For Kerstin Helgason and Jamie Sorenson, providing mental health care isn’t just a profession—it’s a calling. With more than two decades of experience apiece, these licensed psychiatric nurse practitioners (NPs) have dedicated their careers to serving California’s most vulnerable populations.
Kerstin works with adults and teens who have experienced childhood abuse and neglect. For over 20 years, she worked in community mental health settings, providing critical care for very ill patients. Now she works in private practice and provides focused care to her individual patients.
Jamie’s practice draws on her military background, including 20 years of mental health care for U.S. Navy patients. She also established the first embedded independent psychiatric provider program in San Diego. Her current practice focuses on teenage girls and young women dealing with serious medical problems.
Both women run successful private practices, but because they are NPs and not MDs, their businesses come with strings attached. Until recently, California’s nurse practitioners could operate in private practice only if supervised by a collaborating physician. This mandate forces NPs to pay supervising physicians fees often topping $6,000 per year—with many physicians charging more than twice that. Despite these exorbitant costs, the state does not dictate the health or safety standards in the collaborating agreements; physicians are not required to actively oversee NPs in any meaningful way. It’s simply a required handout to physicians.
In 2020, faced with a crisis-level provider shortage, California passed AB 890 in an effort to open a path to independent practice for NPs. The law established two new nurse practitioner categories known as “103 NP” and “104 NP.”
103 NPs can work in medical group settings without a physician supervisory agreement after they complete at least 4,600 “transition to practice” hours (three full-time equivalent years). 104 NPs, on the other hand, can operate independently in any setting—including private practice—but must first qualify as 103 NPs and have an additional three years of work experience “in good standing.” As written, the law requires 104 NPs to meet the 103 NP eligibility requirements. It does not require NPs to practice as a 103 NP—a category which did not even exist before the law was enacted.
Ignoring the text and intent of the law (expand access to independent practice for NPs), the California Board of Registered Nursing has interpreted AB 890 to require that 104 NPs must practice as 103 NPs in a group setting for three years.
Rather than expanding opportunities for nurse practitioners, the Board’s regulation impedes the path to independent practice. Under the new regulatory scheme, Kerstin and Jamie must abandon their existing practices—and patients—and spend three years spinning their wheels in work settings where they’d learn nothing new about running an independent practice. Only then can they return to doing what they’ve been doing for years: running their own private practices.
Far worse would be the disruption in care for their patients—many of whom are very vulnerable and struggle with trauma and mental health challenges. Kerstin and Jamie have seen first-hand the devastating effects of limited access to care. Neither they, nor their patients, can afford to abandon this care for three years to satisfy the Board’s requirement for independent practice.
Absent those three years in a group setting now mandated by the Board, Kerstin and Jamie have no route to independent practice. Continuing their existing practices means they’ll have to abandon any hope of becoming 104 NPs—and keep shelling out thousands of dollars a year to collaborating physicians.
The law was never intended as a barrier to opportunity for accomplished NPs like Kerstin and Jamie. The Board’s wrong-headed interpretation of state law not only exceeds its legal authority but also unconstitutionally discriminates against private practice nurse practitioners, as only 103 NPs can ever achieve independent practice authority. Kerstin and Jamie cannot.
Represented at no charge by Pacific Legal Foundation, Kerstin and Jamie are fighting back. They’re challenging the Board’s interpretation of state law that hobbles their ability to care for their patients and earn an honest living. Their win will also ensure that qualified nurse practitioners can serve their communities without unnecessary barriers.
What’s At Stake?
- The CA Board of Registered Nursing has exceeded its authority by impeding nurse practitioners’ path to independent practice, contrary to legislative intent.
- It violates California law for the CA Board of Registered Nursing to issue regulations that run contrary to legislative intent.
- California nurse practitioners should be allowed to provide the care they are fully educated and trained to provide, including operating in an independent practice, without being forced to enter into a collaborative agreement with a physician.
