NJ Strikes Down Bill to Allow Nurse Practitioners to Prescribe Medication
On January 8, 2020, New Jersey denied the passage of Bill A854, also known as the “Consumer Access to Health Care Act,” and its companion bills, NJ S1961 bills and NJ A669, which proposed to give Advanced Practice Registered Nurses the ability to prescribe medication independently without a physician.
The bill proposed limitations for APRNs with fewer than 24 months or 2,400 hours of licensed, active, advanced nursing practice in an initial role to be required to have a “formal collaborating agreement with a provider” in place. According to its sponsors, the bill adheres to the Institute of Medicine (IOM) recommendations to eliminate barriers for APRN care in the best interest of patients and the future of nursing.
The Movement Behind the Bill
There has been a big push to transform healthcare by allowing APRNs to practice as independent practitioners, which would include being allowed to prescribe medication. For instance, the position statement of the American Association of Nurse Practitioners (AANP) maintains that five decades of research support that NPs should have “unrestricted prescriptive authority, including dispensing privileges, within their scope of practice.”
A large part of the movement towards allowing full prescriptive authority to APRNs came after IOM’s 2011 report on the Future of Nursing. The report listed four key recommendations to transform healthcare through nursing that support a bill that would offer APRNs the ability to prescribe medication. For instance, the report listed the following recommendations:
- Nurses should practice to the full extent of their education and training.
- Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
- Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.
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After the report was released, many states either confirmed their criteria for full practice authority for APRNs or changed their laws to give Nurse Practitioners (NPs) full practice and prescribe authority.
Currently, 21 states allow NPs to practice independently and prescribe medication on their own.
Not Everyone is a Fan
While many leading nursing organizations support legislation that would increase the autonomy of nurse practitioners, not all medical organizations are in support. For instance, the American Medical Association (AMA), announced the news that the bill had been rejected by efforts from physicians who convinced lawmakers to vote against the proposal.
In a post by Kevin B. O'Reilly, the news editor for the AMA, who said that the bill would “weaken the physician-led health care team,” the organization explained that the AMA Scope of Practice Partnership provided the Medical Society of New Jersey with a grant to “support its efforts to defeat the legislation.” The AMA explained their position that the bill presented a threat to patients and physicians, writing:
“Patients deserve care led by physicians, we cannot allow less. Thanks to ongoing advocacy by the AMA and the Medical Society of New Jersey, lawmakers in NJ this week opted against moving forward with a bill that would have allowed advanced practice registered nurses to prescribe without any physician oversight.”
What People Are Saying About the Bill
The AMA’s post was met with conflicting viewpoints over how they described the bill.
Some pointed out that healthcare--including prescribing medication--should be a collaborative, team-based decision, and that studies have shown effective outcomes with APRN-directed care. “This is a terrible article AMA—do better!” wrote one reader. “There is a difference between collaboration when needed/appropriate versus unnecessary administrative oversight that actually hurts patient outcomes like needing signatures on things that can be handled easily by an advanced practice provider. Thanks for bashing APP training and professions—way to be leaders of a healthcare ‘team’.”
Others maintained the stance that medical physicians and medical physicians only should be ordering medication.
“No matter how expert a nurse is in her or his field, a nurse shouldn't be allowed to prescribe anything because she's not a doctor. I'm a doctor and the years it takes to study Medicine are not the same, the curriculum is not the same as nursing school. If any nurse or any person wants to prescribe, study Medicine. Being a nurse and being a doctor are two very different profession[s] and it's not for nothing that doctors take longer years to get their diplomas,” said another.
Despite differing opinions and a lack of federal uniformity, the debate will continue on in a state-by-state basis, as many other states are facing decisions in the new year over similar bills expanding the scope of practice for APRNs and PAs, including Georgia, Massachusetts, and California.
