Advanced practice nurses in New Jersey, who are the best in their field, are one step closer to full authority to make all decisions about patient care, which advocates say is necessary to expand the state’s health care system, especially in communities that are not served. But opponents warn that it could put patients at risk.
The state Senate Health and Human Services Committee has advanced a controversial bill that would eliminate the need for practice nurses, or APNs, to contract with a doctor to prescribe medications, including cannabis. Here, nurses have argued for more than a decade that this “joint protocol” requirement creates costly, time-consuming barriers and limits their ability to grow their practice without ensuring greater patient safety.
“There is no significant evidence in New Jersey that this (joint protocol requirement) improves the quality of care, the value of care,” said Dr. Vincente Gracias, head of Rutgers University and professor of trauma surgery at the Robert Wood Johnson Medicine School in New Jersey. – Brunswick.
“We have a growing labor shortage and we need more suppliers,” he said. “It increases value and quality for the patient. It becomes on the patient’s side.’
The measure – which codifies temporary changes introduced at the start of the pandemic – has received support from APNs and health groups. stressed the need for more suppliersespecially in historically underserved communities.
Sponsors include New Jersey Citizen Action, Planned Parenthood Action Fund of New Jersey and AARP-New Jersey. CVS Health, a provider group affiliated with a national drug chain that relies heavily on nurse practitioners and other APNs, also supported the proposal.
However, several doctors opposed the legislation, including representatives of the New Jersey Medical Society, the state psychiatric association and specialty groups. Several health professionals also testified against the measure, which they said would allow someone with a third-year medical student’s education to lead a care team – something they said would be dangerous.
“This is not an attack on doctors and the work they do.” – Sen. Joe Vitale (D-Middlesex)
While physicians emphasized the importance of collaborative, team-based care, they also emphasized that teams should be physician-led, not APN-led. “As doctors, the widget we sell to the public is clinical judgment, so to speak. We have that, and advanced practice nurses don’t because of a relative lack of experience and training compared to physicians,” said New Jersey Medical Society President Dr. Stephen Orland, a urologist with a Mercer County practice.
There has been considerable debate about the different levels of education required for physicians and nurses, with physicians insisting that they are better equipped than APNs to make clinical decisions. There are approximately 10,000 licensed APNs in New Jersey, representing less than 10% of the entire nursing workforce.
Doctors must complete a college degree, four years of medical school, and at least three years of internship at a hospital or medical center. APNs go to nursing school and a two-year nursing program before starting their internship for several years. Registered nurses, or RNs, only require a bachelor’s degree. All nurses must pass a state licensing exam; some obtain additional professional certification.
Time in school versus clinical training
Supporters of the change say APNs may spend less time in school, but their clinical training begins in undergrad, allowing them to better focus on health care and become highly specialized. They also cited studies showing that APN-led care saved the health system money and improved outcomes. Physicians pointed to other studies showing that APNs ordered more tests and clinical consultations than physician-led groups, with no benefit to patients.
APNs in New Jersey have been working without physician supervision since the beginning of the pandemic.
After more than an hour of heated testimony from both sides, the committee voted 7-0 in favor of the measure, with several Republican members saying they would push for amendments.
“This is not a knock on doctors and the work they do,” said Sen. Joe Vitale (D-Middlesex), lead sponsor and chairman of the committee. “It doesn’t really change anything other than (APNs) being able to prescribe” medication, he said.
Account (C-1522) sponsored by Sen. Troy Singleton (D-Burlington) — notes the important role APNs play in the state’s health care system, including by relieving pressure on physicians and increasing access to care in underserved communities. The Senate version, introduced in both chambers in February, is the first to receive a hearing.
Other states allow it
More than two dozen states allow APNs to work without a doctor’s supervision, including Massachusetts and New York, which also lifted the requirement after it was temporarily suspended at the start of the pandemic, according to advocates. Supporters of the measure expressed concern that policy changes elsewhere could lure skilled New Jersey providers to work outside the state if New Jersey does not change what they called its “antiquated” law.
“Emigration could negatively impact long-term health outcomes in New Jersey if we don’t have enough health care providers,” said Edna Cadmus, executive director of the New Jersey Nurse Collaborative Center. “There is no evidence that a barrier to practice, such as a physician contract, protects society.”
APNs in New Jersey have been working without restrictions on shared protocols, called physician monitoring, since the start of the pandemic, when Gov. Phil Murphy lifted that requirement through an executive order that also eased other health regulations to ease the state’s COVID-19 burden. 19 answer. “During the waiver period, there were no reported adverse incidents involving advanced practice nurses practicing without practice restrictions,” the bill notes.
The measure amends the existing statute to eliminate the need for an experienced APN to contract with an “associating physician” to write prescriptions, an arrangement that can cost the APN more than $500 per month. These doctors have had little to no oversight, reviewing only a few papers a year, are advocating for change and requiring APNs to buy their own malpractice insurance. Under the bill, APNs who complete a six-hour pharmacology course, including controlled substance education and addiction prevention, would be able to prescribe and practice without physician supervision.
Under the bill, APNs with less than two years of experience would need a “collaborating provider” to oversee their prescribing practice, allowing either a physician or an APN with additional training to fill the role. The legislation also states that experienced nurse anesthetists APNs do not need a joint protocol to practice in a surgical or dental office.