Call to Action!! Additional information re: "Consumer Access to Health Care" Bill

Dear APN colleagues and supporters,

In addition to the announcement posted by Amita Avadhani, APN I would like to add the following.

Call to Action!!!!!

 

On June 3rd, 2019, Senator Joseph Vitale and the Senate Health Committee will hear testimony on S1961 the “Consumer Access to HealthCare Act” which will remove the Joint Protocol currently required for an Advanced Practice Nurse to prescribe medications and devices in NJ.

This barrier requires only that the physician and APN meet once annually to review one patient in order for the APN to prescribe medications and devices.  The protocol needs to be reviewed and signed annually.  This barrier inhibits consumers from obtaining access to providers who are competent, cost-effective and who could help to ease the back log and wait times NJ citizens currently experience when seeking treatment, and especially for psychiatric & substance use issues.

National APRN (Advanced Practice RN) Landscape as of 2017:    There are greater than 248,000 APRNs in practice across the United States. APRNs have provided almost [60] years of practice equal in patient safety & efficacy to that of physicians & should be granted FULL PRATICE AUTHORITY as per their Education, Training & Experience (IOM, “The Future of Nursing: Leading Change, Advancing Health” 2010), http://www.academicprogression.org/about/future-of-nursing.shtml

APNs have been safely prescribing in NJ for over 25 years and our surrounding states (NY, DE & soon PA) have moved toward Full Practice Authority for APNs, as have 22 other states and the District of Columbia.  

Attached please find a copy of the Bill, as well as a Fact sheet regarding APN practice in NJ.  

We are asking that you reach out to your “network,” of health care professionals and patients to get endorsements supporting the passage of this Bill.

We would like the endorsements to come from your network, i.e. agencies who seek APNs and have a hard time finding Collaborators for them are a good example. Also, Directors of Nursing and other healthcare organizations, Deans of Universities, FQHCs, Community Health and Mental Health Centers, Physicians who support us would be great.

We need the Senators to know that not all are in line with Organized Medicine. How about the mayor of your town, or another public figure who knows you and the quality of care you provide.  A union leader or anyone who can speak for a larger group. And of course your patients!! 

Send all letters of support large or small to Nick Blanck via email at nblanckcrna@gmail.com or via snail mail to him at 1606 Hawthorne Ct Sewell NJ 08080. 

 

https://www.apn-nj.org/resources/Documents/S1961.pdf

https://www.apn-nj.org/Templates

https://www.njleg.state.nj.us/districts/districtnumbers.asp

BACKGROUND INFORMATION AND TALKING POINTS

On November 19, 2012 Sen. Joseph F Vitale introduced the bill in the Senate. The legislation would authorize 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. Twenty-two 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.

 

NJ APN Legislative History

1991-NJSA 45:11-45 to 49 Permitted Duties of Advanced Practice Nurses (Prescriptive Practice)

1993- NJAC 13: 37-7.1-7.12 & 13:27-8.1 Certification of APNs & Standards for Joint Protocols

2004- NJ APNs Granted Prescriptive Privileges for Controlled Dangerous Substances Schedules II-V

  

NJ APNs are Licensed Independent Practitioners & Perform ALL Duties Independently As per their Education & Training except Prescriptive Practice (prescription medications & devices)

 

NJ APNs Granted Prescriptive Practice (including CDS Schedules II through V) Under Joint Protocol with Collaborating (NOT Supervising) Physician

 

NJ APNs Independently Treat Their Patients…Collaborating Physician Does NOT need to see Patient

 

NJ APNs sign their Own Prescriptions, Orders, Evaluations & Progress Notes…NO Physician Signatures

 

NJ APNs Carry Their Own Liability Insurance…NO Impact on Collaborator's Liability Insurance

 

Joint Protocol Requires ONE Annual Meeting (can be via electronic means) to Review ONE Patient & update Collaborative Agreement…contact between APN & physician can occur via electronic means

 

POLITICAL DISTRICTS IN New Jersey
https://www.njleg.state.nj.us/districts/districtnumbers.asp

Posted by:

V. Eftychiou, APN