Advanced Practice Registered Nurse Regulation Research Articles

LACE and the APRN Consensus Model: Implications for Advancing Nursing Practice.

Understanding the historical context and contemporary trends in advanced practice registered nurse (APRN) education and regulation is pivotal for effective professional advocacy. Until the release of the APRN Consensus Model in 2008, a uniform model for APRN regulation was lacking. Adopting the model's recommendations has implications for APRNs beyond licensure and regulation, including full practice authority, license portability, and patient access to APRN-led care. A comprehensive understanding of APRN education and regulation empowers nurses, APRNs, and stakeholders to drive the profession forward through informed advocacy.

PREPARED NP: Preparation for Emergency Care Delivery Among Nurse Practitioners

The PREPARED NP (Preparation for Emergency Care Delivery Among Nurse Practitioners) study sought to describe the certification of the advanced practice registered nurse working in emergency care settings. A 14-item survey using the nomenclature and classification of advanced practice registered nurses from the Consensus Model for APRN (Advanced Practice Registered Nurse) Regulation was disseminated widely via social media, email, and newsletters. A total of 746 respondents completed the survey, with 713 respondents reporting that they work in the emergency care setting as advanced practice nurses. The majority reported their current certification as a family nurse practitioner (FNP). The data from this study underscore the variability in certification requirements for NPs working in emergency care settings. The lack of a single population-level certification examination that meets the needs of emergency care NPs appears to have national implications. Although further clarification and understanding of advanced practice nurse certification in emergency care settings are needed, the findings in this study support further research to inform practice and policy surrounding the emergency NP workforce.

Consideration of the emergency nurse practitioner as a population within the APRN Consensus Model: A SWOT analysis

After adoption of the 2008 Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation, evolution of the nurse practitioner (NP) role and emergency NP (ENP) specialty has outpaced regulatory standards. Lack of uniformity among regulators, health insurance providers, and employers in acknowledging the ENP specialty has created barriers to practice and access to care. This article serves to identify potential outcomes if the ENP specialty was transitioned to a population within the Consensus Model of Regulation. A strengths, weaknesses, opportunities, and threats (SWOT) analysis methodology was used to assess ENP specialty current state, specifically focusing on the licensure, accreditation, certification, and education model for APRN regulation. The data were collected from peer-reviewed literature, clinical subject-matter experts, and academic and advanced practice executive leaders. Variances in ENP licensure, recognition, and acknowledgment among State Boards of Nursing leave the ENP specialty in a precarious position. For each of the strengths and opportunities that could exist in recognizing the ENP at the population level of the Consensus Model, there are abundant weaknesses and threats. Although full acknowledgment of the ENP specialty is lacking, regulatory implications are highly variable, and employers' understanding of the APRN educational model is limited, our findings reveal that the ENP specialty is an evolving role that deserves regulatory legitimization. Although ideal placement for the ENP within the Consensus Model remains to be determined, challenges and opportunities exist with both specialty and population options.

AORN Position Statement on Advanced Practice Registered Nurses in the Perioperative Environment

<scp>AORN</scp> Position Statement on Advanced Practice Registered Nurses in the Perioperative Environment

Understanding nurse practitioner scope of practice: Regulatory, practice, and employment perspectives now and for the future.

The nurse practitioner (NP) role has existed for 50 years. During the past 10 years, a national effort to use NPs to the full extent of their education based on the 2008 Consensus Model for Advanced Practice Registered Nurse Regulation and the 2010 Institute of Medicine Report on the Future of Nursing continues to result in variable scopes of practice (SOP) between states. Subsequently, NPs have a lack of clarity on SOP because it relates to population foci and practice setting. Review and analysis of state-based statutes and rules with the current literature focused on NP SOP, including documents by the National Council of State Boards of Nursing, was conducted. Clarification and understanding of SOP is essential for safe practice and optimum access to care. Inconsistent SOP regulation continues to exist between states, and NPs can be in employment situations that place them in a position to possibly breech their SOP. Although practice is not setting specific, NP licensure is based on NP education and certification that is competency based within population foci, and credentialing by employers should align with these parameters. Continuing to work toward a more common NP SOP between states and achievement of full practice authority means periodic reassessment of NP education and practice models. Practice mobility is essential for continued advancement of the NP profession and increased access to care by the public.

Delaware’s Pathway to Achieving APRN Consensus

Delaware became the first Mid-Atlantic State to implement the Advanced Practice Registered Nurse (APRN) Consensus Model, a framework that established standards for uniform APRN regulation. Delaware's success was a result of the efforts of the Advanced Practice Committee of the Delaware Board of Nursing, composed of 14 APRNs representing the four advanced practice roles, the executive director of the board of nursing, and the efforts of numerous Consensus Model stakeholders. This noteworthy achievement concluded 4 years of concentrated work between the Advanced Practice Committee and other key stakeholders and permits APRNs to practice to the full extent of their education and training. This article delineates the grassroots efforts, legislative activities, and strategic approaches instrumental in the process, and it provides recommendations for other states forging their pathways to achieving APRN Consensus Model implementation.

