1. 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

2. 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?

3. 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 Lack of common legal recognition across jurisdictions e.g. Less than 30 states recognize or title protect CNS; not all states license/authorize CRNA same as NP

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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)

10. 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.

11. 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.

13. 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.

14. Relationship between Educational Competencies, Licensure and Certification APRN Role Specialty Competencies Specialty Certification * Licensure: based on Education And certification** Identified by Professional Organizations (e.g. oncology, palliative care, CV) Measures of competencies CNP, CRNA, CNM, CNS in Population context APRN Core Courses: Patho/phys, Pharmacology, physical/health assess Population Foci

15. 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.

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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.

22. 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.

23. 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?

24. Thank you. Lisa.Summers@ana.org 301-628-5058 www.nursingworld.org Lisa.Summers@ana.org