Nurse Practitioner Programs in California
California’s nurse practitioners are recognized as primary care providers. They have advanced skills in physical diagnosis, psychosocial evaluation, and management of healthcare conditions.
Nurse Practitioner Programs in California
#1: The University of California—San Francisco boasts a competitive nurse practitioners program in a traditional academic setting. Students who want to delve deeply into care management of particular chronic illnesses can opt for a diabetes minor or HIV/AIDS focus. UCSF is ranked #10 of all family nurse practitioner programs in the nation by U.S. News and World Report.
#2: Samuel Merritt University offers a family nurse practitioner program among its online master’s options; the school is ranked #31 out of all schools in the nation that offer online nursing master’s programs.
#3: The University of San Diego offers doctoral level programs in family nurse practitioner, adult-gerontology/ nurse practitioner, pediatric/ family nurse practitioner, and psychiatric mental health nurse practitioner programs. It is ranked #44 out of all U.S. DNP programs. Some specialties are available at the MSN level.
Becoming a Nurse Practitioner
Nurse practitioner is a graduate level profession. There are several methods to become a nurse practitioner. A registered nurse will be eligible after completion of a California-approved Nurse Practitioner program. State code requires a minimum 30 credit hours. 50 hours is more typical for a post-BSN program, though there is a wide range. Nurse practitioner students spend time out in the field. Coursework, though, can often be completed at home. Many programs are hybrid or online.
A list of California-approved Nurse Practitioner programs is available on the website of the Board of Registered Nursing (http://www.rn.ca.gov/education/programs.shtml).
A nurse can also achieve eligibility after completion of an equivalent program if he or she seeks national certification in a specialty area. The Board has made available a description of general standards for different certification organizations; they all require nursing education at at least the master’s level. The certification will be determined by the population foci of the program However, in some cases, the graduate will have more than one option, drawn from the following list:
- American Academy of Nurse Practitioners (AANP)
- American Association of Critical-Care Nurses (AACN)
- American Nurses Credentialing Center (ANCC)
- Pediatric Nursing Certification Board (PNCB)
- National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties (NCC)
A nurse practitioner who is certified by a national agency can bill Medi-Cal independently for services rendered.
Future NPs will have the most options if his or her program is accredited at the programmatic level. California boasts a number of CCNE-accredited programs.
Scope of Practice
California state certification does not automatically grant a higher scope of practice. However, a nurse practitioner who is operating under the standard procedures of his or her organization may carry out duties that would otherwise be considered the practice of medicine. Nurse practitioners are granted the authority to carry out various duties necessary for provision of primary care.
A California NP can order or ‘furnish’ medications to treat his or her patient’s health conditions; this requires a furnishing number. California is more restrictive than some states. Standardized procedures determine the drugs and other devices that the NP is allowed to furnish. The furnishing of drugs or devices requires some level of supervision. The physician will need to be accessible by telephone at the time the time the assessment is carried out.
Standardized procedures may vary. The Board of Registered Nursing has provided the example of an organization that required a physician to be on-site when one particular procedure was performed but otherwise allowed for performance of procedures with only telephone availability (http://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf).
In long-term care facilities, nurse practitioners and physicians may alternate visits. The state has published regulations for use of nurse practitioners in long-term healthcare facilities.
California is the only state in the west classified as a ‘restricted practice’ state and one of only two in this region that is not considered ‘full practice’. Legislation has been introduced more than once to expand NP practice in California, but has met with opposition. Proponents argue that reducing barriers to practice can increase access at a time when there are shortages of healthcare providers. The California Association for Nurse Practitioners is a source of information about legislative activity and advocacy (https://canpweb.org/).
California NP Work Settings
Nurse practitioners often work in settings where relatively routine medical care is provided. They are sought to staff clinics and federally qualified health centers. Nurse practitioners may also carry out home visits with the elderly and with others who have conditions that make it difficult to visit a provider. Medical practices frequently seek nurse practitioners to join their teams. Some practices provide pediatrics or specialty services.
California organizations use different healthcare professional staff mixes to help meet the dual challenge of care and cost effectiveness. Retail clinics are an innovative example of how payers may opt to utilize nurse practitioners, while working under constraints of state code. Target Clinics, a partnership with Kaiser Permanente, are located inside retail shopping centers. They are staffed with nurse practitioners and have physicians available on-call. The success of the first clinics prompted the organization to announce in late 2017 that more than 30 new clinics were on their way to Southern California (https://www.prnewswire.com/news-releases/kaiser-permanente-and-target-to-open-31-more-retail-clinics-in-southern-california-300519499.html). Clinic NPs can treat minor illnesses like the flu and help people manage chronic illnesses like diabetes and asthma; women’s health and pediatric services are available. This type of delivery system is not unique. It has become popular among insurance companies; CVS is among the other retailers that places nurse practitioners in on-site clinics. For safety as well as convenience, nurse practitioners are making their way to places truck drivers frequent.
California NPs can work in emergency departments. Here their role includes assessment and evaluation. Emergency department utilization, notably, can be quite different in different parts of the country.
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