The Consensus Model for APRN Regulation Licensure,
Accreditation, Certification, Education Presented By: Carol
Hartigan, MA, BSN, RN Certification Programs Strategist Slide 2
Heard on social media By 2015, all Clinical Nurse Specialists will
need to have their DNP in order to keep practicing. This
credentialing controversy only gets more complicated as they change
the exams and the credentials given out. ALL should be accepted
equally. Georgia has reached out to the National Council of State
Boards of Nursing and other professional organizations requesting
they intervene as currently half the CNSs in the state are forced
back into school and/or clinical so they can sit for certification
exams. The Consensus Model regulations are aimed more at making
money for the Universities by requiring more education than
benefiting patient care which is the ultimate goal. Slide 3 Webinar
Objectives Identify how the Consensus Model for APRN Regulation
will change the practice of CNSs or NPs Discuss nursing program
curricula changes needed to be ready for the new regulatory model
by the 2015 deadline For students going forward For current CNSs
Consider opportunities to positively influence implementation of
the model in your educational program Slide 4 Slide 5 1. 1.What do
the Consensus Model for APRN Regulation and the AACN-Colleges DNP
Initiative have in common? 2. 2.What are the components of a
certification examination which ensure regulatory sufficiency? 3.
3.What steps would a currently-certified Adult Acute/Critical Care
Nurse CNS take to become nationally certified as an
Adult-Gerontology Acute Care Nurse CNS? 4. 4.When will the Boards
of Nursing begin to require the DNP to take the certification
exams? Slide 6 Key Regulatory Issues in Advanced Practice
http://journals.lww.com/aacnadvancedcriticalcare/Fulltext/2011/01000/APRN_Regula
tion__The_Licensure_Certification.8.aspx Slide 7 Who and How to
Regulate? MedicineNursing Slide 8 MedicineNursing Who and How to
Regulate? Slide 9 Registered Nurse Advanced Practice Registered
Nurse Who and How to Regulate? Slide 10 Primary Care APRN Acute
Care APRN Who and How to Regulate? Slide 11 NeonatalPediatric Adult
Gero Who and How to Regulate? Slide 12 Regulatory Concerns
Inconsistency across APRN educational programs Lack of knowledge
of/control over APRN certification examination programs
Proliferation of subspecialties Practice beyond or outside of scope
as determined by education and certification Inconsistent
enforcement of certification eligibility requirements Slide 13
Reaching Consensus Key Issues Identified Who is an APRN? What
characterizes APRN practice? Primary care vs. Acute care what are
the differences and what is the overlap? What are the similarities
and what are the differences among the four roles related to
educational preparation, scope of practice, educational
accreditation and regulation? How does the age of the patient fit
into the population-focused model? Where does specialty preparation
fit in the model? What is the best model for the future needs of
patients and families? Slide 14 APRN Licensure How did we get here
anyway? Slide 15 NCSBN Historical Position Statements and
Activities 1986 NCSBN adopts a position paper on Advanced Clinical
Nursing Practice Determines that the educational requirement should
be a minimum of a Masters degree and The preferred method of
regulation of advanced nursing is designation/ recognition 1993 -
NCSBN adopts Model Legislative Language and Model Administrative
Rules for Advanced Nursing Practice and the position paper on the
regulation of advanced nursing practice Moves the recommended
method of regulation of advanced nursing from
designation/recognition to licensure. This change was made due to
the fact that the activities of the practitioners are complex,
require specialized knowledge and skill, and independent decision
making. There is an established scope of practice and
prequalification for safe practice must be determined by licensing
boards. Because of potential harm to the public, licensure affords
the ability to discipline practitioners Directs the Board of
