Who Holds the Pen - The Agencies That Regulate Nursing
- ANA California Staff
- Mar 5
- 5 min read
Updated: Mar 5
Part 2 of the Nursing Regulations Guide.
What You’ll Learn
The state agencies responsible for regulating nursing in California.
How the Board of Registered Nursing (BRN) fits into the larger system of government.
How these agencies develop, enforce, and interpret regulations that affect your practice.
Where and how nurses can connect with agency work to influence change.
Why It Matters
Understanding who creates and enforces regulations is key to understanding how nursing practice evolves.
Every rule that governs your license, your continuing education, or your workplace safety standards originates from a government agency.
Nurses often know of the BRN, but may not realize that it operates within a vast ecosystem of state departments and divisions that collectively shape healthcare policy.
Knowing who holds the pen helps you identify the right audience when you advocate for change.
The Big Picture: How California’s Agencies Work Together
California’s government operates through departments, boards, and commissions, each established by state law to manage specific responsibilities.
For nursing and healthcare, the key structure looks like this:
Governor
Appoints agency secretaries and department heads.
Approves regulations through the Office of Administrative Law.
California Health and Human Services Agency (CHHS)
Oversees departments focused on public health, healthcare delivery, and social services.
Department of Consumer Affairs (DCA)
Oversees professional licensing boards and bureaus, including the Board of Registered Nursing (BRN).
This hierarchy means that nursing regulation sits within a broader web of agencies responsible for protecting public safety and ensuring professional accountability.
The Board of Registered Nursing (BRN)
The BRN is the primary agency regulating the practice of nursing in California.
It functions under the Department of Consumer Affairs and is authorized by the Nursing Practice Act in the Business and Professions Code, Section 2700 et seq.
Key Responsibilities of the BRN:
Licensing and renewing registered nurses.
Approving nursing education programs.
Investigating complaints and enforcing disciplinary actions.
Defining scope of practice for advanced practice roles.
Establishing continuing education and professional development requirements.
The BRN’s authority to create and amend regulations comes directly from the Legislature through its enabling statute.
Example: If the Legislature passes a law requiring new mental health training for nurses, the BRN develops regulations to define training content, delivery methods, and compliance processes.
Other Agencies That Shape Nursing Practice
While the BRN regulates nursing licensure and education, several other agencies influence nursing practice across the healthcare continuum.
Agency | Primary Role in Nursing and Healthcare |
California Department of Public Health (CDPH) | Oversees public health programs, healthcare facility licensing, and infection control standards. Nurses often encounter CDPH regulations through hospital compliance requirements. |
Department of Health Care Services (DHCS) | Administers Medi-Cal and sets reimbursement and service delivery standards that affect nurses in community and acute settings. |
California Medical Board | Regulates physician practice. Collaborates with the BRN on nurse practitioner furnishing and prescribing authority. |
Board of Pharmacy | Oversees medication management, prescribing, and dispensing standards that impact nursing practice. |
Emergency Medical Services Authority (EMSA) | Manages paramedic, EMT, and emergency preparedness standards that align closely with acute care nursing functions. |
Occupational Safety and Health Standards Board (Cal/OSHA) | Develops workplace safety regulations, including PPE and exposure standards that directly affect nursing work environments. |
Each of these agencies operates within the rulemaking system described in Part 1.
They hold public meetings, issue regulations, and provide comment opportunities that allow nurses to contribute expertise and real-world experience.
How Agency Authority Is Created
An agency’s power to write regulations is granted by the Legislature through statutory delegation.
This means a statute explicitly authorizes the agency to take certain actions.
For example:
The Business and Professions Code § 2715 authorizes the BRN to adopt regulations as necessary to carry out the Nursing Practice Act.
The Health and Safety Code authorizes CDPH to adopt regulations protecting patient safety in licensed healthcare facilities.
