AND PROFESSIONS CODE

SECTION 2834-2837

2834. The Legislature finds that various and conflicting
definitions of the nurse practitioner are being created by state
agencies and private organizations within California. The Legislature
also finds that the public is harmed by conflicting usage of the
title of nurse practitioner and lack of correspondence between use of
the title and qualifications of the registered nurse using the
title. Therefore, the Legislature finds the public interest served by
determination of the legitimate use of the title "nurse practitioner"
by registered nurses.

2835. No person shall advertise or hold himself out as a "nurse
practitioner" who is not a nurse licensed under this chapter and does
not, in addition, meet the standards for a nurse practitioner
established by the board.

2835.5. (a) A registered nurse who is holding himself or herself
out as a nurse practitioner or who desires to hold himself or herself
out as a nurse practitioner shall, within the time prescribed by the
board and prior to his or her next license renewal or the issuance
of an initial license, submit educational, experience, and other
credentials and information as the board may require for it to
determine that the person qualifies to use the title "nurse
practitioner," pursuant to the standards and qualifications
established by the board.
(b) Upon finding that a person is qualified to hold himself or
herself out as a nurse practitioner, the board shall appropriately
indicate on the license issued or renewed, that the person is
qualified to use the title "nurse practitioner." The board shall also
issue to each qualified person a certificate evidencing that the
person is qualified to use the title "nurse practitioner."
(c) A person who has been found to be qualified by the board to
use the title "nurse practitioner" prior to the effective date of
this section, shall not be required to submit any further
qualifications or information to the board and shall be deemed to
have met the requirements of this section.
(d) On and after January 1, 2008, an applicant for initial
qualification or certification as a nurse practitioner under this
article who has not been qualified or certified as a nurse
practitioner in California or any other state shall meet the
following requirements:
(1) Hold a valid and active registered nursing license issued
under this chapter.
(2) Possess a master's degree in nursing, a master's degree in a
clinical field related to nursing, or a graduate degree in nursing.
(3) Satisfactorily complete a nurse practitioner program approved
by the board.

2835.7. (a) Notwithstanding any other provision of law, in addition
to any other practices that meet the general criteria set forth in
statute or regulation for inclusion in standardized procedures
developed through collaboration among administrators and health
professionals, including physicians and surgeons and nurses, pursuant
to Section 2725, standardized procedures may be implemented that
authorize a nurse practitioner to do any of the following:
(1) Order durable medical equipment, subject to any limitations
set forth in the standardized procedures. Notwithstanding that
authority, nothing in this paragraph shall operate to limit the
ability of a third-party payer to require prior approval.
(2) After performance of a physical examination by the nurse
practitioner and collaboration with a physician and surgeon, certify
disability pursuant to Section 2708 of the Unemployment Insurance
Code.
(3) For individuals receiving home health services or personal
care services, after consultation with the treating physician and
surgeon, approve, sign, modify, or add to a plan of treatment or plan
of care.
(b) Nothing in this section shall be construed to affect the
validity of any standardized procedures in effect prior to the
enactment of this section or those adopted subsequent to enactment.

2836. (a) The board shall establish categories of nurse
practitioners and standards for nurses to hold themselves out as
nurse practitioners in each category. Such standards shall take into
account the types of advanced levels of nursing practice which are or
may be performed and the clinical and didactic education,
experience, or both needed to practice safely at those levels. In
setting such standards, the board shall consult with nurse
practitioners, physicians and surgeons with expertise in the nurse
practitioner field, and health care organizations utilizing nurse
practitioners. Established standards shall apply to persons without
regard to the date of meeting such standards. If the board sets
standards for use of nurse practitioner titles which include
completion of an academically affiliated program, it shall provide
equivalent standards for registered nurses who have not completed
such a program.
(b) Any regulations promulgated by a state department that affect
the scope of practice of a nurse practitioner shall be developed in
consultation with the board.

