Almost six years ago, when New Jersey permitted advanced practice nurses full practice authority under Executive Order 112, tens of thousands of patients across the state saw real, measurable benefits. Access to primary care and mental health services improved, wait times shortened, and care delivery became more efficient, especially in underserved and rural communities. APNs continued to provide safe, high-quality care while reducing administrative burden and unnecessary delays. The pandemic, which necessitated EO112, has concluded, but the benefits of this provision have continued.
Until now.
In one of former Gov. Phil Murphy’s last acts in office, he signed Executive Order 415, which removed all existing states of emergency, including the Covid-19 state of emergency (Executive Order 103), which provided the basis for Executive Order 112. In essence, this reinstates a “joint protocol,” which will require independently-practicing APNs to pay a physician (one who does not even necessarily practice in the APN’s specialty and does not have any patient-provider relationship with the APN’s patients), a monthly fee in order to continue prescribing to their patients.
APNs have practiced independently in New Jersey since the formalization of the APN role in the early 1990s. The joint protocol is not a supervisory requirement; it is simply a monetary agreement necessary for an APN to have prescribing privileges. Throughout the entirety of the COVID-19 pandemic and beyond, the joint protocol requirement was waived and tens of thousands of patients continued to be served, with zero complaints or negative outcomes reported. With the return of a joint protocol, APNs will lose the ability to prescribe critical medications to their patients, unless they agree to pay a physician to “collaborate” with them.
Additionally, the reintroduction of a physician’s name on a prescription pad or on lab test orders will create confusion and delays in patient care. Oftentimes, pharmacies will contact the physician instead of the APN with questions about the patient’s prescription – physicians who have no involvement in the patient’s care and may not even work in the same specialty as the APN. Furthermore, lab results can be forwarded to the physician instead of the APN, further delaying the APN’s ability to efficiently address patient needs.
Reinstating restrictive practice requirements on APNs will limit health care access, slow care delivery, and place additional strain on an already stretched healthcare system, particularly in low-income areas where many patients rely on Medicaid, often not accepted by physicians (notably in the area of psychiatry), or in rural areas where overall provider shortages are most severe.
Allowing APNs to continue practicing without restriction directly advances Gov. Mikie Sherrill’s priorities of affordability, access and efficiency. Evidence shows that the 27 states across the Country with Full Practice Authority (including our neighbors in New York and Delaware), have more primary and mental health care providers, lower costs, and shorter wait times, especially in underserved areas. Removing outdated barriers will eliminate red tape, strengthen the workforce, improve outcomes, and deliver faster, more affordable care to New Jersey families.
The New Jersey Legislature needs to return full practice authority to APNs. Fortunately, State Sen. Joe Vitale (D-Woodbridge) has sponsored S2996, and 24 of his fellow Senators have signed on as co-sponsors. We urge our legislative leaders to move this bill to the front of their agenda in the new session to solve a completely preventable healthcare crisis and ensure patient access to critical care and necessary medications.
Marcel Kaganovskaya is a dual-certified family and psychiatric mental health nurse practitioner. He is the founder of a multi-site outpatient mental health practice, based in Montclair, dedicated to expanding access to high-quality, patient-centered care in New Jersey and New York.
He serves as a graduate nursing program director at Felician University and is the president of the Society of Psychiatric Advanced Practice Nurses where he leads statewide advocacy efforts focused on practice authority, workforce sustainability and patient access to care.
