Due to the increasing demand for primary care providers and the assertion that APRNs will be key to increasing accessibility to high-quality, advanced medical care in patient population specialty areas, two significant changes are being considered by national credentialing, educational accrediting, and state licensing bodies tentatively set to be implemented in 2015: The implementation of a nationwide regulatory consensus model that will bring homogeneity to licensing qualification requirements and scope of practice for APRNs in all states and territories; and the establishment of the DNP (Doctor of Nursing Practice) as the educational requirement for APRN national certification and state licensure.
Although these proposals have been on the table since 2008 and many steps are being taken towards their implementation, from a current perspective, in 2012, it seems unlikely that the full scope of these sweeping changes will take effect as soon as originally expected.
The goal of both proposed changes is the elevation of advanced practice nursing for the betterment of healthcare delivery and increased accessibility to advanced level primary care throughout the nation. As 2015 approaches, prospective APRNs are more often evaluating the Consensus Model for APRN Regulation and the proposed DNP educational requirement as they consider entering advanced practice.
Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education
Because the regulations developed by individual state Boards over many years have been identified as inconsistent from one state to another, some certifying and accrediting bodies, along with many state Boards of Nursing believe that there are benefits to the adoption of a more consistent approach to certification and licensing. In 2008, the Consensus Model for APRN Regulation was published by the APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee. The model had the support and input of more than 40 nursing organizations that believed that uniform regulations between states would improve advanced practice nursing nationwide. The model was developed in collaboration with certifying organizations, national nursing program accreditation agencies, regulators, and managing members of advanced practice professional organizations. The committee evaluated all variations in regulation and practice with the goal of developing a model that provided consistency so advanced practice nurses could practice in more than one location with the assurance that the standards of practice would be the same. The desired outcome is an increase in patient access to more cost-effective professional care by APRNs, who, under current laws, are often limited in their scope of practice by regulations that prevent them from practicing within their full range of knowledge and abilities.
Two key goals of uniform regulations would be increased patient access to care and the elimination of barriers that prevent APRNs from practicing in neighboring jurisdictions. Forty-eight nursing organizations have pledged their support to meet the proposed implementation date of 2015. Their goal requires clearer definitions of all four advanced practice registered nursing roles and will include an evaluation and remodeling of state laws and school curriculum components. Each state Board is currently in the process of evaluating the model to identify:
- Recommendations with which they already comply
- Changes necessary to meet compliance
- Any recommendations that will not be adopted due to failure to meet state legislation goals
The model also provides strategies for the implementation of legislative changes that would bring a state into alignment with major elements of the model. Currently, 35 state and US territory Boards of Nursing have enacted the consensus model, and another five are pending. Only 11 have yet to propose any legislation concerning the implementation of the model.
In light of the organizational and state Board support for the changes recommended in the model, a couple of certifying organizations are in the process of redesigning existing certification exams. For example, the American Academy of Nurse Practitioners (AANPCP) will be eliminating the certification exam for Gerontological NP by the end of 2012. Because the model recommends a combined Adult-Gerontology NP certification in the future, the AANPCP is also planning to end the Adult NP certification by the year 2014. New exams will reflect the combined patient populations proposed by the consensus model. Other certifying organizations are considering similar changes.
The status of each state’s level of consensus model implementation, including which states currently allow independent practice and prescriptive authority, can be seen by selecting the state of interest:
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District of Columbia
Doctor of Nursing Practice (DNP)
Although most APRN education programs are still offered at the master’s level, a number of DNP programs have been developed in recent years, and more are currently under development. Doctoral programs in nursing are not new. The first DNP program was established in 1979 and two others opened in Tennessee and Kentucky in 1999 and 2001 respectively. However, in a 2004 position statement, the American Association of Colleges of Nursing (AACN) presented a proposal recommending that the DNP be adopted as the minimum practice-focused advanced degree required to qualify for APRN certification and licensure. Educational standards and competences are being developed, but a final decision will require a coordinated effort by regulatory, educational, and credentialing organizations.
This change in the educational minimum for APRNs has been talked about for a number of years, and implementation is still being considered as a possibility for the year 2015. Although many support the concept, just as many do not. In fact, as of an April 2012 survey, only about half the APRN certification and accreditation agencies have signed on in full agreement. Clearly, there is still considerable discussion, evaluation, planning, and consensus that will need to take place before a final decision will be made. Until the time this complex change takes effect, RNs will continue to qualify for APRN recognition by completing any accredited master’s degree or post-graduate certificate program that meets requirements for APRN certification.
Should the DNP requirement be adopted, the proposal will still allow all master’s program students and existing master’s-prepared APRNs to enter practice or continue to work in their advanced practice roles. In addition, a defined transition period has been proposed that would allow existing APRNs with a master’s or other post-graduate degree to meet specified criteria so that practice experience and credits previously earned could be applied to the credit requirements for a DNP degree.