Forum of Nurses in Advanced Practice New Jersey Nurses Association General Meeting Minutes I March 28, 2007

Transcription

1 Forum of Nurses in Advanced Practice New Jersey Nurses Association General Meeting Minutes I March 28, 2007 The March meeting was held during Professional Education Day at the Tropicana Hotel, Atlantic City. Meeting was called to order by Maryanne Crowther, FNAP President, at 10:05 AM. Grace Reilly, Pres. Elect and Chair, Education Comm. and her committee members were warmly thanked for their hard work to make the day possible. I. Treasurer s Report: Harriet Berliner for Mary Krug Jan.-March 2007 Beginning Balance $ Total Expenses - $ FNAP Ending Balance $ II. III. IV. Secretary s Report: Harriet Berliner Annual mailings were sent in early February All FNAP minutes and announcements will be posted on the new Members Only Section of the NJSNA website. No minutes will be mailed. The January 2007 Meeting Minutes have been posted. ListServ Members: to be part of the APN Forum New Jersey State Nurses Association members will go to the FNAP website to register anew. As we pay for each member on the list, registering through the Members Only site will allow ONLY those who belong to NJSNA to use the listserv benefit. Educational Awards: Harriet Berliner, Scholarship Comm. Chair Nancy Fortna Educational Award: Karla Tramutola, RN, BSN. Karla will complete her MSN from Seton Hall Univ. 12/07and will begin practice as an APN/Adult Health FNAP Members Only Educational Award: Carol Ann Chupak, RN, MS,APN. Carol has AAS and MSN degrees in nursing, BA in psychology with School Nurse Certification. She has just started the DNP program at Fairleigh Dickinson Univ. Neither recipient was able to attend the Award Luncheon. They were sent a check for $1000 and a framed Award Certificate. Legislative Updates: Kris Olson, Legislative Chair, AANP Regional Director Kris distributed legislative handouts. She stated that with the Democrats now in power in Congress, there is a renewed interest in healthcare issues. Rush Holt with co-sponsors Bill Pascrell, Jr. and Donald Payne have proposed a bill for a study to be done identifying factors contributing to fewer slots in nursing programs. We need to thank them for their support. On Medicaid Issues: funds are being sought to fund proposals to add CNS Mental Health Providers in NJ as Medicaid providers. Funds are also needed for a workforce to development geriatric training courses for healthcare providers. Please thank Sen. Lautenberg for his support. Also, continued funding for nursing education and training is needed. Practice & Regulatory Updates: Carolyn Torre, NJSNA Director of Practice

2 Carolyn distributed information on State Legislative Issues. The complete handout is attached. The data is posted on the NJSNA website. There are 108,000 nurses in NJ and 4000 belong to NJSNA. There were legal questions about different procedures that the State allows APN s to perform. There is NO list of such tasks in the regulations for RN s and APN s. For example: there is nothing that prohibits giving Botox injections in your practice IF it meets the algorithm online which will show you if you have adequate education and experience to do it. Acupuncture is title protected and must meet State laws under the Board of Medicine. V. Chapter Announcements: Next meeting is Sat., June 2, 2007 and is a joint meeting with SPAPN. The Topic: Pain Management will include case studies. Please go to NJSNA website for time and location. VI. Upcoming meetings: Mid-Atlantic Regional Conference for Nurse Practitioners, April 19-21, 2007, Inn and Conference Center, College Park, MD. AANP 22 nd National Conf, June 20-24, 2007, Indiana Convention Center and RCA Dome, Indianapolis, Indiana Primary Care and HIV in 2007: What every practitioner needs to know, June 29, 2007, NY and NJ AIDS Education and Training Center, The Kimmel Center at NY University, New York City, NY VII. New Business: Audience comments and suggestions were made on a variety of issues. Meeting was adjourned at 10:35 AM. Respectfully Submitted, Harriet Berliner FNAP Secretary

