California NP Scope of Practice: Categories, Furnishing, and CURES

The California nurse practitioner scope of practice is defined by three overlapping layers: the registered nurse scope every NP builds on, the NP’s education and national certification, and which of three practice categories the NP qualifies for under state law. Those categories — traditional NPs working under standardized procedures, 103 NPs, and 104 NPs — determine whether a physician agreement is required, where the NP can practice, and how prescribing works. Practicing outside your authorized category is a disciplinable offense, so the category you fall into is not a formality.

The Three Practice Categories

Assembly Bill 890, signed in September 2020, kept the traditional supervised model in place and added two new categories above it. Every California NP today practices in one of these three.

Traditional NPs

Traditional NPs practice under standardized procedures: written agreements developed jointly by the NP, a supervising physician, and the facility administrator that spell out which services the NP may provide, which medications they may prescribe, and how much oversight is required.¹ No physician may supervise more than four NPs at once, and the physician must be reachable by phone during patient encounters even when not physically present. Any NP who has not obtained 103 or 104 certification practices in this category by default.

103 NPs

A 103 NP practices without standardized procedures, but only in settings where at least one physician also practices. Qualifying for the category requires a transition-to-practice period of at least three full-time equivalent years, or 4,600 hours of direct patient care.² An NP who has already practiced that much in direct patient care within the last five years can be deemed to have met the requirement, with attestation from a licensed physician, a certified 103 NP, or a certified 104 NP.³

The approved settings for 103 practice are:

Clinics as defined in Health and Safety Code Section 1200
Health facilities as defined in Health and Safety Code Section 1250, except correctional treatment centers and state hospitals
Medical group practices, including professional medical corporations, medical partnerships, and medical foundations
Home health agencies and hospice facilities

A 103 NP working in a nursing corporation cannot practice without standardized procedures.² If a 103 NP’s national board certification expires, they must immediately revert to the traditional supervised model.

104 NPs

The 104 category allows practice outside the group settings 103 NPs are confined to, meaning true independent practice. The requirements are steeper. On top of everything a 103 NP must meet, a 104 NP needs a master’s degree in nursing or a related clinical field, or a doctoral degree in nursing, plus at least three additional years of NP practice in good standing beyond the transition-to-practice period.⁴ That is a minimum of six years of NP practice before reaching full independence. The BRN has discretion to lower this for NPs holding a Doctor of Nursing Practice degree, based on experience gained during doctoral education.

Full independence does not mean working alone. The statute requires physician consultation for emergent conditions that need prompt medical intervention, problems not resolving as expected, clinical findings inconsistent with the overall picture, and any time a patient requests it.⁴ Every 104 NP must also maintain a written referral plan for complex cases and emergencies, with specific criteria for when referral is appropriate.

One boundary worth knowing before planning around this category: the BRN has stated it will not be able to certify 104 NPs until 2026.² 103 applications are already being accepted.

What California NPs Can Clinically Do

No single regulation lists every procedure a California NP may perform. The scope builds in layers. Title 16, Section 1485 of the California Code of Regulations states that NPs function within the scope of practice defined by the Nursing Practice Act as it applies to all registered nurses.⁵ That base RN scope, set out in Business and Professions Code Section 2725, covers direct patient care, administering ordered medications and treatments, performing skin tests and immunizations, drawing blood, observing and assessing patient conditions, and initiating emergency procedures or treatment changes under standardized procedures.⁶

NP education and national certification extend that foundation. A 103 or 104 NP may perform physical exams, diagnose health conditions, order and interpret diagnostic tests, develop and manage treatment plans, and prescribe medications and devices within their population focus of national certification.³ Traditional NPs perform these same functions, but only as laid out in their standardized procedures.

Procedures like suturing, wound debridement, and joint injections are permitted when the NP has received formal training and can demonstrate proficiency. More advanced procedures may require additional credentialing from the facility where the NP practices. The rule that governs across all three categories: you cannot practice beyond your clinical education, training, and national certification, no matter how many years of experience you have.

Prescriptive (Furnishing) Authority

California calls NP prescribing “furnishing,” and any NP who wants to prescribe must obtain a furnishing number from the BRN, which requires completing an advanced pharmacology course covering drug selection, dosage, and patient management.⁷ This coursework can be built into an NP program or completed separately through a board-approved course.

How that furnishing authority works depends on the pathway. Traditional NPs can furnish Schedule II through Schedule V controlled substances, but only drugs specifically agreed upon with the supervising physician and written into the standardized procedure.¹ Schedule II and III drugs add another layer: they must be furnished under a patient-specific protocol approved by the treating or supervising physician. That physician does not need to be on site but must be reachable by phone during patient encounters.

103 and 104 NPs can furnish without standardized procedures, within the NP’s area of national certification. NPs furnishing controlled substances must still register with the U.S. Drug Enforcement Administration and obtain a DEA number, and those who furnish Schedule II drugs must complete additional continuing education on Schedule II controlled substances as established by the BRN.¹

CURES Checks

Every NP with furnishing authority must participate in the Controlled Substance Utilization Review and Evaluation System, California’s prescription drug monitoring program. Before prescribing any Schedule II through V controlled substance, you must check the patient’s CURES history.⁸ The consultation is required the first time you prescribe a controlled substance to a patient, within 24 hours before each subsequent prescription, and at least once every six months if the substance stays part of the treatment plan. The law was amended to include Schedule V substances, so the obligation is broader than many NPs realize.

Keeping Your Expanded Scope

For 103 and 104 NPs, the expanded scope depends on continuous national certification. If your certification lapses, you must immediately stop practicing without standardized procedures and revert to the supervised model.²

National certification renews every five years, and the requirements depend on the certifying body. AANP-certified NPs must complete 1,000 practice hours in their population focus and 100 continuing education contact hours, including at least 25 hours in advanced pharmacology.⁹ ANCC-certified NPs need 75 continuing education hours, again with a minimum of 25 in advanced pharmacology, and at least 60 of those hours must come from formally approved CE providers.¹⁰ Because NP certification sits on top of the RN license, the underlying RN license and its 30 contact hours of CE per two-year cycle must also stay current.¹¹

Discipline can collapse scope just as fast as a lapsed certification. The BRN investigates complaints involving professional misconduct, negligence, substance abuse, and criminal activity, and the most common infractions it sees involve improper prescribing, inadequate recordkeeping, and practicing beyond the authorized scope of certification. Outcomes range from fines and probation to suspension or revocation. For 103 and 104 NPs, a disciplinary finding can cascade: losing your furnishing number does not just limit prescribing, it may effectively end your ability to practice in settings that require prescriptive capability. License status and disciplinary documents are publicly accessible through the Department of Consumer Affairs’ BreEZe system.¹²

1
California Legislative Information. California Business and Professions Code 2836-1
2
California Board of Registered Nursing. Assembly Bill 890
3
California Legislative Information. California Business and Professions Code 2837-103
4
California Legislative Information. California Business and Professions Code 2837-104
5
Cornell Law Institute. California Code of Regulations Title 16 1485 – Scope of Practice
6
California Legislative Information. California Business and Professions Code 2725
7
California Board of Registered Nursing. Advanced Practice and PHN Certification
8
Medical Board of California. CURES Mandatory Use
9
AANPCB. Recertification
10
American Nurses Credentialing Center. ANCC Certification Renewal Handbook
11
California Board of Registered Nursing. Continuing Education for License Renewal
12
California Board of Registered Nursing. License Verification