End Joint Protocol

NJANA is committed to protecting the rights of our members and ensuring safe, affordable anesthesia care for patients by educating lawmakers and the public about issues that can potentially impact the ability of Certified Registered Nurse Anesthetists (CRNA) and Advanced Practice Nurses in Anesthesia (APN-A) to practice in New Jersey and beyond our borders.

Top NJ Issue #1: Unnecessary Joint Protocol

The Issue: The “Joint Protocol” that was enacted in 2009 created an unfair, restrictive barrier that tied the hands of APN-Anesthesia professionals/Certified Registered Nurse Anesthetists (CRNA) by only allowing them to work in the physical presence of a licensed physician anesthesiologist. Prior to 2009, APN-A’s/CRNA’s could work under the supervision of qualified surgeons, dentists, dermatologists and other physicians — just like any other CRNA’s in non-opt-out states. The restrictions of the Joint Protocol are also causing unnecessary disruptions in the supply of highly qualified APN-A’s/CRNA’s.

It is important to note that the Joint Protocol and physician supervision also restricts the practice of a variety of other specialized Advanced Practice Nurses (APN’s) in New Jersey.

The Challenge: With only 1,200 physician anesthesiologists and around 1,000 CRNA’s/APN-Anesthesia professional in the state, this severely restricts independent employment opportunities for advanced practice nurses, drives up the costs of anesthesia care and ultimately reduces the accessibility of quality anesthesia care for patients.

The Brain Drain: NJ institutions provide a rigorous but outstanding education for APN-A’s who graduate with doctorates and more than 10,000 hours of specialized nursing education and training. 100 percent of all APN-A’s are nationally board-certified to provide anesthesia at the same level as our physician anesthesiologist colleagues. Unfortunately, 50% of these highly trained professionals leave to practice in states without “Joint Protocol,” such as NY, PA and DE, because of the tremendously different impact they can have on patient care.

The Climate: Over the past 25 years, 27 states and the District of Columbia have removed practice restrictions for APN-A/CRNA’s because of their proven cost-effectiveness and the exemplary safety records in every type of healthcare setting. Not one state has ever reversed that decision.

COVID-19 Impact

The COVID-19 Pandemic resulted in Governor Murphy signing Executive Order #112 which temporarily lifted the Joint Protocol requirement in New Jersey. This was intended to increase the number of nurse anesthetists available to assist where needed to provide care for patients across the state without any restrictions on their license or certification. This resulted in CRNAs and APN-Anesthesia nurses from across the country taking to the frontlines, serving as the backbone for ICUs, directing care and managing the most critical patients in hospitals across the state — saving lives..

Bi-Partisan Legislation that could PERMANENTLY REMOVE the requirement for a Joint Protocol/Supervision

There are two companion bills, “Practice Restrictions for Advanced Practice Nurses,” currently being presented for consideration in the Assembly and Senate that would eliminate certain practice restrictions for APNs, including permanently removing the Joint Protocol requirements for APNs, CRNAs, and APN-As in New Jersey.

Assembly Bill: NJ A994 – Sponsor: Munoz N (R)
Senate Bill: NJ S1983 – Sponsor: Vitale (D)

Justification for the legislation:

“As authorized under Executive Order No. 112 and the waivers issued pursuant to the executive order. No adverse incidents were reported during the waiver period involving advanced practice nurses practicing without practice restrictions. Given the need for expanded access to care, it is necessary and appropriate to take steps to remove practice restrictions that serve as a barrier for advanced practice nurses to practice in New Jersey to the full extent of their education, clinical training, and national certification”

“The bill further provides that every APN who is an APN-Anesthesia and who has completed 24 months or 2,400 hours of licensed, active, advanced nursing practice in an initial role will be authorized to practice as an APN-Anesthesia to the full scope of practice for APNs-Anesthesia, without any requirement for supervision by a licensed physician and without any requirement that the APN-Anesthesia enter into joint protocols with a licensed physician.”

Why this legislation is important:

Advanced practice nurses (including APN-Anesthesia professionals/CRNA’s) augment the system of care in NJ and nationwide by providing treatment services at a level that can relieve some of the demand on physicians, of whom there is a chronic shortage, and expedite access to care for patients, including those in medically underserved areas and among medically underserved populations

Currently, 27 states and the District of Columbia have adopted full practice authority for advanced practice nurses. The requirement to practice in collaboration with a physician limits the ability of advanced practice nurses to provide primary care and specialty care services and has been associated with advanced practice nurses leaving New Jersey for other geographical areas with fewer practice restrictions.

It has been estimated that removing practice restrictions for advanced practice nurses has the potential to reduce healthcare access disparities by a factor of more than 38 percent.