California Nursing Practice Act

As with most states, California has its own version of the Nursing Practice Act, which, if you're a registered nurse, you probably already know is a general name that's used for a set of laws and regulations governing the practice of registered nursing in the state. Each state's Nursing Practice Act covers things like testing and licensing requirements, continuing education obligations, disciplinary procedures, and the administration of the nursing profession in the state. In addition, the Nursing Practice Act also describes in both broad and specific terms what registered nurses are allowed to do and what they're prohibited from doing.

It's important to have a good understanding of exactly what your registered nursing license permits you to do, the level of care you're expected to provide, and what kinds of conduct can result in sanctions from the California Board of Registered Nursing. If you have questions about whether you are meeting your obligations as a licensed nurse in California or have been accused of failing to do so, contact the Lento Law Firm's Professional License Defense Team for help. We can be reached at 888.535.3686 or by using our contact form to schedule a confidential consultation with one of our experienced attorneys.

What is the Nursing Practice Act?

California's Nursing Practice Act (NPA) includes statutes found in California's Business and Professions Code, and regulations that are part of the California Code of Regulations. The California Board of Registered Nursing (BON) is responsible for administering the NPA, and for disciplining registered nurses who are found to have committed misconduct or who violate certain provisions of the NPA. (Licensed vocational nurses, known in most other states as licensed practical nurses, are separately governed by the Board of Vocational Nursing and Psychiatric Technicians in California.) The NPA includes well over 100 different statutory sections and almost as many regulations that together cover all aspects of the practice and regulation of registered nursing in California.

To help registered nurses understand what is expected of them by the Nursing Practice Act, the California BON publishes “practice information, advisories, and guidelines” on several topics, including general practice, advanced practice, the NPA itself, and different types of nursing licenses. There are dozens of different publications available which reflect the wide range of responsibilities that licensed nurses are expected to be able to take on. And because the requirements and expectations for licensed nurses are constantly changing, the BON encourages nurses to “check back often for updates.”

What Does California's Nursing Practice Act Authorize Registered Nurses to Do?

California's NPA provides both general guidelines for the types of care that various types of licensed nurses are allowed to provide and authorizations for nurses to administer specific types of procedures and treatments. The scope of the care that a licensed nurse is allowed to provide will depend on their training and the type of nursing license that they hold. Here are some examples of the types of care that California's NPA expects of registered nurses:

Provide patient care that ensures the “safety, comfort, personal hygiene, and protection” of patients.
Administer medications and therapeutic agents that are necessary to treat or rehabilitate a patient or to prevent disease, as ordered by a licensed medical professional such as a physician, dentist, podiatrist, or clinical psychologist.
Perform skin tests, immunizations, and blood withdrawals.
Observe patients for “signs and symptoms of illness,” their “reactions to treatments,” and their general behavior and physical condition and determine whether any of those are abnormal.
In cases where patient abnormalities are observed, provide the appropriate response, whether it's to report the abnormality, change the treatment regimen, or begin emergency response procedures.
Where appropriate, follow standardized procedure guidelines set by the Division of Licensing of the Medical Board of California and the Board of Registered Nursing.
Dispense drugs or medical devices as ordered by a licensed physician, certified nurse-midwife, nurse practitioner, or physician assistant under appropriate clinical circumstances.
Dispense “self-administered hormonal contraceptives” to patients as well as inject patients with hormonal contraceptives that are approved by the FDA, provided the registered nurse has received the proper training.

The BON has standards that it expects registered nurses to meet when it comes to delivering “competent performance.” To be considered “competent,” the nurse must consistently demonstrate “the ability to transfer scientific knowledge from social, biological, and physical sciences in applying the nursing process.” In particular, a competent nurse is expected to be able to:

Formulate a nursing diagnosis based on observing the patient's physical condition and behavior as well as through interpreting information received from the patient and the care team.
Develop a care plan for the patient, in collaboration with the patient, that ensures the patient receives nursing care services that provide for the patient's “safety, comfort, hygiene, and protection” as well as for “disease prevention and restorative measures.”
Explain the patient's health treatment to the patient and family, and teach the patient and family how to care for the patient's health needs.
Appropriately delegate tasks to subordinates, and supervise them.
Evaluate the effectiveness of the care plan and modify it where appropriate.
Advocate for the patient where necessary and appropriate.

