The Importance of Uniformity of Licensing of Aprns

Consensus Model

The question of why the Consensus Model was developed in the first place is a worthy first point to make in this paper. The number of advanced practice registered nurses (APRNs) has greatly grown in numbers over the past twenty to thirty years in the United States. The healthcare system in America needed the skills and experiences of these nurses, not just because the APRNs had more education and had obtained a position higher on the ladder of respect than other registered nurses. But rather, the diversity of expertise of APRNs was welcomed and vital to the care of patients, and the need for patient safety. This paper delves into the need for a uniform model -- a consensus model -- that all states can embrace that will bring consistency to the field.

The Need for a Consensus Model

In the 2008 report ("Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education"), the four specific specialties of APRNs include: certified registered nurse anesthetists; certified nurse-midwives; clinical nurse specialists; and certified nurse practitioners. And indeed there is no doubt that while there are certain necessary components that must be available for fully licensing APRNs, there has been no standard approach to this matter. "Currently there is no uniform model of regulation of APRNs across states," and moreover, the fact that each state develops its own regulations and models for certification has created what the APRN Joint Dialogue Group calls "a significant barrier for APRNs to move from state to state" (APRN Consensus Work Group, p. 5).

Under the Frequently Asked Questions (FAQ) format of LACE (Licensure, Accreditation, Certification and Education), it is explained that the Consensus Model seeks to fully address the "lack of uniformity" in the licensing and accreditation of qualified APRNs. Barriers always need to be addressed, and to eventually be torn down so the best possible healthcare services can be delivered to patients. The Consensus Model allows APRNs to move freely from one state to another -- and practice as an APRN -- and be successfully licensed in that new state "... if they meet the educational criteria that were in place when that individual was originally licensed to practice" (LACE, p. 1). The responsibility of verifying the APRN's license, no matter in which state the APRN practices, will be in the hands of the employer (LACE, p. 2).

Another question in the FAQ document that is germane to this issue is: are LACE and the APRN Consensus Model the same thing? No, the APRN Consensus Model is a result of work done by the National Council of State Boards of Nursing (NCSBN) in cooperation with the APRN advisory committee and the Consensus Work Group. LACE is just a "mechanism" that brings together the stakeholders impacted by the implementation of the Model.

Meanwhile in order to be recognized, an APRN role should meet these challenges: a) nationally recognized educational standards; b) recognition by U.S. Department of Education, the Council for Higher Education Accreditation (CHEA); and c) a professional nursing certification program that meets "nationally recognized accreditation standards" (APRN Joint Dialogue Group, 2008).

Six Characteristics of Direct Clinical Care Provided by Advanced Practice Nurses: In the book, Advanced Practice Nursing: An Integrative Approach, the authors zero in on what is expected by an APRN. The expectations / characteristics include: a) taking a "holistic perspective"; b) showing "expert clinical performance"; c) use of "reflective practice"; d) evidence must be the guide to good practice; and e) embracing "diverse approaches to health and illness management" (Hamic, et al., 2014). Moreover, Hamic and colleagues point out that the clinical nurse specialist (CNS), one of the 4 specialties of APRNs, must provide "direct care to patients with complex diseases"; must develop clinical skills equal to staff nurses; and the CNS must be able to not only intervene in situations that are complex, but must guide and educate staff nurses (Hamic, 359).

What about the role of APRNs with Obamacare (the Patient Protection Affordable Care Bill - PPACA) now the healthcare policy? Author Kelly A. Goudreau points out that in order to increase the number of APRN graduates the PPACA funded clinical preparation for five APRN programs: Rush Hospital, Chicago; Duke University; University of Pennsylvania; Houston Memorial Center; and Scottsdale Medical Center in Arizona. Along with these funded facilities -- increasing the number of APRNs -- there must be a Consensus Model wherever graduates work, so guidelines are similar (Goudreau, 2013).