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In 2004, the American Association of Colleges of Nursing (AACN) called a meeting of all organizations representing advanced practice registered nurses (APRNs). Seventy-three organizations attended a meeting in Washington DC that summer to identify the most APRN pressing issues particularly with regard to the alignment of licensure, accreditation, certification, and education. At that meeting all 73 organizations agreed to establish smaller work groups to address these issues. Twenty-three organizations then began meeting on a regular basis and were referred to as the APRN Consensus Group.
A draft paper was completed by the APRN Consensus Group in 2006. Concurrently, the National Council of State Boards of Nursing (NCSBN) proposed a similar draft paper known as the "Vision Statement: The Future Regulation of Advanced Practice Nursing." Since the papers were very different and the APRN Consensus Group and the NCSBN did not want to have two conflicting papers, an agreement was reached to form a small group with representatives of the APRN Consensus Group and the NCSBN to negotiate the differences.
A joint effort has since been established between the groups to develop a single document delineating a future model for APRN regulation. Regulation is defined more broadly in this document to include licensure, accreditation, credentialing, and education.
In the spring of 2008, the APRN Consensus Work Group and the National Council for State Boards of Nursing APRN Advisory Committee met to offer all nursing stakeholder organizations the opportunity to hear the details of the new model firsthand and to seek clarification on the intentions, anticipated outcomes, and proposed steps toward implementation. According to the APRN Consensus Group, under this APRN Regulatory Model, there are four roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). These four roles are given the title of Advanced Practice Registered Nurse (APRN). APRNs are educated in one of the four roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology, women's health/gender specific, neonatal, pediatrics, or psych/mental health. Individuals will be licensed as independent practitioners for practice at the level of one of the four APRN roles within at least one of the six identified population foci. Education, certification, and licensure of an individual must be congruent in terms of role and population foci. APRNs may specialize but they can not be licensed solely within a specialty area. (APRN Consensus Group, 2008, p. 9)
It is important to note that "APRN" is a protected title. State Boards will issue a second license to APRNs and the license will include role and population whether the license is electronic or paper. APRNs will need to include APRN and role when writing on charts or dictating however, inclusion of their population foci is at the APRN's discretion.
Thus, the educational content and clinical programs must prepare APRNs with knowledge and competencies to care for these patients.
The CNS should receive advanced education commensurate with the health and wellbeing of individuals, families, groups, and communities; CNSs should also attain an appropriate national certification.
The CNP should be prepared with acute care competencies and/or primary care competencies. These acute care and primary care competencies apply to the pediatric and adult-gerontology CNP populations. Scope of practice for the primary care or acute care CNP is not setting specific. Programs may prepare individuals across both the primary care and acute care CNP roles. If programs prepare graduates across both roles, the graduate must be prepared with the consensus-based competencies for both roles and must successfully obtain certification in both acute and the primary care CNP roles.
Issues that still need to be addressed include "titling"(i.e., the legal title and for thirdparty reimbursement). This question is currently being addressed by the Joint Dialogue Group of the APRN Consensus Group. In addition, the specific details of "grandfathering" individuals are yet to be determined; however, there will be a grandfathering clause.
First, academia must offer the degrees and curricula that reflect this new consensus model. Clinical experiences that adequately prepare APRNs for these roles should be provided along with the didactic educational program. Many curriculums will need to be revised to meet these new standards. Faculty will need to include state boards when considering the development of new programs for APRNs.
Second, credentialing bodies should continue to provide credentialing programs for APRNs and certify them so they can attain "practice excellence." Credentialing bodies will also need to review their tests to ensure that the required 3 P's of physical assessment, pharmcology, and pathophysiology across the lifespan are included in their examinations.
Third, nurses need to foster relationships with their state boards of nursing to achieve and maintain regulatory excellence. The goal to protect the public by ensuring the competence of all practitioners is regulated by state boards of nursing.
Finally, it is also recommended that all state boards have at least 1 APRN representative and that all state boards of nursing create an APRN advisory group that includes representative from each of the four APN roles. Specialty nursing organizations with APRN members need to conduct research within their ranks, propose mechanisms (e.g., examination, portfolio, peer review) to achieve specialty competency, and then include these proposed ideas in their associations' future strategic plans. Specialty organizations have the option to (1) develop a specialty certification examination for APRNs and/or (2) provide certification through another mechanism (e.g., portfolio, peer review).
In summary, this consensus model for APRN regulation integrates licensure, accreditation, certification, and education for the first time in the history of advanced practice nursing. This model is unprecedented. It is a model that we as APRNs should wholeheartedly embrace, endorse, and support-for ourselves and for the patients we serve.
K. Sue Hoyt, RN, PhD, FNP-BC, CEN, FAEN, FAANP
Emergency Nurse Practitioner St. Mary Medical Center, Long Beach, CA
Jean A. Proehl, RN, MN, CEN, CCRN, FAEN
Emergency Clinical Nurse Specialist Dartmouth-Hitchcock Medical Center Lebanon, NH
APRN Consensus Group. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Completed through the work of the APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Retrieved August 1, 2008, from http://www.aacn.nche.edu/Education/pdf/APRNReport.pdf[Context Link]
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