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California State Senator Ed Hernandez has introduced Senate Bill 491. The bill expands the scope of practice for a Nurse Practitioner (NP) in order to allow them to set up their own practices. Under current California law, NPs are allowed to treat patients under doctor supervision. While doctors do have more training than NPs, NPs can act as physicians and have been referred to as “physician extenders."

Hernandez introduced the bill as a response to the current and coming doctor shortage under the Affordable Care Act. With 30 million previously uninsured Americans now having access to healthcare, there simply aren't enough doctors to go around. A 2009 report by the American Association of Medical Colleges (AAMC) predicted that California “would likely face a physician shortage in 2015."

In another study, the Health Affairs surveyed Americans on whether or not they would be open to seeing an NP:

“...when presented with scenarios wherein they could see a physician assistant or a nurse practitioner sooner than a physician, most elected to see one of the other health care professionals instead of waiting.”

Despite the public support, the bill faces opposition in the Assembly. It was voted down by the Business, Professions, and Consumer Protection Committee, but is being reconsidered.

The main opponents of the bill is the California Medical Association, which represents doctors. They oppose the bill stating:

“Under this bill, nurse practitioners will no longer need to work pursuant to standardized protocols and procedures or any supervising physician and would basically give them a plenary license to practice medicine.”

Currently, 18 other states allow NP's to practice independently.

One issue SB 491 doesn't address is the high demand for nurses.

It's already estimated that Medi-CAL (California's version of Medicaid) is set to drastically expand under the ACA. Not only will more doctors be needed, but nurses as well. A big part of that will involve home health care.

According to the California Association for Health Services at Home, there were over 600,000 patients requiring over 12 million visits. That industry has been growing and, with it, the demand for skilled nursing care.

Some researchers, such as Dr. Peter Burhaus, believe this will contribute to a continuing nationwide nursing shortage:

“...[D]espite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025. A shortage of this magnitude would be twice as large as any nursing shortage experienced in this country since the mid-1960s.”

California would be ill equipped for such a shortage, considering it's narrow scope of practice for nurses. Licensed Vocational Nurses (LVNs), who are a step below Registered Nurses (RN's), have a very narrow scope compared to other states.

For example, an LVN in Colorado can take a job doing home visits where they care for IV's and PICC lines (a sort of super IV that goes directly to the heart), but they cannot in California. This not only severely limits home health agencies in who they can hire, but disincentives nurses from out of state to move to California.

SB 491 is making its way through committee. There are currently no bills concerning an LVN's scope of practice.