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Reaching Consensus in Advanced Practice Nursing

With the election year in full swing, we are constantly being bombarded with news about presidential hopefuls and their campaigns, and how the momentum keeps shifting based on individual state primaries. Each state seems to relish its individuality and follow its own moral compass when it comes to picking candidates.

States also have their own views about many important healthcare issues, including the scope of practice for advanced practice nurses. Can they ever reach a consensus, for the sake of clinicians and their patients? One group has launched a campaign of its own to try to make that happen.

Advanced practice nurses provide patient care in a variety of settings, often from a holistic health and wellness perspective that is unique in medicine. However, it is difficult to provide one consistent definition for an advanced practice nurse due to significant variations in education, licensure, certification, and scope of practice across the states.

The National Council of State Boards of Nursing (NCSBN) has begun work to reduce the inconsistencies. In 2008, the Council first published its Consensus Model for APRN Regulation. The Model gives clarity to current and future roles bring educational requirements into a more consistent framework and propose a consistent form of reference to the profession. NCSBN has set a target of 2015 for implementation of the Model.

The Advanced Practice Registered Nurse (APRN) title is a new comprehensive form of referring to the four distinct categories of nurses with advanced degrees. These four roles are:

CRNA – Certified Registered Nurse Anesthetist

CNM – Certified Nurse Midwife

CNS – Clinical Nurse Specialist

CNP – Certified Nurse Practitioner

There are currently more than 267,000 APRNs who serve an essential role in providing healthcare to various patient populations across all 50 states, and they are expected to play an even greater role in meeting the future healthcare needs of our nation. National healthcare coverage, a greater percentage of elders in our population, increasing complexity, and physician shortages will all place a strain on the healthcare system. Primary care settings are likely to be most affected, with APRNs well-positioned to bridge the gap between supply and demand.

And with the launch of the APRN Consensus Model in 2015, a new definition will be born.  An APRN will be a nurse who:

  • Has completed an accredited, graduate-level education program in preparation for one of the four recognized APRN roles;
  • Has passed a national certification exam;
  • Has acquired advanced clinical knowledge and skills;
  • Is educationally prepared to assume responsibility for health promotion, assessment, diagnosis, and management of patient problems;
  • Has clinical experience of sufficient depth and breadth to reflect the license; and
  • Has obtained a license to practice as an APRN in one of the four roles.

The act of licensure will govern the APRN role itself, so a nurse will be licensed as a CRNA, CNM, etc., and include the title APRN-CNM (as an example) after his or her name. In addition, professional certification will give additional recognition and practice capabilities to APRNs – in particular, population foci and/or specialty (i.e. adult/older adult oncology).

A grandfathering process will be implemented as the transition progresses. When states adopt the Model through their legislative processes, APRNs currently practicing will be permitted to continue to practice in that state. If an APRN applies for licensure in a state that has adopted the Model, he or she must meet the following criteria:

  • Current, active practice in the role and population focus;
  • Current, active certification in the role and population focus;
  • Compliance with education requirements in the new state that was in effect AT THE TIME THE APRN completed his/her education program; and
  • Compliance with all other criteria set forth by the state.

Adopting the Model will be a “work in progress” for years to come, but as we move into a new era of healthcare demands, it is absolutely critical that we provide a clear, consistent definition for the practice of the APRN.

More information about the APRN Consensus Model can be found on the NCSBN website.

(References: National Council of State Boards of Nursing (2008). Consensus Model for APRN Regulation.)