California Nurse Practice Act: Facility Guide

The nursing profession is constantly adapting to the rising demands of the healthcare industry. To keep up with evolving roles, duties, and responsibilities, each state’s board of nursing is responsible for enacting laws to regulate everything related to nursing practice. In California, Nurse Practice Act (NPA) provisions ensure that nursing professionals stay within their scope of practice while delivering safe and competent care.

As a facility leader, it’s important to understand what’s in your state’s NPA to help enforce appropriate practice protocols for your staff. We’ll provide an overview of the Nurse Practice Act in California, highlight provisions affecting daily nursing care, and provide tips on how to comply with these rules to promote a better culture of safety.

The California Nurse Practice Act: Summary

In the state of California, Nurse Practice Act provisions authorize the state’s board of registered nursing (BRN) to determine the scope of practice for nursing professionals. These laws also establish all other procedures relating to nursing practice, such as licensure renewal, board appointments, and penalties for professional misconduct.

The California Nursing Practice Act can be found in the state’s Business and Professions Code (BPC) and is further broken down into 13 articles that establish:

• Procedures for regulating and funding the BRN.
• The definitions and scope of California’s NPA.
• Procedures for nursing certification and licensure.
• Practice standards for nursing professionals (including APRNs).
• Standards for operating nursing schools/businesses.
• Criminal violations and disciplinary procedures for nursing professionals.

California’s Code of Regulations (CCR) further specifies how these BPC articles are implemented and enforced by the state. We’ll break down how these regulations more specifically apply to your nursing staff in the table below.

• Graduate from a California-approved nursing program.
• Submit an application to the BRN via mail or online.
• Register for and pass the NCLEX exam.
• Complete a fingerprint background check.
• Optional:Obtain an interim permit to work in a supervised setting while awaiting NCLEX results.

• Fill out an endorsement application via mail or online.
• Submit fingerprints using either the Live Scan Process or the Applicant Fingerprint Card (Hard Card) processing.
• Submit a verification of license form or complete a paperless verification online (only for select, participating states).
• Send transcripts from an accredited school of nursing.

In general, RNs can delegate tasks if:

• They’re explicitly supported by NPA provisions.
• They’re within the scope of practice of the RN/LPN/UAP.
• There has been an assessment of the patient’s needs.
• They can be performed without critical nursing judgment.
• They can be repeated without a nursing assessment.
• Appropriate supervision is available.

RNs explicitly cannot delegate:

• Assessment, diagnosing, planning, or evaluation to LVNs.
• UAPs to carry out nursing functions in lieu of an RN.
• UAPs to carry out functions that require a substantial amount of knowledge and technical skills, even under supervision.
• Scope of practice and direction of care for LVNs.
• Functions in BPC 2725 or CCR 1443.5 except as allowed by the LVN scope of practice.

• Practicing as a nurse without an active license.
• Using any titles, signs, or devices to indicate the ability to practice without proper licensure.
• Using the titles “registered nurse,” “RN,” “graduate nurse,” “trained nurse,” or “nurse anesthetist” without proper licensure.
• Impersonating a nurse or pretending to be licensed to practice.
• Making any false representation or impersonating another person for nursing examination or application processes.
• Operating a school of nursing without approval from the BRN.

Any person who violates these provisions may be subject to one or both of the following penalties:

• Imprisonment for up to one year
• Fines of up to $1,000

1. California nurses must obtain additional licensure to practice out-of-state and;
2. Nurses from other states cannot practice in California without applying for endorsement.

Improving NPA Compliance: 3 Tips for Facilities

Beyond learning what’s in the California Nurse Practice Act, leaders should take steps to ensure that all facility-level protocols support regulatory compliance. Here are three tips on how to comply with these laws in practice to better support your staff and protect your patients;

1. Screen for Fraudulent Credentials

While uncommon, some individuals may try to forge educational certificates or licenses to get a nursing job. This endangers patients since these uncertified nurses don’t have the training or knowledge to provide safe care. Furthermore, these actions are considered a misdemeanor in California and could place your facility at risk of liability if you accidentally hire an unqualified individual.

It’s important to protect your facility from fake nurses by thoroughly screening the credentials of your job applicants and staff. Here are a few ways you can strengthen your screening process:

• Check that nurses have obtained a degree from an accredited institution.
• Verify the licenses of staff and applicants through the BRN.
• Report suspected fraud via the BRN’s complaint filing system.
• Ensure your pre-employment screening is robust. Are you checking for resume red flags? Is your background screening done by trained individuals in-house or a vendor you trust?

2. Stay Informed About Regulatory Updates

California’s NPA is updated annually, which means that you may need to make changes to your facility’s protocols each year. Keeping track of updates ensures that you’re retiring outdated practices and providing timely training to your staff. Here are a few ways you can keep up with changes to the NPA:

• Obtain the latest copy of the NPA through the BRN’s LexisNexis store.
• Join the BRN mailing list to get real-time updates about the NPA.
• Stay informed about pending legislation that may impact the NPA in the future.

3. Provide Regular Staff Training

While your nursing staff make individual efforts to keep up with the NPA, your facility plays an important role in helping them stay informed. Provide annual training that reflects pertinent changes affecting delegation of tasks or daily nursing duties. This will ensure that your staff aren’t stepping outside of their scope of practice and compromising patient safety.

Take Additional Steps to Maintain Regulatory Compliance;

Now that you’ve learned about the California Nurse Practice Act, you may be seeking practical ways to keep up with other regulatory changes while juggling the demands of running a facility. Stay informed about the latest healthcare news and updates through IntelyCare’s free newsletter.

Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.