Board of Registered Nursing
Initial Statement of Reasons
Page 1 of 6
Title 16 CCR 1410.5
Coursework Exemptions for Out-of-State Applicants
1/25/23
CALIFORNIA BOARD OF REGISTERED NURSING
CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS
INITIAL STATEMENT OF REASONS
Hearing Date: No hearing has been scheduled.
Subject Matter of Proposed Regulations: Coursework Exemptions for Out-of-State
Applicants
Sections Affected: Add Section 1410.5 to Title 16, Division 14, Article 2 to the
California Code of Regulations (CCR).
Background and Statement of the Problem:
Pursuant to Business and Professions Code (BPC) Section 2700 et seq., the Board of
Registered Nursing (Board) licenses registered nurses (RN), and certifies Advanced
Practice Registered Nurses (APRN), which include certified nurse-midwives (CNM),
nurse practitioners (NP), registered nurse anesthetists (CRNA), clinical nurse specialists
(CNS), and public health nurses (PHN). In addition to licensing and certification, the
Board establishes approval requirements for California nursing schools and reviews
nursing school criteria for both prelicensure and NP programs; receives and
investigates complaints against its licensees; and takes disciplinary action as
appropriate. The Board currently regulates over 502,000 RNs and almost 34,000 NPs.
According to BPC Section 2715, the Board is authorized to amend or adopt regulations
in accordance with the Administrative Procedure Act that may be reasonably necessary
to enable it to carry into effect the Nursing Practice Act. Furthermore, BPC Section 2786
authorizes the Board to determine the required subjects of instruction to be completed
in an approved school of nursing for licensure as an RN; BPC Section 2786.6
authorizes the Board to prescribe the education for which credit is to be given and the
amount of credit that is to be given for each type of education.
In California, there are two major pathways to attain an RN license: 1) licensure by
examination, and 2) licensure by endorsement, as described below. Additionally, all
APRNs must endorse into California and be licensed as an RN before they can be
recognized as an APRN. This includes NPs, CNMs, CRNAs, and CNSs.
For licensure by examination, an applicant must take the National Council Licensure
Examination (NCLEX-RN) if they have never taken and passed the examination or been
licensed as an RN in another state or U.S. territory. All applicants must have completed
an educational program that meets California’s requirements for an approved
educational program.
Board of Registered Nursing
Initial Statement of Reasons
Page 2 of 6
Title 16 CCR 1410.5
Coursework Exemptions for Out-of-State Applicants
1/25/23
For licensure by endorsement, an applicant must hold a current and active RN license
in another state, U.S. territory, or Canada, have completed an educational program
meeting all California requirements, and have passed the NCLEX-RN or the State
Board Test Pool Examination to qualify. This is the pathway used to request reciprocity
into California as an RN. The Board has seen a steady increase in the number of
endorsement applications over the last several years and anticipates that trend will
continue. In Fiscal Year 2021-22, the Board received over 38,000 endorsement
applications.
Existing state law requires that an RN applying for endorsement into California must
meet the education requirements outlined in Title 16 CCR Section 1426. The
requirement in 16 CCR 1426(c)(3) includes successful completion of nursing-related
natural science laboratory. If an applicant has not completed the lab component for any
of the nursing-related natural science courses, then their application is deemed
deficient, and they are not able to receive a license until that deficiency is cleared. If the
applicant completes the missing lab component(s) at that time or submits proof of prior
completion of the lab component(s) then the deficiency is cleared and the Board can
issue a license, assuming the applicant has met all other pertinent requirements.
The laboratory component of California’s nursing-related natural science course
requirements has been a long-time barrier for applicants seeking licensure by
endorsement into California. This is due in part to the fact that several other states do
not have the same nursing-related natural science laboratory requirements for their
nursing education licensure requirements. Consequently, individuals in those states can
become licensed and practice as an RN without completing a lab as part of their
anatomy, physiology, and microbiology courses.
Furthermore, it is sometimes difficult or impossible to obtain or access their prelicensure
nursing program’s course descriptions or syllabi to prove that a lab was part of their
nursing-related natural science curriculum if the laboratory component was integrated
and not scheduled as a separate course and noted on the transcript.
The laboratory requirement has caused processing delays and an inability for some
applicants to become licensed. The Board discussed the matter at their November 17,
2021, meeting and voted to reconsider the laboratory component of the natural science
course requirements for RNs who are licensed in another state and endorsing into
California. Board staff worked with the Department of Consumer Affairs Legal Office to
draft proposed regulatory language, which was approved by the Board at their May 18,
2022, meeting.
Subsequently, the item was brought to the Board’s Nursing Education and Workforce
Advisory Committee (NEWAC) for discussion at their July 28, 2022, meeting. The
Committee recommended several clarifying changes to the proposed language. The
revised language was approved by the Board at their August 17, 2022, meeting.
Board of Registered Nursing
Initial Statement of Reasons
Page 3 of 6
Title 16 CCR 1410.5
Coursework Exemptions for Out-of-State Applicants
1/25/23
Anticipated benefits from this regulatory action:
This proposal will add Section 1410.5 to Title 16, CCR, Division 14, Article 2, titled
“Coursework Exemptions for Out-of-State Applicants.”
The proposed exemption will streamline the endorsement process by removing an
educational barrier frequently encountered by out of state nurses who want to become
licensed in California. This will help California to recruit and maintain a larger pool of
qualified nurses from across the country, thereby increasing access to care. The
change will also reduce administrative workload for the Board’s licensing staff.
Specific purpose of, and rationale for, each adoption, amendment, or repeal:
1. Add Section 1410.5(a)
Purpose
Title 16 CCR Section 1410.5(a) sets forth the definitions for “proof of successful
completion,” “good standing,” and “unrestricted.”
