Guide

Do 104 NPs Still Need Standardized Procedures? No — Here Is What Replaces Them

Summary

No. A certified 104 NP performs the §2837.103(c) functions without standardized procedures, outside physician-staffed settings. What replaces them is Business and Professions Code §2837.104(c): a scope limit tied to education, training and national certification; a consultation-and-collaboration duty with four mandatory physician-consultation triggers; a written referral plan with five specific criteria; and sole responsibility for the services provided.

By Gale · Updated 2026-07-31. Every figure cited to a dated source. How we write.

Does a 104 NP Practice Without Standardized Procedures?

Yes — that is the certificate's entire function. BPC §2837.104(a)(1) authorizes a certified 104 NP to perform the functions in §2837.103(c) "outside of the settings or organizations specified under subparagraphs (A) to (F)" of §2837.103(a)(2), which is where the standardized-procedure exemption first appears 13.

Standardized procedures are the written protocols defined at BPC §2725 and developed jointly by the nurse practitioner and a supervising physician; §2837.101(b) imports that definition into this article 3. The 103 removes the need for them inside six physician-staffed settings; the 104 removes the setting condition as well.

One clarification worth keeping straight. The BRN states that "the ability to work under standardized procedures remains whether or not the licensee is a 103 or 104 NP" 2. Certification adds an option; it does not delete the traditional route. See 103 vs. 104 for the fork.

What Replaces Standardized Procedures in the Statute?

Four obligations, all inside BPC §2837.104(c), and each one is a compliance artifact rather than an attitude 1:

ObligationStatutory hookWhat it is in practice
Scope limit§2837.104(c)(1)Practice only within your clinical and professional education, training, areas of concentration, knowledge, experience and national certification
Consultation and collaboration§2837.104(c)(2)Consult and collaborate based on the patient's clinical condition, with physician consultation in four named circumstances
Sole responsibility§2837.104(c)(3)Consultation "alone shall not create a physician-patient relationship"; you are solely responsible for your services
Referral plan§2837.104(c)(4)A plan for complex cases and emergencies, specific to your practice area, with specific referral criteria

The trade is legible once you set it out this way. Standardized procedures were a document co-owned with a physician. What replaces them is a set of documents and duties you own alone.

When Must a 104 NP Obtain Physician Consultation?

In four circumstances the statute names, plus whatever your own protocols specify. BPC §2837.104(c)(2) requires you to "consult and collaborate with other healing arts providers based on the clinical condition of the patient," and states that physician consultation "shall be obtained as specified in the individual protocols and under the following circumstances" 1:

  • (A) Emergent conditions requiring prompt medical intervention after initial stabilizing care has been started.
  • (B) A problem which is not resolving as anticipated after an ongoing evaluation and management of the situation.
  • (C) History, physical, or lab findings inconsistent with the clinical perspective.
  • (D) Upon request of patient.

Note the phrase "as specified in the individual protocols." The statute presumes you have protocols of your own; the four circumstances are a floor beneath them, not a substitute for them.

Note also (D). A patient asking to see a physician triggers a consultation obligation — and it is entirely separate from the disclosure question SB 1451 touched. AB 890 originally listed five circumstances here, including "Acute decompensation of patient situation." SB 1451 deleted that standalone consultation trigger; decompensation, already present in AB 890's referral criteria, now sits reworded at §2837.104(c)(4)(B) 4.

What Must the Referral Plan Actually Contain?

Five criteria, specified in BPC §2837.104(c)(4) 1. The plan must be for "referral of complex medical cases and emergencies to a physician and surgeon or other appropriate healing arts providers," must be "specific to the practice area," and must include specific referral criteria addressing:

  • (A) Whenever situations arise which go beyond the competence, scope of practice, or experience of the nurse practitioner.
  • (B) Whenever patient conditions fail to respond or the patient is acutely decompensating in a manner not consistent with the progression of the disease and corresponding treatment plan.
  • (C) Any patient with a rare condition.
  • (D) Any patient conditions that do not fit the commonly accepted diagnostic pattern for a disease or disorder.
  • (E) All emergency situations after initial stabilizing care has been started.

