Essay on Comparing the Roles of the APN in the State of New Jersey to Those in Illinois

Introduction

Advanced practice nurses (APNs) refer to those who possess the required advanced training from accredited institutions as well as certification; often inclusive of a doctorate or master’s degree in the field of nursing (Miranda et al., 2019). They are part of a group of healthcare providers that is described as advanced practice providers (APPs) and are often referred to as advanced practice registered nurses (APRNs); APPs are often inclusive of both APNs and physician assistants (PAs). Due to the supplementary training that is necessitated for individuals to become APNs, they are often afforded the liberty to practice within a clinical setting or organization with a higher level of independence and responsibility for patient safety. They may be certified to attend to patients without physician supervision, request diagnostic tests for patients, subsequently make diagnoses as well as generally make crucial medical decisions regarding the care of patients. It is critical to note that APNs are nurses at their core, their additional training adding on the base of knowledge that they already possess to specialize their expertise.

This paper will attempt to perform an in-depth analysis of the regulations that apply to APNs’ practice and compare their roles between the states of New Jersey and Illinois with regards to the facets of board certifications and renewal, collaborative agreements with involved parties, and perspective authority. This comparison is because every state accords unique authorization to their nurses for what they can and cannot perform, consequently possessing their licensure protocols. In this regard, the paper will also analyze the various restrictions that apply to APRNs in each state, the hospital privileges that they are granted, their nursing compacts, and finally the differences in palliative end-of-life care. APN practice is based on a firm foundation of expert nursing skills, values, and ethics which coupled with the rapidly rising number of nurses make it one of the areas in healthcare delivery that was identified as being paramount to the attainment of universal healthcare coverage.

Description and Comparison of Roles

As highlighted earlier, APNs and the roles they perform are subject to regulations that are unique in every state. In the state of New Jersey, they are inclusive of nurse practitioners (NPs) as well as clinical nurse specialists (CNSs). The former are providers of primary care whose scope of practice involves the diagnosing and subsequent management of both chronic and episodic illnesses. They can request and infer diagnostic tests for patients as well as prescribe drugs and other treatment formalities to them; in essence, nurse practitioners offer care with an emphasis on the promotion of general patient health and prevention of diseases (Joel, 2017). They traditionally operated in ambulatory settings but recent developments are seeing them shift to care provision in acute care settings as well. Clinical nurse specialists on the other hand are staples in acute care settings and specialize in the coordination in addition to the provision of education concerning complex conditions such as diabetes, oncology, and cardiology to patients and their families as well as other staff members. CNSs with a specialty in psychiatric care often independently provide psychotherapy to patients in nurse-based settings. Others with additional post-masters level; training in pharmacology and pathophysiology are allowed to provide primary care.

In addition to this, APNs in the state of New Jersey are also allowed to practice in the areas of pediatrics, psychiatric mental healthcare, women’s health, nursing anesthesia, acute care as well as other fields in which they possess the required expertise and accreditation. When their patients’ conditions are beyond their scope of knowledge, APNs may seek consultation from more qualified healthcare providers to increase their ability in delivering care, refer them to specialists when completely overwhelmed, and even apply team-based care when it is benefitting for the cost, quality, and effectiveness of healthcare. With regards to the prescription of medication, APNs in New Jersey do so without the supervision of superiors but are required to own a joint protocol collaborative agreement (JP) especially for the prescription of controlled substances to patients. This is a compulsory practice agreement that was legislated in the year 1992 when APNs were awarded the authority to independently prescribe medication and mandates a yearly review of patient charts without their knowledge or that of physicians.

