New Jersey’s advanced practice nurses would be able to prescribe medication on their own, without needing a formal agreement -- or joint protocol -- with a consulting physician, under a bill that's being introduced into the Legislature.
The measure (S-2354) would make it easier for advanced practice nurses, or APNs, to establish their own practices. It also would eliminate the difficulty of finding a doctor who's willing to sign a joint protocol.
Advanced practice nurses have taken an increasingly large role as primary care providers, one that is expected to grow as a result of the federal Affordable Care Act.
ACA will extend health insurance to a number of currently uninsured New Jerseyans and expand the Medicaid rolls. The first is likely to exacerbate the state's worrisome shortage of family care physicians. The second is likely to be even more problematic: Many doctors do not accept Medicaid recipients as patients.
Advanced practice nurses hold graduate degrees and 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. They must pass an exam to receive state certification.
Regardless of those qualifications, however, many primary care physicians say they are concerned that enabling APNs to establish independent practices without collaborating doctors will affect the quality of patient care.
The Senate version of the bill was introduced by Sen. Joseph Vitale (D-Middlesex) on November 21. Assemblywoman Nancy F. Munoz (R-Morris, Somerset and Union) plans to introduce an Assembly version on December 3, according to Elizabeth Cairney, her chief of staff.
Advanced practice nurse Melissa Rubin said joint protocols with collaborating physicians are not needed.
“The problem is they never see your patients, they never see what’s going on with your patients,” Rubin said. She added that she has seen roughly 60 patients per week in two and a half years as an APN, but hasn’t had a situation where consulting with a doctor about medication was necessary.
Rubin works as an APN on a per-diem basis at Robert Wood Johnson University Hospital in New Brunswick and for other providers. She said encouraging more APNs to set up independent practices is crucial for the state.
“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,” Rubin said.
The bill received a negative reception from officials with the New Jersey Academy of Family Physicians.
Claudine M. Leone, the academy’s government affairs director, said the bill is a step backward from the increasing emphasis on patient-centered medical homes. Under the PCMH model, healthcare providers collaborate closely to deliver care.
“Our philosophy has always been these are professionals we work with,” Leone said, along with physician assistants and other healthcare providers who aren’t doctors.
“They work as a team, just like in the PCMH model. The PCMH model doesn’t work if you don’t have a team that works together and it’s kind of going in the reverse direction of coordinated care, to have independent, primary care practices out there not coordinating care for patients, Leone added.
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