California Expands Nurse Practitioner Practice Authority

California has opened a path for nurse practitioners to practice without physician supervision. In a state where nearly 45% of residents lack adequate access to primary care providers, that matters. NPs can now work toward running their own practices, or joining existing ones in underserved communities, without negotiating physician agreements or meeting physician-to-NP ratios.

Here is how the law works and what it means for NPs in California and beyond.

What the law does

Assembly Bill 890, signed by Governor Gavin Newsom in September 2020, created two new NP categories that practice within a defined scope without standardized procedures. The Board of Registered Nursing finalized the requirements, and the first category opened in January 2023.

An NP who completes 4,600 hours or three years of full-time clinical practice in California can apply for "103 NP" status. A 103 NP works without standardized procedures but stays in a group setting where at least one physician also practices, and can consult that physician when needed.

After three years as a 103 NP, an NP can apply for "104 NP" status. This category opened January 1, 2026. A 104 NP can practice outside a group setting and open an independent practice, within the population focus of their national certification: family, adult-gerontology, neonatal, pediatrics, women's health, or psychiatric mental health. Some experienced NPs who had already logged the required California hours reached 104 status in 2025, ahead of the general timeline. By 2026, nearly two-thirds of California's NPs are expected to qualify for full practice authority.

Full practice authority lets an NP work within the complete scope of the NP license without a supervising physician. That includes diagnosing patients, ordering tests, prescribing medications, and performing physical exams. It adds no duties beyond the NP scope, and it does not end the need to collaborate. Collaboration with physicians and other providers is built into NP training, and most NPs who practice independently still work alongside other clinicians.

What it means nationally

Primary care and psychiatric mental health are the first and fourth most common NP specialties, and they are two of the services California needs most. The state projects a 50% shortage of psychiatrists by 2028. By 2030, it expects to need between 78,000 and 103,000 primary care providers, half of them advanced practice providers.

Full practice authority lets NPs open practices in underserved areas without a supervising physician, and lets existing practices hire more NPs without meeting a ratio. More NPs can mean shorter waits, broader access, and better outcomes.

California pays NPs the highest average salary in the country, around $161,540 a year (BLS, May 2024). Even so, pay and looser practice rules may not close the roughly 4,100 primary care practitioner gap. Nevada, Oregon, and Arizona already grant full practice authority, and some NPs value independence over salary. California may still struggle to pull NPs away from those states into its underserved areas.

The bill could start a trend. Other states may watch whether California measurably improves access in areas with more than 2,000 residents per primary care provider, then pass similar laws of their own.