Nursing Practice Update: Answers to Questions Recently/Frequently Asked by NJ APNs

New Jersey Nurse, Jul/Aug 2004 by Tore, Carolyn T

QUESTION: Can APNs order Physical Therapy?

ANSWER: Yes. P.L. 2003, c. 18, the new law concerning the practice of physical therapy allows patients to seek direct access to physical therapy. That is, patients are not required to come to physical therapists by virtue of a referral from another health care provider except in the instance of seeking reimbursement for the service under personal injury protection after an automobile accident: the new law requires that this individual be referred by a physician.

Some insurance companies may require that providers approve the visit for PT so a referral by APNs would be needed for the provider but not by tbe phyical therapist.

Physical therapists are required, by the law, to consult with the patient's licensed health care provider of record within the first thirty days of therapy (and if the person has no such provider, to recommend that the person seek an evaluation from a provider) and to send the patient back to a licensed health care professional, if the patient does not make reasonable progress within thirty days of initial treatment. Final regulations clarifying the parameters of this aspect of the law have not yet been promulgated. For a copy of the statute, go to: http://www.njleg.state.nj.us/2002/Bills/PL03/18

QUESTION: 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 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, 2002.

APNs are not authorized to initiate DNR orders in acute care settings.

QUESTION: Can APNs order Home Care and/or Hospice for Medicare Patients?

ANSWER: No. Current Federal law restricts the ordering of Home Care and Hospice for Medicare Patients to physicians. APNs in NJ, as nationwide need to contact federal legislators and asked that the Medicare statute be amended to include APNs for this purpose.

QUESTION: Can APNs perform and sign off on working paper physicals?

ANSWER: The language of the current statute (Child Labor Law) N.J.S.A. 34:2-21.8 requires that a statement attesting to physical fitness for work in the case of minors must be signed by a medical inspector employed by the Board of Education "or any other physician licensed to practice medicine and surgery." Clearly this law is consistent neither with current School Health Law nor current Nursing Law. NJSNA currently has a bill pending in the NJ legislature which would do that; write your state legislators and ask them to support A826/S1319.

QUESTION: Can APNs certify for temporary disability?

ANSWER: Current NJ Labor law does not include APNs in the language of those providers who can certify for temporary disability but until such time as the necessary statutory change is made, the Department of Labor has been accepting temp, disability forms signed by APNs as long as the collaborating physician's name (not signature) is attached to the form. A82/S1319-see working papers, above-would also correct this problem.

QUESTION: 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.

QUESTION: 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.

QUESTION: 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: http://www.state.nj.us/1ps/ca/pharm/pha rmacy.pdf; advance to p. 59: 13:39-5.9 "Labeling."