Defining the Future of Nursing: THE APRN CONSENSUS MODEL

BY LINDA SULLIVAN, DSN, FNP-BC, PNP-BC
Director of Advanced Practice, Mississippi State Board of Nursing

The APRN Consensus Model for practice for advanced practice nurses (APRNs) was approved in the summer of 2008, endorsed by more than 40 professional nursing agencies in 2009 and whose plans for enactment in 2015 are now under way.  The National Council of the State Boards of Nursing is busily readying for the changes that will be related to the adoption of this model as well.  This comprehensive model will have far reaching implications for licensing boards, accreditation agencies, certification agencies and educational programs. The model came about because of a lack of common definitions related to the APRN role, lack of standardization of programs preparing APRNs, a proliferation of specialties and subspecialties and the lack of common legal recognition across jurisdictions.  The benefit of this model is that it will facilitate the mobility of APRNs from state to state, ensure the public safety by providing a model for standardization, increase access to health care and that it advocates appropriate scope of practice for specific training.

In the new APRN Model, there are four roles which include certified registered nurse practitioner, certified nurse midwives, certified registered nurse anesthetist and clinical nurse specialist.  These four roles will all be identified by the title of APRN.  There are four arms of the APRN’s underlying preparation to consider when examining this model, and they include licensure, accreditation, certification and education. Each of these has specific requirements and standards that must be met in order to adhere to the model.

Boards of nursing will be required to license APRNs in one of four roles with a population focus, and these boards will be solely responsible for this licensure except in those few states where midwives are licensed by the board of midwifery only.  Only graduates from an accredited program can be licensed, and national certification will be required nationwide.  Licenses will only be granted when preparation and certification are congruent.  There will be no temporary licenses granted in any state.
In addition, boards of nursing may license APRNs as independent practitioners with no regulatory requirements for collaboration, direction or supervision in those states that allow such.  Boards of nursing can provide a mechanism for grandfathering that will allow those APRNs currently licensed to continue to do so without having to meet new eligibility requirements, and APRNs will continue to have an option for compact licensure. Each state board of nursing must have at least one APRN representative position on the board and utilize an APRN advisory committee that includes representatives from all four APRN roles.

Accreditors will be responsible for the evaluation of all graduate and post graduate programs with an emphasis on the APRN, role and population core requirements. Each accrediting agency must also include an APRN visiting team when reviewing APRN programs, and continued monitoring of these throughout the accreditation period must also be assured.

Certification agencies must establish psychometrically sound testing that has legally defensible standards for APRN examinations for licensure, assess APRN core and role competencies across at least one population focus of practice, and assess specialty competencies separately from the APRN core, role and population foci.  This certification exam must require congruence between education and the type of exam a person is eligible to take, provide a mechanism for ongoing competence and maintenance of certification, participate in a relationship with boards of nursing that make his/her processes transparent, and finally he/she must participate in a mutually agreeable mechanism to ensure communication with the board of nursing at all times.

Educational programs will be required to adhere to the requirement of the model in their approach to education.  In order to have a track eligible for APRN license in any state, some educational programs will need to make changes in their curriculum so as to meet the standardization required nationally by the model.  These changes will include establishing a means to ensure attainment of the APRN core, role core and population core competencies.  Each program must be nationally accredited in order for its graduates to be eligible for licensure.  Each program must include at a minimum three separate, comprehensive graduate-level courses (the APRN Core) in:
•    Advanced physiology/pathophysiology, including general principles that apply across the lifespan;
•    Advanced health assessment, which includes assessment of all human systems, advanced assessment techniques, concepts and approaches; and
•    Advanced pharmacology, which includes pharmacodynamics, pharmacokinetics and pharmacotherapeutics of all broad categories of agents.
Additional content, specific to the role and population, in these three APRN core areas should be integrated throughout the other role and population didactic and clinical courses.  These courses must:
•    Provide a basic understanding of the principles for decision making in the identified role;
•    Prepare the graduate 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; and
•    Ensure clinical and didactic coursework is comprehensive and sufficient to prepare the graduate to practice in the APRN role and population focus.

Preparation in a specialty area of practice is optional, but if included must build on the APRN role/population-focus competencies. Clinical and didactic coursework must be comprehensive and sufficient to prepare the graduate to obtain certification for licensure in and to practice in the APRN role and population focus.  Programs will be held to a higher standard and will be evaluated in a more comprehensive way.  This increased evaluation will ultimately produce better prepared graduates who have similar preparation regardless of which program they have attended.  The ultimate goal of adoption of the model is to promote patient safety and public protection and congruity among programs across the nation.

For Mississippi, adoption of the model will take place in 2015 as scheduled, and educational programs will need to begin the processes needed to comply with preparation standards.  Students applying to graduate programs will need to be aware if the standards are being met in a program so as to ensure their eligibility for sitting for certification examinations and ultimately receiving licenses to practice.  The matter of grandfathering is currently being adopted by nearly all the states, and it is anticipated that Mississippi will follow suit with this as well, but ultimately this decision will rest with the board members.  
Standardization of educational programs, licensure and accreditation practices and uniform student preparation is essential so as to produce the highest level graduate and to add credibility to our profession. It actually creates an added layer of protection for the public by ensuring standardization of education, credentialing and certification across the 50 states.  Hopefully all agencies and educational programs in the state will welcome this model which has been a long time coming! •

Reprinted with permission from the Mississippi Board of Nursing.