Consensus Model for APRN Regulation:
Licensure, Accreditation, Certification, Education
Presentation for Constituent Member Associations of the
American Nurses Association
October 2009
Lisa Summers, CNM, DrPH
ANA Department of Nursing Practice & Policy
Overview
•
•
•
•
•
What drove development of the Model?
How was the Consensus Model for APRN
Regulation developed?
What are the key components of the model?
What are the plans for implementation?
What tools are available to help members and
policy makers understand the model?
What drove development of the Model?
•
•
•
Lack of common definitions for APRN roles
Lack of standardization in APRN education programs
Proliferation of specialties and subspecialties, e.g.
Palliative Care NP, Cardiovascular CNS, Homeland Security NP
• e.g.
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
•
•
•
How was the Model developed?
Multi-year process
Ultimately involved 73 organizations
Basic assumptions
•
•
•
The ultimate goal is to promote patient safety and public
protection.
Recommendations must address current issues facing the APRN
community
Goal must be forward looking and do no harm
ANA’s role
•
•
•
•
•
Active role on APRN Consensus Model Workgroup
Hosted 4 national APRN Stakeholder meetings at
ANA
Active role on Joint Dialogue Group
ANA was one of the first national organizations to
endorse
ANA continues an active role in LACE process
What are the key components of the model?
•
•
Definition of an APRN
Four essential elements of APRN Regulation (LACE)
Licensure, Accreditation, Certification, Education
•
•
Relevance of APRN specialties
Implementation strategies
Key components of the model:
definition of an APRN
An APRN is a nurse:
•
•
•
•
Who has completed graduate education
Passed a national certification examination and maintains
continued competence
Acquired advanced clinical knowledge and skills
Whose practice builds on RN competencies
Key components of the model:
definition of an APRN cont.
An APRN is a nurse:
•
•
•
Who is educationally prepared to assume responsibility and
accountability for assessment, diagnosis, and management
of patient problems, including prescription of pharmacologic
and non-pharmacologic intervention .
Who has sufficient clinical experience to reflect the intended
license.
Who has obtained a license to practice in one of the 4 APRN
roles
Key components of the model:
Four APRN roles
•
•
•
•
Certified Registered Nurse Anesthetist (CRNA)
Certified Nurse-Midwife (CNM)
Clinical Nurse Specialist (CNS)
Certified Nurse Practitioner (CNP)
APRN Specialties
•
•
•
Preparation in a specialty area is optional.
Specialty education and practice build upon and are in
addition to the education and practice of the APRN role and
population focus.
Specialty practice may focus on specific patient populations
or health care needs.
Examples: a FNP could specialize in nephrology; an Adult-Gero
CNS could specialize in palliative care; a CRNA could
specialize in pain management; a CNM could specialize in
care of post-menopausal women.
APRN Specialties cont.
•
•
•
Criteria for defining a specialty is built on ANA Criteria for
Recognition as a Nursing Specialty (2004).
Certification in the specialty area is strong recommended.
State boards will not regulate the APRN at the level of
specialties.
Emergence of New APRN Roles and
Population Foci
“Careful consideration of new APRN roles or population-foci is in
the best interest of the profession.”
Characteristics of the process to be used to develop a new role
or focus are spelled out.
Criteria for recognition of a new APRN role are also spelled out.
Relationship between Educational Competencies,
Licensure and Certification
Competencies
Measures of competencies
Identified by Professional
Organizations
(e.g. oncology, palliative
care, CV)
Specialty Certification
*
Specialty
CNP, CRNA, CNM, CNS in
Population context
Population Foci
Role
APRN Core Courses:
Patho/phys,
Pharmacology,
physical/health assess
APRN
Licensure: based
on Education
And certification**
What are the plans for implementation?
•
•
•
•
Target date for full implementation and all
recommendations: 2015
Implementation will occur incrementally.
Certain recommendations will be implemented
sequentially.
Expectations for each of the four prongs are
enumerated in the document.
Implementation strategies: Licensure
Boards of nursing will:
•
•
•
•
Be solely responsible for licensing APRNs
Only license graduates of accredited programs
Require successful completion of national certification
exam
Not issue a temporary license
•
•
•
•
Implementation strategies: Licensure cont.
License APRNs as independent practitioners with no
regulatory requirements for collaboration, direction or
supervision
Allow for mutual recognition through the APRN
Compact
Have at least 1 APRN on board and utilize APRN
advisory committee that includes representatives of all
4 roles
Institute a grandfathering clause
Implementation strategies: Accreditation
Accreditors will:
•
•
•
•
•
Evaluate graduate degree and post-graduate certification APRN
programs
Assess APRN programs in light of core, role and population
competencies
Review developing programs for pre-approval, pre-accreditation,
or accreditation prior to student enrollment
Include an APRN on site visiting team
Monitor APRN programs throughout the accreditation period
Implementation strategies: Certification
Certification programs will:
•
•
•
•
Follow established testing and psychometrically sound, legally
defensible standards
Assess APRN core and role competencies across at least one
population focus
Assess specialty competencies separately, if appropriate
Be accredited by a national certification accreditation body
Implementation strategies: Certification cont.
Certification programs will:
•
•
•
Enforce congruence between the education program and the
type of certification.
Provide a mechanism to ensure ongoing competence and
certification maintenance.
Participate in a mutually agreeable mechanism to ensure
communication and transparency with boards of nursing and
schools
Implementation strategies: Education
Education programs will:
•
•
•
•
•
Follow established educational standards and ensure attainment
of core, role and population competencies.
Be accredited.
Be pre-approved, pre-accredited, or accredited prior to accepting
students.
Ensure that graduates are eligible for national certification and
state licensure.
Ensure that the transcript specifies the role and population focus.
Creating the LACE Structure and Processes
The report outlines principles to guide the formulation of the LACE
structure
•
•
•
It should include all 4 entities of LACE.
It’s size should allow effective discussion.
Structure should not be duplicative of existing structures.
ANA is actively involved in ongoing discussions regarding how best
to implement this.
ANA’s role moving forward
ANA is committed to work with our constituents, the nursing
community, and the broad stakeholder community to achieve the
successful and timely implementation of the Consensus Model
Toolkit is available on the web site.
http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNur
ses/Consensus-Model-Toolkit.aspx
What are your questions and needs?
Thank you.
Lisa.Summers@ana.org
301-628-5058
www.nursingworld.org