Abstract
Communication is essential between nursing education program and regulation to ensure that graduates are prepared to meet licensure eligibility requirements. Not only should educational programs be aware of their own state requirements but they should also be knowledgeable of the variations of eligibility requirements among the states. Formal and informal meetings between educators and regulators are encouraged.
Background
The skill and professionalism of advanced practice registered nurses (APRNs) in the United States can be attributed to the high quality of education that graduate nursing students receive in schools across the country. After becoming a registered nurse (RN), the individual wishing to practice as an APRN must complete a graduate program in an APRN specialty area. This additional professional education is vital to the continued development of the APRN beyond the RN level. Only through graduate-level education can the APRN develop the knowledge, skills, and abilities necessary to produce a competent independent professional capable of providing safe care. Traditionally, academic institutions have the ability to be innovative in the creation of academic programs and operate with considerable independence. Nursing educators have academic freedom to create educational programs and were instrumental in initiating advanced practice nursing.
Licensure is the last step in the process for an individual to become an APRN. The vast majority of APRN students rely on their academic institution to be aware of state board regulations and inform them of licensure requirements. Therefore, educational programs must be knowledgeable on the variations in state regulations regarding the practice of APRNs. In addition to knowing their own state requirements, APRN programs should be aware of the regulations in neighboring states. For example, a graduate with less than 500 clinical hours may meet the clinical requirements outlined in the state nurse practice act in the school where he or she attended but may not meet the clinical requirements for licensure in the state where he or she intends to practice. Also, different states recognize different specialty areas. Since APRNs are becoming increasingly mobile, it is essential that schools know the current state regulations and provide education regarding licensure to their students. Students, likewise, should research on state advanced practice regulations when investigating for APRN programs that they will avail of and schools that they will apply to.
Accreditation is required for all APRN masteral-level programs, and individuals should be aware that differences exist between accreditation and licensure. Accreditation is a voluntary, self-regulating, nongovernmental process which assures a basic level of quality education. The Commission on Collegiate Nursing Education and the National League for Nursing Accreditation Commission are the 2 accrediting bodies that accredit nursing education organizations for the purposes of assuring the quality of the institution and assisting in the improvement of the program by measuring nursing programs to their standards. Both organizations use the Criteria for Evaluation of Nurse Practitioner Programs by the National Task Force on the Evaluation of Nurse Practitioner Programs1 and the Essentials Masters Education for Advanced Practice Nursing by the American Association of Colleges of Nursing.2 Thus, accreditation applies to organizations. Licensure applies to individuals. Accreditation status can give assurance that the nursing program meets minimal standards; however, it does not guarantee licensure eligibility. An APRN graduate program may be accredited, but its graduates must meet individual state licensure eligibility requirements to become an APRN.
A basic tenet of APRN regulation is that the breadth of educational experiences should be reflected in the scope of the certification examination taken and the scope of practice permitted by licensure. In other words, the APRN education of an individual stipulates for the certification examination that can be taken and the scope of his or her practice. If an individual is educationally prepared to be a pediatric nurse practitioner, he or she should take a pediatric certification examination and limit his or her scope of practice to pediatrics. The pediatric nurse practitioner cannot change his or her practice to another specialty, such as in adult or psychiatric mental health, unless he or she had additional training and successfully passed an appropriate APRN certification examination for the additional specialty.
This tenet has implications for education. The narrower the focus on the APRN education, the narrower will be the scope of an APRN's education, thereby limiting the APRN's scope of practice. Broad preparation is necessary to give the APRN a basis for a safe, independent practice.3 This refers to areas such as adult health and pediatric and psychiatric mental health. More narrow subspecialties are a concern because of the great need for APRNs to recognize and treat a wide variety of health disorders. From a regulatory perspective, the state nurse practice act may limit the legal scope of practice of a nurse practitioner who is educated in a narrow advanced practice subspecialty. Narrowly focused specialties should be pursued only after APRNs have completed a broad-based educational program which will give them the expertise to practice in today's complex healthcare system consisting of patients with a wide variety of health disorders.
Advanced practice registered nurse educational programs have been very creative in developing dual track programs to meet the desires of potential students. Programs, with a minimal number of clinical hours, have been developed that combine specialty areas. For instance, a nurse practitioner program may offer a dual track in adult and family. Others offer combined clinical nurse specialist and nurse practitioner credentials. The challenge for these programs is to justify the number of clinical hours required to obtain the additional credentials. According to the recommendations in the NCSBN's Criteria for Certification Programs,4 500 supervised clinical hours should be the minimum for each specified specialty. There may be common courses for 2 specialties when an overlap of clinical hours could be justified. However, these justifications should be transparent. It should be noted that some boards of nursing require 500 clinical hours for each specialty/role no matter how similar the specialties of the dual track program are.
Many boards of nursing have specific qualifications for faculty who supervise APRN students in the clinical area. These criteria may be directed to the role and/or specialty area. Supervision should be provided by appropriately licensed individuals who are engaged in the role and specialty. For instance, a pediatric nurse practitioner should be the supervisor in the clinical area for students in a pediatric nurse practitioner program.
When APRNs cross state lines to practice, they are required to submit educational transcripts to state boards of nursing. Individuals who are reviewing APRN transcripts for licensure evaluate the transcripts to ensure that the applicant has met all the course-work required by their state regulations. Evaluating transcripts from across the United States can be a challenge for nursing regulators because of the differences in APRN curricula. Basic courses in assessment, pharmacology, and so forth that have indeterminate titles may make it difficult for boards of nursing to determine if the applicant has completed the course content required by their state regulations. Advanced practice registered nurse educators should periodically review their curricula to ensure that the titles of basic courses are readily understandable and easy to detect on transcripts.
Summary
Advanced practice registered nurse educators need to be aware of APRN issues such as specialty practice, dual track options, and so forth to make informed choices regarding their program offerings. Educators need to be aware of APRN nursing regulations not only within their state but also in neighboring states. The basic APRN educational content should be clearly visible on the transcript.
Variations in APRN licensure requirements exist across states. Historically, these variations reflect state needs, political environments, and stakeholder interests. These differences are not isolated to nursing. These types of variations among states laws, such as the differences in marriage and driving laws, can be noted on a daily basis. However, in 2000 at the NCSBN's annual meeting, the document "Uniform Advanced Practice Registered Nurse Licensure/Authority to Practice Requirements"5 (as Uniform APRN Requirements) was approved. The Uniform APRN Requirements are intended to promote the mobility of APRNs as well as to maintain licensure standards for public safety. They are the basis for the APRN compact which was passed in 2002 by the NCSBN Delegate Assembly and is modeled after the mutual recognition model for RN and practical nurse practice. The purpose of the APRN compact is to facilitate interstate APRN practice. There are several requirements that a state must meet to enter the APRN compact, one of which is to meet the Uniform APRN Requirements. It is anticipated that the APRN compact will be the driving force to promote uniformity among APRN regulation.
Above all, there is a need to establish formal and informal lines of communication between educators and regulators. In some states, there are regularly scheduled formal meetings of educators and regulators to discuss common issues. Educators can attend the meetings of a board of nursing to bring up issues. It is also very important to work with boards of nursing if there are new programs under consideration to determine if graduates will be eligible for licensure under the said new programs.
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