Nurses Speak in One Voice, Calling for More Independence from Doctors

Andrew Kitchenman | May 1, 2014 | Health Care
NJ Nursing Leadership Council lobbies for nurses, adding urgency to their concerns

Kathleen Russell-Babin is serving as coleader of the New Jersey Nursing Leadership Council. She is a senior manager with Meridian Health.
It’s hard for nurses to get their message across in Trenton if they don’t speak with a single voice. That helps explain why nurse executives and other registered nurses, as well as academics, have launched a new lobby to make sure their messages get heard loud and clear.

First issue of importance: The New Jersey Nursing Leadership Council wants to push through legislation that would allow advanced practice nurses (APNs) to establish independent offices without having agreements with doctors.

Many doctors oppose the idea.

Nursing groups felt they wouldn’t be able to galvanize policymakers behind key bills like the Consumer Access to Health Care Act (S-870/A-906) unless individual organizations were acting in concert.

By finding areas of consensus, “policymakers and others will see a strong, unified voice on certain key issues that might not otherwise be as evident,” said Kathleen Russell-Babin, who is serving as the coleader of the council. She is a senior manager with Meridian Health.

The council’s first lobbying priority would allow APNs to operate on their own, without being required to have agreements with physicians. Bill supporters argue that it would increase patients’ access to primary care via professionals who have advanced degrees and are trained to diagnose and treat acute and chronic illnesses.

But opponents say the proposal fails to account for the importance of doctors and overestimates the cost-effectiveness of APNs. They argue that physicians should direct all primary care.

The bill drew broad support from the different council members, including nursing educators, according to council member William L. Holzemer, dean of Rutgers University’s College of Nursing in Newark.

“The research is overwhelmingly supportive,” said Holzemer, adding that professors who are advanced practice nurses are directly affected by the bill, since they currently must have an agreement in place and pay a fee to a doctor in order to maintain their licenses.

The council includes representatives of the New Jersey State Nurses Association, the largest nursing professional organization; the Organization of Nurse Executives of New Jersey (ONENJ); the New Jersey League for Nursing, which promotes nursing education; nursing college professors; and home-care nurses.

These groups and individuals “came together because we felt it was important that we bring nurses to the table from different areas, ” said Susan Cholewka, executive director of ONENJ and the organizer of the council’s meetings.

Holzemer said the council presents an opportunity for nursing faculty members to join with professional groups on issues that affect both how nurses practice and how they are taught.

“We’re all so busy it’s important to get to know people with different roles and different educations,” Holzemer said. “The more we can bring the different practices together, the better it will be for patients.”

The council plans to take positions on a wider range of issues as council members get a better sense about areas of consensus.

One issue on the council’s agenda is a proposal that’s long drawn support from several of its member organizations: requiring that registered nurses have bachelor’s degrees. Holzemer noted that hospitals have opposed the proposal in the past when there were nursing shortages, but “now in New Jersey, most hospitals won’t even interview nurses for jobs if they don’t have a bachelor’s degree.” Current opposition to the proposal is centered on community colleges, where associate’s degrees in nursing are key attractions.

One area where there may be less of a consensus is the proposal by nurses unions –- which aren’t a part of the new council — to increase minimum staffing levels, which they argue will increase patient safety. ONENJ is opposed to the measure, with organization representatives saying it’s too restrictive and doesn’t allow flexibility for nurses.