Eliminates certain practice restrictions for advanced practice nurses.
What changed between versions
The experience threshold for practicing without a joint protocol was raised from 24 months or 2,400 hours to more than 5,000 hours of licensed, active, advanced nursing practice in a role with the applicable population focus.
APNs meeting the 5,000-hour threshold and practicing in primary health care or behavioral health care may authorize medical cannabis and issue written instructions without a joint protocol, subject to conditions including not providing general obstetrics or elective cosmetic services.
Independent practice (without a joint protocol) is now limited to APNs providing primary health care or behavioral health care. It explicitly excludes general obstetrics and elective aesthetic or cosmetic services. The original bill had no such setting restrictions.
The provisions allowing APN-Anesthesia (Certified Registered Nurse Anesthetists) to practice without physician supervision or joint protocols after 24 months/2,400 hours were removed entirely.
The original bill repealed three existing statutory sections (C.45:11-49.2, C.45:11-51, C.45:11-52). The ACS instead amends these sections to preserve their rulemaking functions while adding the 'not more restrictive than' standard.
The definition of 'collaborating provider' was changed to 'collaborating physician,' removing the option for an experienced APN (with 2,400+ hours) to serve as the collaborating party. Only a licensed physician can now be the collaborator.
New definitions added for 'primary health care,' 'reproductive health services,' 'behavioral health care,' and 'higher level of care' to define the scope of independent practice.
APNs practicing independently must carry malpractice liability insurance (or a letter of credit) at least equal to the minimum amount applicable to a licensed physician, and must notify the Board of Nursing of their insurance carrier.
Pharmacology continuing education for controlled substances was increased from 6 contact hours to 14 contact hours, of which 8 must be in addition to existing Board of Nursing requirements at the time of initial certification.
APNs practicing independently must be held to the same standard of care as other independent health care practitioners, and if not providing services to Medicare beneficiaries, must prominently display an appropriate notice in their office and inform the Board of Nursing in writing.
APNs practicing independently must immediately notify the Board of Nursing if they become medically incapable of practicing, are indicted or convicted of certain crimes, are named in malpractice or misconduct complaints, are subject to disciplinary action by any state or federal agency, or fail to maintain required certifications.
New disciplinary authority explicitly granted to the Board of Nursing to limit, restrict, deny, suspend, or revoke an APN's licensure or prescriptive/dispensing authority for unsafe prescribing, prescribing outside their role or population focus, or violating state and federal controlled substance laws.
The effective date was changed from 'the first day of the fourth month next following enactment' to 'immediately,' with a transition period for APNs currently practicing under Executive Order No. 13 (2026). Those who will reach 5,000 hours within 12 months may continue independently; those who will not get a 6-month grace period before being required to establish a joint protocol.
New section requires the Board of Nursing and Commissioner of Health to adopt implementing regulations immediately upon filing notice with the Office of Administrative Law (bypassing normal rulemaking timelines), effective for up to 18 months, including a process to verify APN hours.
