Committee advances bill to expand APN prescribing authority after heated testimony

The Assembly Appropriations Committee on Thursday voted to advance a committee substitute for Assembly Bill 4,052 that would eliminate certain joint-protocol requirements for advanced practice nurses and set a 5,000-hour threshold for independent prescribing in primary and behavioral health care.

Supporters said the change is necessary to preserve access to primary and mental-health services hit by provider shortages. Louise Gabriel, a doctorally prepared psychiatric nurse practitioner and former president of the Society of Psychiatric Advanced Nurse Practitioners, said the proposal “is not just legislation, again, it's a lifeline” for patients who otherwise face long waits or no coverage.

“Having affordable energy is essential for both New Jersey families and small businesses,” Alex Ambrose had said earlier during a different agenda item; in this hearing the argument from nursing advocates focused on access and continuity of care. Dr. Stephanie McGowan, a council president and special-education director who described a family emergency, told the panel that being referred to a psychiatric mental-health nurse practitioner “saved my daughter's life,” saying practical access to APNs shortened dangerous waits for care.

Opponents, including physicians and specialty groups, urged caution. Dr. Beth Warren, an emergency-medicine physician, said many studies cited by proponents evaluated APNs working under physician supervision and warned that fully independent practice can increase testing, referrals and medication errors. “I strongly oppose this bill,” Warren said, describing cases she said illustrated clinical risks when providers practice without physician oversight.

Senator Vitale, the bill’s Senate sponsor, told the committee that the measure reflects six years of a pandemic-era waiver during which APNs worked under fewer restrictions with broadly positive outcomes, and that the amended substitute narrows the scope to primary care and mental-health prescribing with the 5,000-hour requirement.

Committee members pressed witnesses on competing claims about access and patient safety, citing both anecdotal case examples and academic studies. Nursing representatives pointed to the state’s nursing workforce data, saying more than 19,000 APNs are licensed in New Jersey and that many would lose access to patients if the executive-order waiver lapses.

After testimony and questions, the committee voted to adopt and report the substitute. The roll call recorded a majority in favor; the substitute now moves forward for further consideration.

The committee action leaves intact limits on anesthesia practice and includes the increased-hours requirement for independent prescribing, a compromise sponsors said was necessary to balance access with safety concerns. Committee members who asked for more data were told parties would continue to work on implementation details and oversight.

The committee adjourned the APN item after adopting the substitute; the measure will appear on the Assembly floor schedule in a future session.