Sponsored by:
Assemblywoman ANNETTE QUIJANO
District 20 (Union)
SYNOPSIS
Permits attending advanced practice nurse to determine cause of death and execute death certification when physician is not available.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the determination of cause of death and amending R.S.26:6-8 and P.L.1991, c.377.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. R.S.26:6-8 is amended to read as follows:
26:6-8. In the execution of a death certificate, the personal particulars shall be obtained by the funeral director from the person best qualified to supply them. The death and last sickness particulars shall be supplied by the attending, covering or resident physician; or if there is no attending, covering or resident physician, by an attending registered professional nurse licensed by the New Jersey Board of Nursing under P.L.1947, c. 262 (C. 45:11-23 et seq.); or if there is no attending, covering or resident physician or attending registered professional nurse, by the county medical examiner.
Within a reasonable time, not to exceed 24 hours after the pronouncement of death, the attending, covering or resident physician, the attending advanced practice nurse pursuant to section 10 of P.L.1991, c.377 (C.45:11-49), or the county medical examiner shall execute the death certification. The burial particulars shall be supplied by the funeral director. The attending, covering or resident physician, attending advanced practice nurse, the attending registered professional nurse, or the county medical examiner and the funeral director shall certify to the particulars supplied by them by signing their names below the list of items furnished, or by otherwise authenticating their identities and the information that they have provided through the NJ-EDRS. If a person acting under the direct supervision of the State Medical Examiner, a county medical examiner, funeral director, attending, covering or resident physician, advanced practice nurse, or licensed health care facility or other public or private institution providing medical care, treatment or confinement to persons, which is registered with the NJ-EDRS, is not authorized to authenticate the information required on a certificate of death or fetal death, that person may enter that information into the NJ-EDRS in anticipation of its authentication by the State Medical Examiner or a county medical examiner, funeral director, attending, covering or resident physician, attending advanced practice nurse, local registrar, deputy registrar, alternate deputy registrar or subregistrar, as applicable.
(cf: P.L.2003, c.221, s.5)
2. Section 10 of P.L.1991, c.377 (C.45:11-49) is amended to read as follows:
10. a. In addition to all other tasks which a registered professional nurse may, by law, perform, an advanced practice nurse may manage preventive care services, and diagnose and manage deviations from wellness and long-term illnesses, consistent with the needs of the patient and within the scope of practice of the advanced practice nurse,by:
(1) initiating laboratory and other diagnostic tests;
(2) prescribing or ordering medications and devices, as authorized by subsections b. and c. of this section; and
(3) prescribing or ordering treatments, including referrals to other licensed health care professionals, and performing specific procedures in accordance with the provisions of this subsection.
b. An advanced practice nurse may order medications and devices in the inpatient setting, subject to the following conditions:
(1) the collaborating physician and advanced practice nurse shall address in the joint protocols whether prior consultation with the collaborating physician is required to initiate an order for a controlled dangerous substance;
(2) the order is written in accordance with standing orders or joint protocols developed in agreement between a collaborating physician and the advanced practice nurse, or pursuant to the specific direction of a physician;
(3) the advanced practice nurse authorizes the order by signing his own name, printing the name and certification number, and printing the collaborating physician's name;
(4) the physician is present or readily available through electronic communications;
(5) the charts and records of the patients treated by the advanced practice nurse are reviewed by the collaborating physician and the advanced practice nurse within the period of time specified by rule adopted by the Commissioner of Health and Senior Services pursuant to section 13 of P.L.1991, c.377 (C.45:11-52);
(6) the joint protocols developed by the collaborating physician and the advanced practice nurse are reviewed, updated and signed at least annually by both parties; and
(7) the advanced practice nurse has completed six contact hours of continuing professional education in pharmacology related to controlled substances, including pharmacologic therapy and addiction prevention and management, in accordance with regulations adopted by the New Jersey Board of Nursing. The six contact hours shall be in addition to New Jersey Board of Nursing pharmacology education requirements for advanced practice nurses related to initial certification and recertification of an advanced practice nurse as set forth in N.J.A.C.13:37-7.2 and 13:37-7.5.
