Nursing Licensure and
Certification
Reasons for a Future
APRN Model
• Lack of common definitions
related to APRN roles
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Regulation
Role
Specialty
Sub-Specialty
Broad-based education
Population foci
Core examination
Reasons for a Future
APRN Model
• Lack of standardization in
programs leading to APRN
preparation
– Initial accreditation/approval
necessary
– Blended programs with variable clinical hours
– Inconsistent Master’s Essentials compliance
– Programs graduating students that cannot be
licensed
Reasons for a Future APRN
Model
• Proliferation of specialties and
subspecialties
– Examples: Palliative Care NP,
Cardiovascular CNS and
Homeland Security NP
• Lack of common legal
recognition across jurisdictions
– Less than 30 states recognize or title protect CNS
– Not all states license/authorize CRNA same as NP
Basic Assumptions
• Recommendations must address current
issues facing the APRN community
• The ultimate goal of accreditation,
education, licensure and certification is to
promote patient safety and public
protection.
• Goal must be forward looking and do no
harm
APRN Working Groups
NCSBN APRN Committee
(formerly Advisory Group)
APRN Consensus Process
50 Organizations
APRN Consensus
Work Group
23 Organizations
Joint Dialogue Group
Organizations represented at Joint
Dialogue Group
• American Academy of Nurse Practitioners Certification
Program
• American Association of Colleges of Nursing
• American Association of Nurse Anesthetists
• American College of Nurse-Midwives
• American Nurses Association
• American Organization of Nurse Executives
• Compact Administrators
• National Association of Clinical Nurse Specialists
• National League for Nursing Accrediting Commission
• National Organization of Nurse Practitioner Faculties
• National Council of State Boards of Nursing
• NCSBN APRN Advisory Committee (5 representatives)
Assumption for the Joint Dialogue Group
• Recommendations must address current issues facing the
APRN community but should be future oriented.
• The ultimate goal of licensure, accreditation, certification
and education is to promote patient safety and public
protection
• The recognition that this document was developed with the
participation of the APRN certifiers, accreditors, public
regulators, educators, and employers. The intention is that
the document will allow for informed decisions made by
each of these entities as they address APRN issues.
Definition of Advanced Practice
Registered Nurse
The definition includes language that
addresses responsibility and accountability
for health promotion and the assessment,
diagnosis, and management of patient
problems, which includes the use and
prescription of pharmacologic and nonpharmacologic interventions.
Definition of Advanced Practice
Registered Nurse
• An APRN is an individual who has:
– Completed an accredited graduate-level educational
program
– Passed a national certification examination that matches
the educational preparation
– Acquired advanced clinical skills and knowledge
– Practice built upon the competencies of a RN
– Clinical experience of sufficient depth and breadth to
reflect the intended license
– Obtained a license to practice as an APRN in one of the
four roles
Relationship Between Educational
Competencies, Licensure and Certification
Measures of competencies
Competencies
Identified by Professional
Organizations
(e.g. oncology, palliative
care, CV)
Specialty Certification*
Specialty
Population Foci
CNP, CRNA, CNM, CNS
in Population context
Role
APRN Core Courses:
Patho/phys,
Pharmacology,
Physical/health assess
APRN
Licensure: based
on Education
And certification**
APRN Direct Care
Component
•
Advanced clinical knowledge and skills to
provide direct care to patients is a defining
component of practice
• All APRNs have a significant
component of education
and practice focusing on
direct care of individuals.
APRN Regulatory Model
APRN Specialties
Licensure at levels of role and
population foci
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, Critical Care
POPULATION FOCI
Family/Individual
Across lifespan
AdultGerontology
Women’s Health/
Gender Related
Neonatal
Pediatrics
Psych/Mental
Health
APRN ROLES
Nurse
Anesthetist
Nurse
Midwife
Clinical Nurse
Specialist
Nurse
Practitioner
Establish Ongoing Communication:
Lace Structure and Processes
• Entities of LACE include
– Licensing bodies
– Accreditors
– Certifiers that offer APRN certification for
regulatory purposes
– Educational organizations that set standards for
APRN education
• Total participants allow effective discussion
• Not duplicative of existing structures
• Will obtain consultation on structure
The Future
Foundational Requirements for Licensure
• The Boards of Nursing (Licensure) will
– License APRNs in one of four roles with a population focus
– Be solely responsible for licensing (exception for states where
boards of midwifery regulate nurse-midwives and midwives)
– Only license graduates of accredited graduate programs
– Require successful completion of a national certification
examination that assesses APRN core, role and population
competencies.
– Only license an APRN when education and certification are
congruent
– Not issue a temporary license
Foundational Requirements for Licensure (cont.)
• The Boards of Nursing will:
– License APRNs as independent practitioners with no regulatory
requirements for collaboration, direction or supervision
– Have at least one APRN representative position on the board and
utilize an APRN advisory committee that includes representatives
of all four APRN roles
– Institute a grandfathering clause that will exempt those APRNs
already practicing in the state from new eligibility requirements
– Have the option for mutual recognition of advanced practice
nursing through the APRN Compact
Foundational Requirements for Accreditation
of Education Programs
• Accreditors will:
– Evaluate APRN graduate degree and post-graduate certification
programs
– Through their established accreditation standards and process, assess
APRN education programs in light of the APRN core, role core and
population core competencies
– Assess developing APRN education programs and tracks by reviewing
them using established accreditation standards and granting preapproval, pre-accreditation or accreditation prior to student enrollment
– Include an APRN in the visiting team when reviewing an APRN
program
– Monitor the APRN education programs throughout the accreditation
period
Foundational Requirements for Certification
(cont.)
