Nurse practitioners who practice pursuant to Sections 2837.103 and 2837.104 of the California Business and Professions Code may practice independently, without standardized procedures, in certain settings. (See our 2022 article “AB 890’s Independent Nurse Practitioner and the Medical Staff.”) These nurse practitioners are called “103 Nurse Practitioners” or “103 NPs” and “104 Nurse Practitioners” or “104 NPs,” respectively. 103 NPs have been licensed in California since 2023. A 103 NP may qualify for licensure as a 104 NP after practicing as a 103 NP for at least three years. Given the timing of the licensing of the first 103 NPs, the Board of Registered Nursing may start issuing 104 NP licenses as early as January 1, 2026.

While 103 NPs have been eligible to serve on medical staff and hospital committees, 104 NPs will be eligible for medical staff membership, subject to any applicable conflict-of-interest policies in the bylaws and compliance with professional liability insurance requirements. January 2026 is not far off, and hospitals and their medical staffs should be prepared. Medical staff leadership should review their bylaws, rules, and policies now to prepare for 104 NP applicants.

Health facilities where 103 NPs work and where 104 NPs may work once licenses are issued should also be aware of Senate Bill (“SB”) 1451’s recent updates to the law governing 103 and 104 NPs. SB 1451 took effect on January 1, 2025, and eases or clarifies some of the requirements for 103 and 104 NPs.

“Transition to Practice” Requirements

Nurse practitioners must complete a “transition to practice” before they are eligible for licensure as a 103 NP. SB 1451 clarifies the “transition to practice” requirements as follows:

• The transition to practice requires the equivalent of three years—either three full-time equivalent years or 4,600 hours—of direct patient care in California within the last five years. SB 1451 clarifies that those three years need not be consecutive or uninterrupted.
• Nurse practitioners may practice in six categories of practice: family, adult gerontology, neonatal, pediatrics, women’s health, and mental health. SB 1451 provides that a 103 NP applicant’s clinical experience during the transition to practice does not need to fall within a single category.
• 103 NP applicants must provide proof to the Board of Registered Nursing in the form of an attestation by a licensed physician and surgeon, another 103 NP, or a 104 NP. SB 1451 provides that the attesting practitioner does not need to verify the applicant’s “competence, clinical expertise, or any other standards related to the practice of the applicant.” Instead, the attesting practitioner only needs to verify the applicant’s completion of the transition to practice. Further, under SB 1451, attesting practitioners are immune from legal liability and other adverse action for providing or refusing to provide an attestation as to the completion of a transition to practice unless they produce the attestation fraudulently.

Disclosures to Patients

SB 1451 specifies that 103 and 104 NPs do not need to inform patients that they have a right to see a physician and surgeon. However, SB 1451 does not change the requirement that 103 and 104 NPs inform new patients in a language the patients understand that 103 and 104 NPs are not physicians and surgeons. SB 1451 also leaves in place the requirement that 103 and 104 NPs post a notice stating they are licensed by the Board of Registered Nursing with information about how to check licensure status.