NEW JERSEY - PHYSICIAN AIDES, PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS (Scope of Duties)

March 25, 2008

New Jersey state laws and regulations that affect your medical practice

1. What tasks may a physician direct to a licensed health care provider or an unlicensed physician aide?

A. A “physician,” for the purpose of this section, shall mean a doctor of medicine (M.D.), a doctor of osteopathic medicine (D.O.) or a doctor of podiatric medicine (D.P.M.).

(1) A “licensed health care provider,” for the purpose of this section, shall mean an individual holding a current, valid license in this State as a physical therapist, registered nurse, licensed practical nurse, physician assistant, chiropractor or athletic trainer.

B. A physician may direct his or her unlicensed employee to administer to the doctor’s patients certain physical modalities in the limited circumstances set forth in this section, without being in violation of the pertinent professional practice act implemented by the Board, to the extent such conduct is permissible under any other pertinent law or rule administered by the Board or any other State agency.

C. A physician may direct a licensed health care provider with training and experience to administer to the physician’s patients physical modalities including ultraviolet (B and C bands) and electromagnetic rays including, but not limited to, deep heating agents, microwave diathermy, shotwave diathermy, ultrasound and those modalities listed in (D) below. The physician shall retain responsibility for examining the patient, determining the appropriate modalities, assessing training and experience, as well as providing the appropriate level of supervision consistent with practice standards, applicable to the specific licensed health care provider.

D. A physician may direct an unlicensed aide to administer the following physical modalities: hot packs, cold packs, paraffin baths, contrast baths, and whirlpool baths. The aide shall not be permitted to perform any rehabilitative exercise programs. No other modalities including T.E.N.S. or traction shall be performed by the unlicensed physician’s aide.

E. A physician may direct the administration of an appropriate physical modality by an unlicensed assistant only where the following conditions are satisfied:

(1) The doctor shall examine the patient to ascertain the nature of the trauma or disease; to determine whether the application of a physical modality will encourage the alleviation of pain and promotion of healing; to assess the risks of the modality for a given patient and the diagnosed injury or disease and to decide that the anticipated benefits are likely to outweigh those risks.

(2) The doctor shall determine all the components of the precise treatment to be given at the present therapy session, including the type of modality to be used, extent of area to which it shall be applied, the length of treatment, and any other factors peculiar to the risks of that modality such as strict avoidance of certain parts of the body. This information shall be written on the patient’s chart and made available at all times to the assistant carrying out the instructions. The doctor shall assure that the aide administering the treatment is identified in the patient chart on each such occasion.

(3) The doctor shall ascertain a satisfactory level of education, competence and comprehension of the particular assistant, who shall be at least 18 years of age, to whom instruction has been given by the doctor as to modalities used in that office. The doctor shall prepare and maintain a written document certifying as to the instructions given to each assistant, and both doctor and assistant shall sign it.

(4) The doctor shall see the patient prior to any subsequent scheduled application of the modality to ascertain that continued treatment is appropriate and that no contraindications to treatment have become apparent.

(5) The doctor shall remain on the premises at all times that treatment orders are being carried out by the assistant and shall be within reasonable proximity to the treatment room and available in the event of emergency.

F. A physician shall have due regard for the specialized training and experience of registered physical therapists, and of physiatrists and orthopedists. Injuries or diseases requiring prolonged treatment, if not administered personally by the doctor, shall normally be referred to a licensed physical therapist, to a physiatrist, orthopedist or other appropriate health care provider.

G. A bill rendered for the limited consultation set forth above shall not exceed a sum which reasonably reflects the actual level of service, supervision and responsibility personally rendered by the doctor, and consistent with the factors listed in the rule prohibiting excessive fees.

H. On a health insurance claim form pertaining to such service and requiring certification by the doctor, the doctor shall specify the modality applied and shall not generically identify physical therapy.

(N.J.S.A. 13:35-6.14)

5. What are the licensing requirements for physician assistants?

A. No person shall practice as a physician assistant or present, call or represent himself or herself as a physician assistant unless that person is licensed pursuant to the Physician Assistant Licensing Act.

B. No person shall assume, represent himself or herself as, or use the title or designation "physician assistant" or "physician assistant--certified" or the abbreviation "PA-C" or any other title or designation which indicates or implies that he or she is a physician assistant unless that person is licensed pursuant to section 4 of this act.

(N.J.S.A. 45:9-27.12)

C. The board shall issue a license as a physician assistant to an applicant who has fulfilled the following requirements:

(1) Is at least 18 years of age;

(2) Is of good moral character;

(3) Has successfully completed an approved program; and

(4) Has passed the national certifying examination administered by the National Commission on Certification of Physician Assistants, or its successor.

D. In addition to the requirements of subsection a. of this section, an applicant for renewal of a license as a physician assistant shall:

(1) Execute and submit a sworn statement made on a form provided by the board that neither the license for which renewal is sought nor any similar license or other authority issued by another jurisdiction has been revoked, suspended or not renewed; and

(2) Present satisfactory evidence that any continuing education requirements have been completed as required by this act.