Directors continue collaboration with the American Nurses
Association, American Association of Nurse Anesthetists, American
College of Nurse-Midwives and other nursing organizations,
including nurse certifying bodies. Slide 16 1994 - NCSBN performs a
study to identify core competencies of nurse practitioners and a
study exploring the regulatory, fiscal and political implications
of developing a core competency examination for nurse
practitioners. 1995 NCSBN collaborates with NP certification
organizations to move toward legally defensible examinations and
processes and third-party accreditation. 2000 NCSBN collaborates
with APRN stakeholders to develop Uniform Advanced Practice
Registered Nurse Licensure/Authority to Practice Requirements,
which serve as the foundation for the APRN Compact. 2002 NCSBN
Board of Directors approves the Advanced Practice Advisory
Committees Position Paper on the Regulation of Advanced Practice
and the Requirements for Accrediting Agencies and the Criteria for
Certification Programs which delineates required elements of
certification programs that would result in a legally defensible
examination suitable for the regulation of APRNs. NCSBN Historical
Position Statements and Activities Slide 17 History of the Model
The Alliance for APRN Regulation Established in 1997 by
AACN-Colleges and CCNE as The Alliance for Nursing Accreditation
Goal to establish a framework and mechanism to foster collaboration
among the regulatory bodies that oversee or review baccalaureate
and graduate education Original membership included: American
Academy of Nurse Practitioners Certification Program American
Association of Colleges of Nursing American College of
Nurse-Midwives Division of Accreditation American Nurses
Credentialing Center Association of Faculties of Pediatric Nurse
Practitioners Commission on Collegiate Nursing Education Council on
Accreditation of Nurse Anesthesia Educational Programs National
Certification Corporation National Council of State Boards of
Nursing National Organization of Nurse Practitioner Faculties
National Association of Nurse Practitioners in Women's Health,
Council on Accreditation National Certification Board of Pediatric
Nurse Practitioners & Nurses (Pediatric Nursing Certification
Board) Added AACN Certification Corporation to membership in
February 2002 and National Association of Clinical Nurse
Specialists in October 2003 Slide 18 History of the Model The
Alliance for APRN Regulation In March 2004, AACN-Colleges and NONPF
submitted a proposal to the Alliance to establish a process to
develop a consensus statement on the credentialing of advanced
practice nurses (APNs) Thirty-two organizations participated in the
APN Consensus Conference in June 2004 to initiate an in-depth
examination of issues related to APN definition, specialization,
sub-specialization, and regulation, which includes accreditation,
education, certification and licensure. A smaller work group made
up of designees from twenty-three organizations with broad
representation of APN certification, licensure, education,
accreditation, and practice was charged with development of a
statement that addressed the issues, delineated during the APN
Consensus Conference with the goal of envisioning a future model
for APNs. Slide 19 History of the Model Parallel Processes The
Alliance APN Consensus Work Group convened for sixteen days of
intensive discussion between October 2004 and July 2007 to develop
a working model. In a parallel process, the National Council of
State Boards of Nursing (NCSBN) APRN Advisory Panel had been
drafting an APRN Vision Paper to provide direction to boards of
nursing regarding APRN regulation for the next 8-10 years by
identifying an ideal future APRN regulatory model. The NCSBN Board
of Directors disseminated the draft Vision Paper to Boards of
Nursing and APRN stakeholders in April 2006 for feedback. A Joint
Dialogue Group consisting of representatives from the APRN
Consensus Work Group and the NCSBN APRN Advisory Panel convened to
craft one, consensus-based APRN regulatory document which would be
future-oriented and promote patient safety and public protection.