The roles of APNs in the state of Illinois however, differ from those in New Jersey in several ways. The premise of the Covid-19 pandemic offers a good opportunity for their roles within the state’s healthcare system to be reviewed. They are required to possess education in the knowledge of disease prevention, health promotion, diagnosis, and subsequent treatment as well as the ability to incorporate a wide range of skill-sets during the collaboration with providers in other disciplines such as nutrition, physical therapy, general medicine, and even social work. Legislature within the state defines APNs as being inclusive of nurse practitioners (NPs), certified nurse-midwives (CNMs), certified nurse anesthetists (CRNs), and clinical nurse specialists. The practice of APNs in Illinois is defined and regulated by legislation at the state level as opposed to the federal level and despite being allowed to practice without physician supervision, they often work in tandem with them as demonstrated by the practice of physicians regularly referring patients who require development screening, counseling on medication and even case management to APNs.

With there being distinct variations in the specialties within APN practice; their roles have also been defined to fit their educational competencies and training. One such specialty in the state of Illinois involves the certified nurse practitioner whose primary duties are taking histories of patients with regards to health, providing physical examinations to them, diagnosing and treatment of both chronic and acute diseases, the management and prescription of medication, requesting and interpretation of laboratory tests as well as X-rays, provision of education through teaching and provision of counseling services. They are licensed to practice in almost all areas within the healthcare setting such as acute care, general family health, neonatal care, psychiatric health, women’s health, and other areas of their expertise.

Certified clinical nurse specialists on the other hand are tasked with the provision of advanced nursing care in healthcare institutions as well as other clinical settings. Apart from the provision of both chronic and acute care, they act as educators to patients and other staff, mentors to their juniors, researchers for the progression of care, and even consultants to other care providers when possible. Their areas of operations are home care settings, ambulatory settings, nursing homes, and public health centers such as dispensaries. Another specialist within APN practice in the state of Illinois is the certified registered nurse anesthetist who is responsible for the administration of anesthesia and related care practices to patients before and after surgical procedures, diagnostic and obstetrical procedures, and therapy. They are also required to carry out pain management to patients such as trauma and burn victims and some emergency services such as the management of blocked airways. They operate in dental settings, outpatient surgical centers as well as operating rooms within healthcare institutions. They are also the primary providers of anesthesia in rural areas which makes it possible for the often underdeveloped care centers to perform minor surgical services, stabilization of trauma, and general pain management.

The last specialist in the field is the certified nurse-midwife whose primary responsibilities involve the provision of primary care to women in the form of gynecology services, prenatal care, contraceptives, low-risk labor management, and neonatal care. They operate in the hospital setting, patient homes, and community clinics.

Board Certification, Renewal, Collaborative Agreements, and Prescriptive Authority

There are also differences between the two states with regards to certification policies with New Jersey, in accordance to Nurse Practice Act and Board of Nursing Administrative Code, mandating that all aspiring APNs possess a nursing license in good standing from the state board of nursing. Verification of the individual’s educational qualifications from their attended school is also necessary, as is a certification of the successful passage of examinations and conclusion of required certification requirements. The aforementioned certifications are offered and valid for a maximum of two years, upon which immediate application for renewal is mandated as operation without one is against the state’s laws. During the renewal, proof of current certification by an agency that is accredited by the American Board of Nursing Specialties or the National Commission for Certifying Agencies as well as the renewal fee (Cadmus & Wurmser, 2019). APNs within the state of New Jersey are required to carry out prescriptions of medication and treatment devices in line with a joint protocol that is mandated by statutes. The protocol is agreed upon beforehand and subsequently signed off by the physician collaborating with the APN by designation. The state also authorizes the prescriptive authority to APNs who practice within its borders. For prescription to be allowed current professional-nursing licensure is required and controlled and dangerous substances license number along with a federal Drug Enforcement Agency number for the prescription of controlled substances.

