Scope of Practice for Nurse Practitioners in New Jersey

The scope of practice for Nurse Practitioners (NPs) varies significantly across the United States, with nearly half of the states, along with the District of Columbia, allowing NPs to practice fully autonomously. According to Poghosyan et al. (2022), NPs currently account for about one out of every five primary care providers, and this number is projected to increase to nearly 30% by 2025. In states with the least restrictive practice regulations, there was a 15-fold increase in the frequency of patients receiving care from NPs between 1998 and 2010, highlighting the critical role that NPs play in healthcare delivery (Neff et al., 2018).

Reduced Practice Authority in New Jersey

In New Jersey, Nurse Practitioners operate under reduced-practice authority, which imposes certain limitations and restrictions on their practice. Unlike NPs in full practice states, NPs in New Jersey cannot practice autonomously and are required to have a collaborating physician. While the collaborating physician does not need to be physically present when the NP is working, they must be available for communication. This requirement can create challenges, especially in situations where immediate decisions are necessary.

Some of the limitations faced by NPs in New Jersey include restrictions on operating their own practice and prescribing certain types of medications. For example, prior to 2009, NPs in New Jersey were not allowed to order specimens from clinical labs, a restriction that has since been lifted (Pittman et al., 2020). Although NPs in New Jersey have the authority to diagnose and order tests, these limitations can hinder their ability to provide comprehensive care, particularly in rural and underserved areas.

Despite these limitations, New Jersey has made strides in expanding the scope of practice for NPs. The state frequently follows regulatory changes made in New York, which recently adopted Full Practice Authority legislation. This legislation allows NPs to provide the full scope of services they are educated and trained to deliver (Black, 2022). New Jersey is likely to continue this trend, gradually expanding the autonomy of NPs.

Process for Obtaining NP Licensure in New Jersey

The New Jersey Office of the Attorney General provides detailed instructions for the advanced practice nurse (APN) certification process. To obtain NP licensure in New Jersey, applicants must meet several requirements:

1. Active RN Licensure: The applicant must hold an active Registered Nurse (RN) license in New Jersey.
2. Educational Requirements: The applicant must complete all educational and clinical requirements, including a master’s program in nursing.
3. Application Process: The application for APN certification must be completed on the Board of Nursing’s website and submitted with a copy of the U.S. passport and a full-face signed photograph.
4. Notarization: The application must be signed and notarized by a notary public.
5. Criminal History Check: A criminal history background check is required.
6. Pharmacology Education: The applicant must also submit proof of completing six contact hours in pharmacology (New Jersey Division of Consumer Affairs, 2023).

Impact of Reduced Practice Authority on Patient Care

The reduced-practice authority in New Jersey places a burden on NPs and somewhat restricts their ability to meet all patient needs. This limitation can have significant implications for patient care, particularly in the emergency department (ED) setting. In my experience working at one of the top-ranked hospitals in New Jersey, I have observed the impact of these restrictions firsthand.

For instance, when I was floated to the Emergency Department, I was struck by the number of patients lying on stretchers in the hallways, some of whom had been waiting for hospital beds for over 30 hours. Many of these patients came to the ED because they lacked a primary care provider, and their untreated conditions had become severe. While NPs in the ED contribute to reducing disparities by providing more timely access to care, their ability to intervene is somewhat limited by the need for physician oversight. This can delay necessary interventions and exacerbate healthcare disparities, particularly in underserved communities (Pittman et al., 2020).

Addressing Healthcare Disparities

Healthcare disparities are complex and multifaceted, particularly in the ED setting. NPs play a crucial role in addressing these disparities by providing continuity of care, educating patients, and ensuring that no one is discharged without follow-up instructions. However, the limitations imposed by reduced-practice authority can hinder the effectiveness of NPs in this role.

Despite these challenges, NPs in New Jersey are well-positioned to contribute to reducing healthcare disparities. As the state continues to amend its regulations and expand the scope of practice for NPs, there is potential for NPs to have an even greater impact on improving access to care and addressing disparities, particularly in rural and underserved areas.

In conclusion, while the reduced-practice authority in New Jersey presents challenges, the state has made significant progress in expanding the role of NPs. As the state continues to follow the lead of neighboring states like New York, there is hope that NPs in New Jersey will eventually be granted full practice authority, enabling them to provide the full scope of care they are educated and trained to deliver.

References

• Black, B. (2022). State of New York grants full and direct access to nurse practitioners. American Association of Nurse Practitioners. Retrieved from www.aanp.org/news-feed/state-of-new-york-grants-full-and-direct-access-to-nurse-practitioners#:~:text=New%20York%20joins%2024%20other,and%20clinically%20trained%20to%20provide
• Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., Bumbach, M. D., Everhart, D., & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379–385.
• New Jersey Division of Consumer Affairs (2023). Instructions for advanced practice nurse certification in N.J. Retrieved from https://www.njconsumeraffairs.gov/nur/Applications/Application-for-Advanced-Practice-Nurse-Certification.pdf
• Pittman, P., Leach, B., Everett, C., Han, X., & McElroy, D. (2020). NP and PA privileging in acute care settings: Do scope of practice laws matter? Medical Care Research and Review, 77(2), 112–120.
• Poghosyan, L., Stein, J. H., Liu, J., Spetz, J., Osakwe, Z. T., & Martsolf, G. (2022). State‐level scope of practice regulations for nurse practitioners impact work environments: Six state investigation. Research in Nursing & Health, 45(5), 516–524. https://doi.org/10.1002/nur.22253