The Consensus Model for APRN Regulation:
Implications for Licensure, Accreditation,
Certification and Education
December 9, 2011
MidAtlantic Faculty Infusing Gerontology into the Curriculum
Conference
Philadelphia, PA
Joan Stanley, PhD, CRNP, FAAN, FAANP
Senior Director of Education Policy
Objectives
• Recognize the implications of the Consensus
Model for APRN Regulation for licensure,
accreditation, certification, and education
programs.
• Analyze issues that have arisen secondary to the
implementation of the Consensus Model.
• Identify resources available to transition to the
Adult-Gerontology NP and CNS
IOM The Future of Nursing (2010)
Key Messages related to APRNs:
• Nurses should practice to full
extent of their education and
training
• Nurses should be full partners
with physicians and other HPs
in redesigning HC in U.S.
• Remove scope of practice
barriers for APRNs
• Expand opportunities for
nurses to lead improvement
efforts.
• Double the number of nurse
with a doctorate by 2020
Reaching Consensus: Timeline
• March 2004 – AACN & NONPF submitted proposal to
Alliance for APRN Credentialing
• June 2004 - APN Consensus Conference convened; 32
organizations participated
• October 2004 – APN Work Group charged with developing
future model for APN
• Work group convened 16+ days Oct 2004 and July 2008
• AACN & ANA co-hosted 3 larger Consensus mtgs during
same timeframe (> 70 org.)
• Feb 2006- NCSBN APRN Committee disseminated draft
APRN Vision Paper
APRN Consensus Timeline (cont.)
• Jan 2007 – APRN Joint Dialogue Group formed,
included 7 representatives from Work Group and
NCSBN APRN Committee
• July 2008 - Consensus Model for APRN Regulation:
Licensure, Accreditation, Certification & Education
finalized and disseminated
• 48 national nursing organizations have endorsed the
Model including all major APRN organizations
• August 2010 – MOU signed by LACE organizations to
create LACE Network (renewed August 2011)
LACE Network
30 organizations have committed to supporting and
participating in LACE electronic network
Ensure transparent and ongoing communication
among LACE entities
Provide a platform for the ongoing work
LACE not a formal, separate organization
Based on social networking principles
The LACE Network is a communication network that
includes organizations that represent the Licensure, Accreditation,
Certification, and Education components of APRN regulation.
LACE provides a mechanism for communicating about APRN regulatory
issues, facilitating implementation of the APRN Consensus Model, and
involving all stakeholders in advancing APRN regulation.”
LACE Structure
Public site (http://www.aprnlace.org)
Posting updated information, documents
Protected work site (3 seats/organizations
8 Discussion/Work groups : LACE components and four
roles
Posting documents to be shared and worked on
Ongoing dialogue on posted questions
Scheduling virtual meetings
Calendar
Consensus Model for APRN Regulation




Finalized in 2008
Endorsed by 48 nursing organizations
Implementation began immediately and is actively ongoing
Addresses all APRN roles: CRNA, CNM, CNS, CNP
 Definitions
 Titling
 Has implications for all APRN education programs,
certifying entities, accrediting bodies, and licensing bodies
Projected Timeline for Sequential
Implementation of Model
Implementation started immediately by all LACE entities
Target for full implementation is 2015
APRN education programs should be transitioned by
2012-2013
Accreditation processes should be in place by 2012-2013
Implications for Accreditation of APRN
Programs
Will pre-approve all new APRN programs
Will accredit all post-graduate certificate programs.
Will ensure that programs are designed to prepare
graduates for national certification/licensure
Education program must include 3P’s, nationally
recognized role and population competencies
CCNE goal is to have processes in place by 20132015
Implications for APRN Certification
All APRNs must be nationally certified by a
recognized, accredited certifying body
Assess APRN core, role/population competencies
For licensure, individuals must be certified in the
role/population which matches education program
Specialty must be tested separately
Certification Timeline
Certification examinations should be transitioned
by 2013 - 2014
 NP & CNS certification bodies have indicated
that they will maintain the current certification
examinations until at least 2014 and possibly
2015
Currently certified NPs and CNSs will be
grandfathered if maintain certification
Implementation Questions related to
Certification
Who is eligible to sit for the current exams?
Clinical hours, 3P’s
Who will be eligible to sit for the new adult-gerontology
NP exam?
What new exams are needed for the roles/population
foci, e.g. psych/MH NP across the lifespan?
What specialty certifications are needed or will be
developed?
Implications for Licensing APRNs
State Boards of Nursing will:
Implement the APRN legislative language
Issue a second APRN license
License APRNs as independent practitioners with full
prescriptive authority
Ensure APRN representation on the Board of
Nursing
Include a grandfathering clause for those APRNs
already practicing
Implementation Issues Related to Licensing
of APRNs
 Collecting accurate data regarding implementation by
state boards of nursing
 Clarification to ensure accurate interpretation of
Consensus Model as states work to implement and change
regulations
 Acute vs. primary care NP differentiation and scope of
practice, practice settings
 Recognition of all four roles and populations
 Development of resources for public and state boards
www.ncsbn.org/2276.htm

