The Consensus Model of APRN Regulation, LACE how we got here where we are going. Maureen Cahill

Transcription

1 The Consensus Model of APRN Regulation, LACE how we got here where we are going Maureen Cahill

2 Collaborative practice to advanced practice, an evolution Evolved in separate silos Lack of common definitions Lack of common legal recognition across jurisdictions Lack of standardization in programs preparing APRNs Lack of legal recognition and role definitions Cross over between roles

3 Benefits of Consensus if it works Facilitates mobility Ensures public safety Increases access to health care Advocates appropriate scope of practice Decrease the existence of silos Allows the profession to meet the health Care needs of populations

4 Which roles? APRN Direct Care Component 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

5 Broad based education For entry into APRN practice and for the purpose of licensure, the APRN education must: Be a formal accredited graduate or post-graduate certificate program in an academic institution. 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

6 Broad based education APRN education must also: Include three separate comprehensive graduate level courses in the APRN core Advanced Physiology/Pathophysiology Advanced Health Assessment Advanced Pharmacology 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

7 APRN Specialty 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 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

8 The role of the boards of nursing The Boards of Nursing (Licensure) will License APRNs in one of four roles with a population focus Be solely responsible for licensing (exception for states where boards of midwifery regulates nurse-midwives and midwives) Only license graduates of accredited graduate programs 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

9 The boards will License APRNs as independent practitioners with no regulatory requirements for collaboration, direction or supervision 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

10 LACE licensure action coalitions accreditation education certification

11 The NCSBN APRN Maps Project; Outlining Progression in Adopting Consensus Stephanie Fullmer and Maureen Cahill

12 Comparison and Mapping Project Process Reviewed each jurisdiction s act and rules Compared current law with components of the Consensus Model Sent each BON a comparison report Compiled maps based on reports and BON feedback

13 APRN Requirements Consensus Model Title Roles Recognized Education Certification Licensure Practice Autonomy Prescriptive Authority Advanced practice registered nurse (APRN) Certified registered nurse anesthetist (CRNA) Certified nurse midwife (CNM) Clinical nurse specialist (CNS) Certified nurse practitioner (CNP) Graduate degree or post graduate certificate National Certification State grants APRN license separate from RN license Independent Independent: pharmacologic and nonpharmacologic

14 Definitions Independent - no requirement for a written collaborative agreement, no supervision, no conditions for practice Collaborative - a written agreement exists which specifies scope of practice and medical acts allowed with or without a general supervision requirement by a MD, DO, DDS, podiatrist Supervised - direct supervision required in the presence of a licensed, MD, DO, DDS, podiatrist with or without a written practice agreement

15 Let s see the maps! Maps //

16 2012 APRN Maps; Outlining Progression in Adopting Consensus

17 Consensus is definitely not a sprint, but, if this were the marathon, we would already be at mile 17!