There are differences in state laws and regulations that restrict nurse practitioners (NPs) from performing certain functions of patient care such as signature recognition. These restrictions create increased costs to the healthcare system and delays in patient care. In California, it has been a slow, incremental process for NPs to gain the ability to sign and/or certify forms that document and facilitate patient care. States are moving forward to ensure NP signatures are recognized either by updating language in their state laws and allowing NPs to sign specific forms or adopting statutes that provide NPs with global signature recognition. A Policy Delphi approach was used as a roadmap to guide the analysis of global signature recognition for NPs in California. Three iterative rounds of surveys were conducted using a Qualtrics survey platform. A total of 22 themes were generated, with participants reaching consensus on eight of the themes. Of the remaining themes, four over-arching opposing viewpoints were related to barriers to NP practice, the effect on physicians, education, and cost. The roadmap to action must address these opposing views if NPs are to achieve global signature recognition in California.