Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
Senator TROY SINGLETON
District 7 (Burlington)
Co-Sponsored by:
Senators Stanfield, Diegnan, Zwicker, Cryan, Madden, Stack, Cruz-Perez, Beach, Johnson, Turner, O'Scanlon, Greenstein, Ruiz, Oroho, Burgess, Codey, Holzapfel, Thompson, Steinhardt and Testa
SYNOPSIS
Eliminates certain practice restrictions for advanced practice nurses.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning advanced practice nurses, revising various parts of the statutory law, and supplementing P.L.1991, c.377 (C.45:11-45 et al.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. (New section) The Legislature finds and declares that:
a. Advanced practice nurses are registered nurses who are certified to provide an advanced level of health care to patients that exceeds the standard scope of nursing practice.
b. Advanced practice nurses augment the system of care in New Jersey and nationwide by providing treatment services at a level that can relieve some of the demand on physicians, of whom there is a chronic shortage, and expedite access to care for patients, including those in medically underserved areas and among medically underserved populations.
c. Studies suggest that approximately one quarter of the population of the United States lives in an area with a shortage of primary care professionals. Limited access to care is frequently worse among racial and ethnic minorities, people with low incomes, and individuals for whom a lack of transportation creates logistical barriers to health care.
d. One way to reduce gaps in health care access is to allow full practice authority for advanced practice nurses, over 75 percent of whom are educated in a primary care specialty and can directly improve access to both primary care services and specialty care services.
e. Currently, 24 states, the District of Columbia, and two U.S. territories have adopted full practice authority for advanced practice nurses. The requirement to practice in collaboration with a physician limits the ability of advanced practice nurses to provide primary care and specialty care services, and has been associated with advanced practice nurses leaving New Jersey for other jurisdictions with fewer practice restrictions.
f. It has been estimated that removing practice restrictions for advanced practice nurses has the potential to reduce health care access disparities by a factor of more than 38 percent.
g. In response to the coronavirus disease 2019 (COVID-19) pandemic, Governor Murphy issued Executive Order No. 112, which, among other things, directly and through waivers issued pursuant to its authority, waived existing practice restrictions for advanced practice nurses, including joint protocol and supervision requirements.
h. According to surveys, over 45 percent of advanced practice nurses in New Jersey reported working without practice restrictions as authorized under Executive Order No. 112 and the waivers issued pursuant to the executive order. No adverse incidents were reported during the waiver period involving advanced practice nurses practicing without practice restrictions.
i. Given the need for expanded access to care, it is necessary and appropriate to take steps to remove practice restrictions that serve as a barrier for advanced practice nurses to practice in New Jersey to the full extent of their education, clinical training, and national certification.
2. Section 1 of P.L.1947, c.262 (C.45:11-23) is amended to read as follows:
1. As used in this act:
a. The words "the board" mean the New Jersey Board of Nursing created by this act.
b. The practice of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential physical and emotional health problems, through such services as casefinding, health teaching, health counseling, and provision of care supportive to or restorative of life and well-being, and executing medical regimens as prescribed by a licensed or otherwise legally authorized physician or dentist. Diagnosing in the context of nursing practice means the identification of and discrimination between physical and psychosocial signs and symptoms essential to effective execution and management of the nursing regimen within the scope of practice of the registered professional nurse. Such diagnostic privilege is distinct from a medical diagnosis. Treating means selection and performance of those therapeutic measures essential to the effective management and execution of the nursing regimen. Human responses means those signs, symptoms, and processes which denote the individual's health need or reaction to an actual or potential health problem.
The practice of nursing as a licensed practical nurse is defined as performing tasks and responsibilities within the framework of casefinding; reinforcing the patient and family teaching program through health teaching, health counseling and provision of supportive and restorative care, under the direction of a registered nurse or licensed or otherwise legally authorized physician or dentist.
The terms "nursing," "professional nursing," and "practical nursing" as used in this act shall not be construed to include nursing by students enrolled in a school of nursing accredited or approved by the board performed in the prescribed course of study and training, nor nursing performed in hospitals, institutions and agencies approved by the board for this purpose by graduates of such schools pending the results of the first licensing examination scheduled by the board following completion of a course of study and training and the attaining of age qualification for examination, or thereafter with the approval of the board in the case of each individual pending results of subsequent examinations; nor shall any of said terms be construed to include nursing performed for a period not exceeding 12 months unless the board shall approve a longer period, in hospitals, institutions or agencies by a nurse legally qualified under the laws of another state or country, pending results of an application for licensing under this act, if such nurse does not represent or hold himself or herself out as a nurse licensed to practice under this act; nor shall any of said terms be construed to include the practice of nursing in this State by any legally qualified nurse of another state whose engagement made outside of this State requires such nurse to accompany and care for the patient while in this State during the period of such engagement, not to exceed six months in this State, if such nurse does not represent or hold himself or herself out as a nurse licensed to practice in this State; nor shall any of said terms be construed to include nursing performed by employees or officers of the United States Government or any agency or service thereof while in the discharge of his or her official duties; nor shall any of said terms be construed to include services performed by nurses aides, attendants, orderlies and ward helpers in hospitals, institutions and agencies or by technicians, physiotherapists, or medical secretaries, and such duties performed by said persons aforementioned shall not be subject to rules or regulations which the board may prescribe concerning nursing; nor shall any of said terms be construed to include first a