Political Action Paper

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Bill Selected: NJ A 2286: Summary of the Bill and Why I selected It

The bill primarily focuses on eliminating advanced practice nurses (APNs) practice restrictions. Specifically, the bill targets restrictions that undermine APNs ability to administer anesthesia and prescribe medications by creating new requirements for prescribing medications (New Jersey Legislature, 2022). With these changes, advanced practice nurses with more than two years or 2400hrs of advanced, active, and licensed advanced nursing practice will provide services minus a joint agreement with a collaborating provider (New Jersey Legislature, 2022). Regarding medication prescriptions, the bill mandates the utilization of New Jersey Prescription Blanks and educational qualifications in prescribing controlled substance and pharmacology (New Jersey Legislature, 2022). Therefore, APNs with less than two years or 2400hrs of practice will only prescribe medications if there is a joint agreement with an experienced APN or physician. 

The bill also reviews APNs requirements to prescribe medical cannabis and written instructions regarding its consumption. The new revisions requires APNs to comply with the “Jake Honing Compassionate Use Medical Cannabis Act” PL.2009, C.307 (C.24:61-1et al.) to prescribe medical cannabis. The Act states that APNs should have an active federal and state registration for controlled dangerous substances prescription to prescribe medical cannabis (New Jersey Legislature, 2022). Additionally, the Act requires that APN should be in charge of the continuous treatment of the patient prescribed with the controlled dangerous substance and comply with medical cannabis prescription standards. The bill also mandates APN-anesthesia to practice within the full scope of their training if they meet the necessary requirements without licensed physician supervision or entering into agreements with licensed physicians (New Jersey Legislature, 2022). Thus, I selected the bill because it allows APNs to practice within the scope of their training minus supervision or joint agreement with licensed physicians. Expanding APNs scope of practice empowers them to address gaps that undermine patients’ access to safe and quality care (Park et al., 2020). With the rapidly evolving healthcare sector, expanding APNs scope of practice will contribute to innovations in healthcare delivery. Therefore, expanding APNs scope of practice will improve care access and boost productivity.

The Bill Title, Number, Sponsors, and their Political Party Affiliation

The Bill title is” Eliminates Certain Practice Restrictions for Advanced Practice Nurses”. The Bill number is “A 2286” (New Jersey Legislature, 2022). The bill has been introduced and referred to the “Assembly Health Committee”. The primary sponsors of the Bill are Munoz, Nancy F., Jasey, Mila M., & Spearman, William W (New Jersey Legislature, 2022). The Bill co-sponsors include McKeon, John F., Reynolds-Jackson, Verlina, Lopez, Yvonne, Sumter, Shavonda E., DeAngelo, Wayne P., Moen, William F., Jr., Murphy, Carol A., Stanley, Sterley S.,  DePhillips, Christopher P., Clifton, Robert D., Mejia, Pedro.,  Jimenez, Angelica M., Giblin , Thomas P., Karabinchak, Robert J., Scharfenberger, Gerry., McKnight, Angela V., Dunn, Aura K., Speight, Shanique and Atkins, Reginald W (New Jersey Legislature, 2022). The bill sponsors are affiliated to both American Republican Party and the Democratic Party. For instance, Munoz, Nancy F. is affiliated with the Republican Party while Jasey Mila and Spearman William are affiliated with the Democratic Party. 

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Professional Organizations Regarding the Bill

Nursing and other organizations support the bill. Some of the organizations supporting the Bill include  New Jersey Association of Nurse Anesthetists(NJSNA), New Jersey Palliative Care Advanced Practice Nurse Consortium(NJPC APNC),  Advanced Practice Nurses of New Jersey,  Society of Psychiatric Advanced Practice Nurses, and FNAP(Forum of Nurses in Advanced Practice New Jersey State Nurses Association) (NJ Advanced Practice Nurses, n.d). These organizations consider the bill a viable and proven way of increasing healthcare access and providing high quality and best care to New Jersey residents. The organizations also maintain that the bill S1522/A2286 promotes choice and flexibility for APN providers, healthcare facilities and patients (NJ Advanced Practice Nurses, n.d). Similarly, the organizations maintain that the bill will not exert any financial burden on the state, healthcare systems, or patients. On the contrary, some APNs financial burden will decline because of the bill. NJ Advanced Practice Nurses (n.d) note that a 2022 survey found that some New Jersey Advanced Practice Nurses were paying about $ 1000 monthly to their collaborating physician. However, the actual cost of collaborative agreements is hidden because healthcare systems and hospitals also pay some fees to contracted physician groups providing healthcare services. Therefore, supporting the bill will reduce the financial burden incurred by healthcare systems and APNs. 

Literature Review

According to Kleinpell et al. (2022), APRNs promote health and enhance patients’ care in diverse healthcare settings. Nonetheless, APRNs face significant barriers in their endeavor to practice within the scope of their licensure and training. The barriers include lack of APRNs recognition, lack of comprehension of their role, poor relations with physicians and administrators. Also, APRNs face multiple restrictions in their practice, including collaborative agreements with physicians for hospital admissions and prescriptive capabilities. These limitations undermine APRNs’ ability to offer follow-up care while limiting patients’ choice of healthcare providers and rendering APRN care insignificant. Barriers to APRNs practice undermine healthcare systems’ ability to address healthcare disparities between urban and rural areas because the barriers limit the amounts and types of services that APRNs can offer to patients. 

