Consensus Model for Practice, Education and Licensure

1. Consensus Model for Practice, Education and Licensure Presented by Louisa Golay, Julia Jennings, Krystal Morris & Stephanie Swiercinsky

2. Problem Identification • Nursing roles must be structured and marketed in a way that best meets the need of patients, families, and communities. • Role delineation among care providers is both critical and challenging. • In the nursing profession, one of the most important challenges is clarifying the role of nurses in advanced practice

3. Social Background • Increasing demand for accountability in the primary care setting. • Primary care competencies and education are serving as a framework to ensure APNs abilities. • APNs need to remain committed to health as a basic social value.

4. Economic Background • Health promotion and disease prevention programs are essential health services. • Nurse-run centers and academic community outreach have been found to decrease costs and improve the vulnerable populations’ reports of health

5. Ethical & Legal Background • The Federal government has supported APNs in response to community requirements for access to affordable, quality health care and the specialize nursing requirements of complex patients. • The USA has a large range of expanded and extended nursing roles that vary considerably state by state, but all claiming to be advanced practice. • Multiple challenges arise when evaluating how APNs may be credentialed. • APNs must recognize that healthcare fraud is occurring

6. Political Background • No clear agreement regarding how the role of an APN is defined exists • International Council of Nurses (ICN) launched an International Nurse Practitioner/Advanced Practice Network (INP/APNN) in 2000 • INP/APNN organization defined APN • The emergence of APNs requires a healthcare environment that treasures multidisciplinary efforts and the unique contribution of APNs in improving access to care particularly in a cost containment era for health care

7. Issue Statement Evaluations of the APN role suggest that nursing contributions lead to a high level of patient satisfaction. The expectation of nurses is to maintain and further develop their professional status. Debates regarding the implications of the advanced practice nursing role and terminology used in describing the scope of the role are crucial to the profession. How should the credentials of a APN be evaluated for appropriate fit?

8. Stakeholders • Patients • Hospitals • Insurance companies • Physicians • Academic programs • Nursing profession

9. Policy Objectives Goal:Ensure standardized credentialing, licensing, and education amongst APNs nationwide. * Scope of practice consistent allowing a common identity. 5 Objectives Obtaining Standardization ANPs nationwide 1. Promoting DNP movement/increasing clinical hours 2. Developing nationwide standardized credentials 3. Expansion of physical assessments & clinical competency NP programs 4. Successful collaboration amongst APNs & other stakeholders. 5. Application of concept of a unified APN identity is theoretically valid.

10. Policy Alternatives • How should the credentials be evaluated for appropriate fit? • 1. Standard do nothing… • State policies govern APNs in 50 different styles. • Rules of authority to autonomy to highly restrictive limits. Major change possibility… 2. Pass federal legislation… Nationwide standardization of certification, licensure & authority to practice for all APNs in the USA. APN authority would be a consistent nationalized policy. Alleviate confusion for the general public.

11. Policy Alternatives (cont’d)  Timely change driver… 3. Structured Clinical Competency Provision of a baseline for clinical competencies of APNs upon completion of a graduate program. Possibility of use of model objective structured clinical examination (OSCE)  Assess APNs clinical competencies to ensure all demonstrate same level of skill prior to obtaining national licensure. Implementation of such a model as OSCE in every school nationwide.  Skill level not demonstrated than additional education maybe warranted.

12. Evaluation Criteria The following criteria was used to evaluate the policy alternatives: 1. Cost 2. Benefits 3. Political feasibility 4. Ability to meet current & future demands.

13. Comparison Alternatives Alternative 1Alternative 2Alternative 3 Do Nothing/ Federal Structured Maintain the Legislation clinical Status Quo competency Criteria Cost + +/- +/- Benefits - + + Political + + +/- feasibility Ability to meet - + + Current & future Demands 2+/2- 4+/1- 4+/2- Score for 0 3 2 Alternative

14. Analysis & Comparison of Policy Alternatives • Of the three Options: • Do nothing/status Quo • Cost: which doesn’t exist, no change. • Reimbursement: issue due to confusion. • Benefits: Each state has jurisdiction over regulation APN • Political feasibility: states already established. • Non-unified across nation • Ability meet current & future demands. • Move due to strict legislation have autonomy • ***Change ultimate driver, change isn’t always bad especially when improves quality/continuity of care. .

15. Comparison of Policy Alternatives • Federal Legislation • Cost: maintained at national level. • Benefits: Unified certification, licensure, authority to practice APNs. • Political feasibility: • Ability meet current future demands: • Structured clinical competency • Cost: national government trying help cost education. Education hours (clinical) —salary, increased faculty, transportation • Benefits & feasibility: Competence, structure, unified, measurable, mandated, equality. • Ability meet demands: determined by government, economy, funds.

16. Comparison of Policy Alternatives…Summary • Clarifying challenges and putting steps in place to improve consistency • and establish upward mobility of practice. • Ensuring equality of states regulations on APNs. • Provide same level of care regardless of location. • Clarity for patients & families would be achieved. • Once have federal legislation in place hopefully could move toward the third option of structured clinical competency.

17. Recommended Policy • Implementation of Federal Legislation to have the funds, necessary • resources to back the ANP career force could be empowering. Unification • of the career path throughout the states with equality throughout prove • beneficial for everyone. • Continuity of patient care • Funds provided to help with education • Possibility of decrease in the shortage of providers • Affordability of APN education • Consistency, congruency.

18. Thank you!