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Amy Higgins
Diane Morris
Stephanie Kimbrel
CONSENSUS MODELFOR APRN REGULATION:
LICENSUREACCREDITATIONCERTIFICATION &EDUCATION
LACK OF UNIFORMITY ACROSS STATE LINES DEFINING APRNS
SCOPE OF PRACTICEADVANCED PRACTICE EDUCATIONLICENSINGCREDENTIALING TITLE
PROBLEM IDENTIFICATION
LIMITING THE ACCESSIBILITY OF HIGH QUALITY, COST-EFFECTIVE HEALTHCARE
BACKGROUND: TIMELINE
**1940’S APRN ROLE CAME INTO EXSTENCE
**EARLY 1990’S OFFICIAL CERTIFICATION EXAMS
**1993 POSITION STATEMENT: NEED FOR CERTIFICATIONS
**2002 2ND POSITION STATEMENT: REGULATORY CONCERNS REGARDING CERTIFICATION EXAM
**2004 THE ALLIANCE FOR APRN CREDENTIALING
**2008 CONSENSUS MODEL FOR APRN REGULATION: LICENSURE, ACCREDITATION, CERTIFICATION& EDUCATION 2015
LICENSURE• GRANTING THE INDIVIDUAL
AUTHORITY TO PRACTICE• STATE LICENSURE• INDEPENDENT PRACTITIONER
ACCREDITATION• VOLUNTARY, SELF-REGULATING, NON-GOVERNMENTAL PROCESS
• ASSURES BASIC LEVEL OF EDUCATION• COMMISSION OF COLLEGIATE NURSING EDUCATION AND NATIONAL LEAGUE OF NURSING ACCREDITATION
CERTIFCATION• NATIONAL CERTIFICATION EXAM
EDUCATION• CORE COMPREHENSIVE COURSES• PATHO• HEALTH ASSESSMENT• PHARMACOLOGY
• APPROPRIATE CLINICAL AND DIDACTIC EXPERIENCES
BACKGROUND: LACE MODEL
IMPROTANT FOR THE PUBLIC TO TRUST THAT ANY APRN PROVIDING CARE IS EDUCATED, CERTIFIED, AND LICENSED WITHIN HIS/HER SCOPE OF PRACTICE.
ENSURING PATIENT THAT THEY RECEIVE SAFE AND EQUITABLE CARE.
ETHICAL FACTORS
Politically-NEED EFFECTIVE CONSENSUS MODEL
DEFINED ROLEREGULATIONS ACROSS ALL 50 STATES
UNITED FRONT WITH A UNIFIED VOICE
POLITICAL FACTORS
OUTLINE THE SCOPE OF PRACTICE FOR EACH OF THE FOUR ROLES OF APRNS.
PRESCRIPTIVE AUTHORITY AUTHORITY TO PRESCRIBE W/OUT MD INVOLVEMENT AUTHORITY TO PRESCRIVE WITH MD COLLABORATION WRITTEN PROTOCOL REQUIRED TO PRESCRIBE AURTHORITY TO PRESCRIBE CONTROLLED SUBSTANCES
ADDITIONAL LIABILITY ISSUES UNLICENSED PRACTICE OF MEDICINE FAILURE TO ADEQUATELY DIAGNOSE NEGLIGENCE IN THE DELIVERY OF HEALTHCARE CONDUCT EXCEEDING MD-DELGATED AUTHORITY: RESULTING IN
HARM CONDUCT EXCEEDING SCOPE OF PRACTICE: RESULTING IN HARM FAILURE TO REFER APPROPRIATELY
LEGAL FACTORS
How can the LACE model be expeditiously implemented in all states to ensure that the APRN profession continues to grow and meet the demands of changing healthcare, while increasing the APRN scope of practice and assuring that licensure, accreditation, certification, and education are uniform across all 50 states?
ISSUE STATEMENT
STAKEHOLDERS
FUTURE APRNSTATE
LEGISLATURE
NURSING EDUCACTION PROGRAMS
APRN NURSING EDUCATION PROGRAMS
“CONSUMER” OR PATIENT
EXISTING APRN
INDIVIDUAL STATES
NURSES SHOULD PRACTICE TO THE FULL EXTENT OF EDUCATION AND TRAINING
NURSES SHOULD ACHIEVE HIGHER LEVELS OF EDUCATION AND TRAINING THROUGH AN IMPROVED EDUCATION SYSTEM THAT PROMOTES SEAMLESS ACADEMIC PROGRESSION
NURSES SHOULD BE FULL PARTNERS, WITH PHYSICIANS AND OTHER HEALTH CARE PROFESSIONALS
EFFECTIVE NURSING WORKFORCE PLANNING AND POLICY MAKING REQUIRE BETTER DATA COLLECTION AND IMPROVED INFORMATION STRUCTURE
POLICY OBJECTIVES
•CONTINUE APRN PROGRAMS AS THEY ARE
DO NOTHING•RECOM
MENDATION OF THE AACN
•MASTERS TO DNP BY 2015
DNP
•PROVIDE SUFFICIENT KNOWLEDGE AND SKILLS TO OFFER HIGHER QUALITY CARE WITHIN SPECIALTY FIELDS
•PREPARE APRNs IN SPECIALTIES SUCH AS MENTAL HEALTH
SPECIALISTS’
POLICY ALTERNATIVES
ONGOING FUNDING
PRO: FEDERAL FUNDING INCLUDING
TITLE VII, VIII, MEDICARE EDUCATION
FUNDING, AND AFFORDABLE CARE ACT
CON: CURRENT STATE OF HEALTHCARE IS
FAILING AND IN NEED OF PRIMARY CARE
PROVIDERS.