Report of the Joint Dialogue Group was agreed to by both
stakeholder groups and released on July 7, 2008. Slide 20 Boards of
Nursing Endorse Consensus Model through Model Documents
https://www.ncsbn.org/Article_XVIII_1.31.11.pdf Slide 21 NCSBN
Model Nurse Practice Act APRN Scope of Nursing Practice APRNs are
expected to practice as licensed independent practitioners within
standards established and/or recognized by the BON. Each APRN is
accountable to patients, the nursing profession and the BON for
complying with the requirements of this Act and the quality of
advanced nursing care rendered; for recognizing limits of knowledge
and experience; planning for the management of situations beyond
the APRNs expertise; and for consulting with or referring patients
to other health care providers as appropriate. Slide 22 APRNs are
accountable for: Health promotion Assessment, diagnosis, and
management of patient problems Which includes the use and
prescription of pharmacologic and non-pharmacologic interventions
Slide 23 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 Slide 24 An APRN is an
individual who has: 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 Slide 25 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 Slide 26 Slide 27
Slide 28 APRN Regulatory Model Nurse Anesthetist Nurse Midwife
Nurse Practitioner + Adult- Gerontology Womens Health/ Gender
Related Family/Individual Across lifespan NeonatalPediatrics
Psych/Mental Health Licensure occurs at Levels of Role &
Population Foci POPULATION FOCI APRN ROLES APRN Specialties 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 Clinical Nurse
Specialist ++ +The certified nurse practitioner (CNP) is prepared
with the acute care CNP competencies and/or the primary care CNP
competencies. At this point in time the acute care and primary care
CNP delineation applies only to the pediatric and adult-
gerontology CNP population foci. Scope of practice of the primary
care or acute care CNP is not setting specific but is based on
patient care needs. Program may prepare individuals across both the
primary care and acute care CNP competencies. If programs prepare
graduates across both sets of roles, the graduate must be prepared
with the consensus-based competencies for both roles and must
successfully obtain certification in both the acute and the primary
care CNP roles. CNP certification in the acute care or primary care
roles must match the educational preparation for CNPs in these
roles. ++The Clinical Nurse Specialist (CNS) is educated and
assessed through national certification processes across the
continuum from wellness through acute care. Slide 29 Slide 30 + The
Clinical Nurse Specialist (CNS) is educated and assessed through
national certification processes across the continuum from wellness
through acute care. Slide 31 just a few words about the clinical
nurse specialist role for those with blended and/or post- graduate
programs Slide 32 Slide 33 +Nurse Practitioner The certified nurse
practitioner (CNP) is prepared with the acute care CNP competencies
and/or the primary care CNP competencies. At this point in time the
acute care and primary care CNP delineation applies only to the
pediatric and adult-gerontology CNP population foci. Slide 34
+Nurse Practitioner Scope of practice of the primary care or acute
care CNP is not setting specific but is based on patient care
needs. Programs may prepare individuals across both the primary
care and acute care CNP competencies. Slide 35 +Nurse Practitioner
If programs prepare graduates across both sets of roles, the
graduate must be prepared with the consensus-based competencies for
both roles and must successfully obtain certification in both the
acute and the primary care CNP roles. CNP certification in the
acute care or primary care roles must match the educational
preparation for CNPs in these roles. Slide 36 For entry into APRN
practice and for regulatory purpose the APRN education must: Be a
formal accredited graduate or post-graduate certificate program in
an academic institution. The program must be comprehensive and on
the graduate level Be awarded pre-approval, pre-accreditation or
accreditation status prior to admitting students Prepare graduates
in one of four roles and in at least one of the population foci
Slide 37 For entry into APRN practice and for regulatory purpose
the APRN education must: Include at least three separate
comprehensive graduate level courses in the APRN core Advanced
Physiology/Pathophysiology Advanced Health Assessment Advanced
Pharmacology Slide 38 For entry into APRN practice and for
regulatory purpose the APRN education must: Provide basic
understanding of decision-making principles Ensure clinical and
didactic coursework is comprehensive to prepare the graduate to
practice in the APRN role and population foci Slide 39 More focused
area of practice than role and population foci Specialty
preparation cannot replace educational preparation in the role or
one of the six population foci Specialty preparation cannot expand
one s scope of practice beyond the role and population focus Slide
40 Addresses a subset of the population-focus Definition built on
ANA (2004) Criteria for Recognition as a Nursing Specialty The
title may not be used in lieu of the licensing title, which
includes the role and population Is developed, recognized and
monitored by the profession Slide 41 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 Slide 42 Boards of
Nursing 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 Slide 43
Boards of Nursing will: 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 License