In addition to the standards that the NPA expects registered nurses to meet, the NPA also has standards that apply to specific types of advanced practice nurses. If you are licensed for advanced nursing practice in California, it's important that you understand the additional requirements you are expected to meet.

Nurse-Midwives

In addition to the care that a registered nurse is authorized to provide by California's Nursing Practice Act, nurse midwives are authorized by the NPA to do the following:

Attend to patients in “cases of low-risk pregnancy and childbirth.”
Provide prenatal, intrapartum, and postpartum care.
Provide immediate care for newborns.
Deliver inter-conception and family planning care.
Provide care for “common gynecologic conditions.”
Conduct deliveries and care for the newborn and infant.
Perform episiotomies and certain other repairs in connection with childbirth.
Providing emergency care where necessary “until physician assistance can be obtained.”
Observe the “Core Competencies for Basic Midwifery Practice” as adopted by the American College of Nurse-Midwives and as approved by the BON.
Where authorized by a “physician and surgeon,” provide care that falls outside the scope of the specific types of care described above; provide intrapartum care to a patient who has had a cesarean section in the past; and “furnish or order” patients with certain controlled substances.
In cases where a “physician and surgeon” assume care for a patient, continue to provide care to the patient pursuant to “mutually agreed-upon policies and protocols” signed by both the nurse-midwife and the physician and surgeon.
In appropriate cases, attend pregnancy and childbirth “in an out-of-hospital setting.”
Perform “abortion by aspiration” in appropriate circumstances, provided the nurse-midwife has received the training required by California law.
Dispensing or furnishing drugs or medical devices, including certain drugs that are listed in California's Uniform Controlled Substances Act, under appropriate circumstances and provided the nurse-midwife has the appropriate authorization from the BON.

Nurse Practitioners

In addition to the care that a registered nurse is authorized and expected to provide by California's Nursing Practice Act, nurse practitioners are authorized by the NPA to do the following:

Order “durable medical equipment” pursuant to standardized procedures.
Certify a patient's disability pursuant to California's Unemployment Insurance Code, following a physical examination and “in collaboration with a physician and surgeon.”
“Approve, sign, modify, or add to” a treatment plan for patients receiving home health or personal care services,after consulting with the treating physician and surgeon.
Perform “abortion by aspiration” in appropriate circumstances, provided the nurse practitioner has received the training required by California law.
Dispense or furnish drugs or medical devices, including those that are listed in California's Uniform Controlled Substances Act, under appropriate circumstances, including under the supervision of a physician and surgeon, and provided the nurse practitioner has the appropriate authorization from the BON.
Where the nurse practitioner has the appropriate qualifications, the nurse may perform certain “functions without standardized procedures,” including conducting an “advanced assessment;” they may order, perform, and interpret diagnostic tests; order and use the results of radiological procedures; “prescribe, order, administer, dispense, and procure” a variety of therapeutic measures; as well as order and interpret diagnostic radiological procedures.

The Lento Law Firm's Professional License Defense Team understands what's expected of Nurse Practitioners in California and can help defend you if you're a nurse practitioner accused of misconduct.

Nurse Anesthetists

Certified Registered Nurse Anesthetists (CRNAs) are, of course, expected to meet the practice requirements for registered nurses, as well as to be able to do the following:

Assess and evaluate patients before administering anesthesia.
Develop an anesthesia plan for the patient and administer it effectively.
Be able to administer general, regional, or local anesthesia to a patient.
Administer the appropriate monitors to track the patient's status while anesthesia is administered.
Manage the patient's breathing and heart status during anesthesia.
Intervene as necessary and appropriate to help the patient recover from anesthesia.
Discharge the patient after anesthesia and provide follow-up evaluation and care.
Respond to emergency situations in an appropriate way based on the situation and the CRNA's training.

If you are a CRNA in California and are facing a BON disciplinary investigation or proceeding, contact the Lento Law Firm's Professional License Defense Team for help.

Continuing Education Requirements

All nurses are expected to meet the California BON's continuing education requirements that apply to their particular type of license and practice area. Nurses who fail to do so may not be able to renew their licenses and those who falsely claim that they have met the continuing education requirements when they did not can be disciplined by the BON.

What Does California's Nursing Practice Act Prohibit Nurses from Doing?

