Date of Completion
Fall 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Katie Hooven
Second Advisor
Dr. Lois Marshall
Abstract
Problem:
California Children’s Services (CCS) is a state and federally funded program administered by the Department of Health Care Services that provides care coordination, therapy services and referrals for residents under the age of 22 years. CCS Numbered Letter 07-0123 outlines the requirements for nurse practitioner (NP) practice in CCS’ Special Care Centers. The Numbered Letter (NL) policy may have workforce and operational impacts that have not been assessed.
Aim of the Project:
The policy analysis’ aims were to describe policy impacts of the Numbered Letter on CCS programs, clients and providers, communicate impacts with stakeholders, and share policy recommendations with CCS leaders.
Review of the Evidence:
The evidence shows that barriers to NP practice, whether administrative or regulatory, hinder patient access to care and increase healthcare costs. When evaluating evidential impacts, three policy options can be considered, i.e. maintaining the policy as is, amending parts of the current policy or removing the entire policy.
Project Design:
The CDC’s POLARIS Analytical Framework guided the implementation of this project. Qualitative data from interviews with APP leaders familiar with NP practice and CCS programs were collected. The policy impact examples shared in the interview responses were entered into an impact table for clarity and organization.
Intervention:
The policy impact examples informed a policy letter to CCS written by the California Association of Nurse Practitioners. The policy impact letter was shared with CCS leaders and administrators.
Significant Findings/Outcomes:
Based on the policy analysis, three of the NL requirements restricted the scope of practice for NPs and differed from practice in non-CCS clinics. The NL three requirements are oversight of NP documentation by CCS–paneled physicians, physician oversight of NP prescriptions, and need for additional post-matriculation experience, education and training. When viewed through the lens of regulatory authority and scope of practice, the NL policy holds the NP to a different standard than the state’s NPA.
Implications for Nursing:
Nurses' involvement in policy analysis can illuminate impacts on patients, programs, and providers. Policy analysis and practice advocacy are processes that nurses can provide for programs like CCS to improve patient-provider experiences and program operations.
Recommended Citation
Josiah-Davis, Erna, "A Policy Analysis of Nurse Practitioner Requirements in California Children’s Services Programs" (2026). All Doctor of Nursing Practice (DNP) Scholarly Projects. 94.
https://fuse.franklin.edu/dnp-project/94
Rights
Copyright, all rights reserved