E. The board, in consultation with the committee, may accept, in lieu of the examination required, proof that an applicant for licensure holds a current license in a state which has standards substantially equivalent to those of this State.

F. The board shall issue a temporary license to an applicant who meets the requirements of this section and who is either waiting to take the first scheduled examination following completion of an approved program or is awaiting the results of the examination. The temporary license shall expire upon the applicant's receipt of notification of failure to pass the examination.

(N.J.S.A. 45:9-27.13)

3. Who may employ a physician assistant?

A. A physician assistant may be employed by a physician, a health care facility, an institution or a veterans' home.

B. A physician, health care facility, institution or veterans' home which employs a physician assistant shall file with the board a notice of employment within 10 days after the date on which the employment commences, on a form and in accordance with rules to be promulgated by the board.

(N.J.S.A. 45:9-27.14)

4. What are the conditions for practice and authorized medical settings for physician assistants?

A. A physician assistant may practice in all medical care settings, including, but not limited to, a physician's office, a health care facility, an institution, a veterans' home or a private home, provided that:

(1) The physician assistant is under the direct supervision of a physician pursuant to this act;

(2) The practice of the physician assistant is limited to those procedures authorized this act;

(3) An appropriate notice of employment has been filed with the board;

(4) The supervising physician or physician assistant advises the patient at the time that services are rendered that they are to be performed by the physician assistant;

(5) The physician assistant conspicuously wears an identification tag using the term "physician assistant" whenever acting in that capacity; and

(6) Any entry by a physician assistant in a clinical record is appropriately signed and followed by the designation, "PA-C."

B. Any physician assistant who practices in violation of any of the conditions specified in subsection a. of this section shall be deemed to have engaged in professional misconduct.

(N.J.S.A. 45:9-27.15)

4. What procedures may be performed by a physician assistant?

A. A physician assistant may perform the following procedures:

(1) Approaching a patient to elicit a detailed and accurate history, perform an appropriate physical examination, identify problems, record information and interpret and present information to the supervising physician;

(2) Suturing and caring for wounds including removing sutures and clips and changing dressings, except for facial wounds, traumatic wounds requiring suturing in layers and infected wounds;

(3) Providing patient counseling services and patient education consistent with directions of the supervising physician;

(4) Assisting a physician in an inpatient setting by conducting patient rounds, recording patient progress notes, determining and implementing therapeutic plans jointly with the supervising physician and compiling and recording pertinent narrative case summaries;

(5) Assisting a physician in the delivery of services to patients requiring continuing care in a private home, nursing home, extended care facility or other setting, including the review and monitoring of treatment and therapy plans;

(6) Facilitating the referral of patients to, and promoting their awareness of, health care facilities and other appropriate agencies and resources in the community; and

(7) Such other procedures suitable for discretionary and routine performance by physician assistants as designated by the board.

B. A physician assistant may perform the following procedures only when directed, ordered or prescribed by the supervising physician or specified in accordance with protocols promulgated pursuant to this act:

(1) Performing non-invasive laboratory procedures and related studies or assisting duly licensed personnel in the performance of invasive laboratory procedures and related studies;

(2) Giving injections, administering medications and requesting diagnostic studies;

(3) Suturing and caring for facial wounds, traumatic wounds requiring suturing in layers and infected wounds;

(4) Writing prescriptions or ordering medications in an inpatient or outpatient setting in accordance with this act; and

(5) Such other procedures as may be specified in accordance with protocols promulgated in accordance with this act.

C. A physician assistant may assist a supervising surgeon in the operating room when a qualified assistant physician is not required by the board and a second assistant is deemed necessary by the supervising surgeon.

(N.J.S.A. 45:9-27.16)

5. Does the physician have direct responsibility for tasks delegated to physician assistants?

Yes. A physician may delegate to a physician assistant under his supervision only those procedures identified in this act. Any physician who permits a physician assistant under his supervision to practice contrary to the provisions of this act shall be deemed to have engaged in professional misconduct and shall be subject to disciplinary action by the board. In the performance of a medical procedure, a physician assistant shall be conclusively presumed to be the agent of the physician under whose supervision the physician assistant is performing.

(N.J.S.A. 45:9-27.17)

6. Must a physician assistant be under the direct supervision of a physician at all times?

Yes. A physician assistant and a temporary licensed physician assistant shall be under the direct supervision of a physician at all times during which the physician assistant or temporary licensed physician assistant is working in his official capacity.

A. In an inpatient setting, direct supervision of a physician assistant shall include, but not be limited to:

(1) Continuing or intermittent presence with constant availability through electronic communications;

(2) Regularly scheduled review of the practice of the physician assistant; and

(3) Personal review by a physician of all charts and records of patients and countersignature by a physician of all medical orders, including prescribing and administering medication, within 24 hours of their entry by the physician assistant.

