By Lauren Gilmore
The COVID-19 pandemic brought many challenges to New Jersey’s healthcare system. As a registered nurse in a critical care unit, I watched as otherwise healthy people were annihilated by a novel, foreign virus.
I watched as the virus infected and killed a wide range of people, regardless of age, race, sex, socioeconomic status and health status. I never imagined that, to so many strangers, I would be the only person holding their hand as they passed away. I watched as the Intensive Care Unit became overfilled, overrun, overburdened and overwhelmed.
In the midst of these challenges, nurses took on increased responsibility to get through this crisis. Gov. Phil Murphy issued executive order No. 112, which waived existing practice restrictions for advanced practice nurses (APN).
An advanced practice registered nurse (APRN or APN) is a registered nurse with a post-graduate degree in one of the following specialties, certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), certified nurse midwife (CNM), and certified nurse practitioner (CNP).
Each of these practitioners specializes in different aspects of health care across the lifespan, trained in a specific aspect of health care delivery. During executive order No.112, in the realm of critical care, I watched APNs rise to these challenges by alleviating the gap of desperately needed providers and ultimately saving countless lives. New Jersey surveys report that over 45% of APNs worked without practice restrictions during the COVID-19 crisis, with no reported adverse events.
It’s no secret there is a shortage of health care providers and limited access to health care in New Jersey and other parts of the United States; as much as a quarter of the nation lives in a health care shortage area.
For many who live in underserved, low socioeconomic status areas, health care providers are most desperately needed. In New Jersey, a physician-APN collaborative model exists, wherein the APN and physician establish combined treatment plans for patients, with either actual or electronic availability of the supervising physician.
The reality of the existing model is this: mandatory physician supervision is a barrier to providing care for patients who need it. If a supervising physician retires, and another willing physician is unavailable, a nurse practitioner will have to stop seeing patients entirely.
Furthermore, the stringent policies of health care systems restrict APNs from performing clinical skills that are within the scope of their education and training. These strict requirements often push APNs to move outside New Jersey’s jurisdiction, into the other 24 states and Washington, D.C., which grant full practice authority to APNs. Thus, New Jersey Senate Bill 1522 seeks to eliminate APN practice restrictions and increase access to health care for its citizens.
A main source of opposition to this bill is the concern that a physician should be consulted and brought in for certain treatments and patient scenarios. However, this concern is unfounded; the bill does not prohibit an APN from contacting or consulting with a physician for the treatment of a patient.
Moreover, an APN who does not refer a patient exceeding his or her level of training and expertise should be held accountable and legally responsible for that decision. This bill is not to condone or encourage APNs to practice outside the scope of their education; instead, this legislation argues that APNs should be able to practice to the full extent of their training and licensure.
Another opposing argument is that APN practice expansion could increase malpractice premiums for physicians. However, there is no evidence that lenient health care licensing laws increase malpractice premiums, according to the National Bureau of Economic Research. In actuality, APNs, who are reimbursed at lower rates compared to their physician counterparts, offer immense cost savings to health care facilities and health insurance companies.
There are more than 10,000 APNs practicing in New Jersey, with a large percentage of them working in primary care. According to the legislation, eliminating practice restrictions on APNs in New Jersey has the power to reduce health care disparities by more than 38%.
Despite this fact, this bill faces stringent opposition from physician groups, who possess formidable lobbying power and whose concerns are misguided and unfounded. Physicians are invaluable members of the health care team, and no one is disputing this.
Senate Bill 1522 is simply a solution to the issue of patient access to care in New Jersey. Everyone becomes a patient at some point. Everyone deserves health care. Support New Jersey Senate Bill 1522.
Lauren Gilmore is a registered nurse from Princeton. She worked in the ICU during the height of the pandemic.
Here’s how to submit an op-ed or Letter to the Editor. Bookmark NJ.com/Opinion. Follow us on Twitter @NJ_Opinion and on Facebook at NJ.com Opinion. Get the latest news updates right in your inbox. Subscribe to NJ.com’s newsletters.
Follow us on Twitter @NJ_Opinion and on Facebook at NJ.com Opinion.