3 APN Related State Legislative, Regulatory and Practice Update: For FNAP Business Meeting: APN Professional Education Day: 3/28/07 Carolyn Torre RN,MA,APN,C., Director of Practice New Jersey State Nurses Association Legislative Issues: Current: NJSNA could use support of these bills which may impact APNs Bill: S2529 Vitale (D19): Summary: Educational Advancement: Requires newly licensed registered professional nurse to attain baccalaureate degree in nursing within 10 years of initial licensure. Bill: A3027 Conaway (D7); Prieto (D32); Voss (D38) + 3 Summary: Violence Prevention in Health Care Facilities Act, requires certain health care entities to establish violence prevention programs to protect health care workers. Bill: A3028 Sponsors: Conaway (D7); Prieto (D32); Schaer (D36), Voss (D38) + 4 Summary: Safe Patient Handling Practices Act, requires health care facilities to establish programs for safe patient handling practices. Bill: A4042 Sponsor: Conaway (D7): Summary: Nursing Licensing Compact Bill, establishes mechanism whereby RNs licensed in 20 other compact states can be recognized for licensure in NJ. (Not now for APNs but that is being considered by other states at present) Legislative Issues: Past: Following recently adopted laws impact APNs directly: APN Law: P.L. 2004, c.122 This law, affecting APN practice and in particular, controlled substance prescribing was, as you know, signed by Gov. McGreevy in August, The New Jersey Board of Nursing has been working since on developing regulations to operationalize the law. At the 3/20/07 Board of Nursing open meeting, Regulatory Analyst, Charles Manning, lawyer to the BON described progress with the proposed regulations. He relayed hope that the regulations will be published as a Proposal in the New Jersey Register by mid-summer. Mr. Manning also said that the proposed regulations will be published without a completed section on the Joint Protocol. That is still in process in the Division of Law and will be published as a separate proposal. The new Joint Protocol will address not only language necessary related to controlled substance prescribing but additionally, administration of anesthesia by CRNAs b/c the new rules provide a mechanism for CRNAs to be certified as APNs in NJ. As a reminder to any APN new to the state or new to prescribing: Until the APN regulations have finally been completed and adopted, the Board of Nursing has issued permission for APNs in the state of New Jersey to follow this law regarding controlled substance prescribing if they have done the following: 1. Completed 6 contact hours of continuing professional education in pharmacology related to controlled substance prescribing, including pharmacologic management and addiction prevention and management. (All APNs must take this course once. Keep the contact hour certificate in your files for future reference in case you are randomly audited by the Board of Nursing). 2. Revised their joint protocol to explicitly state whether or not in this particular practice, the APN must consult with the collaborating physician prior to initiating prescriptions or orders for controlled substances. Note that the new law does not require prior consultation unless the APN and collaborating physician have agreed that this is necessary and have so stipulated in the joint protocol. When you order prescription pads through a Board of Nursing approved vendor you will see that the pad no longer contains those boxes which needed to be used when you prescribed controlled substances; those restrictions no longer apply. The prescription pad must still include both the APN and the Collaborating physician s contact and licensing information. To see the BON approved vendor list go to: Check the following for APN Controlled Substance Prescribing course availability for Spring/Summer/Fall: 1. Rutgers University, Newark:

4 2. UMDNJ: 3. Brookdale CC: or Pronouncement of Death:: P.L. 2006, C. 86 was signed by the Governor August 21, 2006 and took effect 60 days after enactment on October 21, This law allows nurses (both RNs and APNs) to pronounce death in all settings, including acute care and to complete that portion of the death certificate related to pronouncement. It does not authorize nurses to certify the cause of death; that must still, by law, be done by a physician. Additionally, it does not allow nurses to pronounce brain death. Regulatory Issues: A. Draft Regulations for APN Law: NJSNA successfully worked to get BON to remove restrictions on APN titling categories in draft of proposed APN regulations Discuss in relation to timing/apn titling B. NJSNA intervention prevented proposed regulatory language (related to Health Care Quality Act) that would have removed APNs as PCPs C. Patient Safety Regulations (state reaction to Cullen): complicated; Proposed Regulations published 2/07; available at njsna.org; response due by April 6, D. NJSNA successfully added APNs to DHSS regulations so that they can chosen as a PCP by residents in Assisted Living E. NJSNA wrote or testified to ask that: APNs be added to Developmental Disability regulations among those providers authorized to order restraints APNs be added to Developmental Disability regulations so that they be chosen as PCPs and provide primary care APNs be added to regulations for Children s Group Homes so that they can be PCPs DOE retain language mandating that every school have a certified school nurse present during every school day Practice Concerns: APN Reimbursement: FNAP Reimbursement Task Force met with Horizon Blue Cross Blue Shield, fall, 2006; next expected meeting will be with Horizon- Mercy to determine how their corporate decision was made to reimburse APNs at 100% of physician rate and to determine how this decision has impacted both the insurer and the insured. ANCC APN Certification ANCC is no longer notifying APNs when certification is about to expire and you need to submit materials for renewal. Check your certificate for expiration date and realize that you need to submit completed materials for recertification days in advance of the expiration date. Go to to determine ANCC requirements for NP/CNS recertification. Realize that once the APN regulations are adopted (which operationalized the 2004 APN law), they will require that all APNs in NJ hold current national APN certification not only for initial state certification but also for state recertification. (This was a loophole that was not closed when the first APN regulations were adopted in 1993 in NJ). As noted above, don t expect the new APN regulations to appear in the NJ Register as a proposal for at least another 4 months. When these regulations are published as a proposal, NJSNA will post them at njsna.org so that APNs can read them and write comments, if desired, to the Board of Nursing. NPI: If you don t have one, apply at: Recently or Frequently Asked Questions/Answers: Can APNs initiate DNR orders? Answer: Yes; in long term care. NJSNA had requested that advanced practice nurses (APNs) be added to the language of the regulations related to withholding/withdrawing treatment from elderly institutionalized residents. The Office of the Ombudsman for the Institutionalized Elderly published the final adopted new rules (N.J.A.C. 8:90) in the February 4, 2002 New Jersey Register with these changes added. Because the language of the original statute governing advanced directives (P.L. 1991, Chapter 201: 26:2H-53) uses the word attending physician, alone, the new regulations avoid a contradiction by employing the phrase: DNR (and DNH) orders are orders written by a physician or APN in consultation with the physician and Prior to writing a DNR (or DNH) the attending physician or advanced practice nurse after consultation with the attending physician shall.these new regulations should make it possible for

