FAQs: APRN Consensus Model for Clinical Nurse Specialists

About the Consensus Model for APRN Regulation

What is the APRN Consensus Model?

The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education is a broad-based model for regulation of advanced practice registered nurses (APRNs) throughout the United States. The model was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee, with extensive input from APRN stakeholders.

It addresses:

  • Lack of common definitions of APRN roles.
  • Lack of standardization of APRN education programs.
  • Proliferation of APRN specialties and subspecialties.
  • Lack of common legal recognition of APRNs across states.

Intended outcomes are to:

  • Ensure public safety.
  • Facilitate mobility of APRNs.
  • Advocate for the appropriate scope of practice.
  • Increase access to healthcare.

What APRN roles are defined under the Consensus Model?

The Consensus Model defines four APRN roles:

  • Clinical Nurse Specialist (CNS)
  • Certified Nurse Practitioner (CNP)
  • Certified Nurse Midwife (CNM)
  • Certified Registered Nurse Anesthetist (CRNA)

When will the Consensus Model go into effect?

The target date for full implementation of Consensus Model recommendations is by 2015.

Clinical Nurse Specialists and Their Scope of Practice

What are the educational requirements for new CNSs under the Consensus Model?

New CNSs will be required to be educated and their competencies assessed via national certification exams, across the continuum from wellness through acute care in one of six population foci:

  • Adult-gerontology (entire adult population: young adults, older adults, the frail elderly)
  • Pediatric
  • Neonatal
  • Psych/mental health
  • Family/individual across the life span
  • Women’s health/gender-related
     

Education, certification, licensure and practice of an individual nurse must be congruent in terms of both role and population foci.

How will the Consensus Model affect the scope of practice of CNSs?

The Consensus Model language does more to broaden than to limit CNS scope of practice. Under the Consensus Model, all CNSs, regardless of population focus, will be required to attain the knowledge, skills and abilities to care for patients across the continuum from wellness through acute care.

Included within the term acute care are the competencies to care for patients who require complex monitoring and therapies, high-intensity advanced practice nursing intervention and continuous vigilance within the full range of high acuity and critical care.

Why isn’t critical care noted in the Consensus Model?

The Consensus Model encompasses acute care, requiring that CNSs be educated and their competencies assessed via national certification exams, across the continuum from wellness through acute care. While it is not specifically called out in the Consensus Model, critical care falls under the larger umbrella of acute care.

Acute care refers to the care provided to acutely ill patients. The term acute care, while sometimes misunderstood, does not apply to all hospitalized patients.

Will AACN’s “Scope and Standards for the Clinical Nurse Specialist in Acute and Critical Care” be updated to align with Consensus Model recommendations?

Yes. AACN’s “Scope and Standards for the Clinical Nurse Specialist in Acute and Critical Care” was published in 2010, and is currently being updated.

The update aligns CNS scope and standards with Consensus Model language, while also addressing other changes in the healthcare environment since the last edition was published. The key updates are as follows:

  • Allows maximum flexibility for CNS nursing practice to evolve over time by clarifying the wide range of patient care environments CNSs can work in
  • Expands adult population competencies to include geriatric content
  • Incorporates the CNSs’ role to facilitate patient transitions across a complex environment for optimal patient outcomes
  • Integrates the translation of evidence into nursing practice
     

The publication “Scope and Standards for the Clinical Nurse Specialist in Acute and Critical Care” has been renamed “Scope and Standards for the Clinical Nurse Specialist in Acute Care.”

The name of this publication — and AACN’s new AACNS certifications — were changed to align with the language adopted by the consensus process and to avoid any confusion among regulators and other stakeholders that would impede licensure for AACNS certificants.

Critical care sits under the umbrella of acute care in the Consensus Model. The CNS competencies are as comprehensive as before, and the patient care problems are the same.

Does the Consensus Model affect CNSs ability to work in critical care?

No. The umbrella of acute care, under which critical care falls, includes any environment in which patients have care requirements that include complex monitoring and therapies, high-intensity advanced practice nursing intervention and continuous vigilance within the full range of high acuity care.

Acutely ill patients may be found in areas such as emergency departments, progressive care units, critical care units, heart failure clinics — those at the higher end of the continuum of wellness to acute care. The term acutely ill refers more to the acuity of the patient, not a specific geographical area.