With regards to the state of Illinois, prospective APNs are required to possess a certification showing completion of necessary examinations. In addition, nurse anesthetists are required to have certification from the American Association of Nurse Anesthetists Council, nurse midwives a certification from the American Midwifery Certification Board, nurse practitioners certification from the American Academy of Nurse Practitioners Certification Program, and clinical nurse specialist certification from the American Association of Critical Care Nurses or other similar accredited institutions. The renewal of the aforementioned certifications is mandated by the state after every two years, without which the individual is not allowed the law to practice as an APN (Barton et al., 2021). APNs in Illinois are also required by law to possess collaborative agreements with the exemption of those operating in exempted settings. Authority for prescription is provided by a collaborative agreement involving the overseeing physician. The state also distinguishes between controlled substances and legend substances with an Advanced Practice Nurse Mid-level Practitioner Controlled Substances license being necessitated and applicable via the IDPR website and signed off by the physician in collaboration.

Restrictions, Privileges, Nursing Compact and Palliative End of Life Care

Despite having a degree of freedom to practice, APRNs are restricted from performing several things. In the state of New Jersey, they are defined by law as licensed independent practitioners but are not allowed to carry out tasks such as the prescription of medication and controlled substances without the collaboration of a designated physician. The prescriptions are also mandated to contain both the information of the APRN as well as that of the collaborating physician, highlighting a degree of restriction. APRN graduates that wish to practice before the attainment of examination certification are prohibited from doing so without a temporary work permit. This is however also a privilege in the sense that new graduates are allowed to use the permit to practice without examination certification, a privilege that is revoked upon failing the exam twice. Other privileges include diagnosing and treating patients without supervision, creating medical documentation without their oversight. They can also complete temporary work disability forms. In terms of the nursing compact, the state of New Jersey recently enacted it but is yet to implement it meaning nurses that reside there cannot yet practice in other compact states (Oyeleye, 2019). As more and more APRNs are involved in primary care for geriatric, hospice, and palliative care patients, determination of the cause of death, pronunciation of time of death, and signing of death certificates has been made possible without the collaborating physician’s signature.

Restrictions within the state of Illinois on the contrary dictate that APRNs cannot perform invasive or non-invasive surgery which is only permitted to physicians by law. They are also required to obtain the signature of the collaborating physician when prescribing medication and controlled substances; an Illinois Controlled Substance License and a Federal Drug Enforcement Agency License are required for prescription of controlled substances. Some privileges are however granted by the state such as the ability to fully practice without the oversight of a collaborating physician through the obtainment of full practice authority. This means that upon its obtainment, APRNs will be able to both perform the duties of advanced practice nursing as well as prescribe medication and controlled substances without the signature of collaborating physicians. Illinois is however not part of the nursing compact as of April 2019, but had legislated and is waiting for the awarding of its full membership meaning that its nurses cannot yet practice in other compact states. APRNs in the state can perform palliative care given they receive the necessary certification from accredited institutions (Schoenherr et al., 2019).

Conclusion

In conclusion, it was noted that there exist stark differences between the areas of specialization as well as the roles of APNs between the states of New Jersey and Illinois. Both states however necessitate certification from accredited institutions with renewals after two years. Restrictions and privileges also vary between them while the nursing compact was found to be unavailable in both states. In general, the role of APRNs in both states’ healthcare was found to be crucial and the need for broadening of their scope of practice was acknowledged.

References

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Schoenherr, L. A., Bischoff, K. E., Marks, A. K., O’Riordan, D. L., & Pantilat, S. Z. (2019). Trends in hospital-based specialty palliative care in the United States from 2013 to 2017. JAMA network open, 2(12), e1917043-e1917043.

Miranda, M. V. D., Rewa, T., Leonello, V. M., & Oliveira, M. A. D. C. (2018). Advanced practice nursing: a possibility for Primary Health Care?. Revista brasileira de enfermagem, 71, 716-721.

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Cadmus, E., & Wurmser, T. (2019). Perceptions of acute care nurse residencies: Perspectives from one state. Journal of nursing management, 27(6), 1251-1260.

Barton, M. J., Hannum, B. C., Lindsey, M., & Towle, T. (2021). The Path Toward Full Practice Authority: One State’s Strategy. The Journal for Nurse Practitioners, 17(2), 147-152.