California Nurse Practitioner Mobile IV Attorney
California Nurse Practitioner Mobile IV and Med Spa Attorney Sebastian Gibson, Named a Top Lawyer 13 Years in a Row and with Over 45 Years of Experience.
At the offices of California Nurse Practitioner Mobile IV Attorney Sebastian Gibson we’ve been closely watching for guidance from the California Board of Registered Nursing and possibly from the California Medical Board as well as to how AB-890 is finally being implemented and we can advise you as a nurse practitioner how to gain your long sought independence in California.
California Nurse Practitioner Mobile IV Attorney Sebastian Gibson has over 45 years of experience and has law degrees in both California and Great Britain. Named a Top Lawyer in 2023 for the past 13 years in a row by the prestigious Palm Springs Life Magazine, California Nurse Practitioner Mobile IV Attorney Sebastian Gibson has been called “Brilliant” and “A Legend.”
California Nurse Practitioner Mobile IV Attorney Sebastian Gibson works daily with registered nurses and nurse practitioners from throughout California to set up their medical spas and IV hydration businesses with one goal in mind, to protect the nurse and provide the necessary guidance to put their business on track to making a success of their new venture.
California AB-890
What California AB-890 Sections 103 and 104 will allow NP’s to do once the Board of Registered Nursing creates the necessary regulations governing this further expansion of what NP’s can provide with and without physician supervision include the following:
What Some Nurse Practitioners Will Be Able to Do In The Future
Conduct advanced assessments
Order, perform and interpret diagnostic procedures as specified with regard to radiologic and clinical laboratory procedures
Establish primary and differential diagnoses
Prescribe, order, administer, dispense, procure, and furnish therapeutic measures including referrals, pharmacological agents, and nonpharmacological interventions, as specified
Certify disability for state disability benefits
Delegate tasks to a medical assistant
However, What Those Nurse Practitioners Allowed Under AB-890 will still be required to do:
Verbally inform all new patients in a language understandable to the patient that the nurse practitioner is not a physician;
Post a notice in a conspicuous location accessible to public view that the nurse; practitioner is regulated by the Board of Registered Nursing, including information about how complaints can be made;
Practice only within the scope of their education and training;
Refer patients to a physician in specified circumstances; and
Carry professional liability insurance.
Which Nurse Practitioners Will Be Afforded Independence Under These New Provisions and the As Of Yet Unknown Regulations Still To Be Promulgated
This is the problem with the current set of legal provisions already contained in AB-890.
First, under AB-890 and until the new Board of Nursing regulations are propagated and thereafter, should an NP wish to create a nursing corporation, and practice as an independent nurse practitioner or a nurse practitioner group, they will need to meet the following scope of practice requirements:
1) The NP must have practiced within the limits of their knowledge, experience, and national certification and have practiced in good standing for at least three years after meeting the requirements to transition to practice; and
2) furnish a California Transition-To Practice (TTP) requirement of three full-time equivalent years or 4600 hours.
To therefore be able to practice independently, a NP will need to have six years of practicing in good standing with no discipline against the nurse practitioner’s license or nurse practitioner’s certificate, in a setting-specific practice with three years in transition-to-practice, plus three years practicing in good standing.
In the opinion of California Nurse Practitioner Mobile IV Attorney Sebastian Gibson, that may serve to 1) prevent far too many nurse practitioners from being able to understand what’s required of them to be independent, 2) make it too expensive and too time consuming to become independent, and 3) still cause many nurses to have to go to the expense of setting up a mobile IV hydration business or a med spa under current requirements currently necessary in order to be approved for a fictitious name to operate under by the California Medical Board.
Transition to Practice
While this term will likely be further defined by the Board of Registered Nursing, it will likely include, but may not be limited to, managing a panel of patients, working in a complex health care setting, interpersonal collaboration and communication, team-based care, professionalism, and business management of a practice.
Business and Professions Code Section 2837.103(a)(1)(D) provides that the transition to practice must include a minimum of three years of full-time equivalent years of practice or 4600 hours. Upon completion of the transition to practice, a nurse practitioner may practice in limited settings or organization in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures.
In order for a nurse practitioner to practice outside of those settings, a nurse practitioner must practice within the limits of their knowledge, experience, and national certification and have practiced in good standing for at least three years after meeting the requirements to transition to practice. In addition, a nurse practitioner who is practicing outside of the limited settings outlined in Business and Professions Code Section 2837.103 shall consult and collaborate with other healing arts providers based on the clinical condition of the patient to whom health care is provided and establish a plan for referral of complex medical cases and emergencies to a physician and surgeon or other healing arts providers.
The Latest Information Provided by the Board of Registered Nursing for Nurse Practitioners in California Seeking To Gain Independence and Full Practice Authority
One might have thought the Board of Registered Nursing would want to make it simpler and quicker for Nurse Practitioners to become independent, i.e. gain Full Practice Authority (FPA). Instead it’s just the opposite.
The latest information provided by the Board is that before Nurse Practitioners can truly become independent and thus own and operate a medical spa or IV hydration business, for instance, without a physician owning 51% of it and being the Medical Director will take for many nurse practitioners 6 years and for some select few, at least another 3 years.
Under AB890, under the first hurdle of obtaining true independence, the new 103 NP provision allows a nurse practitioner to practice at a location where one or more physicians also practice without having to practice pursuant to a set of standardized procedures with a physician in order to gain 103 NP status.
