The advanced practice registered nurse (APRN) title is an umbrella title traditionally used to identify a licensed registered nurse functioning as a clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner.1 Nurses in the various APRN categories have been providing healthcare in the United States for more than 50 years. However, neither the educational preparation nor the certification process for these nurses has been standardized.
At the 2002 Delegate Assembly of the National Council of State Boards of Nursing (NCSBN), Uniform Advanced Practice Nurse Licensure/Authority to Practice Requirements were set forth for consideration by individual state Boards of Nursing.2 This document cites licensure requirements for advanced practice certification to include broad-based examinations, such as medical-surgical, psychiatric, or adult health, stating that this: "broad preparation gives the APRN a basis on which to recognize a range of commonly occurring health conditions and to practice safely."3 In a recent letter to the editor in the journal Clinical Nurse Specialist, the NCSBN defends this requirement, stating: "narrow specialty areas of practice are not an appropriate basis for an APRN. APRNs certified in a sub-specialty have a narrow scope of practice." The practice of wound, ostomy, and continence nursing is viewed by the NCSBN as a subspecialty. Although the NCSBN is not itself a regulatory body, the documents developed by this organization provide the blueprint on which individual state Boards of Nursing base their decisions.
The Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) recognizes and appreciates the significant work of the NCSBN in striving toward standardization of APRN licensure requirements. The WOCNCB takes issue with efforts to categorize advanced practitioners in "subspecialties" and then require certification in a broad-based "specialty." The WOCNCB shares and supports the NCSBN mission of public protection but would argue that medical-surgical, adult health, or other general examinations do not measure knowledge for advanced practice in wound, ostomy, and continence nursing. Our basic license as a registered nurse provides evidence of our broad-based preparation; completion of a master's degree provides verification of an appropriate foundation for advanced practice as defined by the American Association of Colleges of Nursing,4 which includes theoretical frameworks, inquiry skills, nursing therapeutics, evaluation methodologies, and systems thinking.4 The WOCNCB believes that the empirical and practical knowledge that focus on the phenomena of concern (eg, wounds, ostomies, or continence) can be affirmed via completion of a post-baccalaureate WOCN education program with the required hours of supervised clinical practice, basic WOCN certification by examination, and advanced practice WOCN certification via portfolio.
The WOCNCB continues to play an active role at the "tables" where APN issues are being explored and discussed. As we network with various stakeholders, we are disseminating the WOCNCB Position Statements on Entry Level and Advanced Practice in WOC Nursing. If you have not had an opportunity to review these documents, take a moment to review some important talking points at the WOCNCB Web site (http://www.wocncb.org).
The WOCNCB was again represented at the NCSBN APN Roundtable in Chicago last spring. An update was received on the proposed APN Compact Agreement. It was noted that for the APN Compact to be accepted, states must first have accepted the RN/LPN Compact Agreement; currently, 20 states are in the RN/LPN Compact. Utah is the first state to have accepted APN Agreement; however, this one state's acceptance does not provide for an interstate APN licensure compact. Utah currently recognizes only nurse practitioners (NPs) and clinical nurse specialists (CNSs) as APNs, stating that the "timing wasn't right for inclusion of Nurse Anesthetists (CRNAs) and Nurse Midwives (NMs)." These latter 2 groups do not currently require master's-level education for practice. At the time of this writing, the Texas Board of Nurse Examiners is proposing amendments to its advanced practice nurses regulations that would significantly limit the specialties recognized.
Networking at the NCSBN APN Roundtable led to an invitation to attend the APN Consensus Conference sponsored by the Alliance for Nursing Accreditation held in Washington, DC, in June. A focus on advanced practice nursing education, certification, licensure, and specialization was cited with a specific goal to produce a consensus statement on the future of advanced practice nursing. Many voices in attendance cited the need for clarity in the definitions of important terms, eg, nursing specialty vs subspecialty, nursing generalist vs specialist vs subspecialist. It was suggested that NP/CNS role delineation and differentiation would be helpful, because the CRNA and NMs roles are clearly defined. Desired outcomes noted by attendees included streamlining of regulations to remove barriers to quality care, along with respect, support, and an understanding of the value each specialty and subspecialty. Desired products discussed included an alternative method to certification by examination, with consideration of the professional portfolio. The outcome of this meeting was creation of a focus workgroup to meet the intended goals, of which WOCNCB will be a part.
The American Nurses Credentialing Center (ANCC) continues to work with the National Association of Clinical Nurse Specialists (NACNS) for potential development of a core CNS examination and specialty modules via exam or portfolio. The WOCNCB was represented at the NACNS-sponsored CNS Summit in Indianapolis in July, where more specifics on this project were presented. Discussion also focused on the need for state Boards of Nursing to understand how overregulation has the potential for denial of public access to expert care, along with economic harm to APNs. The NACNS is educating individuals on regulatory issues to facilitate communication with individual state Boards of Nursing.
The WOCNCB is committed to staying at the "tables" where significant discussions on APN issues are ongoing!! Please communicate with state Board of Nursing to determine how the current dialogues may affect your practice. We will continue to keep you informed as we work toward a psychometrically sound legally defensible product for APN certification in our WOC specialty!!
Key Points
[check mark] Uniform Advanced Practice Nurse Licensure/Authority to Practice Requirements have been set forth for consideration by the National Council of State Boards of Nursing. The goal is to standardize APRN regulatory requirements nationally.
[check mark] The practice of wound, ostomy, and continence nursing is viewed by the NCSBN as a subspecialty. If the Uniform APRN Requirements are accepted by your State Board of Nursing, advanced practice licensure will necessitate certification via an alternative "broad-based" specialty examination, eg, medical-surgical, pediatric, or adult health.
[check mark] At this time, individual states are proposing multiple changes that alter the intent of the proposed Uniform APRN Licensure Compact. Individual WOCNs need to explore the status of this potential regulatory barrier in their state and communicate concerns with their state Boards of Nursing.
[check mark] The Wound, Ostomy and Continence Nursing Certification Board is committed to addressing the needs of our APRN certificants, while protecting public safety.
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