c. An advanced practice nurse may prescribe medications and devices in all other medically appropriate settings, subject to the following conditions:
(1) the collaborating physician and advanced practice nurse shall address in the joint protocols whether prior consultation with the collaborating physician is required to initiate a prescription for a controlled dangerous substance;
(2) the prescription is written in accordance with standing orders or joint protocols developed in agreement between a collaborating physician and the advanced practice nurse, or pursuant to the specific direction of a physician;
(3) the advanced practice nurse writes the prescription on a New Jersey Prescription Blank pursuant to P.L.2003, c.280 (C.45:14-40 et seq.), signs his name to the prescription and prints his name and certification number;
(4) the prescription is dated and includes the name of the patient and the name, address and telephone number of the collaborating physician;
(5) the physician is present or readily available through electronic communications;
(6) the charts and records of the patients treated by the advanced practice nurse are periodically reviewed by the collaborating physician and the advanced practice nurse;
(7) the joint protocols developed by the collaborating physician and the advanced practice nurse are reviewed, updated and signed at least annually by both parties; and
(8) the advanced practice nurse has completed six contact hours of continuing professional education in pharmacology related to controlled substances, including pharmacologic therapy and addiction prevention and management, in accordance with regulations adopted by the New Jersey Board of Nursing. The six contact hours shall be in addition to New Jersey Board of Nursing pharmacology education requirements for advanced practice nurses related to initial certification and recertification of an advanced practice nurse as set forth in N.J.A.C.13:37-7.2 and 13:37-7.5.
d. The joint protocols employed pursuant to subsections b. and c. of this section shall conform with standards adopted by the Director of the Division of Consumer Affairs pursuant to section 12 of P.L.1991, c.377 (C.45:11-51) or section 10 of P.L.1999, c.85 (C.45:11-49.2), as applicable.
e. (Deleted by amendment, P.L.2004, c.122.)
f. An attending advanced practice nurse may determine and certify the cause of death of the nurse's patient when no attending, covering, or resident physician is available to do so, and may execute the death certification pursuant to R.S.26:6-8.
(cf: P.L.2004, c.122, s.2)
3. a. The Commissioner of Health and Senior Services shall, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt such rules and regulations as the commissioner deems necessary to carry out the provisions of this act.
b. The New Jersey Board of Nursing shall, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt such rules and regulations as the board deems necessary to carry out the provisions of this act.
4. This act shall take effect on the 120th day after enactment, but the Commissioner of Health and Senior Services and the New Jersey Board of Nursing may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act.
STATEMENT
This bill authorizes an attending advanced practice nurse (APN) to determine and certify the cause of death of the nurse's patient when no attending, covering, or resident physician is available to do so, and to execute the death certification pursuant to R.S.26:6-8.
Under current law (section 4 of P.L.1983, c.308; C.26:6-8.1), when there has been an apparent death, a registered professional nurse is permitted to make the actual determination and pronouncement of death (except in the case of brain death), but only a physician is authorized to determine the cause of death and certify the cause for the purpose of completing the death certificate.
Since the APN scope of practice includes the diagnosing and management of deviations from wellness and long-term illnesses, and an APN may be a patient's primary treating health professional, it is appropriate that, in the event of the patient's death, the attending APN be permitted to determine and certify the cause of death. This bill, therefore, expands the scope of practice for APNs to authorize them to make the determination of the cause of death and to certify the cause of death for completion of the death certificate when a physician is not available to do so.
The bill takes effect on the 120th day after enactment, but authorizes the Commissioner of Health and Senior Services and the New Jersey Board of Nursing to take such anticipatory administrative action in advance of the effective date as shall be necessary for the implementation of the bill.