However, the 103 NP provision is only offered to an NP who has completed a transition-to-practice period during which they either worked full time for 3 years or worked 4,600 hours within a 5 year period (which of course would be virtually impossible, for instance, while trying to operate a successful medical spa or IV hydration business with a Medical Director physician who owns 51% of the shares of the Professional Medical Corporation which owns the med spa, and who is rarely if ever there except by telehealth, FaceTime, or Zoom meetings.
Obviously, this 103 NP provision does little to offer nurse practitioners any real independence as they are still forced to practice where one or more physicians are also practicing medicine. However, lets say a nurse practitioner jumps through this first hoop and successfully practices where a physician also practices, and works there either full time for three years or part time for 4600 hours. Now the NP must jump through the second hoop.
Is the nurse practitioner now independent? No. Does the nurse have FPA? No. Before the nurse practitioner can truly be independent and gain 104 NP status, and gain a 104 NP license, and thus Full Practice Authority and before that nurse is able to practice in any number of locations such as a medical spa or operating an IV hydration business, each without the need of operating at a practice location where one or more physicians are practicing, guess what? They still need to practice for at least another 3 years with their 103 NP license. That’s in addition to the first three year period which was required to obtain the 103 NP license in the first place. Which means for most NPs, the soonest they will obtain a 104 NP license is 2026.
Reportedly, the Board of Registered Nursing will not begin qualifying nurse practitioners as 104 NP until 2026.
Before even qualifying to become a 103 NP, a nurse practitioner must complete a “transition to practice” which relates to obtaining additional clinical experience and mentoring provided to prepare a nurse practitioner in order to practice independently. This includes managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice.
So what type of location qualifies as a location where a 103 NP can practice for 3 years in order to gain their 104 NP license? So far, it’s rather unknown. The Board of Registered Nursing has not stated just how often a physician must be present at such a location. It might mean they can just the there occasionally, or it might mean they must always be there. But based on what’s required to complete a “transition to practice” it seems likely that physicians will need to be present all of the time.
If an NP is currently practicing where physicians are only present occasionally and now they must practice where physicians are always present, even the 103 NP may need to change their current job and move to a group practice clinic where physicians practice in order to gain their 104 NP status.
And if an NP is practicing in a med spa or IV hydration setting where a physician Medical Director is never present other than by telehealth or FaceTime or Zoom, that location will certainly not even qualify an NP to obtain 103 NP status.
But lets say a NP finally obtains a 104 NP license and now has Full Practice Authority (FPA). Yay. Now a nurse practitioner may practice without a supervisor physician like a Medical Director and 51% owner of a Professional Medical Corporation in which the nurse practitioner can only own 49% of the shares.
What type of business structure can the nurse practitioner with 104 NP status and FPA operate under? The Code Section under which California Professional Medical Corporations can be formed requires that they are owned by a physician or physicians, or they may be owned 51% by a physician and 49% by an NP or RN or a select number of other medical professionals.
So, unless that code section is changed, a Professional Medical Corporation would seem to be out. A Nursing Corporation? Most likely. However, nursing corporations today generally have nurses performing in a rather limited way. A simple LLC? Even more unlikely without some new legislation. Obviously some new statutes need to be drafted along with additional regulations by the Board of Registered Nursing or the California Medical Board.
California AB-890 Strict Requirements
California AB-890 expands the scope of practice rules for Nurse Practitioners, but the requirements are stiff and the regulations yet to be put into law by the Board of Registered Nursing are likely to leave many nurse practitioners unable to take advantage of the new law until they have many more years of practice under specific guidelines before they can truly be more independent.
Until the new law and new Board of Registered Nursing regulations go into effect, nurse practitioners will not be able to act independently and will still be required to enter into a written practice agreement with a physician or physician group and will need to continue to operate using Standardized Procedures, the mechanism which allows nurse practitioners to perform functions which constitute the practice of medicine.
While California is behind most other states in empowering nurse practitioners to act with more independence, with the forthcoming regulations by the Board of Registered Nursing, California will finally join nearly 40others to grant some level of independence to nurse practitioners.
Unfortunately, California will likely still have some of the most restrictive policies on nurse practitioner independence in the U.S. And with these restrictions, the problem of doctor shortage isn’t going to be solved quickly.
The Solution for Nurse Practitioners Who Don’t Qualify to Act Independently Under AB-890 and Future Regulations
For nurse practitioners who won’t qualify to act with more independence under AB-890, the solution is to set up a Professional Medical Corporation with a physician owning 51% of the shares and the NP owning 49% of the shares and to operate a mobile IV Hydration business analogous to a med spa, or in conjunction with a bricks and mortar med spa, which we can set up for a NP in California with a number of agreements in place to protect the assets of the NP and provide for the continuation of the business with a fictitious name for the med spa or IV hydration business with the California Medical Board. Additionally, an MSO can be created to handle the administrative matters for the med spa or IV hydration business 100% owned by the nurse practitioner.
We invite you to call Attorney Sebastian Gibson to discuss your options in light of the strict regulations still required under AB-890 and the anticipated regulations to be promulgated by the Board of Registered Nurses to implement AB-890.
California Nurse Practitioner Mobile IV Attorney Sebastian Gibson, The Right Choice
With over 44 years of practice, California Nurse Practitioner Mobile IV Attorney Sebastian Gibson has been rated “Superb,” their highest rating, by Avvo, which rates attorneys all across the country. When you’re searching for an experienced Healthcare Attorney with the knowledge to set up your medica spa or mobile hydration business, call California Nurse Practitioner Mobile IV Attorney Sebastian Gibson.
With offices in Palm Desert and Newport Beach California Nurse Practitioner Mobile IV Attorney Sebastian Gibson provides legal services and guidance to nurses all across the state of California.