This sits on top of, not instead of, the general referral duty that applies to 103 NPs under BPC §2837.103(g) — refer any patient whose situation or condition is beyond the scope of your education and training 3. A 104 NP owes both: the general duty, and a written plan with these five headings.

Building it is part of what should be ready before the certificate arrives — see how to apply for 104 NP certification.

What Else Survives the Move to 104?

The consumer-facing duties, essentially intact. A 104 NP not working under standardized procedures must inform all new patients, in a language understandable to the patient, that a nurse practitioner is not a physician and surgeon (BPC §2837.104(d)) 1, and must post a conspicuous notice naming the Board of Registered Nursing with its telephone number and website (BPC §2837.104(f)) 1 — which the BRN specifies at least 48-point Arial, with the patient notification given verbally 2. Professional liability insurance appropriate for the practice setting remains required (BPC §2837.104(g)) 1.

Be precise about what 2024 changed, because this is the single most-garbled point in the published guidance. SB 1451 did not remove the not-a-physician notification, and it did not remove the posted notice — under AB 890 that posting duty sat at §2837.104(e), and SB 1451 renumbered it to (f) while adding the "not working under standardized procedures" qualifier 4. What it added is a new subdivision providing that a 104 NP "shall not be required by the board to tell a patient that the patient has a right to see a physician and surgeon" (BPC §2837.104(e)) 1. That is a bar on the board imposing a different disclosure — not the repeal of the one you still owe. The full before-and-after is at what SB 1451 changed.

And national certification remains load-bearing. If it expires, the BRN says the NP must immediately begin practicing under standardized procedures until it is regained 2.

Can an Employer Still Require Standardized Procedures From You?

Yes. The BRN says so about 103 NPs directly — "an employer can still require a 103 NP to practice under standardized procedures" — and frames the broader point as a licensee, facility and employer decision as to "the extent the expanded authority is utilized" 2. Certification changes what the law permits, not what a contract requires.

That has a practical consequence for anyone certifying in order to negotiate. A 104 certificate gives you the legal standing to practice outside a physician-staffed setting; it does not, by itself, change an employment agreement, a delegation policy, a medical staff bylaw, or a payer's contract terms. Those are separate negotiations, and they are the ones that determine your day.

If the plan is to leave employment rather than renegotiate inside it, the ownership and contracting questions start at what a 104 NP is and continue into owning your insurance contracts.

Common questions

No supervising physician and no standardized procedures. BPC §2837.104(c)(2) does require consultation and collaboration with other healing arts providers based on the patient's clinical condition, with physician consultation mandatory in four named circumstances, and §2837.104(c)(3) states consultation alone creates no physician-patient relationship.

BPC §2837.104(c)(4) requires a 104 NP to establish a plan for referral of complex medical cases and emergencies and to have an identified referral plan specific to the practice area that includes specific referral criteria addressing five listed categories. A plan you cannot produce with those criteria is difficult to demonstrate.

Obtain physician consultation. BPC §2837.104(c)(2)(D) makes a patient request one of the four circumstances in which physician consultation shall be obtained. That is a clinical obligation, entirely separate from the disclosure rules — and you must still inform new patients that a nurse practitioner is not a physician and surgeon.

Yes. The BRN states the ability to work under standardized procedures remains whether or not the licensee is a 103 or 104 NP. The board also says that if national board certification expires, the nurse practitioner must immediately begin practicing under standardized procedures until that certification is regained.

The BPC §2837.104(c) duties attach to the certificate rather than to the location, so a certified 104 NP carries the scope limit, consultation duty, referral plan and sole responsibility wherever they practice under the certificate. Facility bylaws and employer policies may add further requirements on top.