Agencies cannot act outside this authority. Every proposed regulation must cite the specific statute that allows it, which appears in the “Authority Cited” line of the proposed rule.
Understanding this connection helps nurses verify whether a rule is valid and aligns with legislative intent.
Inside the BRN: Structure and Decision-Making
The BRN is governed by a nine-member board, which includes:
Five registered nurses representing different specialties.
Four public members.
Board members are appointed by the Governor and the Legislature, serving staggered four-year terms.
The BRN meets several times a year publicly to discuss and vote on regulatory proposals, policy updates, and disciplinary matters. Meeting agendas and materials are posted in advance, allowing any member of the public to attend, provide comment, or submit written feedback.
Example: A nurse may attend a BRN meeting where proposed amendments to continuing education standards are discussed. Public comments are included in the record and considered before any vote is finalized.
Engagement Opportunities for Nurses
Nurses can influence regulatory decisions by engaging with agencies directly.
Ways to Participate:
Attend Public Meetings
The BRN and other agencies post their calendars on their websites.
Meetings can be attended in person or virtually, and public comments are always welcome.
Monitor Proposed Rules
Subscribe to BRN email updates or the Office of Administrative Law’s (OAL) Z Register.
Review new rule proposals to see how they might affect nursing practice.
Submit Public Comments
Provide input on proposed regulations during open comment periods.
Comments can include data, professional experience, or evidence supporting an improvement or alternative.
Join Advisory Committees
Many agencies form advisory committees or workgroups that rely on nurse expertise.
Participation helps ensure that regulations reflect real-world nursing practice.
Collaborate Through ANA\California
ANA\California often develops unified comment letters or policy positions representing the nursing community.
Running Example: How an Agency Shapes Policy
Let’s revisit the continuing education example from Part 1.
After the Legislature passes the law:
The BRN drafts regulations defining how many hours of CE are required, the topics that qualify, and how compliance will be reported.
The Department of Consumer Affairs reviews and forwards these regulations to the Office of Administrative Law for approval.
Once approved, the new rule is published in the California Code of Regulations and becomes enforceable.
Throughout this process, nurses can comment on the draft rule, attend public meetings, and ensure the regulation supports meaningful and accessible professional development.
Visualizing the System
Hierarchy of Influence
Governor → CHHS → DCA → BRN → Nurses and Institutions
Each layer adds more specificity:
The Governor sets policy priorities.
CHHS and DCA oversee implementation and accountability.
The BRN develops nursing-specific rules.
Nurses carry those rules into practice and provide feedback for improvement.
Advocacy in Action
Understanding who regulates nursing helps you connect your voice to the right audience.
If you want to change how CE courses are approved, your advocacy should target the BRN.
If you want to address infection control policies, your audience may be CDPH.
For workplace safety, the conversation belongs with Cal/OSHA.
Identifying which agency governs your issue makes your advocacy more precise and effective.
Advocacy Tip:
Check the BRN and CDPH websites regularly. Most regulatory updates are posted at least 45 days before adoption.
Think About It
Which agencies affect your day-to-day practice?
Have you ever attended a BRN or public health meeting?
What topic would you most like to see changed or clarified through regulation?
Even one comment, observation, or question can shape the conversation about nursing regulation in California.
Bookmark This
Key Terms
Board of Registered Nursing (BRN): State agency that regulates registered nursing practice under the Department of Consumer Affairs.
Department of Consumer Affairs (DCA): Oversees licensing boards and bureaus for more than 280 professions, including nursing.
California Health and Human Services Agency (CHHS): Coordinates health, behavioral health, and social services departments statewide.
Public Meeting: An open session where the public can observe and participate in agency decision-making.
Rulemaking Authority: Legal power given to an agency by the Legislature to adopt or amend regulations.
Next Up
Part 3: Inside the Rulemaking Process — Step by Step
We will walk through how an idea becomes a regulation under the California Administrative Procedure Act, and exactly where nurses can engage during the process.
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