Cross your fingers, New Jersey advanced practice nurses (APNs), because if Senator Joseph Vitale (D-Middlesex) succeeds in passing his recently introduced S-2354 — the “Consumer Access to Health Care Act,” — you will be able to prescribe medications without joint protocol with a consulting physician. Introduced Nov. 29 into the New Jersey State legislature, the bill, which follows the Institute of Medicine’s recommendation to eliminate barriers to APNs’ scope of practice, would remove the joint protocols for APNs who have more than 24 months or 2,400 hours of licensed, active advanced nursing practice. Other conditions include APNs use the New Jersey Prescription Blank and satisfy continuing professional education requirements related to prescribing controlled substances, the bill says. For new APNs who do not meet these criteria, the joint protocols will remain in place, ensuring those new to the field have support as they bolster their experience and work toward the 24 months /2,400 hours needed to practice without the joint protocols.
Established by a 1991 law, the joint protocols give APNs the authority to write prescriptions and requires doctors be available for consultations. Collaborating physicians must review the charts of at least one of the APNs’ patients each year. But many APNs currently practicing under the joint protocols feel they are unnecessary.
“The problem is they never see your patients, they never see what’s going on with your patients,” Melissa Rubin, APN, Robert Wood Johnson University Hospital, New Brunswick, NJ told NJSpotlight in a recent report. “You’re allowing more patients to have access to care; not only access to care, you’re removing the barriers that clinicians like myself face when we treat the general public.”
She added that, in the two and a half years as an APN seeing about 60 patients each week, she hasn’t had a situation where a doctor consultation about medication was necessary.
And the potential jump in primary care providers couldn’t come at a better time. The bill’s author, Rep. Vitale, admitted the bill came about in part to address a critical need for primary care providers. Although he acknowledged the concerns raised by physicians, he wondered whether providing more opportunities for APNs will help meet the primary care need.
“Is it a need for a family physician, or is it a need for a primary care provider?” Vitale told NJSpotlight. “Nurse practitioners can provide some of the same services.”
APNs hold graduate degrees, must pass an exam to receive state certification and are well-qualified to provide the care most patients seek when visiting their doctors’ offices. They are trained to diagnose and treat acute and chronic illnesses; take health histories; order and interpret lab tests and x-rays; and provide physical examinations, immunizations, and supportive counseling. APNs have taken an increasingly large role as primary care providers and are in a position to help minimize the primary care provider shortage anticipated as a result of the federal Affordable Care Act.
APNs could help fill the need, but with the joint protocols still in place, their scope of practice could be hindered if doctors fail to sign the protocols. Sixteen other states already allow APNs to prescribe without joint protocols, according to the article.
While the senate bill sits in the Senate Health, Human Services and Senior Citizens Committee, Assemblywoman Nancy F. Munoz (R-Morris, Somerset and Union) introduced an Assembly version on December 3, A-3512.
Do you think states should eliminate the requirement of joint protocols for APNs to prescribe medication? Let us know what you think…