Rise of ‘Telemedicine’ Drives Move Toward Multi-State Nursing Agreement
State lawmakers, nursing groups want to make sure NJ health-safety standards are maintained
This scenario could happen as soon as next year: A nurse is treating a patient in New Jersey, and the nurse isn’t even in the room – or even in New Jersey.
There’s a nationwide effort underway to make it easier to provide healthcare by telephone or over the Internet, in what is known as “telemedicine.”
New Jersey lawmakers are weighing whether to join the Nurse Licensure Compact, which would allow registered nurses and licensed practical nurses to practice across state lines.
The compact has drawn interest from New Jersey nursing groups and legislators from both parties.
But it also presents challenges before New Jersey can sign onto it. For one thing, the state law requiring criminal background checks for nurses is more rigorous than such laws in other states. In addition, the New Jersey Board of Nursing’s license database hasn’t been compatible with those of other states.
Nurses can be involved in interstate phone consultations during emergencies, such as helping with patients who must be transported by helicopter to a hospital in another state. As the number of such cases has grown, the state-based system for regulating nurses’ licenses has become an issue. New Jersey nearly joined an earlier version of the Nurse Licensure Compact in 2001, but the state’s criminal-background checks and database incompatibility derailed the effort.
Sen. Robert W. Singer (R-Monmouth and Ocean) wants to ensure that the same problem doesn’t recur.
“The other states that we’re entering this compact with have a lesser requirement for nursing,” Singer said.
At the same time, Singer said he sees the advantages of making it easier for out-of-state nurses to work in New Jersey. He recalled that during superstorm Sandy, different licensure rules were a roadblock to having nurse volunteers from Delaware and Pennsylvania help at overburdened clinics set up at shelters near the Jersey Shore.
“I think it’s a great idea,” Singer said of the compact.
The New Jersey State Nurses Association, the largest nursing group in the state, has mixed feelings about the bill.
Association CEO Judith Schmidt said her organization supports the “concept of the multistate compact,” but asked legislators to delay action on a bill that would make New Jersey a party to the compact.
“We would like to have some time to see what the other states are experiencing,” Schmidt said, adding that association members are concerned that other states will make changes to the compact that would require New Jersey to also make changes to state law.
If such changes are made after New Jersey has passed the bill, it could delay New Jersey’s participation for several years, Schmidt explained.
Bill sponsor Sen. Jim Whalen (D-Atlantic) said New Jersey legislators could keep an eye on what is happening in other states before passing a final version of the bill.
If other states enact laws that are in synch with New Jersey’s, “fine, we move it on the floor,” Whalen said. “If they don’t, we hold it until the next session -- at least we’re one step in.” The next legislative session begins in January.
Regarding Singer’s concern that other states have lower standards for licensing nurses, Whalen noted that the compact is intended to create universal standards that are similar to those in states with rigorous licensure.
But Singer expressed skepticism, saying “There’s always an intent,” but adding that it may not play out in practice.
Sen. Joseph F. Vitale (D-Middlesex), also a sponsor, noted that the bill must undergo more steps before becoming law, including having the nonpartisan Office of Legislative Services review its impact on the state budget.
Jeanne Otersen, chief of staff for the Health Professionals and Allied Employees labor union, suggested amending the bill to add a provision that it wouldn’t go into effect until the other states' licensing standards are compatible with New Jersey's –and until New Jersey's database is compatible with the others.
Under the terms of the compact, it will go into effect and become binding on the participating states when a majority of the states have joined it. Twenty-five other states, including Delaware and Maryland, have passed laws to join the compact, so it will go into effect when the next state signs on.
The Senate Health, Human Services, and Senior Citizens Committee unanimously released the bill on Monday. It now goes to the Senate Budget and Appropriations Committee for a hearing. The Assembly version has been referred to the Assembly Health and Senior Services Committee.