Will a DNP be required for advanced practice licensure in 2015?

The Consensus Model does not require or exclude the DNP as an entry-level option for APRNs.

The Consensus Model and AACN Certification

Has AACN Certification Corporation revised its CNS certification exams to comply with the Consensus Model?

AACN Certification Corporation completed a study of practice and developed new CNS exams to align with the population foci defined in the Consensus Model:

  • ACCNS-AG Adult-Gerontology CNS (wellness through acute care). Launched July 2013
  • ACCNS-P Pediatric CNS (wellness through acute care). Launched July 2013
  • AACNS-N Neonatal CNS (wellness through acute care). Launching February 2014
     

These new credentials will be awarded to those meeting the population-specific educational eligibility requirements and passing the corresponding certification exam.

If the scope for the new ACCNS exams is wellness through acute care, why is only acute care called out in the credential?

Acute care was retained in the credentials to help ensure protection of the most medically fragile patients by making it explicitly clear to employers, regulators and others that the credential-holder is qualified to care for both acutely ill and less-acute patients.

Are both the CCNS and ACCNS considered acute and critical care certifications?

Both CCNS and ACCNS credentials indicate the CNS has the competencies to care for acutely and critically ill patients. The scope of practice for the ACCNS includes additional competencies in wellness.

How the Consensus Model Affects Current CCNS Certificants

How will the Consensus Model affect AACN’s current CCNS certification program?

Anyone wishing to take the CCNS initial exam needs to apply to test by Dec. 31, 2014. After that date, candidates will not be able to register to take these initial exams.

Current CCNSs may continue to renew their certification into the future, as long as it does not lapse and renewal requirements are met. If you allow your CCNS certification to expire, you will need to meet the eligibility requirements for one of the new ACCNS exams (ACCNS-AG, ACCNS-P or AACNS-N).

Current CCNS certificants interested in the new ACCNS certifications most likely will need additional postgraduate education to be eligible to sit for the new ACCNS exams. However, to provide current CCNSs every opportunity to renew, AACN offers CCNSs three renewal options:

  • Practice Hours + CNEs
  • Practice Hours + Renewal Exam
  • CNEs + Renewal Exam

Will my state continue to recognize my current CCNS certification for APRN licensure?

States that currently recognize CCNS certification for advanced practice licensure should continue to do so; however, this will be a state-by-state decision. CNSs are encouraged to contact their state board of nursing for clarification on the continuation of their practice under the Consensus Model.

The Consensus Model states, “Boards of nursing will institute a grandfathering* clause that will exempt those APRNs already practicing in the state from new eligibility requirements.”

*Grandfathering is a provision in a new law exempting those already in or a part of the existing system that is being regulated. When states adopt new APRN licensure eligibility requirements, currently practicing APRNs will be permitted to continue practicing within the state(s) of their current licensure.

Will AACN Certification Corporation grandfather current CCNS certificants into the new ACCNS certifications?

No. While individual states may grandfather nurses currently working in the role, making them exempt from new requirements, national certification accreditation standards prohibit AACN Certification Corporation from grandfathering current certificants into the new credentials. Current CCNS certificants interested in the new ACCNS certifications most likely will need additional postgraduate education to be eligible to sit for the new ACCNS exams.

What if the board of nursing in my state does not recognize the CNS role for advanced practice licensure?

If you practice in a state that does not currently recognize the CNS role, we strongly urge you to contact your board of nursing to inquire about its plans for implementation of the Consensus Model, which recognizes the CNS as an APRN role. To contact your state board, visit www.ncsbn.org/contactbon.htm.

What if I am not currently certified but am practicing as a CNS?

We recommend that you get certified as soon as possible. APRN certification eligibility requirements are based exclusively on educational preparation. You are more likely to be eligible to test under current CCNS criteria as opposed to the new ACCNS criteria defined under the Consensus Model.

If you do not meet current educational eligibility requirements, makeup coursework must be completed in a postgraduate or doctorate program. Candidates must apply for the CCNS initial exam by Dec. 31, 2014.

As a CNS, what can I do to be prepared for implementation of the Consensus Model?

AACN Certification Corporation recommends the following:

  • Keep your certification current; don’t let it lapse.
  • Stay connected to AACN for the latest updates on Consensus Model implementation.
  • Monitor what is happening in your state and, as needed, advocate for recognition/protection of your APRN role.

 

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