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References

  1. 1.California State Legislature (2024). Business and Professions Code § 2837.104 — Nurse practitioners: practice outside specified settings (amended by Stats. 2024, Ch. 481 (SB 1451), effective January 1, 2025). California Legislative Information (leginfo.legislature.ca.gov). link ✓BPC §2837.104(a)(1) authorizes the §2837.103(c) functions outside the six settings; (c)(1) 'shall not practice beyond the scope of their clinical and professional education and training, including specific areas of concentration and shall only practice within the limits of their knowledge and experience and national certification'; (c)(2) consultation and collaboration duty with physician consultation required '(A) Emergent conditions requiring prompt medical intervention after initial stabilizing care has been started. (B) Problem which is not resolving as anticipated… (C) History, physical, or lab findings inconsistent with the clinical perspective. (D) Upon request of patient'; (c)(3) 'Nurse practitioner consultation with a physician and surgeon alone shall not create a physician-patient relationship. The nurse practitioner shall be solely responsible for the services they provide'; (c)(4)(A)–(E) the referral plan and its five criteria; (d)–(g) notification, the removed right-to-see-a-physician requirement, posted notice and liability insurance.
  2. 2.California Board of Registered Nursing (2026). Assembly Bill 890 — Nurse Practitioners: Scope of Practice: Practice Without Standardized Procedures (program page and frequently asked questions). California Board of Registered Nursing (rn.ca.gov). link ✓BRN AB 890 FAQ: 'the ability to work under standardized procedures remains whether or not the licensee is a 103 or 104 NP'; 'It is up to each licensee/facility/employer as to the extent the expanded authority is utilized'; 'an employer can still require a 103 NP to practice under standardized procedures'; consumer notification requires a posted notice 'in at least 48-point Arial font' and verbal notification of all new patients that a nurse practitioner is not a physician and surgeon; if national board certification expires 'the NP must immediately begin practicing under standardized procedures.'
  3. 3.California State Legislature (2024). Business and Professions Code § 2837.103 — Nurse practitioners: practice without standardized procedures (amended by Stats. 2024, Ch. 481 (SB 1451), effective January 1, 2025). California Legislative Information (leginfo.legislature.ca.gov). link ✓BPC §2837.103(a)(2)(A)–(F) enumerates the six settings the 104 certificate lifts; §2837.103(c) supplies the six functions; §2837.103(g) requires referral of a patient to a physician and surgeon or other licensed health care provider 'if a situation or condition of a patient is beyond the scope of the education and training of the nurse practitioner.' BPC §2837.101(b) provides that 'standardized procedures' has the meaning defined in Section 2725.
  4. 4.Assembly Member Jim Wood (California State Legislature) (2020). Assembly Bill 890 — Nurse practitioners: scope of practice: practice without standardized procedures (Chapter 265, Statutes of 2020), chaptered bill text. California Legislative Information (leginfo.legislature.ca.gov). link ✓AB 890 (Wood, Chapter 265, Statutes of 2020), chaptered text of BPC §2837.104 as originally enacted — the baseline for what SB 1451 changed. Original §2837.104(c)(2) listed FIVE physician-consultation circumstances: '(A) Emergent conditions requiring prompt medical intervention after initial stabilizing care has been started. (B) Acute decompensation of patient situation. (C) Problem which is not resolving as anticipated. (D) History, physical, or lab findings inconsistent with the clinical perspective. (E) Upon request of patient.' Original §2837.104(c)(3) carried the referral plan, whose criteria ALREADY included decompensation at '(C) Any patient with acute decomposition or rare condition' — so SB 1451 deleted the standalone consultation trigger rather than relocating it, and the current (c)(4)(B) is a rewording of criteria already present. There was no provision corresponding to the current §2837.104(c)(3) on physician-patient relationship and sole responsibility. Original §2837.104(d) read 'A nurse practitioner shall verbally inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon. For purposes of Spanish language speakers, the nurse practitioner shall use the standardized phrase “enfermera especializada.”' Original §2837.104(e) carried the conspicuous Board of Registered Nursing posting duty — renumbered to (f) by SB 1451, not repealed. AB 890 contained no provision requiring an NP to tell a patient they have a right to see a physician and surgeon.

https://www.gale.care/for-providers/do-104-nps-still-need-standardized-procedures · 4 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

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