SIZE & AVAILABILITY OF
FUNDING STREAM
PRO: TITLE VIII NURSING WORKFORCE
DEVELOPMENT PROGRAMS PRIMARY SOURCE OF FUNDING
CON: TITLE VIII AND OTHER MONIES ALLOTTED TO
NURSING EDUCATION ARE PRIMARILY DISCRETIONARY
FUNDS.
ANALYSIS FOR OPTION 1: DO NOTHING
ABILITY TO MEET CURRENT
& FUTURE DEMAND
PRO: PRIMARY CARE PROVIDERS ARE IN NEED, APRN’S CAN FULFILL THIS NEED
CON: APRNs ARE NOT BEING FULLY UTILIZED AT
THIS TIME DUE TO DECREASE ACCESSIBILITY
POLITICAL FEASIBILITY
PRO: CURRENT ADMINISTRATION SUPPORTS AND
RECOGNIZES THE NEED FOR APRNs AND ROLE
THEY CAN FILL
CON: WITHOUT A UNIFIED MESSAGE FROM THE
APRN COMMUNITY APRNs COULD GET LOST
ANALYSIS FOR OPTION 1: DO NOTHING
ONGOIN
G FUNDINGPRO:FEDERAL FUNDING
INCLUDING TITLE VII, VIII, MEDICARE
EDUCATION FUNDING, AND AFFORDABLE CARE
ACT
CON: INCREAED COST OF
EDUCATION
SIZE & AVAILABILITY OF FUNDING STREAM
PRO: CURRENT ADMINISTRATION SUPPORT
REAUTHORIZATION OF TITLE VIIINEW LOAW REMOVING 10% CAP
PREVIOUSLY IMPOSED ON SUPPORT FOR DOCTORAL
STUDENTS
CON: SIZE OF FUNDING WOULD BE DECREASED
DUE TO INCREASED COST OF EDUCATION
ANALYSIS FOR OPTION 2-DNP
ABILITY TO MEET CURRENT
& FUTURE DEMAND
PRO:CURRENTLY THE DEMAND IS GREATER THEN
THE SUPPLY, ADMINSITRATION MAKING IT
A PRIORITY TO INCREASE NUMBERS OF PRIMARY
CARE PROVIDERS
CON: DECREASES THE NUMBER OF GRADUATING
APRNs AFTER 2015AVAILABILITY OF DNP
PROGRAMS FACULITY
POLITICAL FEASIBILITY
PRO: DEVELOPMENT OF NON-RESEARCH CLINICAL DOCTORATE
PROGRAM WILL: PREPARE EXPERT PRACTITIONERS ALIGN APRNs WITH DOCTORATES OF OTHER HEALTH PROFESSIONS
CON: SIGNIFICANT FUNDING ALONG WITH SUPPORT IS REQUIRED FOR
THIS CHANGE: CURRENT US ECONOMIC STATUS
POSSIBLE TURF WAR WITH AMA
ANALYSIS FOR OPTION 2-DNP
ONGOING FUNDING
PRO:FEDERAL FUNDING INCLUDING TITLE VII, VIII, MEDICARE EDUCATION
FUNDING, AND AFFORDABLE CARE ACT
CON:MODEL DOES NOT ALLOW FOR WORKFORCE
MOBILITYDECREASED COST
EFFECTIVENESS OF MODEL
SIZE & AVAILABILITY OF FUNDING
PRO: INCREASED MONIES ALLOTTED TO
ADVANCED EDCUATION NURSING GRANTS FROM TITLE
VIIICON: DISCRETIONARY FUNDS
WILL BE DISTRIBUTED TO AREAS OF NURSING FULFILLING
GREATEST NEEDS. CURRENT FOCUS IS ON PREVENTATIVE,
PRIMARY, AND CHRONIC CARE MANAGEMENT
OPTION 3: SPECIALISTS’
ABILITY TO MEET CURRENT
& FUTURE DEMANDS
PRO: FULFILL HEALTH DISPARITIES SUCH AS
MENTAL HEALTH, WOMAN’S HEALTH, OR
PEDIATRICS
CON: SHORTAGE OF AVAILABLE HEALTHCARE
WILL BE BENEFITED MORE BY A
PRACTITIONER WHO IS ABLE TO OFFER BROADER CARE
POLITICAL FEASIBILTY
PRO: CREATE A HEALTHIER AMERICA AND REDUCE HEATLH DISPARITIESHEALTH PEOPLE 2020
CON: CURRENT ADMINISTRATIVE SUPPROT IS ON PRIMARY, PREVENTATIVE
AND CHRONIC CARE MANAGEMENT.
OPTION 3: SPECIALISTS’
Alternativ
es
Do Nothing
Option
DNP’s Specialists
’’
LACE
Criteria
Substantive Funding
Stream
++ +++ + +++
Likelihood of Ongoing
Funding
+ ++ + ++
Ability to Meet
Current/Future
Demands
- - - ++
Political Feasibility + ++ - +
4+/1- 7+/1- 2+/2- 8+/0-
Score for Each Alternative 3 6 0 8
SCORECARD COMPARISON
As the LACE model is implemented across all states, it will ensure that the APRN profession continues to grow and meet the demands of changing healthcare. The LACE model also ensures the APRN’s scope of practice is utilized to its fullest extent. It also will assure that licensure, accreditation, certification, and education are uniform across all 50 states for APRNs, creating more accessible healthcare to meet the increasing demands of the nation.
SUMMARY
LACE
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