Nursing Licensure & Scope of Practice in California
California employs more than 99,000 nursing assistants, more than 294,000 registered nurses(RNs), more than 15,000 advanced practice nurses (APRNs) and more than 64,000 licensed vocational nurses (LVNs). It also leads the nation in pay for all of these categories. The state’s size and geographic features offer jobs in multiple work settings from metropolitan university hospitals to small rural clinics to home care. Scope of practice is relatively broad compared to other states, especially for APRNs.
Nursing License Requirements in California
California licenses registered nurses, advanced practice registered nurses, licensed vocational nurses and certified nursing assistants (CNA). APRNs include Nurse Practitioners(NP), Certified Registered Nurse Anesthetists (CRNA), Clinical Nurse Specialists (CNS) and Certified Nurse-Midwives (CNM). RNs and APRNs are licensed by the Board of Registered Nursing (BRN). LVNs are licensed by the Board of Vocational Nursing and Psychiatric Technicians (BVNPT). The California Department of Public Health (CDPH) certifies CNAs. California is not a nursing licensure compact state, which means that a California license does not allow you to practice in other states – you must take an examination or undergo a screening process to obtain a second license.
Each level of nursing practitioner has different licensure requirements. In all cases, however, the applicant must supply a 2-inch X 2-inch front view, head and shoulders photograph and submit his or her fingerprints for a criminal background check.
- CNA – there are three options to become a CNA in California:
- Complete a CDPH-approved program and the competency evaluation exam.
- Prove equivalent training in an RN, LVN or licensed psychiatric technician program, in the military or by receiving a CNA certification in another state or foreign country and take the competency evaluation examination. Applicants must also submit proof of paid work providing nursing or nursing-related services to skilled nursing facility residents within the last two years.
- Provide proof of active CNA certification and registration as a CNA in another state’s registry as well as proof of providing nursing or nursing-related services to facility residents within the last two years.
- LVN – proof of a high school diploma and completion of a BVNPT-accredited school is required to become an LVN in California. The applicant must also pass the NCLEX-PN examination. LVN applicants can also challenge the licensure examination by providing proof of 54 hours of pharmacology education, 51 months of paid bedside nursing experience and verification of skill proficiency. For former military personnel, California will issue an LVN license upon proof of education and experience in the US military as a corpsman. The applicant must submit proof of completion of the basic course in nursing in a branch of the armed forces, 12 months active duty rendering direct bedside patients care and a general honorable discharge from the military.
- RN – in order to apply for an RN license in California, the applicant must have successfully completed an associate or baccalaureate California BRN-approved nursing program and passed the national NCLEX-RN examination.
- APRN – the applicant must have a current valid RN license in the state of California, complete a BRN-approved master’s degree APRN program and pass a certification examination. APRNS must also obtain a furnishing certificate, which allows them to prescribe.
A current active license is required to practice nursing in California. A licensee who wants to maintain the license but does not want to practice can choose inactive status. CE requirements are waived for inactive status. The final option is to allow a license to lapse or become delinquent if the applicant no longer wants to practice nursing. A lapsed license of less than eight years can be returned to active status through payment of a fee and completion of CE requirements. After eight years, the applicant must submit the fee, complete required CE and provide either verification of licensure in another state or retake the licensure examination.
- CNA – the certification period is two years. To re-certify, the CNA must complete 48 hours of approved continuing education (CE), at least 12 of which must be completed in each year and pay a re-certification fee. A maximum of 24 hours can be completed online. The CE requirement is waived for the first renewal.
- LVN – certification period is two years. The applicant must complete 30 hours of approved continuing education and pay a license renewal fee. The CE requirement is waived for the initial renewal. LVNs who were licensed prior to 1/1/1998 must also submit fingerprints.
- RNs – the licensure period is two years. A license renewal fee is required, as is fingerprinting if the applicant was licensed prior to 1/1/1998. The applicant must have completed 30 hours of approved CE except for the first renewal.
- APRNs – the licensure period is two years. APRNs must meet the same 30-hour CE requirement as RNs. In addition to an RN license fee, APRNs must pay additional fees for certification in their specialty and for furnishing certificate renewal.
Other Methods of Licensure
California applicants who were educated/licensed in another state or a foreign country can become licensed in California. The process is known as endorsement or reciprocity. The process for gaining reciprocity from California to another state is similar, but specific requirements depend on the state. Some states will require the CNA or nurse to pass the licensing exam in the state where the candidate wants to practice. To qualify for reciprocity in California:
Certified Nurse Assistant
The CNA applicant must submit a copy of the out-of-state CNA certificate, proof of employment for compensation in a resident facility under the supervision of a licensed health care professional within the preceding two years and the Verification of Current Nurse Assistant Certification completed by the applicant and the state agency from the state in which the applicant is currently certified.
Licensed Vocational Nurse
The LVN applicant must hold a current active license as an LVN or licensed practical nurse (LPN) in another US state or territory and have passed the NCLEX-PN or National League for Nursing State Board Test Pool Examination for Practical Nurse (SBTPE). Applicants licensed in a foreign country can only apply for endorsement if the country administers one of the two exams mentioned.
