The New APRN Regulatory Model: Defining the Future of Advanced Practice Nursing

The recently endorsed Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education provides a definitive foundation for nurses who want to pursue an advanced practice credential.

Problems with existing regulation included lack of common definitions related to APRN roles, lack of standardization in programs leading to APRN preparation, proliferation of specialties and subspecialties and lack of common legal recognition across jurisdictions. The development of the new regulatory model sought to alleviate these problems and at the same time enhance patient safety, improve consumer understanding of APRN roles, provide ease in regulation and promote interstate mobility of APRNs.

The comprehensive document has far-reaching impact on licensing boards, accreditation agencies, certification organizations and educational programs. Following are some of the significant highlights of the new model.

Overview

• The new Consensus Model defines four APRN roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS) and certified nurse practitioner (CNP). These four roles are given the title of advanced practice registered nurse (APRN).
• Education, certification and licensure of an individual must be congruent in terms of role and population foci. NP and CNS programs are held to the same accreditation criteria; for example, a graduate of an acute care NP or CNS program would be expected to provide a transcript documenting both comprehensive didactic and clinical education in acute care APRN practice in order to qualify to take an acute care NP or CNS certification and qualify for acute care NP or CNS APRN status by a Board of Nursing. A student may not substitute didactic education in an adult program and clinical practice in an acute care setting for the educational requirements and be qualified for an acute care certification exam, or vice versa. If a certification organization were to allow this, it would violate both the National Council of State Board of Nursing (NCSBN) Criteria for APRN Certification Examinations and agreements which the certification agency has entered into with each Board of Nursing that agreed to approve that APRN certification exam as a proxy measure for APRN designation.
• The term "critical care" does not appear in the new regulatory model. AACN and the AACN Certification Corporation believe that "critical care" is inseparable from "acute care" and that patient needs must govern competencies when APRNs care for acutely and/or critically patients. Therefore, in order to fulfill the organizational missions of patient safety and optimal nursing care, AACN and AACN Certification Corporation established a strong advocacy position to preserve the role of the acute care nurse practitioner as a regulated APRN and to ensure that all clinical nurse specialists would be educated, evaluated and regulated through acute care competencies.

Education

• The model calls for all APRNs to be educated in an accredited graduate-level education program in one of the four roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related or psych/mental health.
• Adult-gerontology - The population focus adult-gerontology encompasses the young adult to the older adult, including the frail elderly. APRNs educated and certified in the adult-gerontology population are educated and certified across both areas of practice and will be titled Adult-Gerontology CNP or CNS. In addition, all APRNs in any of the four roles providing care to the adult population, e.g., family or gender specific, must be prepared to meet the growing needs of the older adult population. Therefore, the education program should include didactic and clinical education experiences necessary to prepare APRNs with these enhanced skills and knowledge.
• The defining factor for all APRNs is that a significant component of the education and practice focuses on direct care of individuals
• All APRNs must be educationally prepared to assume responsibility and accountability for health promotion and/or maintenance as well as the assessment, diagnosis and management of patient problems, which includes the use and prescription of pharmacologic and non-pharmacologic interventions whether or not an APRN later chooses to gain prescriptive authority.
• An educational program may to 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.

Certification

• All APRNs must pass a national certification exam that measures APRN role and population-focused competencies. APRNs will be required to maintain continued competence as evidenced by recertification in the role and population through a national certification program.
• APRN practice builds on the competencies of registered nurses (RNs) by demonstrating a greater depth and breadth of knowledge, a greater synthesis of data, increased complexity of skills and interventions and greater role autonomy. It is important to note that performing a nursing assessment and establishing a nursing diagnosis are delineated as being within the scope of practice of the Registered Professional Nurse in most Nursing Practice Acts and in the NCSBN Model Practice Act.
• Under the new APRN regulatory model all CNSs will be educated and assessed through national certification processes across the continuum from wellness through acute care.

Licensure

• Advanced practice registered nurses will be licensed independent practitioners who are expected to practice within standards established or recognized by a licensing body. Licensure will be required because these APRNs will be practicing in a role beyond that of the Registered Professional Nurse.
• The terms "primary care" and "acute care" apply to patient needs and competencies of Nurse Practitioners — not to geographic or patient-care settings.
• The certified nurse practitioner (CNP) may be educated as an acute care CNP or a primary care CNP. Or, an individual may choose to obtain both certifications, but would be required to obtain two complete and separate certifications. 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. In other words, the acute care CNP does not practice only in what is traditionally considered to be an acute care geographic setting such as an intensive care unit or an acute care hospital, but may practice wherever acute care patients are found. The same is true for the primary care CNP; the primary care CNP practices wherever patients in need of primary care are physically located.
• APRNs may specialize, but licensure will not be granted within a specialty area. Specialties can provide depth in one’s practice within the established population foci. Examples of specialties include, but are not limited to, oncology, orthopedics, nephrology, palliative care and cardiology.