B. In an outpatient setting, direct supervision of a physician assistant shall include, but not be limited to:

(1) Constant availability through electronic communications;

(2) Regularly scheduled review of the practice of the physician assistant; and

(3) Personal review by a physician of the charts and records of patients and countersignature by a physician of all medical orders, within seven days of their entry by the physician assistant, except that in the case of any medical order prescribing or administering medication, a physician shall review and countersign the order within 48 hours of its entry by the physician assistant.

C. In any setting, direct supervision of a temporary licensed physician assistant shall include, but not be limited to:

(1) Continuing physical presence of a physician or a licensed physician assistant;

(2) Regularly scheduled review by a physician of the practice of the temporary licensed physician assistant; and

(3) Personal review by a physician of all charts and records of patients within 24 hours of an entry by the temporary licensed physician assistant.

(N.J.S.A. 45:9-27.18)

5. What procedures must be followed by a physician assistant when prescribing medications?

A physician assistant treating a patient in an inpatient or outpatient setting may order or prescribe medications, subject to the following conditions:

A. Controlled dangerous substances may be ordered or prescribed if:

(1) A supervising physician has authorized a physician assistant to order or prescribe Schedule II, III, IV or V controlled dangerous substances in order to:

(a) Continue or reissue an order or prescription for a controlled dangerous substance issued by the supervising physician;

(b) Otherwise adjust the dosage of an order or prescription for a controlled dangerous substance originally ordered or prescribed by the supervising physician, provided there is prior consultation with the supervising physician;

(c) Initiate an order or prescription for a controlled dangerous substance for a patient, provided there is prior consultation with the supervising physician if the order or prescription is not pursuant to subparagraph (d) of this paragraph; or

(d) Initiate an order or prescription for a controlled dangerous substance as part of a treatment plan for a patient with a terminal illness, which for the purposes of this subparagraph means a medical condition that results in a patient's life expectancy being 12 months or less as determined by the supervising physician;

(2) The physician assistant has registered with and obtained authorization to order or prescribe controlled dangerous substances from the appropriate State and federal agencies; and

(3) The physician assistant complies with all requirements which the board shall establish by regulation for the administration of controlled dangerous substances; applicable requirements with respect to educational programs approved by the board; and continuing professional education programs;

B. The order or prescription is administered in accordance with protocols or specific physician direction;

C. The prescription states whether it is written pursuant to protocol or specific physician direction; and

D. The physician assistant signs his/her own name, prints his/her name and license number and prints the supervising physician's name, and in the case of an order or prescription for a controlled dangerous substance, prints the physician assistant's Drug Enforcement Administration registration number.

(N.J.S.A. 45:9-27.19)

6. May a temporary licensed physician assistant write orders for medications?

A temporary licensed physician assistant may write an order for medications; however, the order may not be executed without the immediate countersignature of a physician or licensed physician assistant. When the countersignature is provided by a licensed physician assistant, the order must also be countersigned by a physician within 24 hours of its entry by the temporary licensed physician assistant. Any limitation on the authority of a temporary licensed physician assistant to order medications as provided in this section shall be in addition to any such limitation on a licensed physician assistant pursuant to the "Physician Assistant Licensing Act.”

(N.J.S.A. 45:9-27.19a)

7. What qualifications must an individual have to be a nurse practitioner?

A. The New Jersey Board of Nursing may issue a certification as an advanced practice nurse to an applicant who fulfills the following requirements:

(1) Is at least 18 years of age;

(2) Is of good moral character;

(3) Is a registered professional nurse;

(4) Has successfully completed an educational program, including pharmacology, approved by the board; and

(5) Has passed a written examination approved by the board.

B. In addition to the requirements of this section, an applicant for renewal of a certification as an advanced practice nurse shall present satisfactory evidence that, in the period since the certification was issued or last renewed, all continuing education requirements have been completed as required by regulations adopted by the board.

C. The board may accept, in lieu of the written examination required by this section, proof that an applicant for certification holds a current certification in a state which has standards substantially equivalent to those of this State.

(N.J.S.A. 45:11-47)

6. Will Advanced Practice certification be issued to a nurse previously accreditedby a national accrediting organization?

For 180 days following the date procedures are established by the New Jersey Board of Nursing for applying for certification under this section, the board may issue a certification as a nurse practitioner/clinical nurse specialist to an applicant who fulfills the following requirements:

A. Is at least 18 years of age;

B. Is of good moral character;

C. Is a registered professional nurse; and

D. Has been certified as a nurse practitioner, clinical nurse specialist or advanced practice nurse by a national accrediting organization, which:

(1) Is approved by the board;

(2) Includes pharmacology in its required curriculum; and

(3) Requires successful completion of a written examination, including pharmacology, of all persons awarded its certificates.

(N.J.S.A. 45:11-48)

6. What additional duties may a nurse practitioner perform?

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; 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 Service;

(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.

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, signs his/her name to the prescription and prints his/her 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.

D. The joint protocols employed pursuant to this section shall conform with standards adopted by the Director of the Division of Consumer Affairs, as applicable.

(N.J.S.A. 45:11-49)

Copyright © Kern Augustine Conroy and Schoppmann, P.C. Used with permission.

Updated 2008