Nurses are the backbone of healthcare. But while clinical knowledge and compassion are at the heart of nursing, laws and policies shape what nurses can do, how they do it, and even where they work. From national healthcare reforms to state-level regulations, policy and legislation have a direct impact on how nurses practice and how patients receive care.
In this post, we’ll explore how these factors influence nursing, highlight important policies in California, and share why understanding legislation is essential for nursing students and professionals alike.
Why Policy and Legislation Matter in Nursing
Healthcare is one of the most highly regulated fields in the U.S., and nursing is no exception. Policies and laws determine:
- Scope of practice: What tasks nurses are legally allowed to perform
- Licensing and certification: Who can become a nurse and how
- Workplace safety: Requirements for safe working environments and nurse-patient ratios
- Reimbursement and insurance: How care is funded, which affects what services nurses provide
- Patient rights and protections: Including issues of informed consent and privacy (e.g., HIPAA)
Whether it’s federal legislation like the Affordable Care Act or state rules issued by boards of nursing, these regulations guide how nurses care for their patients every day.
Additionally, policy influences broader professional issues such as pay equity, access to continuing education, and even public perceptions of the nursing profession. Laws like the Nurse Practice Act evolve over time to reflect current clinical standards.
California-Specific Policies Affecting Nursing
Nursing students in California should be aware of several important policies that affect their training, certification, and practice:
1. Nurse-to-Patient Ratios (AB 394)
California is the only state in the U.S. that has mandatory minimum nurse-to-patient staffing ratios for hospitals. Passed in 1999 and enforced since 2004, this law requires hospitals to have a minimum number of nurses for each patient based on the unit type. For example, intensive care units require one nurse for every two patients.
Why it matters: Better ratios improve patient outcomes and reduce nurse burnout.
2. California Board of Registered Nursing (BRN)
The BRN sets standards for nursing education, licensure, and continuing education. They are responsible for licensing RNs and enforcing the Nursing Practice Act, which defines what nurses in California can and cannot do.
Why it matters: The BRN ensures all practicing nurses meet educational and ethical standards.
3. Title 22 Regulations
Part of the California Code of Regulations, Title 22 lays out requirements for healthcare facilities, including skilled nursing and long-term care. It includes detailed expectations around nurse qualifications, responsibilities, and patient care standards.
Why it matters: Title 22 directly impacts how nurses work in many healthcare settings across the state.
4. AB 890 – Nurse Practitioner Scope Expansion
Passed in 2020, AB 890 allows certain nurse practitioners to practice independently without physician oversight in California, provided they meet specific education and experience requirements.
Why it matters: This increases access to care, especially in underserved areas, and creates more opportunities for advanced practice nurses.
Understanding the role of professional organizations in shaping laws and legislation is also essential for nursing professionals. For example, groups like the California Nurses Association often advocate for safe staffing ratios and expanded nurse practitioner authority. Nurses may also participate in lobbying, provide formal testimony, and collaborate with legislators to draft nurse-friendly policies.
How Policies Are Made and How Nurses Can Influence Them
Policies aren’t created in a vacuum. They are shaped by lawmakers, healthcare administrators, and increasingly, nurses. With firsthand knowledge of patient care, nurses are well-positioned to advocate for change.
Ways nursing students and professionals can get involved include:
- Joining professional organizations like the California Nurses Association (CNA) or the American Nurses Association (ANA)
- Attending legislative days to meet with state representatives
- Participating in public comment periods for proposed laws or regulations
- Writing or calling lawmakers to support or oppose healthcare legislation
- Staying informed by following updates from the California Board of Registered Nursing and reputable nursing news sources
Nurses can also influence policy by identifying health problems, helping formulate legislation, and even filing legal action to support healthcare reforms. Political activism through lobbying, testifying, or serving in advisory groups amplifies the voice of nursing at every level.
Professional organizations support these efforts. For example, the ANA provides access to leadership training, policy briefs, and action alerts. Membership can also include benefits like journal access, discounts, and networking opportunities, all of which support nurse advocacy and professional growth.
What Nursing Students Should Know
Understanding healthcare policy isn’t just for politicians or administrators, it’s an essential part of modern nursing. Today’s nurses are expected to:
- Practice within legal boundaries
- Advocate for ethical and patient-centered care
- Understand reimbursement policies that affect treatment options
- Speak up when laws or policies negatively impact care
Furthermore, learning how to differentiate between politics and policy and how each influences nursing can help nurses become effective advocates. Politics is the process of influencing decisions, while policy reflects the outcomes of those decisions. Knowing how to navigate both is a vital leadership skill.
Educational programs, including those at CNI College, are placing greater emphasis on healthcare policy, ethics, and leadership within the curricula to better prepare students for today’s professional demands.
Policy Shapes Practice
Nurses are more than caregivers, they’re advocates, leaders, and change-makers. The policies and laws that govern nursing don’t just influence how care is delivered they influence the future of the profession itself.
By engaging with policy through professional organizations, advocacy, or even simply staying informed, nurses can help improve public health outcomes and reform systems that may not serve patients equitably.