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NJSNA: Fact Sheet on APNs
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New Jersey State Nurses Association: Fact Sheet on APNs

What are Advanced Practice Nurses (APNs)? APNs are registered nurses with master’s level nursing education (at minimum) who provide expert clinical care in a variety of settings including but not limited to acute and long term care facilities, ambulatory care clinics, private practices, college health centers, school based health clinics, correctional facilities and homes. In New Jersey (NJ), the title APN, by law, includes nurse practitioners (NPs) and clinical nurse specialists (CNSs).

What are the differences between NPs and CNSs? Nurse practitioners are primary care providers whose practice involves diagnosing and managing both acute/episodic and chronic illnesses. They order and interpret diagnostic tests and prescribe drugs, devices and other treatment modalities, as indicated. Essential to the care they offer is an emphasis on health promotion and disease prevention. Nurse practitioners have, until recently, largely worked in ambulatory care but that is changing as NPs are being educated to practice in acute care settings. Clinical Nurse Specialists have long worked in acute care settings where they specialize in coordinating care and in educating other staff as well as patients and families about complicated conditions such as oncology, cardiac care and diabetes. Psychiatric CNSs have been pioneers in the provision of psychotherapy to groups and individuals, often in independent, nurse-based practice settings. With additional education in pathophysiology and pharmacology (often in post-masters NP certification programs), CNSs too, are increasingly providing primary care.

How do APNs differ from Physician Assistants (PAs)? First, all APNs are licensed registered nurses, in addition to being licensed as APNs. In the state of NJ, APNs do not work under the supervision of a physician: they are independent professionals who are required to have a joint protocol with a collaborating physician for prescribing purposes only. APN’s charts and orders do not have to be co-signed by a physician and no general collaborative practice agreement is required. APNs have prescriptive authority for controlled substances in NJ. APNs are licensed and regulated in NJ by the Board of Nursing. In contrast, PAs, by law, work under the direct supervision of a physician; all their charts and orders must be reviewed and co-signed by the physician. PAs are licensed and regulated in this state by the Board of Medical Examiners.

How many APNS are there in New Jersey? About 3,700 APNs are currently licensed by the NJ Board of Nursing (essentially, a 75%/25% mix of NPs and CNSs).

What is the average salary of an APN in NJ? According to a January 2006 article in Advance for Nurse Practitioners, the average salary for an APN in NJ is $80,000.  Salaries are higher in northern NJ urban sites than in central or southern NJ practice sites. Acute care settings offer higher salaries than do ambulatory sites of all types, except for private and practices, where APNs tend to earn more.

How are APNS Reimbursed? Both Medicare and NJ (direct) Medicaid reimburse APNs for the provision of primary care. When APNs bill under their own Medicare number, they are paid at 85% of the rate physician’s would be paid for the same care. Increasingly, Medicaid has offered HMO options to its recipients; whether or not APNs are recognized and reimbursed by these plans varies with the business philosophy of the plan. The same is true of other, non-HMO private health care insurers; some recognize APNs as primary care providers and reimburse them; others do not. The APN reimbursement issue is one which the New Jersey State Nurses Association*(NJSNA) is working diligently to address since the employability of APNs may depend upon the degree to which they can be reimbursed, particularly in private practice.

NJSNA: Updated 10/06

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