Revitalizing Learning Outcomes for Adult Gerontology Advanced Practice Programs.

The implementation of the Consensus Model for Advanced Practice Registered Nurse Regulation has defined the model for advanced practice within the four recognized advanced practice nursing roles. The focus of graduate nursing program focus for care of the adult population has been broadened to include gerontology. The change toward increasing graduate program breadth and focus to a lifespan adult/gerontology population will result in the need for analysis and restructuring of advanced practice programs in order to incorporate gerontologic content. The purpose of this article is to describe a process for developing or revitalizing meaningful learning outcomes as an integral component in program revision and evaluation for advanced practice programs incorporating gerontologic content. Learning outcomes will be included with examples and definitions from the beginning basis of role-specific selected adult gerontology competencies through data collection and analysis for program improvement.

Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue

In the United States, Advanced Practice Registered Nurse (APRN) regulations are determined at the state level, through legislation and rule making. The lack of an evidence base to APRN regulation has resulted in a patchwork of varied regulations and requirements for nurse practitioners. The author begins this article by reviewing the history of the Equal Rights Amendment (ERA) in the United States and describing her study that assessed APRN fullpractice authority in states that ratified the ERA versus states that opposed it. She presents the study findings, limitations of the comparison, and discussion of the findings and implications. In conclusion, the findings demonstrated that progress toward full APRN practice will require building strategies for political support and framing the need to update APRN regulations in a manner that aligns with each state’s social and political values.

What’s in a Name? Legislative Challenges with APRN Title Change

The Campaign for Consensus can be a daunting task for state legislatures. The Campaign for Consensus is the National Council of State Boards of Nursing’s (NCSBN) initiative for states to align their Advanced Practice Registered Nurse (APRN) regulation with the major elements of the Consensus Model for APRN Regulation. The major elements for the four roles (clinical nurse specialist [CNS], certified nurse practitioner [CNP], certified registered nurse anesthetist [CRNA]), and certified nurse midwife [CNM]) include: •State recognition of each of the four roles •Title of APRN in all of the four roles •Licensure as a registered nurse (RN) and as an APRN in one of the four roles •Graduate or postgraduate education from an accredited program •Certification at an advanced level from an accredited program •Independent practice •Independent prescribing.

Certification and education as determinants of nurse practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States.

In 2008, a consortium of advanced practice nursing organizations authored the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. The document's aim is to provide guidance for states to adopt uniformity in the regulation of advanced practice registered nurse roles. Despite a target date to complete that work by 2015, there remains an extensive amount of variation in how states define the scope of practice (SOP) for nurse practitioners (NPs). Based on the National Council of State Boards of Nursing online database, state (N = 51 [includes the District of Columbia]) NP practice acts and/or rules and regulations documents were examined for language describing SOP for NPs consistent with the language of the advanced practice registered nurse (APRN) Consensus Model. Results indicated that 18 states and the District of Columbia (37%) had specific regulations defining NP SOP by certification and/or educational preparation while 23 (45%) did not. The remaining nine states (18%) had SOP regulations that were interpreted as being ambiguous in relation to certification and/or educational preparation. The findings suggest much work is needed to ensure NP SOP accurately reflects NP board-certification and graduate educational preparation.

APRN Practice: Challenges, Empowerment, and Outcomes

In her 2008 article entitled “Advanced Practice Registered Nurses: The Impact of Patient Safety and Quality,” Eileen O’Grady reported that the advanced practice registered nurse (APRN) workforce “has been growing exponentially with APRNs employed in every health care sector.” 1 O'Grady ET Advanced practice registered nurses: the impact on patient safety and quality. in: Hughes RG Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043. Agency for Healthcare Research and Quality, Rockville, MDMarch 2008 Google Scholar The Bureau of Labor Statistics agreed, underscoring the demand for APRNs with the ever-increasing need for access to cost-effective, quality health care. 2 Bureau of Labor Statistics, US Department of Labor Registered nurses. Occupational Outlook Handbook. 2006–07 ed. http://www.bls.gov/ooh/healthcare/registered-nurses.htm Google Scholar Today, there are more than 267,000 APRNs across the United States, practicing in communities, hospitals, and many other healthcare settings. APRNs are categorized as certified nurse practitioners (NPs), certified nurse midwives (CNM), certified nurse specialists (CNS), and certified registered nurse anesthetists (CRNAs). 3 APRNs in the U.S. The Consensus Model for APRN Regulation, Licensure, Accreditation, Certification and Education. https://www.ncsbn.org/4213.htm Google Scholar All groups continue to increase in number and effectiveness as integral members of the healthcare team. In her 2008 article entitled “Advanced Practice Registered Nurses: The Impact of Patient Safety and Quality,” Eileen O’Grady reported that the advanced practice registered nurse (APRN) workforce “has been growing exponentially with APRNs employed in every health care sector.” 1 O'Grady ET Advanced practice registered nurses: the impact on patient safety and quality. in: Hughes RG Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043. Agency for Healthcare Research and Quality, Rockville, MDMarch 2008 Google Scholar The Bureau of Labor Statistics agreed, underscoring the demand for APRNs with the ever-increasing need for access to cost-effective, quality health care. 2 Bureau of Labor Statistics, US Department of Labor Registered nurses. Occupational Outlook Handbook. 2006–07 ed. http://www.bls.gov/ooh/healthcare/registered-nurses.htm Google Scholar Today, there are more than 267,000 APRNs across the United States, practicing in communities, hospitals, and many other healthcare settings. APRNs are categorized as certified nurse practitioners (NPs), certified nurse midwives (CNM), certified nurse specialists (CNS), and certified registered nurse anesthetists (CRNAs). 3 APRNs in the U.S. The Consensus Model for APRN Regulation, Licensure, Accreditation, Certification and Education. https://www.ncsbn.org/4213.htm Google Scholar All groups continue to increase in number and effectiveness as integral members of the healthcare team.