Implications for
APRN Education Programs
Timeline for education programs to transition is
projected to be 2012-2013
Ensure that grads eligible for national
certification/licensure
All new APRN programs/tracks must be preaccredited/pre-approved prior to admitting students
All post-graduate certificate APRN programs will
need to be accredited by 2015
Implementation Issues for APRN Education
Clarification of APRN Core (3 P’s)
Official Transcript
Differentiation of Acute and Primary Care NP
roles
Inclusion of wellness in all APRN curricula
Enhancing content related to care of older
adults in all APRN curricula
Implications for
APRN Education Programs (cont.)
Transcript (or official school document) must:
Identify APRN role and population focus of the
graduate
If a post-graduate certificate program, say that
individual completed requirements for a postgraduate certificate in “role/population”
APRN Core
3 P’s (separate graduate-level courses)
Advanced physiology/pathophysiology, including general
principles that apply across the lifespan; (lifespan is defined
as prenatal through old age including death).
Advanced health assessment, which includes all systems and
advanced techniques.
Advanced pharmacology, which includes …. all broad
categories of agents- not solely for population
Specific competencies delineated in 1996 Master’s Essentials &
2006 DNP Essentials
www.aacn.nche.edu/Education/essentials.htm
APRN REGULATORY MODEL
•
APRN SPECIALTIES
•
•
•
Focus of practice beyond role and population focus
linked to health care needs
Examples include but are not limited to: Oncology, Older
Adults, Orthopedics, Nephrology, Palliative Care
Licensure occurs at Levels of Role &
Population Foci