Torrens et al. (2020) note that workforce and workload challenges in primary care setting triggers the need to expand nurses’ roles. APRNs are assuming roles and responsibilities that were initially restricted to doctors. Thus, it is necessary to comprehend factors that may support or undermine the expansion of advanced nurse practitioners’ role in the primary care settings. In light of this, Torren et al. (2020) underscores the need for collaborative relationships in enhancing advanced nurse practitioner’s role implementation in the healthcare setting. The collaboration will enhance APRN role integration into the wider healthcare team. 

According to Lopes-Junior (2021), nurses are prepared to addresses the 21 century healthcare challenges. The challenges include the changing demographic profile of the patient population, the complex disease burden; increased mortality caused by external factors, and increased prevalence of chronic and non-communicable diseases. With these challenges, the article notes that expanding APRNs role is necessary to enhance greater healthcare coverage. Additionally, expansion of APRNs practice will allow healthcare systems to take advantage of nurses’ competence and intellectual capacity and revolutionize healthcare delivery. Thus, Lopes-Junior (2021) supports eliminating barriers that undermine APRNs practice within the scope of their training and education.

Kleinpell et al. (2023) maintain that APRNs play a crucial role in healthcare delivery. Despite their contribution, they still face significant barriers in their practice. These barriers undermine their provision of critical care services to the patient population. Specifically, APRNs face regulatory restrictions that undermine their care delivery based on their certification, licensure, training, and education. Other barriers include federal regulations, practice authority barriers, and transition to practice requirements. These barriers constrain APRNs ability to practice within the s cope of their experience and education, hence the need to be addressed through regulatory changes.

Robeznieks (2020) is against expanding advanced practice registered nurse scope of practice. According to the author, expanding APRNs scope of practice increases healthcare costs and reduces patient’s safety. The article further notes that an integrated care team under physician supervision serves patients better than APRNs because their training and education requirements are higher than their peers. Robeznieks(2020) also notes that  allowing prescriptive privileges and independent practice will increase opioid prescribing, antibiotic prescribing, and overutilization of  diagnostic services, which will escalate healthcare costs and threaten the patient’s health and safety. However, NJ Advanced Practice Nurses (n.d) refutes the claim that expanding APRNs scope of practice will increase healthcare costs and threaten patient’s safety.  On the contrary, APNs will offer cost-effective and high- quality care with outcomes similar to physicians. Similarly, a recent white pater concluded that patients under APNs care experience fewer specialty care and office-based visits, report few cases of hospitalizations and visits to the emergency room (NJ Advanced Practice Nurses, n.d). Therefore, expanding APRNs scope of practice will enhance the cost-effectiveness and efficiency of healthcare systems, leading to costs savings and improved care delivery.

Diez-Sampedro et al. (2020) note that Covid-19 altered patients, clinics, and hospitals practices. The changes had a considerable impact on advanced practice registered nurses. For instance, Covid-19 compelled APRNs to modify their practices and meet the evolving needs of patients, including educating them about the pandemic, preventing new infections, and treating infections. Covid-19 highlighted the need to change APRNs scope of practice that guides their service provision. Many healthcare facilities during the pandemic were forced to shift APRNs focus from their area of specialization to enhancing patient’s access to acute care services. Similarly, physician shortage underscored the need for advanced practice registered nurses to care for patient. However, this is possible if states review their legislations to expand physician assistants and APRNs scope of practice.

According to Stucky et al. (2021), Covid-19 marked a new phase for APRNs (Advanced practice registered nurses). During the pandemic, nurse practitioners through emergency policy and regulatory changes practiced within the full extent of their training and education.  Although the changes were temporary, many states are considering making the policy and regulatory changes permanent because of APRNs unique contribution in care delivery. However, some organizations are against expanding APRNs scope of practice, arguing that it will undermine patient’s safety and preference. Regardless, APRNs post-Covid have a chance to educate  key stakeholders on their unique role in enhancing patient care access and eliminating healthcare disparities while advocating for  permanent changes that will expand their scope of practice.

  According to the summary of the literature review, some researcher advocate for eliminating barriers that undermines nurses practice within the scope of their training and development while others are against the idea. Those supporting the expansion of APRNs role maintain that it will eliminate healthcare disparities, reduce healthcare costs, and improve the quality of care accessed by patients. However, those against APRNs practice expansion maintain that it will increase healthcare costs and undermine patient’s safety. Nonetheless, many are in support of expanding APRNs scope of practice to enhance healthcare access and reduce the escalating costs of delivering care.

