At the height of the COVID-19 pandemic, then-Governor Phil Murphy issued a series of emergency executive orders to address severe healthcare staffing shortages caused by unprecedented hospitalizations. Among them was Executive Order No. 112 (E.O. 112), which temporarily waived long-standing statutory requirements governing advanced practice nurses (APNs), including nurse anesthetists (CRNAs/APN-Anesthesia). The order suspended key patient-protection safeguards embedded in New Jersey law — including requirements for physician collaboration, joint protocols, and oversight — that are central to New Jersey’s physician-led, team-based model of care. E.O. 112 was intended as a temporary emergency measure to expand flexibility during a public health crisis.
Although conceived as short-term relief, the waivers remained in place for an extended period and upended operational norms across healthcare settings statewide. When the COVID-era State of Emergency was terminated, the State began transitioning back to full statutory compliance, requiring health care organizations and clinicians to re-establish collaborative structures and restore safeguards that had been paused for years.
Governor Mikie Sherrill has since inherited this complex landscape and issued a limited 45-day executive order to provide time for providers to transition back into full statutory compliance. This made clear that executive orders are temporary tools — not permanent law — and that lasting changes to how medicine is practiced in New Jersey should be made through the legislative process.
In response to the end of E.O. 112, legislation has been introduced to codify emergency-era flexibilities into permanent statute. Senate Bill S-2996 and Assembly Bill A-4052 would expand independent practice authority for APNs — including provisions affecting CRNAs/nurse anesthetists’ practice — by weakening long-standing requirements that anchor APN care within a physician-led team framework.
Supporters argue this change will improve access to care. But access is not achieved by removing safeguards on paper — it must be measured by real-world outcomes. The few APN-owned, mainly cosmetic practices that opened immediately post pandemic show that independent practice will lead APNs to higher-reimbursement categories of practice, rather than into the underserved communities and high-acuity settings where access gaps are most serious. The result is a system that expanded autonomy without expanding true access — while increasing risk to patients, particularly where complexity is high, and the margin for error is thin. This is a pivotal moment. The decision to codify — or reject — the emergency provisions of E.O. 112 will shape the future structure of team-based care in New Jersey and determine whether a temporary pandemic response becomes a permanent restructuring of medical practice in the State
The Access to Care Coalition strongly opposes S-2996 / A-4052 because it undermines the physician-led, team-based model of care that has long protected New Jersey patients. These bills weaken commonsense safeguards, blur accountability, and increase the likelihood that patients — including those receiving anesthesia care — will be treated without the meaningful involvement of the most extensively trained clinician on the care team.
New Jersey should pursue real access-to-care solutions and robust healthcare workforce development policies that expand capacity without dismantling safeguards — including strengthening physician-led team models, supporting training pipelines, and incentivizing practice in underserved communities and shortage specialties.