Expanding APRN Authority: What California, Oklahoma, and Wisconsin Providers Need to Know

Background

States across the country are granting Advanced Practice Registered Nurses (“APRNs”) greater autonomy—a trend that promises operational flexibility but also introduces new compliance challenges. It is important for APRNs and their employers to be aware of the changes to limit misalignment between internal credentialing and oversight policies and evolving state laws, as well as utilize the opportunity for qualifying APRNs to work to their full scope of practice.

Recent Developments

California, Oklahoma, and Wisconsin have all made significant changes to APRN authority, underscoring how quickly the regulatory landscape is shifting. Healthcare organizations that fail to update policies and protocols risk falling behind—or worse, facing enforcement actions.

CALIFORNIA

Independent Practice Pathway Under AB 890

With the passage of California’s Assembly Bill 890 (“AB 890”) in 2023, the state established two separate categories of nurse practitioners (“NP”).

• 103 NPs: May practice without standardized procedures but only in a California Board of Nursing-approved group setting, such as a health system clinic or medical group. 103 NPs remain subject to statutory limitations on scope and setting.
• 104 NPs: Eligible for independent practice outside approved group settings after working full-time for 3 years or 4,600 hours as a 103 NP in good standing.

Since this pathway started in 2023, NPs will first be eligible for 104 NP licensure in 2026. Even as independent practitioners, 104 NPs can only work within their education, training, and national certification.¹

OKLAHOMA

Independent Prescriptive Authority Under HB 2298²

Under Oklahoma House Bill 2298 (“HB 2298”), as of November 1, 2025, eligible APRNs providing services in Oklahoma were permitted to begin applying for independent prescriptive authority. This change removes the previous legal requirement for physician supervision when prescribing.³

To be eligible for independent prescriptive authority in Oklahoma, individuals must have a valid APRN license in good standing and must complete at least 6,240 supervised clinical practice hours with prescriptive authority. Applications are made through the Oklahoma Board of Nursing nurse portal. It is important to note the law does not expand the types of drugs APRNs can prescribe. For example, APRNs are still prohibited from prescribing Schedule II controlled substances.

WISCONSIN

Independent Practice Under AB 257⁴

Wisconsin passed Assembly Bill 257 (“AB 257”), also known as the APRN Modernization Act, allowing qualified APRNs to practice independently without a collaborative practice agreement beginning September 1, 2026.

To qualify for independent practice, APRNs must meet both of the following:

• 3,840 hours of professional nursing in a clinical setting, during which at least 24 months have elapsed since the APRN first began the required hours.
• 3,840 hours of APRN practice in the person’s recognized role while working with a physician or dentist who was immediately available for consultation and accepted responsibility for the actions of the APRN, during which at least 24 months have elapsed since the APRN first began the required hours.

It is important to note, AB 257 places certain limitations on APRNs independently practicing and providing pain management services. ARPNs may use invasive techniques only when collaborating with a physician who is trained and experienced in pain management. However, this collaboration requirement does not apply if the APRN is otherwise qualified to practice independently and either: (1) is treating pain syndromes through the use of invasive techniques in a hospital or hospital clinic; or (2) has privileges in a hospital to provide such treatment without a collaborative relationship with a physician.

Additionally, the APRN Modernization Act provides a separate exception to the collaboration requirements for Certified Nurse Midwives (“CNMs”) that have submitted to the Board of Nursing and following a plan for births outside of a hospital. The Wisconsin Board of Nursing is now working on rules to finalize details of the APRN’s scope of practice and the application process.⁵

Employers or contracting entities may impose limitations on the scope of practice for independent APRNs and CNMs as a condition of employment or contractual agreement.

Legal & Compliance Considerations and Action Items

APRNs and those healthcare entities employing or contracting with APRNs in California, Oklahoma and/or Wisconsin should consider the following action items:

• Update Current Governance Structures and Agreements: As deemed appropriate for the patient population and current organizational needs, consider updating collaborative practice or supervision arrangements, credentialing systems, and contracts to reflect the new legal realities and utilize APRNs to their full scope of practice.
• Check Licensure: Verify APRN categories, practice hours, and authority before granting independence.
• Revise Policies and Protocols: As necessary and appropriate, review current prescribing policies, delegation systems, and oversight structures to allow for expanded scopes of practice.

• Risk Areas: Review current payor contracts and malpractice policies for any requirements or restrictions that may conflict with expanded scopes of practice. Additionally, ensure that APRNs meet all qualifying criteria for expanded practice authority before allowing them to practice independently, without collaboration or supervision. Whenever possible, verify compliance through documented proof.

Questions

Quarles will continue to monitor these changes and updates. If you have any questions regarding the legal or regulatory implications of these developments, please contact your Quarles attorney or:

• Aaron Sagedahl: (612) 351-5050 / aaron.sagedahl@quarles.com
• Shamika Mazyck: (317) 399-2835 / shamika.mazyck@quarles.com
• Bailey Walden: (602) 229-5432 / bailey.walden@quarles.com

END NOTES

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¹ California Board of Nursing Frequently Asked Questions, available here.

² Oklahoma House Bill 2298, available here.

³ Oklahoma Board of Nursing Frequently Asked Questions, available here.

⁴ 2025 Wisconsin Act 17, available here.

⁵ Id.