Finding a Collaborating Physician in California
As a nurse practitioner, finding a collaborating physician in California may seem like a challenge, but fear not – Zivian is here to guide you through the intricacies of establishing a successful partnership.
California's regulatory structure for nurse practitioners requires a collaborative agreement with a physician. From understanding the legal requirements and NP autonomy in California to identifying physicians who align with your professional goals, this post explores key steps and considerations for finding a collaborative relationship in CA that fosters mutual respect and enhances patient care outcomes.
The Importance of NP-Physician Collaboration in California
Collaboration between nurse practitioners (NPs) and physicians in California is not just a regulatory requirement; it is a cornerstone of delivering high-quality, patient-centered healthcare. In a state where healthcare demands are diverse and dynamic, NPs and physicians work together to expand access and improve care.
Physician collaboration provides NPs with a valuable resource – access to the depth of medical knowledge and experience that physicians bring to the table. This collaboration is a two-way street, benefiting both parties by fostering an environment of continuous learning and skill enhancement. NPs can leverage the expertise of physicians, ensuring a comprehensive approach to patient care that integrates the unique strengths of both professions.
What Is the State Practice Environment for NPs in California?
In which category does the state fall: NP independent practice, transition to independence, or collaboration required?
California is officially a Restricted Practice state, but also offers “transition to independence.”
Within the context of NP autonomy, “transition to independence” refers to the process through which nurse practitioners gain increased professional independence and take on more roles in patient care. This transition involves a progression from a more supervised or collaborative practice to a greater degree of self-directed decision-making and responsibility.
California has two stages APRNs must complete to achieve full independent practice, each require certification from the board:
“103” APRN: APRN must practice in a group setting without collaborative agreement; requires 4,600 hours or 3 full-time years of qualifying experience (completed in California within 5 years prior to the APRN’s application for 103 certification).
“104” APRN: APRN can practice outside group setting; requires 3 years of experience as a certified 103 APRN
Delegation Authority & Process
Is an agreement required?
Yes, a written agreement called “standardized procedures”.
What form of agreement is required and what are the requirements for the substance of the agreement?
No state form is required, but there are specific requirements regarding the components of a California collaboration agreement.
To learn more about the requirements for a California collaboration agreement, contact our team today!
Requirements for substance of agreement are as follows. The agreement must:
Be in writing, dated and signed by the organized health care system personnel authorized to approve it.
Specify which standardized procedure functions registered nurses may perform and under what circumstances.
State any specific requirements which are to be followed by registered nurses in performing particular standardized procedure functions.
Specify any experience, training, and/or education requirements for performance of standardized procedure functions.
Establish a method for initial and continuing evaluation of the competence of those registered nurses authorized to perform standardized procedure functions.
Provide for a method of maintaining a written record of those persons authorized to perform standardized procedure functions.
Specify the scope of supervision required for performance of standardized procedure functions, for example, immediate supervision by a physician.
Set forth any specialized circumstances under which the registered nurse is to immediately communicate with a patient's physician concerning the patient's condition.
State the limitations on settings, if any, in which standardized procedure functions may be performed.
Specify patient record keeping requirements.
Provide for a method of periodic review of the standardized procedures.
Review all requirements and download a sample template here.
Where must the agreement be stored?
There are no restrictions.
Does the agreement need to be filed with the state?
No, it is not required.
Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)?
There are no restrictions.
Who must sign the agreement?
A personnel member of the “Organized Health Care System” authorized to sign and approve the agreement must sign.
"Organized Health Care System" means a health facility which is not licensed pursuant to Chapter 2 (commencing with Section 1250), Division 2 of the Health and Safety Code and includes, but is not limited to, clinics, home health agencies, physicians' offices and public or community health services.
How often must the agreement be reviewed/reauthorized?
There are no restrictions.
What are the required qualifications for the collaborating provider (licensure, same scope, active practice in state, etc.)?
The collaborating provider must be a physician, surgeon or podiatrist.
What are the required qualifications for the NP?
The NP must be certified as a Nurse Practitioner by the BRN. View this link (California Board of Registered Nursing) for further details.
Is an alternate collaborating physician required?
No, an alternate collaborating physician is not required.
Collaboration Requirements
Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
1:4 furnishing NPs (i.e. prescribing) at one time.
Is there an express requirement to review a certain number/percentage of charts?
There are no restrictions.
Is there a requirement to meet and, if so, how often and how?
There are no restrictions.
Are there proximity requirements (e.g., between the NP/collaborator or practice site)?
There are no restrictions.
Are there location-specific requirements (e.g., that collaborator must go to practice site at some frequency)?
There are no restrictions.
Is remote supervision allowed and are there limitations on remote supervision?
Remote supervision is permitted, provided the supervising physician is available “by telephonic contact at the time of patient examination by the NP.”
Physician & NP Filing Requirements
Outside of filing the collaboration agreement, must the physician and/or NP file any separate forms (e.g., notice of delegation of prescriptive authority, notice of collaboration, notice to PDMP, etc.)?
NOTE: timing/frequency should be noted because the state may have requirements for initial filing and/or filing for updates, terminations, etc.
There are no requirements.
Prescription Requirements & Controlled Substance Prescribing
What are the prescription requirements?
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.
What are the requirements for controlled substance prescribing?
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.
Find a Collaborating Physician in California with Zivian Health
We help nurse practitioners connect with physicians within their specialty in a secure online collaboration software. We’ll match you with a collaborating physician in a matter of days. Plus, you’ll have access to our easy-to-use platform to track all of your state requirements, including meetings, chart reviews, and licensure.
Get started with Zivian today by contacting us here.
Sources
Cal Bus & Prof Code § 2837.103
Cal Bus & Prof Code § 2837.104
16 CCR 1480-1487
Cal. Bus. & Prof. Code 2836.1
16 CCR 1471, 1472, 1474
Cal Bus & Prof Code § 2725
Frequently Asked Questions Regarding Nurse Practitioner Practice
An Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice
