Registered Nursing Practice in California


Nursing field remains one of the most sensitive professions in the world. In health care practice, one mistake can lead to severe consequences including loss of life. Nurses and other health care providers are, therefore, expected to observe the highest standards of professionalism and competence to protect vulnerable patients. Despite the sensitivity of this matter, some nurses have engaged in unprofessional activities and exposed the lives of patients to great danger (Pearson, 2007). Since governments have the responsibility to protect citizens against such malpractices, measures are expected to be put in place to ensure that no patient is exposed to death because of nurses’ incompetence. This paper discusses regulation of nursing practice in the state of California, USA.

Source of California State Authority to Regulate Nursing Practice

In California, regulation of nursing practice is done by the Board of Registered Nursing (BRN). BRN draws its powers from the Nursing Practice Act (NPA) established by the state’s legislative arm of government. In this regard, the Nursing Practice Act outlines the functions of BRN as well as the responsibilities of registered nurses.

Functions of California Board of Registered Nursing

The general role of California Board of Registered Nursing is to ensure that nurses remain competent and accountable in discharging their functions as defined in the nursing Act. To realize this objective, the board is expected to read, interpret and enforce the Nursing Practice Act. The board is also responsible for issuance of licenses to qualified nurses. In this regard, the board oversees undertaking of nursing qualifying examination administered to aspiring nurses. BRN has the power to revoke a license if the holder is found to be engaging in activities that contradict the Nursing Practice Act. To ensure high nursing standards, the board also accredits and approves training of nurses. Nursing schools are vetted to ensure they comply with the nursing training requirements.

Nursing laws in California consist of statutes and regulations. While statutes originate from the legislature, regulations are enacted by government agencies to be used in policy implementation. In this case, the Board of Registered Nursing is also charged with the responsibility of developing regulations that aim at improving competence of nursing practice in the state. It is worth noting that such regulations are mere extensions of the statutes rather than replacement. Regulations are used to fill gaps that may exist in statutes.

California Board of Registered Nursing works closely with healthcare consumers and providers in order to identify areas that need strengthening. The board receives complaints regarding nursing malpractices from health care consumers. Complaints can be filed by a patient, independent observer or any person who feels that some nursing officers are engaging in activities that are not in agreement with the accepted nursing practice. After receiving a complaint, the board launches investigations through its trained investigators. At this stage, investigators interrogate the accused and other people who may be in a position to provide useful information. Evidence is also collected at this stage. A report is forwarded to the District Attorney if an offense is found to have been committed. Nurses found to have committed professional malpractices may be fined, suspended or have their licenses revoked.

Requirements for Nursing Licensure

People who wish to become licensed nurses in California must provide a certificate of National Council Licensure Examination for Registered Nurses (NCLEX-RN). Candidates must also have successfully completed nursing training programs that are recognised in California. Nurses who hold licenses from other states or Canada may be considered if they meet the minimum training requirements and have passed NCLEX-RN. Nurses who successfully get licensed are required to renew their licenses after every two years. In this case, licenses will only be renewed if applicants completed at least 30 hours of additional training during the period of two years preceding the application.

Scope of Practice of the Registered Nurses in California

Scope of nursing practice is spelt out in section 2725 of NPA. Nurses are expected to give patients scientific assistance to help them cope with problems associated with their ailments or treatment. According to the Act, nursing practice is divided into three categories. The first category covers independent functions of nurses. In this case, nurses are expected to make sure that patients are safe, comfortable, clean and protected. Nurses should also help in performing functions such as skin tests, immunization against some complications as well as collection of blood samples. Other functions in this category include monitoring symptoms that may require intervention and assessment of patients’ response to medication. In the second category of nursing functions, nurses are expected to administer medications and therapies as recommended by doctors. These are called dependent functions. The third category covers interdependent functions. This category mandates nurses to perform necessary standardized procedures after detecting unusual signs associated with the disease or treatment.

Specific Regulations Included in the Nursing Practice Act

To perform its functions as outlined in the Nursing Practice Act, California Board of Registered Nurses is expected to put in place some regulations for guidance. For example, regulation 1409 which talks about issuance of license is one of the most important regulations included in NPA. According to this regulation, licenses can only be given after applicants have passed the required licensing examination. This regulation was designed to facilitate attainment of the highest competency level in nursing. Regulations 1442 to 1444 talk about the expected conduct of all nurses. These regulations give detailed functions of nurses and notes unacceptable behaviours. Regulation 1445 gives guidelines on the required punishment for those who contravene nursing practice expectations. In general, regulations are included to provide a platform for setting targets and measuring achievements.

Impact of NPA on Practice

In performing their functions, nurses are guided by NPA. The Act reminds nurses of public and legal expectations to ensure they refrain from activities that put beneficiaries of their services at risk. In addition to equipping nurses with the necessary skills, the requirement for proper training also facilitate refreshment of their knowledge to ensure they remain relevant to the changing nursing needs. However, research has shown that threat of punishment is not enough to change people’s attitudes (Lenz, Mundinger, Kane, Hopkins & Lin, 2004). In this case, training of nurses should be designed to enhance good morals. This would ensure that their decisions are guided by the need to do what is right rather than fear of punishment. Motivational technique should also be incorporated to ensure that nurses perform their duties with right attitudes.


The sensitivity of nursing profession calls for the highest degree of sobriety and accountability. In the state of California, the Nursing Practice Act establishes the Board of Registered Nursing and assigns it the task of ensuring that nursing practice is discharged with the highest degree of professionalism. The board oversees registration of nurses and monitors their performance. Although this Act has brought some accountability in the nursing field, application of motivational approach may help to maximise nursing outcomes.


California Nursing Practice Act 1973-74.

Lenz, E. R., Mundinger M. O., Kane R. L., Hopkins S. C., Lin S. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow up. Med Care Res Rev. 61(3):332–51.

Pearson, L. (2007). The Pearson report. A national overview of NP legislation and health care issues. Am J Nurse Pract. 11(2):9–136.

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