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Heated, hourlong panels clash over APN full-practice authority as S2996 is discussed
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Summary
Advanced practice nurses, nursing schools, patient advocates and physician groups made competing safety and access arguments as the committee heard S2996, a bill to remove the joint protocol requirement for APNs. Proponents cited workforce shortages and evidence from other states; opponents warned of higher costs and quality risks.
Trenton ' A hours-long, often contentious hearing over S2996, a proposal to remove the joint protocol and allow advanced practice nurses to practice without career-long physician agreements, filled the Senate Health Committee's afternoon on Feb. 16.
Proponents ' including the New Jersey State Nurses Association, nursing-school deans and many APNs ' described accumulated workforce shortages in primary care and behavioral health and pointed to six years of emergency-waiver experience during which they said the state did not see a spike in reported adverse events. "APNs practicing to the top of their license would increase access to quality, affordable care," said Edna Cadmus, a longtime nurse and educator.
Opponents named by medical and specialty societies ' including the Medical Society of New Jersey, the New Jersey Psychiatric Association, and anesthesiology and surgical societies ' said differences in training matter for patient safety. Dr. Tanisha Arora, an emergency physician, summarized concerns from physicians: the Stanford VA analysis found increased costs and higher 30-day preventable hospitalizations in a study cited by opponents and that independent practice in some contexts has been linked to higher resource use.
APNs and several patient advocates countered that joint-protocol agreements often translate into paperwork and pay-to-play arrangements that create barriers to clinic openings and care in underserved communities. "Requiring APNs to pay for and depend on a physician contract does not add to safety," said Adam O'Brien, a psychiatric nurse practitioner who described a case in which his NP-ordered MRI detected a medullary stroke that an earlier ED visit had missed.
The committee did not take a final disposition on S2996 at this hearing; testimony was recorded and the chair signaled that further committee work or amendments are likely.
Next steps: S2996 was discussed at length; members signaled interest in follow-up hearings, data review and potential amendments related to standards for training, specialty practice limits and transition-to-practice requirements.