2836.1. Neither this chapter nor any other provision of law shall
be construed to prohibit a nurse practitioner from furnishing or
ordering drugs or devices when all of the following apply:
(a) The drugs or devices are furnished or ordered by a nurse
practitioner in accordance with standardized procedures or protocols
developed by the nurse practitioner and the supervising physician and
surgeon when the drugs or devices furnished or ordered are
consistent with the practitioner's educational preparation or for
which clinical competency has been established and maintained.
(b) The nurse practitioner is functioning pursuant to standardized
procedure, as defined by Section 2725, or protocol. The standardized
procedure or protocol shall be developed and approved by the
supervising physician and surgeon, the nurse practitioner, and the
facility administrator or the designee.
(c) (1) The standardized procedure or protocol covering the
furnishing of drugs or devices shall specify which nurse
practitioners may furnish or order drugs or devices, which drugs or
devices may be furnished or ordered, under what circumstances, the
extent of physician and surgeon supervision, the method of periodic
review of the nurse practitioner's competence, including peer review,
and review of the provisions of the standardized procedure.
(2) In addition to the requirements in paragraph (1), for Schedule
II controlled substance protocols, the provision for furnishing
Schedule II controlled substances shall address the diagnosis of the
illness, injury, or condition for which the Schedule II controlled
substance is to be furnished.
(d) The furnishing or ordering of drugs or devices by a nurse
practitioner occurs under physician and surgeon supervision.
Physician and surgeon supervision shall not be construed to require
the physical presence of the physician, but does include (1)
collaboration on the development of the standardized procedure, (2)
approval of the standardized procedure, and (3) availability by
telephonic contact at the time of patient examination by the nurse
practitioner.
(e) For purposes of this section, no physician and surgeon shall
supervise more than four nurse practitioners at one time.
(f) (1) Drugs or devices furnished or ordered by a nurse
practitioner may include Schedule II through Schedule V controlled
substances under the California Uniform Controlled Substances Act
(Division 10 (commencing with Section 11000) of the Health and Safety
Code) and shall be further limited to those drugs agreed upon by the
nurse practitioner and physician and surgeon and specified in the
standardized procedure.
(2) When Schedule II or III controlled substances, as defined in
Sections 11055 and 11056, respectively, of the Health and Safety
Code, are furnished or ordered by a nurse practitioner, the
controlled substances shall be furnished or ordered in accordance
with a patient-specific protocol approved by the treating or
supervising physician. A copy of the section of the nurse
practitioner's standardized procedure relating to controlled
substances shall be provided, upon request, to any licensed
pharmacist who dispenses drugs or devices, when there is uncertainty
about the nurse practitioner furnishing the order.
(g) (1) The board has certified in accordance with Section 2836.3
that the nurse practitioner has satisfactorily completed (1) at least
six month's physician and surgeon-supervised experience in the
furnishing or ordering of drugs or devices and (2) a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section.
(2) Nurse practitioners who are certified by the board and hold an
active furnishing number, who are authorized through standardized
procedures or protocols to furnish Schedule II controlled substances,
and who are registered with the United States Drug Enforcement
Administration, shall complete, as part of their continuing education
requirements, a course including Schedule II controlled substances
based on the standards developed by the board. The board shall
establish the requirements for satisfactory completion of this
subdivision.
(h) Use of the term "furnishing" in this section, in health
facilities defined in Section 1250 of the Health and Safety Code,
shall include (1) the ordering of a drug or device in accordance with
the standardized procedure and (2) transmitting an order of a
supervising physician and surgeon.
(i) "Drug order" or "order" for purposes of this section means an
order for medication which is dispensed to or for an ultimate user,
issued by a nurse practitioner as an individual practitioner, within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations. Notwithstanding any other provision of law, (1) a drug
order issued pursuant to this section shall be treated in the same
manner as a prescription of the supervising physician; (2) all
references to "prescription" in this code and the Health and Safety
Code shall include drug orders issued by nurse practitioners; and (3)
the signature of a nurse practitioner on a drug order issued in
accordance with this section shall be deemed to be the signature of a
prescriber for purposes of this code and the Health and Safety Code.

2836.2. Furnishing or ordering of drugs or devices by nurse
practitioners is defined to mean the act of making a pharmaceutical
agent or agents available to the patient in strict accordance with a
standardized procedure. All nurse practitioners who are authorized
pursuant to Section 2831.1 to furnish or issue drug orders for
controlled substances shall register with the United States Drug
Enforcement Administration.

2836.3. (a) The furnishing of drugs or devices by nurse
practitioners is conditional on issuance by the board of a number to
the nurse applicant who has successfully completed the requirements
of subdivision (g) of Section 2836.1. The number shall be included on
all transmittals of orders for drugs or devices by the nurse
practitioner. The board shall make the list of numbers issued
available to the Board of Pharmacy. The board may charge the
applicant a fee to cover all necessary costs to implement this
section.
(b) The number shall be renewable at the time of the applicant's
registered nurse license renewal.
(c) The board may revoke, suspend, or deny issuance of the numbers
for incompetence or gross negligence in the performance of functions
specified in Sections 2836.1 and 2836.2.

2837. Nothing in this article shall be construed to limit the
current scope of practice of a registered nurse authorized pursuant
to this chapter.