APRNs as independent practitioners with no regulatory requirements
for collaboration, direction or supervision Slide 44 Boards of
Nursing will: 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
Slide 45 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 Slide 46 Accreditors will: Assess developing APRN
education programs and tracks by reviewing them using established
accreditation standards and granting pre-approval, 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
Slide 47 Foundational Requirements for Certification Certification
programs providing APRN Certification used for licensure will:
Follow established certification testing and psychometrically
sound, legally defensible standards for APRN examinations for
licensure Assess the APRN core and role competencies across at
least one population focus of practice Assess specialty
competencies separately from the APRN core, role and population
focused competencies ( example: Adult- Gerontology CNS and Oncology
CNS will take two separate certification examinations ) Slide 48
Foundational Requirements for Certification Certification programs
providing APRN Certification used for licensure will: Be accredited
by a national certification accreditation body (ABNS or NCCA; role
of NCSBN APRN Committee) Enforce congruence between the education
program and the type of certification examination - exam name
matches transcript Slide 49 Key Elements - Certification
Educational eligibility requirements met: 3 Ps Required number of
didactic courses in population focus Sufficient supervised clinical
hours in population focus Educational program prepared graduate to
be eligible to sit for the nationally recognized certification that
corresponds to the APRN role and population focus for which the
student was prepared in the program. Degree awarded on transcript
matches examination name Slide 50 APRN educational programs/tracks
leading to eligibility for a APRN license will: Follow established
educational standards and ensure attainment of the APRN core, role
core and population core competencies Be accredited by a nursing
accrediting organization that is recognized by the U.S. Department
of Education and/or the Council for Higher Education Accreditation
Slide 51 APRN educational programs/tracks leading to eligibility
for a APRN license will: Be pre-approved, pre-accredited, or
accredited prior to the acceptance of students, including all
developing APRN education programs and tracks Ensure that graduates
of the program are eligible for national certification and state
licensure Ensure that official documentation (e.g. transcripts)
specifies the role and population focus of the graduate Slide 52 RN
Licensure Model Initial licensure is based on a combination of
individual jurisdictional requirements (criminal background, good
moral character, etc.), prescribed educational qualifications and
successful completion of national examination. Depending on
statutory authority, Board of Nursing may or may not perform
individual approval of pre-licensure educational programs. Five
individual state boards of nursing are separately recognized as
accrediting agencies by the U.S. Department of Education. Some
jurisdictions consider approval of educational programs an
accountability that may not be delegated to another entity; not all
Boards of Nursing have statutory oversight of APRN educational
programs, and not all APRN programs are located within schools of
nursing. Slide 53 RN Licensure Model All US Boards of Nursing
utilize the NCLEX-RN examination. Boards are afforded the option to
periodically review NCLEX- RN exam forms for compliance with their
state practice acts. Board members and staff may participate as
volunteers on NCSBN examination committees and Boards nominate
NCLEX item writers and exam development committee members, so in
this way are active participants and stakeholders in their
licensure exams. Changes to the passing standard must be approved
by the NCSBN Board of Directors. Changes in exam fees, test plans
and eligibility requirements are determined by the NCSBN Delegate
Assembly. Slide 54 Its a Whole New Ballgame Certification
examinations become high stakes exams with accompanying legal
vulnerabilities. Certifiers enter into agreements with individual
Boards of Nursing as Boards delegate state authority for assuring
educational eligibility. Graduate faculty are now accountable for
preparing students for professional licensure examinations where in
many instances this had not previously been the case (mostly CNS
programs and other APRN types in states where national
certification is not required for practice). Slide 55 Its a Whole
New Ballgame Career mobility, tele-health initiatives, interstate
ACOs, delayed retirement and consulting opportunities increase the
likelihood that APRNs may need to qualify for licensure in other
jurisdictions throughout the course of their careers, making it
essential that all educational eligibility requirements are met,
fully documented, and that documentation is retained for future
use. Educational eligibility requirements vary from vague to
extremely detailed, depending on the jurisdiction; graduates must
be qualified for licensure in any state, not just the state in
which they are educated. Slide 56 Why Does It Matter? What
difference does it make whether or not a is a CNS is categorized as
an APRN in my state, as long as I have title protection? Employment
opportunities Reimbursement Salary Slide 57 Regulatory Sufficiency
For a licensure or certification examination to meet the standards
for regulatory sufficiency, it must meet the following criteria: 1.
