Regarding the April 28 letter from Raymond J. Saputelli, the executive vice president of the New Jersey Academy of Family Physicians, "Nurses cannot perform the duties of physicians":

Saputelli criticizes the effort by advance practice nurses, or APNs, to practice in New Jersey to the full extent of their education. But there are not enough primary-care physicians in New Jersey to care for our citizens. This is not the case with APNs.

He also says that APNs will "be unable to offer complex diagnoses." As a former clinical nursing professor at the University of Medicine and Dentistry and an APN with more than 20 years experience, I feel confident in saying that this is true for many primary-care physicians as well.

The best of us know when we need an expert opinion. The education of advanced practice nurses makes a clear distinction between scope of practice and those problems that are beyond an individual's scope. There is no such thing as independent practice in today's complex world of health care. All clinicians should constantly stay alert to problems that are outside their scope of education and training and refer to a more experienced colleague, who may be a nurse practitioner with more knowledge on a given topic or a physician colleague or a specialist.

Saputelli's approach is wrong for New Jersey patients who need the care of the approximately 5,000 APNs in the state.

CECILIA WEST

Waretown