5 advanced practice nurses working in long term care with the institutionalized elderly to provide the timely services patients and their families require around implementation of advanced directives. They are effective as of February 4, APNs are not authorized to initiate DNR orders in acute care settings. Can APNs perform and sign off on working paper physicals? Answer: Yes. P.L. 2004, c. 168, signed by Acting Governor Codey on 12/7/04 (effective immediately), adds APNs to the list of providers who can perform examinations for and sign working papers. Can APNs certify for temporary disability? Answer: Yes. P.L. 2004, c. 168, signed by Acting Governor Codey on 12/7/04 (effective immediately), adds APNs to the list of providers who can provide examinations related to and certifies temporary disability. Can APNs certify temporary inability to work on Work First NJ Forms? Answer: Yes: A recent change in regulatory law (requested by NJSNA) included APNs in the language of this law, N.J.A.C. 10:90 under the Dept. Human Services. APNs can now sign the Work First NJ Forms WFNJ-5 (DRS1) certifying inability to work. Can APNs working in NJ enter into a joint protocol with a physician not licensed in this state? Answer: Only in Federal institutions in NJ: At their 7/16/03 meeting, the NJ Board of Nursing announced that APNs working in Federal institutions in the state of NJ, like Veterans Administration Hospitals, could enter into a Joint Protocol with a collaborating physician licensed in a state other than NJ. This only applies to APNs working in Federal institutions in the state. In all other instances, the collaborating MD must be licensed in the state of NJ. Are APNs names required to be on medication containers when issued by a pharmacy? Answer: Yes: If the APN is the prescriber, his or her name is required by NJ Pharmacy law to be on the container. For a copy of the law go to: advance to p. 59: 13: Labeling Can NJ APNs be directly reimbursed by health insurance companies? Answer: Once the APN has been credentialed by or obtained a provider number from these insurers, the APN can be directly reimbursed by: Medicare, NJ Medicaid and the following private insurance companies: United Healthcare; Horizon-Mercy; Qualcare; Oxford and Magellan Behavioral Health. Direct reimbursement to APNs is also provided by the Civilian Health and Medical Program (uniformed services members and their families) and by the Federal Employee Health Benefit Plan (federal employees). All APNs should obtain and use their own Medicare numbers. Medicare reimburses approved APN services at 85% of the rate paid to the physician (for similar service). APNs can also seek reimbursement incident to the physician at a 100% rate. This is not recommended since Medicare is extremely strict about having the physician physically present and directly involved in any care billed incident to and an alarming number of cases now exist where Medicare has successfully ordered practices to repay them when incident to services did not occur exactly as required by Medicare rules. Medicaid is a federal program under state control and NJ, at this time, reimburses APNs at 85% of the physician rate. NJ APNs can seek their own Medicaid as well as Medicare numbers; direct link for enrolling: Most HMOs, other than those listed above, do not directly credential APNs as providers but will still allow APNs to bill for services under the collaborating physician s provider number. This is not ideal but it is the present existing method to employ to obtain reimbursement in those instances. Can the APN name on the prescription pad be bigger than that of the collaborating physician? Answer: Yes. The New Jersey Division of Consumer Affairs (direct correspondence with this author, 1/12/01), specifies that when an APN orders prescription pads: on the prescription blank at lines 3-5, the font size for the APN should be no less than 9. At lines 7-8, the physician information should be in Helvetica compressed and in a font size of either 7 or 8. Can APNs obtain Informed Consent from patients in an Ambulatory Care Facility? Answer: Yes. According to New Jersey Standards for Licensure of Ambulatory Care Facilities, Subchapter 16, Patient Rights (8:43A ) Rights of each patient: 4. To receive from the patients physicians(s) or clinical practitioner(s), in terms the patient understands, an explanation of his or her complete medical/health condition or diagnosis, recommended treatment, treatment options, including the of option of no treatment, risk(s) of treatment and expected result(s)... At 8:43A-1.3 Definitions in the same Ambulatory Care regulations: "Clinical practitioner means a physician, dentist, podiatrist, certified nurse midwife, physician assistant or nurse practitioner." Can APNs initiate laboratory and diagnostic tests without a collaborating physician's agreement? Answer: Yes. New Jersey Board of Nursing Statutes, 45:11-49, authorizes APNs to initiate laboratory and other diagnostic tests. The law provides independent authorization for the performance of these tasks. A joint protocol with a collaborating physician is required by APNs only for the prescribing or ordering of legend medications and devices.