• Certification programs providing APRN certification
used for licensure will:
– Enforce congruence between the education program and the type of
certification examination
– Provide a mechanism to ensure ongoing competence and maintenance
of certification
– Participate in ongoing relationship which make their processes
transparent to BON
– Participate in a mutually agreeable mechanism to ensure
communication with the BON
APRN Regulatory Model
• APRN regulation includes:
– Licensure
• The granting of authority to practice
– Accreditation
• Formal review and approval by a recognized agency of educational
degree or certification programs in nursing or nursing related
programs
– Certification
• The formal recognition of knowledge, skills and experience
demonstrated by the achievement of standards identified by the
profession
– Education
• The formal preparation of APRNs in graduate or post-graduate
programs
Work to be Completed
with Endorsement of Model Regulation
• Licensing
– Adopt regulatory model- completed in August 2008
– Adopt licensure language – completed in August 2008
– Implementation by state boards of nursing
• Accreditors
– Pre-approval process
– Review of post Master’s Programs
– Integrate role standards
• Certifiers
– Assess extent of testing of 3 Ps for all roles
– Assess testing of role competencies, including consensus-based CNS
competencies, within each population.
– Integrate adult-older competencies into one assessment mechanism
– Review psych/mental health
What is Certification?
 Validation of an individual nurse’s
qualifications for practice in a defined area
 Administered by a nongovernmental
agency
 Based on predetermined standards
 Recognizes knowledge, skills and abilities
beyond the scope of RN licensure
Why Do Hospitals Support
Certification?
 A means to recruit and retain good nurses
 Knowledge that their nurses have met rigorous
national requirements and are role models of
professional accountability
 Growing evidence links certified nursing
practice and positive outcomes
 Certification is among the key excellence
indicators for programs such as Magnet and
Beacon
Why Do Nurses Get Certified?
 For personal challenge and self-improvement
 To advance knowledge and education
 To demonstrate mastery of skills, knowledge
and abilities to patients and administration
 To distinguish themselves through commitment
to lifelong learning and career growth
 Improve salary and advancement opportunities
Why AACN Certification?
As a vital part of AACN, the recognized
leader and standard-setter in acute and
critical care nursing, AACN Certification
Corporation administers certification
programs for nurses to proudly demonstrate
the specialized knowledge, skills and
abilities necessary for safe and effective
acute and critical care nursing practice
AACN certification contributes to improved
patient health and safety by establishing
and promoting high standards of
professional practice
AACN Certifications
For nurses who care directly for acutely or
critically ill patients at the bedside
For nurses who care for acutely and critically
ill adult patients in progressive care settings
For nurses who care for acutely or critically ill
adult patients from remote location
For clinical nurse specialists who care for
acutely or critically ill patients
For acute care nurse practitioners who care
for acutely and critically ill adult patients
For certified nurses who subspecialize in
caring for adult cardiology patients
For certified nurses who subspecialize in
caring for adult cardiac surgery patients
AACN Certification Exams
AACN Certification Corporation develops and
administers the CCRN, PCCN, CCRN-E,
CCNS, ACNPC, CMC and CSC exams
These exams are legally defensible and
psychometrically sound indicators of the
knowledge, skills and abilities necessary for
effective nursing practice
Exams are open to nurses caring for acutely
and critically ill patients who meet the eligibility
requirements, including a specified period of
clinical practice in the role being tested
CCRN certification is for RNs working at the
bedside of acutely and critically ill patients
The clinical setting may include ICUs, CCUs,
Emergency Departments, Trauma Units,
Interventional Radiology /Cardiology Units, or
Critical Care Transport/Flight Units
There are three separate CCRN exams:
adult, neonatal and pediatric
PCCN certification is for nurses working at the
bedside of acutely ill adult patients in a
progressive care setting
Progressive care is how AACN collectively
describes units such as Intermediate Care,
Direct Observation, Step-down, Telemetry, and
Transitional Care
The PCCN credential is also appropriate for
nurses who practice in Cardiac Cath Labs
CCNS advanced practice certification is for
clinical nurse specialists working with acutely
and critically ill patients
The CCNS may be used by nurses in some
states to help qualify for AP nursing licensure
A candidate must document completion of a
graduate advanced practice education program
meeting specific requirements
There are three separate CCNS exams:
adult, neonatal and pediatric
CCRN-E certification is for RNs caring for
acutely and critically ill adult patients from a
remote location
CCRN-Es work in tele-ICUs (virtual or e-ICUs)
monitoring from behind a camera to identify
trends in patient data and instability and
communicate with patients and bedside nurses
Eligible hours are those worked in a tele-ICU or
in a combination of tele-ICU and direct bedside
care
ACNPC advanced practice certification is for
adult acute care nurse practitioners
A candidate must document completion of a
graduate advanced practice education program
meeting specific requirements
ACNPC certification is approved on a state-bystate basis - check with your State Board of
Nursing to make sure the ACNPC exam meets
your state's requirements for advanced practice
designation or licensure
Cardiac Medicine subspecialty certification is
for nurses who hold a nationally accredited
clinical nursing specialty certification such as
CCRN, PCCN, CCRN-E, CCNS or ACNPC who
subspecialize in caring for adult cardiology
patients
The clinical settings may include:
CCU, Combined ICU/CCU, Medical Cardiology,
Heart Failure Clinics/Home Care, Interventional
Cardiology and/or Electrophysiology Units
Cardiac Surgery subspecialty certification is for
nurses who hold a nationally accredited clinical
nursing specialty certification such as CCRN,
PCCN, CCRN-E, CCNS or ACNPC who
subspecialize in caring for adult cardiac surgery
patients within the first 48 hours postoperatively
The clinical settings may include:
Cardiac Surgery, Cardiothoracic Surgery,
Cardiovascular Surgery and Post-Anesthesia
Recovery Units
For more information about
AACN certifications, visit:
www.aacn.org