Advanced Practice Nurses 
                   of New Jersey





NJ Nursing Leadership Council lobbies for nurses, adding urgency to their concerns

Sen. Vitale, Asw. Muñoz introduce Bills to increase access to healthcare for New Jersey Residents

Trenton – Dec 3rd, 2012

Assemblywoman Nancy Muñoz D21 introduced legislation in the NJ Assembly on December 3 that would increase consumers’ access to primary and specialty care services provided by advanced practice nurses.  On November 19, Sen. Joseph F.Vitale introduced the bill in the Senate. Authorizing advanced practice nurses to practice fully within the scope of their education, training, experience and licensure will streamline healthcare delivery in all settings and most critically in underserved areas where access, quality and cost containment are major goals. 

The proposed legislation seeks to eliminate the current requirement for a formal joint protocol agreement between a physician and advanced practice nurse for the purpose of prescribing medications and medical devices. This is the only aspect of APN practice that requires such an agreement. Removing this barrier will allow for greater access to the full range of services that advanced practice nurses are qualified to provide. Sixteen other states and the District of Columbia already have authorized full access to the care of advanced practice nurses.

Recommendations of the National Council of State Boards of Nursing that has adopted a Model Act have been incorporated in the bill.  The Model Act does not condition an advanced practice nurse’s prescribing authority on a joint protocol with a collaborating physician; it recognizes that collaboration with other health care professionals arises from a professional responsibility, not a legislated mandate. The bill is also consistent with recommendations of the recent Institute of Medicine report to remove scope of practice barriers for advanced practice nurses. Both seek to reform ineffective laws that restrict consumer choice and access to health care.

There are more than 6 million visits yearly across the nation to advanced practice nurses.  In New Jersey, many decades of evidence have demonstrated that APNs have been providing safe, high quality, cost effective healthcare with positive outcomes equal to the care provided by their physician colleagues. Patients report high satisfaction with their care, and studies show that patients cared for by APNs have fewer emergency room visits and hospital admissions, as well as shorter hospital stays resulting in reduced health care costs.

Statistics from the National Practitioner Data Bank, which collects data regarding malpractice reports across provider disciplines, attest to the quality and safety of the care delivered by nurses in advanced practice. Safety ratios based on the number of malpractice actions reported per provider type reflect very favorably on the safety of APN care in comparison to their physician colleagues in NJ, as well as across the United States. The data also frequently indicate that APNs, practicing in the states where autonomy is permitted, are actually less likely to have incidents than those in states without autonomy, based on statistics collected by the databank.

One of the unintended consequences of the joint protocol requirement is the sudden loss of patient services due to physician relocation, retirement or death, leaving the APN unable to practice, thus interrupting care provided to his/ her patients, until a new physician agreement is entered into. The joint protocol often creates confusion for pharmacists, radiology departments, and laboratories, about who is the patient’s care provider.  As a result, lab reports and radiology results are often sent to the physician who may never have seen the patient, delaying care and potentially endangering the patient.  

While APNs are fully accountable for their practice, many physicians have been unwilling to practice with an APN if they must sign a joint protocol, or may charge significant fees to do so. A recent survey of New Jersey APNs cites costs ranging from $600 per year to $17,000.  Many New Jersey health care insurers have mistakenly interpreted the joint protocol to mean that APNs are not legally independent health care professionals and have refused to credential or empanel them as providers who can be directly reimbursed.

The New Jersey State Nurses Association, the Forum of Nurses in Advanced Practice and the Society of Psychiatric Advanced Practice Nurses have been working to address the need for critical healthcare access of New Jersey residents which can be expected to increase, as more individuals gain health care insurance with the roll out of the Affordable Care Act. The availability of adequate healthcare for the residents of New Jersey will depend upon the ability of all qualified providers to practice within the full scope of their training, education and licensure and without unnecessary barriers.


For more information, contact:

Suzanne Drake PhD, APN, Public Relations Director SPAPN 877 727 6283






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