The consensus model for regulation of APRNs: Implications for nurse practitioners

To examine the Consensus Model for APRN Regulation as a proposed solution to simplify and unify regulation of advanced nursing practice with respect to licensure, certification, accreditation, and educational standards. Policy statements and reports issued by national organizations of nursing professionals and discussion within the scholarly literature provided an overview of regulatory differences among the 50 U.S. states, their impacts on advanced practice registered nurse (APRN) practice, and discussion of the Consensus Model as a potential solution. Major organizations of nursing professionals have endorsed the Consensus Model, indicating the importance of this significant step toward standards and consistent quality in APRN education and practice. Diverse regulatory criteria, such as variable accreditation standards, disparate certification and licensing requirements, inconsistent population foci, and scopes of practice, represent barriers to optimized APRN function within today's complex healthcare system and, ultimately, reduced access to safe, quality care for patients. The Consensus Model for APRN Regulation promises to unify APRN education, practice, and licensure, promoting greater mobility among nursing professionals. Elimination of inconsistencies in APRN licensure, education, certification, and accreditation requirements will promote greater value and mobility for the APRN within the healthcare system.

The consensus model for regulation of APRNs: Implications for nurse practitioners.

Purpose: To examine the Consensus Model for APRN Regulation as a proposed solution to simplify and unify regulation of advanced nursing practice with respect to licensure, certification, accreditation, and educational standards. Data sources: Policy statements and reports issued by national organizations of nursing professionals and discussion within the scholarly literature provided an overview of regulatory differences among the 50 U.S. states, their impacts on advanced practice registered nurse (APRN) practice, and discussion of the Consensus Model as a potential solution. Conclusions: Major organizations of nursing professionals have endorsed the Consensus Model, indicating the importance of this significant step toward standards and consistent quality in APRN education and practice. Diverse regulatory criteria, such as variable accreditation standards, disparate certification and licensing requirements, inconsistent population foci, and scopes of practice, represent barriers to optimized APRN function within today's complex healthcare system and, ultimately, reduced access to safe, quality care for patients. Implications for practice: The Consensus Model for APRN Regulation promises to unify APRN education, practice, and licensure, promoting greater mobility among nursing professionals. Elimination of inconsistencies in APRN licensure, education, certification, and accreditation requirements will promote greater value and mobility for the APRN within the healthcare system.

Moving Forward with Role Recognition for Clinical Nurse Specialists

The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education requires the recognition and regulation of all four advanced practice registered nurse (APRN) roles: certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), certified nurse practitioner (CNP), and clinical nurse specialist (CNS). Today, CNPs and CNMs have APRN role recognition in all U.S. jurisdictions but the CNS role is not recognized in 10 jurisdictions. This article focuses on the lack of role recognition of the CNS. It also discusses the role of the CNS in advanced nursing practice and what needs to be done to move it forward to full consensus.

Update on Advanced Practice Registered Nurse Regulation: Licensure, Accreditation, Certification and Education

ADVANCED PRACTICE NURSING (APN) roles have been in existence since the early 1940s. On July 7, 2008, a report was issued by the Advanced Practice Registered Nurses (APRN) Consensus Work Group and the National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee regarding the regulation of these roles. This report (herein referred to as “LACE”) detailed the work of the committee members over the course of the last several years to standardize the licensing, accreditation, credentialing, and education of APNs.

Consensus Model for Advanced Practice Registered Nurse Regulation: Implications for Midwives

Consensus Model for Advanced Practice Registered Nurse Regulation: Implications for Midwives

What Clinical Nurse Specialists Need to Know About the Consensus Model for Advanced Practice Registered Nurse Regulation

What Clinical Nurse Specialists Need to Know About the Consensus Model for Advanced Practice Registered Nurse Regulation