Rationale
The definition of “proof of successful completion” ensures that the applicant provided a
complete transcript of the courses prescribed by the Board for licensure as outlined in
16 CCR 1410. This is necessary to establish that, while this proposal does provide an
exemption for a narrow area of education, the balance of curriculum requirements must
still be met.
The definitions of “good standing” and “unrestricted” ensure that the applicant’s
experience practicing in another state did not include any type of disciplinary action that
would indicate they are not safe to practice in California that could possibly be
contributed to a lack of academic preparation. This is necessary to ensure public safety,
which is the Board’s primary mission.
2. Add Section 1410.5(b)
Purpose
Title 16 CCR Section 1410.5(b) sets forth which out of state applicants are eligible for
the proposed exemption to laboratory component of the natural science coursework
requirement outlined in 16 CCR 1426(c)(3).
Board of Registered Nursing
Initial Statement of Reasons
Page 4 of 6
Title 16 CCR 1410.5
Coursework Exemptions for Out-of-State Applicants
1/25/23
Rationale
The purpose of establishing specific criteria that must be met to receive the proposed
exemption is to ensure that the applicant has the necessary education and training to
practice safely. If a nurse has successfully completed all other educational
requirements, including the theory component of these subject areas, and has been
practicing in good standing for at least two years in another state, then they have
exhibited that they are a safe practitioner and therefore the academic preparation can
be deemed equivalent to the minimum requirements of the Board for licensure as
outlined in BPC Section 2736.
Two years was chosen by the Board because that is the period of time when a nurse
can apply for an advanced practice certification and was seen as consistent for a period
of time in which nurses prove themselves as competent. Once a nurse has proven
competent, the issue of whether or not an anatomy class in college had a laboratory
component is less relevant.
To be clear, every nurse licensed to practice in California must have taken anatomy,
physiology, and microbiology courses, but this regulation waives a laboratory
requirement for each of these classes taken in an out-of-state school, once the nurse
has proven competence by two years of practice without any disciplinary action.
Underlying Data
• Board Meeting Materials November 17-18, 2021 - Agenda Item 9.6
• Board Meeting Minutes November 17-18, 2021 - Agenda Item 9.6
• Board Meeting Materials May 18, 2022 - Agenda Item 5.2
• Board Meeting Minutes May 18, 2022 - Agenda Item 5.2
• NEWAC Committee Meeting Materials July 28, 2022 - Agenda Item 7.0
• NEWAC Committee Meeting Minutes July 28, 2022 - Agenda Item 7.0
• Board Meeting Materials August 17, 2022 - Agenda Item 5.1
• Board Meeting Minutes August 17, 2022 - Agenda Item 5.1
Impact on Businesses
The Board has made the initial determination that the proposed regulations will not
have a significant statewide adverse economic impact directly affecting businesses
including the inability of California businesses to compete with businesses in other
States. This initial determination is based on the following facts:
The regulatory changes do not impose any additional requirements on California’s
licensees or businesses. Rather, the proposed change will make it easier for RNs
licensed in other states to become licensed in California. This will make it easier for
California businesses to hire nurses from across the country.
Board of Registered Nursing
Initial Statement of Reasons
Page 5 of 6
Title 16 CCR 1410.5
Coursework Exemptions for Out-of-State Applicants
1/25/23
Economic Impact Assessment
The Board has determined that this regulatory proposal will not have any of the
following effects:
• Create or eliminate jobs within the State of California.
• Create or eliminate businesses within the State of California.
• Significantly change the creation or elimination of new businesses.
• Affect the expansion of businesses currently doing business within the State of
California, as the proposed regulation only expands on the requirements of
applications through endorsement.
• Have an impact on worker safety, because the proposed regulations are only
detailing requirements for out of state license applicants and do not relate to
worker safety.
• Impact on the state’s environment, because the regulations will simply set forth
minimum requirements for out of state license applicants and do not relate to any
environmental issues.
• Have any effect on housing costs.
The proposed regulation will not result in additional costs to California licensees or RNs
who are already licensed in other states who wish to become licensed in California.
Rather, it will streamline the current endorsement process by removing an existing
barrier.
The Board is not aware of any other cost impacts that a representative private person or
business would necessarily incur in reasonable compliance with the proposed
regulation.
This regulatory proposal will affect the general health and welfare of California residents
by:
• Eliminating a barrier to entry for out of state nursing professionals seeking to
become licensed in California, and
• Reducing the time required for endorsement applicants to become licensed in
California and enabling them to join the workforce more expeditiously.
Specific Technologies or Equipment
This regulation does not mandate the use of specific technologies or equipment.
Consideration of Alternatives
The Board has made an initial determination that no reasonable alternative to the
regulatory proposal would be more effective in carrying out the purpose for which the
regulation is proposed, would be as effective and less burdensome to affected private
persons than the proposed regulation, or would be more cost-effective to affected
private persons and equally effective in achieving the purposes of the regulation in a
manner that ensures full compliance with the law being implemented or made specific.
Board of Registered Nursing
Initial Statement of Reasons
Page 6 of 6
Title 16 CCR 1410.5
Coursework Exemptions for Out-of-State Applicants
1/25/23
The Board did consider eliminating the lab requirement entirely, including for courses of
instruction within California, but rejected that alternative based on feedback received
from nursing programs who said that it was imperative to keep the lab requirement for
students to see how cultures grow, to learn how antibiotics work, and to understand
nosocomial infections and the science. The lab component has support from California
nursing programs.
The Board has also considered the alternative of taking no action. However, taking no
action was rejected because denial and delays in processing out-of-state applications of
qualified nurses in good standing for licensing in California due to the lab requirement
was not desirable. The public is invited to comment on this proposal.