My Position and Rationale on the Bill

I support the bill because it expands APRNs scope of practice leading to enhanced care access by underserved communities while addressing nursing shortage challenges. Covid-19 stress and retiring of nurses have contributed to high turnover of nurses. Consequently, attracting more healthcare providers in the field is crucial by creating more opportunities. Therefore, expanding APNS scope of practice is necessary to feel the gap left by high nurse turnover and meet the underserved communities’ healthcare needs (NJ Advanced Practice Nurses, n.d). Lopes-Junior (2021) further notes that expanding APRNs scope of practice will help healthcare systems tackle the 21st century healthcare challenges, including the complex disease burden, increased mortality rates, and increased prevalence of chronic and non-communicable diseases. APRNs also offer safe and cost-effective care comparable to physicians, hence the need to expand their scope of practice to meet increased patient demands.

Advocacy Efforts

My advocacy emails will be sent to Thomas Giblin (New Jersey State Representative) and Britnee Timberlake (New Jersey Assembly Member). These members were selected because they can put the interest of the state first by supporting the bill. Therefore, the advocacy email will emphasize the benefits of supporting the bill to the general residents of New Jersey State. For instance, the advocacy email will underscore the importance of APRNs practicing within their scope of training and education as the nation is shifting to health-focused from illness-focused care. Therefore, contacting the two legislators provides a chance to highlight the need to expand APRNs scope of practice and their role in improving healthcare access to the most vulnerable and underserved populations.

Copy of Email to Thomas Giblin

Hello! Hope this email gets you well. I am a future APRN and long-term resident of New Jersey State and I am writing this email to urge you to support Bill NJ A 2286:” Eliminates Certain Practice Restrictions for Advanced Practice Nurses” for the benefit of residents and nurse practitioners. Passing the Bill into law will increase residents’ access to high quality and safe care regardless of their status or ages.  Thus, I urge you to support the bill by voting in its favor and representing the wider stand of professional organization and nurses regarding the bill. 

Copy of Email to Britnee Timberlake

 Hello Timberlake! I am writing this email as a professional nurse urging you to support Bill NJ A 2286:” Eliminates Certain Practice Restrictions for Advanced Practice Nurses” that is still under debate. Voting in favor of the bill will benefit patients, healthcare providers, and healthcare facilities. For instance, the bill will promote choice and flexibility, enhance care consistency, promote collaboration among healthcare providers, reduce healthcare cost and improve quality, and enhance healthcare access to underserved communities. I, thus, urge you to vote in favor of this crucial legislation for the benefit of key stakeholders in the healthcare sector. 

Evaluation of Political Actions

Despite writing advocacy emails to two legislators regarding Bill NJ A 2286:” Eliminates Certain Practice Restrictions for Advanced Practice Nurses” I am yet to receive replies from the legislators. Regardless, I believe my political actions were effective because they provider the legislators with significant insights into the significance of supporting the bill and its implications on nurse practitioners. However, I will consider lobbying than writing emails in future because the strategy enhances access to government legislators and pressures governments to consider specific actions regarding a public policy.

References

Diez-Sampedro, A., Gonzalez, A., Delgado, V., Flowers, M., Maltseva, T., & Olenick, M. (2020). COVID-19 and advanced practice registered nurses: frontline update. The Journal for Nurse Practitioners, 16(8), 551-555. https:/doi.org/ 10.1016/j.nurpra.2020.06.014

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19. Journal of Nursing Regulation, 14(1), 13-20. https:/doi.org/ 10.1016/S2155-8256(23)00064-9

Kleinpell, R., Myers, C. R., Likes, W., & Schorn, M. N. (2022). Breaking down institutional barriers to advanced practice registered nurse practice. Nursing Administration Quarterly, 46(2), 137-143. https:/doi.org/ 10.1097/NAQ.0000000000000518

Lopes-Júnior, L. C. (2021). Advanced practice nursing and the expansion of the role of nurses in primary health care in the Americas. SAGE Open Nursing, 7, 23779608211019491. https:/doi.org/ 10.1177/23779608211019491

New Jersey Legislature. (2022). Bill A 2286: Session 2022-2023. https://www.njleg.state.nj.us/bill-search/2022/A2286

NJ Advanced Practice Nurses (NJ-APN),(n.d).  Set the record straight about Joint Protocol. https://njana.com/wp-content/uploads/2022/09/Truth-About-Joint-Protocol.REVISED.9.8.22.pdf

Park, J., Han, X., & Pittman, P. (2020). Does expanded state scope of practice for nurse practitioners and physician assistants increase primary care utilization in community health centers?. Journal of the American Association of Nurse Practitioners, 32(6), 447-458. https:/doi.org/  10.1097/JXX.0000000000000263

Robeznieks, A. (2020, October 30). Why expanding APRN scope of practice is bad idea. https://www.ama-assn.org/practice-management/scope-practice/why-expanding-aprn-scope-practice-bad-idea

Stucky, C. H., Brown, W. J., & Stucky, M. G. (2021). COVID 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority. Nursing Forum, 56(1), 222-227). https:/doi.org/ 10.1111/nuf.12515

Torrens, C., Campbell, P., Hoskins, G., Strachan, H., Wells, M., Cunningham, M., ... & Maxwell, M. (2020). Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: a scoping review. International Journal of Nursing Studies, 104, 103443. https://doi.org/10.1016/j.ijnurstu.2019.103443