1.Be targeted to entry level practice 2. 2.Measure only job-related
knowledge, skills, and abilities 3. 3.Require demonstration of
competence at the minimum level necessary for safe and effective
practice 4. 4.Be psychometrically sound Slide 58 Get with the
Guidelines AACN-Colleges Masters or Doctoral Essentials NCSBN
Criteria for APRN Certification Programs Adult-Gerontology Clinical
Nurse Specialist Competencies AACN Critical-Care Scope &
Standards of Practice for the Clinical Nurse Specialist in Acute
and Critical Care Other Population-based or Specialty-focused Scope
& Standards documents Slide 59 Get with the Guidelines National
Consensus Core CNS Competencies NACNS Criteria for the Evaluation
of Clinical Nurse Specialist Masters, Practice Doctorate, and Post-
Graduate Certificate Educational Programs State Nurse Practice Acts
and Administrative Rules AACN Certification Corporation
Adult-Gerontology, Pediatric and Neonatal Acute Care Clinical Nurse
Specialist Job Analyses and Test Plans and/or American Nurses
Credentialing Centers Adult-Gerontology and Pediatric Clinical
Nurse Specialist Job Analyses and Test Plans when available. Slide
60 Adult-Gerontology CNS Competencies Slide 61 New CNS Resource
Docs Slide 62 Consensus Model Based CNS Examinations and Test Plans
Slide 63 Moving Forward How Do I Get From Here to There? Adult
Acute and Critical Care CNS Adult-Gero Acute Care CNS Slide 64 What
Do I Have to Take? From NONPF NP NTF Criteria: (exemplar) III.F
Post-masters students must successfully complete graduate didactic
and clinical requirements of a masters NP program through a formal
graduate level certificate or masters level NP program in the
desired area of practice. Post- masters students are expected to
master the same outcome criteria as masters NP students. Post-
masters students who are not already NPs are required to complete a
minimum of 500 supervised clinical hours. Slide 65 What Do I Have
to Take? Special consideration should be given to NPs expanding
into another NP population-focused area of practice by allowing
them to challenge selected courses and experiences; however,
didactic and clinical experiences shall be sufficient to allow the
student to master the competencies of the new area of NP practice.
These students must complete a sufficient number of clinical hours
to establish competency in the new population-focused area of
practice.. Programs should be able to document waivers and
exceptions for individual students through a gap analysis. Slide 66
NTF Criteria Appendix F Slide 67 What Do I Have to Take? From NACNS
Criteria for the Evaluation of Clinical Nurse Specialist Masters,
Practice Doctorate, and Post-Graduate Certificate Educational
Programs: Post-graduate certificate program graduates are expected
to meet the same CNS competencies as masters or practice doctorate
program graduates. Evidence that validates a minimum of 500
clinical (clock) hours in the masters and post-graduate certificate
CNS program. Slide 68 New Exam Timeline AACN Certification
Corporation Adult-Gerontology, Pediatric and Neonatal
wellness-through- acute care CNS Analyses completed and Test Plans
posted at http://www.aacn.org/WD/Certifications/Content/APRN-CNS-
Program-Resources.pcms?menu=certification Pilot testing of the new
examinations will begin with selected groups of senior students
begins in February 2013. New exam release scheduled for June 2013
with instant scoring if sufficient numbers of pilot testers are
recruited. Current Adult, Pediatric and Neonatal CCNS exams will be
administered through December 31, 2014. Current CCNS credential
will be maintained as long as there are current certificants in
practice who require it. Slide 69 Slide 70 1. 1.What do the
Consensus Model for APRN Regulation and the AACN-Colleges DNP
Initiative have in common? 2. 2.What are the components of a
certification examination which ensure regulatory sufficiency? 3.
3.What steps would a currently-certified Adult Acute/Critical Care
Nurse CNS take to become nationally certified as an
Adult-Gerontology Acute Care Nurse CNS? 4. 4.When will the Boards
of Nursing begin to require the DNP to take the certification
exams? Slide 71 Audience Questions Slide 72 Contact Us Please let
us know if you would like more information, have suggestions for
us, or would like to get involved as we relentlessly communicate
details and updates about the implementation of the Consensus Model
for APRN Regulation. AACN Certification Corporation (800) 899-2226
or [email protected]@aacn.org