POPULATION FOCI
Family/Individual
Across Lifespan

AdultGerontology*

Neonatal

Women’s
Health/GenderRelated
Pediatrics




APRN ROLES
Nurse
Anesthetist
NurseMidwife
Clinical Nurse
Specialist
Nurse
Practitioner
*
PsychiatricMental Health
Acute & Primary Care NP
 The CNP is prepared with the acute care CNP
competencies and/or the primary care CNP
competencies.
 Applies only to the pediatric and adultgerontology CNP programs
 May prepare individuals across both primary care
and acute care with both sets of competencies and
obtain certification in both.”
Example: adult-gero acute care NP & adult-gero
primary care NP
Building a Curriculum
Competencies
Professional Certification
Specialty
Population
foci
Regulation
Role
APRN
Graduate Core
Professional Organizations
(e.g. oncology, palliative
care, nephrology)
NP, CRNA, CNM CNS
Core competencies in
Population context
3 Ps (Advanced Pathophys,
Pharmacology,
Health Assessment)
2011 AACN
Master’s or 2006
DNP Essentials
Incorporation of Wellness in All APRN
Curricula
“All APRNs are educationally prepared to provide scope of
services across health wellness-illness continuum…
however emphasis and implementation within each role
varies.”
Evaluation of curricula
Enhancement of certification examinations
CNS educated and assessed across the continuum from
wellness through acute care
Requires review and enhancement of national core
competencies for roles and population foci
Adult/Gerontology APRNs
 New Model (fully effective 2015)
 Does away with separate adult & geriatric programs
 Combines Adult and Gerontology NP and CNS
programs into fully merged Adult-Gerontology NP and
CNS programs
 Requires more geriatrics in family, psych/MH,
and women’s health programs
Implications for all APRN education programs, certifying
entities, accrediting and licensing bodies
Enhancing Preparation of APRNs to Care for
Older Adult
Recommended Competencies for Older Adult Care
for Non- Adult-Gerontology APRNs
WHNPs & FNPs
WH and Across the Lifespan CNSs
http://www.aacn.nche.edu/education/nonadultgero.htm
Number of Other NP Programs Impacted
Type of
Program
Number of
programs
Enrollment
Graduations
Family NP
292
19,145
4,648
Women’s
Health NP
53
1,054
306
Adult &
Family Psych
NP
96
1,166
224
Source: AACN IDS 2010
Adult/Gerontology APRN Competencies
Adult-Gerontology Primary Care NP
Competencies (2011)
Adult-Gerontology Acute Care NP
Competencies (2011)
Adult-Gerontology CNS Competencies
(2011)
http://www.aacn.nche.edu/Education/adultgeroco
mp.htm
Number of NP Programs Impacted
Type of
program
Number of
programs
Enrollment
Graduations
Gero NP
62
1,054
306
Adult Primary
Care NP
145
4,782
1,209
Adult/Gero
Primary Care
NP
Adult Acute
Care NP
27
601
125
66
2,574
665
Source: AACN IDS 2010
Number of CNS Programs Impacted
Type of
Program
Number of
programs
Enrollment
Graduations
Gero CNS
28
50
29
Adult CNS
123
1,930
447
Adult/Gero
CNS
3
Acute/Critical
Care Adult
CNS
44
755
145
Source: AACN IDS 2010
Resources
LACE Network
http://www.aprnlace.org
APRN Model Act/Rules and Regulations.
https://www.ncsbn.org/APRN_leg_language_approved_8_08.pdf
Consensus Model for APRN Regulation: Licensure,
Accreditation Certification & Education (July 2008)
http://www.aacn.nche.edu/education/pdf/APRNReport.pdf
APRN Consensus Model FAQs (8/19/2010)
http://www.aacn.nche.edu/education/pdf/LACE_FAQ.pdf
Adult-Gerontology NP & CNS Competencies
http://www.aacn.nche.edu/Education/adultgerocomp.htm
Facilitating Transition to the Adult-Gerontology
APRN Curriculum
With funding from the John A. Hartford Foundation, AACN and
Hartford Institute at NYU have developed/compiled resource
materials to support this transition
To assist faculty in preparing APRNs to care for older adults
New teaching resources developed
Faculty development workshops to provide faculty with the
knowledge, skills, and tools to enhance gerontology content &
support curriculum redesign in NP & CNS programs
Faculty Webinars
Transitioning to Adult-Gerontology APRN Education
Project Introduction, Scope, and Faculty Resource Development
October 31, 2011
Strategies and Resources for Teaching Gerontology Content
November 9, 2011
Innovative Curriculum Models, Integrating Content, and Clinical Exemplars
December 6, 2011
Strategies to Infuse Geropsychiatric Content Intro Nursing Curricula
Presented by Geropsychiatric Nursing Collaborative
December 15, 1-2:30 PM ET
APRN Faculty Resource Center
(http://consultgerirn.org/aprncenter)
APRN Resource Center:
Strategies and Resources for Integrating
Gerontology Content
– Adult-Gerontology NP & CNS Competencies
