Vitale Testimony On Proposed Hospital Licensing Standards

Senator Says New Jersey Should Allow Nurses to Practice to the Extent of their Training

TRENTON – Senator Joseph F. Vitale, D-Middlesex, the prime sponsor of legislation which allows advanced practice nurse anesthetists to work collaboratively with other health care professionals, rather than under the oversight of other professionals, issued the following testimony today to the Department of Health and Senior Services regarding proposed hospital licensing standards which take into account his legislation:

“Thank you for this opportunity to testify. My comments relate specifically to N.J.A.C. 8:43G-6, which establishes standards for hospital anesthesia services. I will limit my comments to provide context to my direct involvement in expanding the scope-of-practice for all advanced practice nurses and why such policy initiatives are important to the future of health care in New Jersey.

“First, I commend Commissioner Alaigh as well as the staff at the Department of Health and Senior Services for their work to negotiate the proposed hospital licensing standards. The proposed regulations as published in the New Jersey Register in August 2010 appropriately modify the standards for hospital anesthesia services by clarifying that advanced practice nurse anesthetists shall practice to the full scope of their licensing act.

“As the primary sponsor of P.L. 2004, C. 122, which enhanced the scope-of-practice for all advanced practice nurses, let me be clear that both the spirit and intent of that law was to ensure that all advanced practice nurses, no matter their specialty, have the autonomy to practice as independent professionals who are required to have joint protocol with a collaborating physician for prescribing purposes only.

“Advanced practice nurses do not function under the supervision of physicians in New Jersey. It was both necessary and appropriate to propose regulations updating hospital licensing standards to accurately reflect both the spirit and intent of New Jersey law defining the scope-of-practice of all advanced practice nurses, including those that specialize in anesthesia.

“Joint protocol ensures that advanced practice nurses and the physicians with whom they collaborate discuss how they will work together. It ensures both parties have the opportunity and flexibility to determine the level of consultation they must follow when initiating or refilling a drug or device, including those used in the discipline of anesthesia. I want to make it absolutely clear that joint protocol does not mean one party supervises the other. It is a plan for how a team of health professionals determines together how to safely and effectively serve patients.

“Effective care teams lead to better patient outcomes and a more efficient use of resources. The Institute of Medicine recommends that states eliminate barriers keeping nurses from practicing to the full extent of their professional education. This includes eliminating the barriers that keep advanced practice nurses from practicing independently.

“The Board of Directors of the AARP agrees with the Institute of Medicine, releasing the following statement in March of 2010: ‘Current state nurse practice acts and accompanying rules should be interpreted and/or amended where necessary to allow advanced practice nurses to fully and independently practice as defined by their education and certification.’

“As many of you know, it is my dream – indeed, my public life’s work – that the health care system becomes accessible to everyone who lives here. As that happens, as the health care system becomes more accessible to more New Jersey residents, the need to coordinate care among multiple providers will become ever more important. Developing well-functioning teams will be critical to meeting the future needs of patients. These teams must make the best use of each member’s education, skill and expertise to achieve optimum patient outcomes and to ensure resources are used efficiently. Quite honestly, we will fail in our accessibility goal without the best use of every member of the health care team.

“The New Jersey Legislature has taken steps to ensure that nurses are able to practice in accordance with their professional training and education. However, system-wide changes are still needed to capture the full economic value of nurses. Modifying the hospital licensing standards as you have to remove language requiring supervision of a physician for the delivery of anesthesia in hospitals is one such needed change and I applaud you.

“New Jersey’s progress to recognize the competencies of advanced practice nurses by expanding their scope-of-practice has had a positive impact on patient care and patient outcomes. These policies do not diminish the role of physicians in the delivery of health care. Instead, they foster collaborative working relationships rather than hierarchal. They replace the silos of health care with interdisciplinary teams. As a result of this improved communication between health care disciplines, New Jersey residents enjoy higher quality of care and better health outcomes.”