The Nursing Practice Act provides that the BON may take disciplinary action against a registered nurse for a wide range of misconduct. The types of misconduct that can result in discipline include:

Incompetently or negligently performing the kinds of functions that the nurse is expected to provide.
Committing fraud or making a false statement in connection with securing their nursing license.
Being involved in a number of different ways with a criminal abortion.
Being convicted or pleading “no contest” to a felony charge or to another offense that is “substantially related” to their qualifications as a registered nurse. The NPA includes a list of specific offenses that are presumed to be substantially related to the nurse's qualifications. These include crimes of violence, sex crimes, harassment, trespass, stalking, child abuse, elder abuse, dependent abuse, and others.
Being convicted of a crime involving the “prescription, consumption, or self-administration” of certain controlled substances or of falsifying records related to certain controlled substances.
Failing to follow the BON's infection control guidelines.
Using any controlled substance or any dangerous drug or alcohol in a way that is “injurious to themselves” or that impairs their ability to practice nursing safely.
Being committed by a court for “intemperate use of or addiction to” certain drugs or alcohol.
Falsifying hospital or patient records or making “incorrect, grossly inconsistent, or unintelligible” patient or controlled substance records.
Failing to provide the BON with requested documents within 15 days of when the BON requests them without good cause for the delay.
Failing to cooperate with any BON investigation against the registered nurse.
Failure to report any conviction, guilty plea, or no contest plea to any felony or misdemeanor within 30 days of when it occurred.
Failure to report any discipline imposed on the registered nurse by any other “licensing entity” in any state or by any federal agency or the US military.
Failure or refusal to comply with a court order requiring the nurse to release records to the BON.
Practicing nursing without an active license.
Dispensing drugs in a pharmacy, keeping a pharmacy, compounding drugs, or operating a retail store for drugs.
Dispensing drugs that are listed in California's Uniform Controlled Substances Act, except that under proper circumstances, a CRNA, nurse-midwife, or nurse practitioner may do so.
Nurse-midwives are not authorized to use “vacuum or forceps extraction” when assisting with childbirth or to perform an ECV.
In the case of a nurse-midwife providing care outside a hospital setting, failing to provide the disclosures required by the BON in both oral and written form signed by both the nurse-midwife and the patient relating to the nurse-midwife's status as such, their license status and number; the settings in which the nurse-midwife practices; any lack of liability coverage; that some conditions may require referral to a physician and surgeon, and how those referrals are made; and a number of other aspects of care, all as required by the BON.
Nurse practitioners may not refer a patient to a laboratory or certain types of treatment or therapy centers when the nurse practitioner or a member of their immediate family has a “financial interest” in the “entity that receives the referral.”
Nurse practitioners can be disciplined for failing to advise patients that they are not a physician and surgeon, for failing to post a required notice that the nurse practitioner is regulated by the BON, and for failing to maintain professional liability insurance “appropriate for the practice setting.”
Nurses can be disciplined for practicing nursing beyond the scope of their clinical and professional trainingas well as beyond the limits of their knowledge, experience, and any national certification.
Nurse practitioners who fail to consult with a physician when the patient's situation requires it can be disciplined for failing to do so.

If a misconduct complaint has been filed against you by a patient, a patient's family member, a co-worker, or someone else, or if the BON has notified you that it is beginning disciplinary proceedings against you, you need the help of an experienced professional license defense attorney to help you protect your nursing license.

The Lento Law Firm's Professional License Defense Team Can Help

If you are facing a disciplinary investigation or proceeding by the California Board of Nursing, you need to take it seriously. Depending on the allegations against you, your nursing license and your livelihood could be at risk. Even in minor cases, failing to properly cooperate with an investigation or to provide a timely response to the BON's request for information can result in you facing additional sanctions.

The best way to protect yourself, your license, and your future is by retaining an experienced professional license defense attorney. The Lento Law Firm has been helping nurses and other healthcare professionals across California and the US defend themselves against BON investigations and disciplinary proceedings for years. We understand the rules, regulations, and procedures that apply in BON disciplinary cases, and we are ready to vigorously defend you and protect your rights.

The sooner we are involved, the more we will be able to help. Call the Lento Law Firm's Professional License Defense Team today at 888.535.3686 or use our contact form to schedule a confidential consultation. You've worked hard to earn your nursing license; let us help you protect it!

California’s Nursing Practice Act