– Introduction to the Resource Center
– Unfolding and Interactive Web-based Case
Studies
– Content Slide Library and Evidence-based
Literature Reviews
– Integration of Gerontological Content
Worksheet and Instructions
Unfolding and Interactive Web-based
Case Studies
• 15 case studies
12 developed by the Hartford Institute
3 developed by the NACNS
• Focus of case studies are for student use
• All developed by national experts teaching in
programs
APRN
Gerontology-Focused Case Studies
8 new unfolding case studies for CNSs and
NPs
Geropsych cases for NP and for CNS
Comorbidities for NP and for CNS
Polypharmacy
Transitional care from acute to subacute to
home for NP and for CNS
Urinary incontinence
Geriatric Resources: Web-based
Web-Resources
http: //www.ConsultGeriRN.org Try This ® and How to Try This General
Assessment Series, e.g.
 Confusion Assessment Method (CAM)
 Beers Criteria for Potentially Inappropriate Medication Use in the
Elderly
 Mental Status Assessement of Older Adults: the MiniCog
 The Geriatric Depression Scale (GDS)
http: //www.ConsultGeriRN.org Try This ® and How to Try This Dementia
Assessment Series, e.g.
 Assessing and Managing Delirium in Persons wih Dementia
 Recognition of Dementia in Hospitalized Older Adults
Geriatric Resources: Books
Auerhahn, C., Capezuti, E., Flaherty, E., & Resnick, B. (eds.) (2007). Geriatric Nursing
Review Syllabus: A Core Curriculum in Advanced Practice Geriatric Nursing, 2nd
Edition: New York: American Geriatrics Society. (3rd Edition, May, 2011)
•
•
•
A concise & comprehensive text developed by the American Geriatrics Society (AGS) & the
NYU Hartford Institute for Geriatric Nursing , adapted for APRNs from the AGS Geriatrics
Review Syllabus: A Core Curriculum in Geriatric Medicine, 6th Edition
Authored by > 100 interdisciplinary experts in care of older adults
59 chapters on prevailing management strategies, extensive reference, appendix with
assessment instruments, 100 case-oriented, multiple choice questions and a self-assessment
tool. (www.americangeriatrics.org/.../the_geriatric_nursing_review_syllabus_2nd_edition/
Auerhahn, C. & Kennedy-Malone, L. (2010). Integrating Gerontological Content into
Advanced Practice Nursing Education. New York: Springer Publishing Co.
•
•
•
•
Clear, user-friendly guidelines for integrating gerontological content into non-gerontological
APRN programs
Detailed lists of print resources and e-Learning materials
Utilizes a competency-based framework
“Success stories” written by APRN faculty who have integrated gerontological content into
non-gerontological courses
Innovative Curriculum Models for Both NPs
and CNSs
 Examples of merged/integrated adult and gerontology
content in NP and CNS programs nationally
 Strategies to use these curricula in your own programs
 Examples of how content integrated into didactic and
clinical components of adult-gero program
Web-based Content Slide Library
Topics of importance for Adult-Gero APRNs
*Urinary incontinence
*Delirium
*Atypical Presentation of Illness
*Cardiac Disease in Complex Older Adults
• Evidence-based content developed by national
experts
• Evidence-based lit review of 3 topics
(www.HartfordIGN.org)
Specialty Nursing Associations Resources
Specialty nursing associations (with the Hartford Institute) have geriatric
specific resources:
• American Association of Critical-Care Nurses (AACN) and
American Academy of Nursing (AAN): "Best Practices for Elder
Care" online course
• American Society for Pain Management Nursing (ASPMN):
Curriculum to prepare hospital nurses to be a Geriatric Pain
Management Resource Nurse
• Association of PeriOperative Registered Nurses (AORN): online
Confidence-Based Learning (CBL) Module, “Perioperative Care
of the Older Adult”
• Emergency Nurses Association (ENA): Universal recommended
guidelines for the safer handoff of older adult patients
between long-term care (LTC) facilities and emergency
departments (ED)
Consensus Model Resources
APRN Model Act/Rules and Regulations.
https://www.ncsbn.org/APRN_leg_language_approved_8_08.pdf
Consensus Model for APRN Regulation: Licensure,
Accreditation Certification & Education (July 2008)
http://www.aacn.nche.edu/education/pdf/APRNReport.pdf
APRN Consensus Model FAQs (8/19/2010)
http://www.aacn.nche.edu/education/pdf/LACE_FAQ.pdf
APRN LACE Network (site for information regarding
implementation of LACE and related issues)
http://www.APRNLACE.org
APRN Resource Center
http://consultgerirn.org/aprncenter
For additional information or questions:
http://www.aacn.nche.edu
jstanley@aacn.nche.edu