RN or APRN
The RN or APRN applicant must hold a current, active RN license in another state, US territory or Canada. In addition, the applicant must have completed an educational program that meets all California requirements and have passed either the NCLEX-RN or the State Board Test Pool Examination. APRNs must also provide proof of certification in their specialty.
Veterans who received corpsman training in the military can apply for licensure as a CNA or LVN in California as noted above.
There are no options for paramedics to become licensed as CNAs, LVNs or RNs in California without completing the required course of study and passing the necessary examinations.
Foreign-born or Foreign-educated Nurses
There is no option for a foreign-born or foreign-educated CNA to become certified in California. The applicant must complete the required training and examination.
Foreign-born or foreign-educated nurses must have completed a program that meets the requirements of a California LVN or RN program and pass the NCLEX-PN or NCLEX-RN examination.
Online Services Related to Nursing Licensure in California
The CDPH, BVNPT, and BRN offer a variety of online services. All include ways to contact the relevant organization as well as:
- Initial application
- Verification of certification
- Training programs.
- Application information
- Approved vocational nursing schools
- License renewal.
- License application
- License renewal
- Duplicate certificates
- Verification of a license, permit or continuing education provider number
- Regulations that govern the practice of nursing
- Scope of practice information
- FAQs about nursing, nursing education requirements, initial licensure, and renewal.
Criminal History Reports
The mandate of all licensing or certification boards is to ensure a competent, safe practitioner and to protect the public. To that end, they require applicants and those applying for certification or license renewal to provide information about criminal offenses. A licensee who provides this information to the relevant board must also supply a detailed written explanation of the circumstances, documents related to the arrest, including court documents, and any mitigating circumstances or evidence of rehabilitation.
- CNAs must report any criminal convictions with the exception of traffic offenses and marijuana-related offenses.
- LVNs must report all criminal convictions, including nolo contendere and those that were expunged from the record, each time they renew an LVN license. This includes traffic tickets with fines over $1000 or that involved alcohol or controlled substances. Arrests are not reportable.
- RNs and APRNs have the same requirements as LVNs, but they must also report convictions that were set aside or deferred.
The CDPH, BVNPT, and BRN may take action in cases when criminal convictions, substance abuse or unprofessional behavior is confirmed in a CNA, LVN, RN or APRN. In most cases, the focus is on crimes substantially related to the qualifications, functions, and duties of the licensee. Once a report is filed or the licensee reports a conviction, the relevant licensing organization will investigate. The accused individual has an opportunity to make a defense at an administrative hearing. The board will then make recommendations for action against the licensee. The action taken depends on the specific charges, the outcome of the case and the severity of the individual’s actions. For example, substance abuse may result in a temporary suspension of the right to practice, but if the individual completes a rehabilitation program, the suspension may be lifted. The individual may still have some restrictions, however, such as not being able to access controlled substances. Among the most common reasons for a license restriction or termination are ongoing substance abuse, exceeding the scope of practice, theft from patients or clients, embezzlement, gross negligence, battery, and abuse of patients, children or a spouse. Failure to report abuse witnessed by the licensee is also cause for disciplinary action.
Scope of Practice
Scope of practice in nursing is defined by the individual state. In California, the CDPH defines the scope of practice for a CNA. The BVNPT defines the scope of practice for an LVN and the BRN defines the scope of practice for an RN or APRN.
- CNAs must work under the supervision of a physician or licensed nurse. They are trained to perform direct services related to daily living activities and to assist the physician or licensed nurse. A CNA might provide bed baths or showers, help a patient with toileting activities, feed a patient or collect specimens.
- LVNs must be supervised by a physician, RN or APRN. In addition to direct bedside care such as that performed by CNAs, an LVN may administer medications including injections and immunizations, perform skin tests and withdraw blood. LVNs who have completed IV therapy training may also start, manage and discontinue intravenous lines.
- RNs perform all of the tasks in the CNA and LVN scope of practice, as well as additional tasks such as the administration of intravenous medications. RNs are considered independent practitioners in California. As long as they work within their scope of practice, they are not required to be supervised. Standardized procedures allow an expanded scope of practice in which the RN may perform tasks normally reserved for a physician, such as refilling medications according to specific criteria.
- APRNs have an expanded scope of practice very similar to that of a physician. Like RNs, they must operate under standardized procedures that are approved by their organization but do not require actual physician supervision. However, they do collaborate with physicians and may seek them out for advice or recommendations. When the NP is furnishing Schedule II or III controlled substances, physician involvement is required. APRNs can prescribe medications and medical devices, including controlled substances, within their field of practice. They cannot perform surgery. CRNAs can administer anesthesia and CNMs can perform prenatal care and deliver babies.
Resources for more information:
- The California Department of Public Health
- The California Board of Vocational Nursing and Psychiatric Technicians
- The California Board of Registered Nurses
- Advanced Practice and Public Health Nurse Certification
- State Approved LVN Programs
- State Approved ADN Programs
- State Approved BSN Programs
- List of all Nursing Schools in California