I Am A Nurse Practitioner. Do I Have Full Practice Authority In New Jersey?
This article will address:
- The reduced practice authority of nurse practitioners, also known as advanced practice nurses, in New Jersey.
- Certification requirements for nurse practitioners in New Jersey.
- Joint protocols between nurse practitioners and collaborating physicians in New Jersey.
No. As a nurse practitioner, you do not have full practice authority in the State of New Jersey. Instead, as a nurse practitioner in New Jersey, you operate in a reduced practice environment, where state practice and licensure laws limit your ability to engage in certain aspects of nurse practitioner practice. In New Jersey, a career-long, regulated collaborative agreement with a collaborating physician is required for nurse practitioners to prescribe or order medications or devices. Further, that joint protocol may restrict one or more elements of the nurse practitioner’s practice.
Advanced Practice Nurses
In New Jersey, nurse practitioners are officially referred to as advanced practice nurses (“APNs”). The New Jersey Division of Consumer Affairs (the “NJ DCA”)’s Board of Nursing (the “New Jersey Board of Nursing,” the “Board of Nursing,” or the “Board”) may issue an APN certificate to a registered professional nurse who, among other requirements:
- Has successfully completed an approved educational program, including pharmacology; and
- Either:
- Has passed a written examination approved by the Board; or
- In lieu of the written examination, holds a current certification in a state which has standards substantially equivalent to those of New Jersey.
What Are Joint Protocols Between Nurse Practitioners and Collaborating Physicians in New Jersey?
In New Jersey, nurse practitioners who seek to prescribe or order medications or devices and the collaborating physician(s) with whom they are in collaboration must develop a joint protocol. Pursuant to a joint protocol, an APN may prescribe or order, for patients, medications or devices.
“Collaboration” means the ongoing process by which an APN and a physician engage in practice, consistent with agreed-upon parameters of their respective practices.
The nurse practitioner’s and the collaborating physician(s)’ joint protocol must be in writing, must be signed by both the nurse practitioner and the physician, must be updated on an ongoing basis to reflect changes in the practice, and must be reviewed at least annually.
The content of a nurse practitioner’s and the collaborating physician(s)’ joint protocol must address, among other topics:
- The nature of the practice, the patient population (for example, pediatric patients), and settings (for instance, in-patient, nursing home, patient residences or other alternative care environments);
- The record-keeping methodology to be used in the practice;.
- Categories of medication appropriate to the practice;
- Specific medications and the specific number of refills, to be prescribed as per the direction of the physician;
- Specific requirements for recording medications prescribed or dispensed;
- Any medical conditions or findings within the nature of the practice requiring direct consultation before the prescribing or ordering of medications or devices;
- The frequency and methodology of periodic review of patient records;
- The means of direct communication between the APN and the collaborating physician, and arrangements which will assure that the collaborating physician or peer coverage is accessible and available; and
- Procedures for the use of medications in emergency circumstances
What Are the Consequences of Failure, by Nurse Practitioners or Collaborating Physicians in New Jersey, to Establish and Implement Joint Protocols or to Comply with Their Joint Protocols?
Failure to establish and implement joint protocols consistent with the above-mentioned standards, or any violation of the joint protocol by a nurse practitioner or physician, may be deemed professional misconduct or other grounds for professional discipline by the New Jersey Board of Nursing or the New Jersey State Board of Medical Examiners (the “NJ BME”), as applicable.
Under What Circumstances May Nurse Practitioners in New Jersey Prescribe Controlled Substances Or Medical Cannabis?
Collaborating physicians and nurse practitioners must address in their joint protocols whether prior consultation with the collaborating physician is required to prescribe a controlled dangerous substance.
So, too, collaborating physicians and APNs must address in their joint protocols whether prior consultation with the collaborating physician is required to authorize a qualifying patient for the medical use of cannabis, also known as marijuana.
The Nurse Practitioner Practice Environment, State by State
In other words, the practice and licensure laws of 27 states, D.C., Guam, and the Northern Mariana Islands permit all nurse practitioners to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and management treatments, including prescribing medications and controlled substances. New Jersey is not one of these full practice authority jurisdictions. Rather, as a nurse practitioner and as detailed above, you have reduced practice authority in New Jersey.
If you are a professional and a Professional or Occupational Board or Committee of the New Jersey Division of Consumer Affairs has called you or sent you an inquiry letter, a Professional or Occupational Board or Committee of the NJ DCA has summoned you to testify under oath in an on-the-record interview, or a Professional or Occupational Board or Committee of the NJ DCA has initiated, against you, a formal disciplinary action, call New Jersey Professional Disciplinary Actions Lawyer David S. Rich at (347) 970-5550 today.
