AACN Semiannual Meeting November 2, 2009 Joan Stanley, PhD, CRNP, FAAN

1. Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and EducationImplications for AACN Member Schools AACN Semiannual Meeting November 2, 2009 Joan Stanley, PhD, CRNP, FAAN Senior Director of Education Policy

2. APRN Consensus Process • March 2004 – AACN & NONPF submitted proposal to Alliance for APRN Credentialing • June 2004 - APN Consensus Conference convened; 32 organizations participated • October 2004 – APN Work Group charged with developing future model for APN • Work group convened 16 days Oct 2004 and July 2007 • AACN & ANA co-hosted 3 larger Consensus mtgs during same timeframe (> 70 org.) • Feb 2006- NCSBN APRN Committee disseminated draft APRN Vision Paper

3. APRN Consensus Process • Jan 2007 – APRN Joint Dialogue Group formed, included 7 representatives from Work Group and NCSBN APRN Committee • Initial goal was to develop 2 complementary papers • Goal eventually became 1 joint paper which reflected work of both groups • Outcome was Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education (July 2008) • To date 45 national nursing organizations have endorsed the Model; AACN Board endorsed July 2008 • Work Group & Joint Dialogue groups continue to meet to work towards implementation

4. Implementation of Model • June 2009 - Teleconference held for leadership of all endorsing organizations • Development of electronic network to support implementation of LACE • Ensure transparent and ongoing communication among LACE entities • Provide a platform for the ongoing work • LACE not a formal, separate organization • Based on social networking principles

5. Implementation of Model • Implementation has begun among all LACE entities • Consensus Work Group mtg. early October – every participating organization reported actions taken to date, issues identified,& impact on other LACE components • Timeline: • State Boards of Nursing will have regulations and/or legislation enacted by 2015 • APRN education programs will be transitioned by 2012 • Certification examinations will be transitioned by 2012 - 2013

6. Implementation of Model • Examples: • NCSBN House of Delegates August 2008 overwhelmingly passed APRN Model Act/Rules and Regulations • Developing resources/materials for boards • Monthly networking call • Certification organizations have begun analyzing exams to determine changes needed; changing program review and documentation processes • ACNM Certification Board will require recertification for all CNMs by 2011; moving to require master’s degree, and accreditation Board now reviewing all programs for 3 P’s • COA reviewing all programs for 3 P’s • CCNE Board agreed to initiate development of pre-approval process for new NP and CNS programs • CCNE Board agreed to initiate development of accreditation process for post-graduate certificate APRN programs

7. Consensus Model • Establishes clear expectations for licensure, accreditation, certification, and education for ALL APRNs. • Defines 4 roles: CRNA, CNM, CNS, CNP • Legal titling • APRN, CRNA • APRN, CNP or APRN, Family CNP

8.  APRN REGULATORY MODEL POPULATION FOCI Family/Individual Across Lifespan Adult- Gerontology Women’s Health/Gender- Related Psychiatric-Mental Health Neonatal Pediatrics APRN SPECIALTIES Focus of practice beyond role and population focus linked to health care needs Examples include but are not limited to: Oncology, Older Adults, Orthopedics, Nephrology, Palliative Care Licensure occurs at Levels of Role & Population Foci        APRN ROLES Nurse Anesthetist Nurse- Midwife Clinical Nurse Specialist Nurse Practitioner

9. Implications for APRN Education Programs • Timeline for education programs to transition is 2012 ! • All new APRN programs/tracks must be pre-accredited prior to admitting students • All post-graduate certificate APRN programs will need to be accredited. • Transcript must: • Identify APRN role and population focus of the graduate • Say that individual completed requirements for a post-graduate certificate in role/population • Name the 3 P courses

10. APRN Curriculum • Curriculum must include APRN Core = 3 P’s (separate graduate level courses); competencies in Master’s Essentials & DNP Essentials • Nationally recognized role competencies (CRNA, CNM, CNS, or CNP) • For CNS: National consensus-based core competencies for CNSs currently out for endorsement and finalization of document. • For CNP: NONPF NP core competencies • Population-focused competencies for role • Each role must include preparation across the health wellness-illness continuum – emphasis on either end of continuum will vary by role

11. Competencies Measures of competencies Identified by Professional Organizations (e.g. oncology, palliative care, CV) Specialty Certification* Specialty Population Foci CNP, CRNA, CNM, CNS in the Population context Licensure: based on education and certification** Role APRN Core Courses: Patho/physiology, Pharmacology, Health/Physical Assessment APRN * Certification for specialty may include exam, portfolio, peer review, etc. ** Certification for licensure will be psychometrically sound and legally defensible examination by an accredited certifying program,

12. APRN Core: 3 P’s • APRN Core: 3 P’s (separate graduate level courses) • Advanced physiology/pathophysiology, including general principles that apply across the lifespan; (lifespan is defined as conception through old age including prenatal and death). • Advanced health assessment, which includes all systems and advanced techniques. • Advanced pharmacology, which includes …. all broad categories of agents.

13. Adult-Gerontology Population • All NP or CNS programs preparing individuals to provide care to the adult or the gerontology populations must merge or expand programs so graduates are prepared with enhanced competencies to care for entire adult population (young adult thru older adult as well as frail elderly!) • Adult Health CNS, Acute and Critical Care CNS – Adult, Gerontology CNS, Medical-Surgical CNS • Adult NP, Gerontology NP, Adult Acute Care NP • AACN leading JAHF-funded initiative to develop Adult-Gerontology Competencies for NPs & CNSs, anticipated completion by March 2010

14. Psychiatric/Mental Health CNS or CNP • Under the new Model, all CNPs or CNSs prepared with a population focus in psychiatric/mental health must be prepared across the lifespan. • Population-focused competencies being looked at by APNA and ISPEN

15. National APRN Certification • All APRNs must be nationally certified by a recognized, accredited certifying body • Education programs must prepare graduates for national certification in role/population • For licensure, individuals must be certified in the role/population which matches education program • NP Certification organizations have stated that all NP programs must meet National TF Criteria (2008) for graduates to sit for certification

16. Specialty NP or CNS Programs • All programs must prepare graduates to sit for national certification in the role + one population! • Clinical and didactic coursework must be comprehensive in role + population • Preparation in a specialty area is optional, e.g. oncology, palliative care, cardiology – these are regulated by the profession & assessed through specialty certification.