6 Can APNs prescribe or order medications if they do not have a joint protocol with a collaborating physician? Answer: No. In order to prescribe in the state of New Jersey, APNs must have a joint protocol with a collaborating physician. APN prescription pads must include identifying information about both the APN and the collaborating physician Can an APN work as a registered nurse first assistant (RNFA)? Answer: Yes. Like an RN, she can work as an RNFA, if she has met the requirements specified in the Board of Medical Examiner s rules: N.J.A.C. 13: Major Surgery: qualified first assistant: she is qualified to do so and the institution in which she is employed has credentialed her to work as an RNFA. The Association of Peri-operative Nurses (AORN) has defined the standards for education for an RNFA at Since few APN programs are focused on perioperative nursing practice the APN, like the RN, will have completed an RNFA educational program to meet this requirement. Can an APN perform the pre-admission physical examination and obtain informed consent in a hospital setting? Answer: Yes. Hospital licensing standards (N.J.A.C. 8:43 G) were readopted with amendments on September 6, 2005, and included were language changes which had been requested by NJSNA. The language now reads that each patient admitted to the hospital s shall have a medical history and physical examination that includes a provisional diagnosis performed by a clinical practitioner within 7 days prior to admission or within 24 hours after admission. The language of the rule also reads that the patient may give informed, written consent only after a physician or clinical practitioner has explained the details about a procedure, its risks, outcomes and alternatives. In the rule, clinical practitioner is defined as a physician, dentist, podiatrist, certified nurse midwife, physician assistant, or nurse practitioner operating within his or her scope of practice. (The Department of Health and Senior Services states in its comment to this amended rule that it uses the phrase nurse practitioner synonymously with advanced practice nurse). Can an APN sign for drug samples in NJ? Answer: Yes. In Fall, 2006, two APNs working in different venues contacted NJSNA to say that their Bristol Myers Squibb drug reps had told them that as of 10/1/06, APNs in NJ could no longer sign for drug samples. One drug rep. explained that it was related to a new law of 2002 ; the other said it was related to a law of I suggested that both APNs challenge BMS re. this prohibition since no law of which either I or any other professionals at NJSNA is aware, has mandated such a prohibition. One of these APNs, did indeed contact the legal dept at BMS and one day later, she received a call from the BMS district manager saying that she could now sign for drug samples. The explanation was that they had misread a 2004 APN law and didn t realize that APNs included NPs! BMS said that they were going to require that the NPs collaborating physician sign a form agreeing that it is acceptable for NPs to sign for drug samples in that practice. Note: Check NJ Nurse bimonthly Practice Update and Institute of Nursing Newsletter, Practice Update for timely information about Issues Impacting NJ APNs CTT: 3/16/07