New Model For Advanced Practice Nursing: A Promising Change in Direction
Denver, CO—The new model for advanced practice registered nurses (APRNs) has the potential to change the field for the better, according to Diane L. Thompkins, MS, RN, Assis - tant Director, Certification, the American Nurses Credentialing Center, who described the coming changes and their impact at the 2011 meeting of the Association of Women’s Health, Obstetric and Neonatal Nurses.
“I view the consensus model as my gift from those of us in the profession to those coming behind us. Your future should be brighter because of this,” Ms Thompkins told attendees during her update on new directions and regulations in advanced practice nursing.
The Consensus Model for APRN Regulation was developed by stakeholders representing licensure, accreditation, certification, and education of APRNs and has been endorsed by 48 organizations. It will be fully implemented in 2015.
“Often, documents are created and then nothing happens. Not here—this will occur,” Ms Thompkins assured the attending nurses.
The consensus model addresses vexing issues, such as regulations being set by each state, scope of practice, the lack of common definitions and titles for APRNs, increasing specialization without regulation, uniformity in education, and the lack of requirement for certification in some states. These barriers compromised patient access to care, she said.
The full document can be found at www.aacn.nche.edu/education/apn.htm. Key points include:
- APRN defined: An APRN is a registered nurse who has obtained the advanced knowledge and skills to provide direct patient care, completed a graduate degree or postgraduate program, and is educated in at least 1 of the 6 populations
- All APRN programs preapproved by the accrediting body: An individual starting a new program will not be at risk for not obtaining licensure
- Consistency in APRN titles, mobility across states: Across all states, all APRNs will be considered independent practitioners with no need for collaborative agreements. “There will be no need to worry about which state you are in, especially if you are in a border state, with regard to the scope of your practice. There is no more, ‘I can do it here, but not there,’” Ms Thompkins said
- Uniformity of education, certification, and licensure: The requirements now vary state by state, but with new regulations will come greater consistency.
Roles, Populations, and Specialties
All APRNs must satisfy the core concepts of advanced physical or health assessment, advanced pathophysiology, advanced pharmacology, and a minimum of 500 clinical hours in their chosen role and population.
Licensure occurs at the level of the “role” and “population” foci (Figure). All APRNs must choose 1 role and 1 population.Roles include clinical nurse specialist, nurse anesthetist, nurse midwife, or nurse practitioner. The populations are shown in the Figure.
Above these levels is specialization, which is a focus of practice beyond role and population foci, linked to healthcare needs. Examples include oncology, older adult, orthopedics, nephrology, and palliative care. Specialties will not be regulated. “You can switch around without a change in license,” Ms Thompkins pointed out.
Regarding the fear that the requirements would only become stricter, and that a Doctorate of Nursing Practice (DNP) will eventually be required for certification, she said that this may eventually be the case. But even if this should happen, APRNs who are already certified, licensed, and in practice will be grandfathered in and not required to obtain a higher degree. A number of schools are already converting to DNP programs.
Some of the positive outcomes anticipated with the new APRN regulation are:
- Recognition of independent practice for all roles
- Congruent scope of education, certification, and practice
- Set criteria for a population versus a specialty, for purposes of regulation
- Role and title to reflect educational preparation and certification
- APRNs practicing to the full extent of their education and training.
“When we started with the model, we saw huge barriers,” Ms Thompkins acknowledged. “We have gone over the rocky shore, and we are all now in the same boat, working in harmony. This ship will get us to the future.”