APRN Vision Paper APRN Vision Paper Update and Outcomes Update and Outcomes

from thefrom the NCSBN Sponsored NCSBN Sponsored

Member Board SummitMember Board Summit

Summit held February 26, 2007Summit held February 26, 2007Chicago, ILChicago, IL

Randall Hudspeth, MS, APRN-CNS/NPRandall Hudspeth, MS, APRN-CNS/NPBoard Member, Idaho Board of NursingBoard Member, Idaho Board of Nursing

Member, APRN CommitteeMember, APRN Committee

Purpose of SummitPurpose of Summit Update member Boards of NursingUpdate member Boards of Nursing Provide a historical perspective for new Provide a historical perspective for new

board membersboard members Provide review of original Provide review of original DraftDraft Vision Paper Vision Paper

released March 2006 and its 8 released March 2006 and its 8 recommendationsrecommendations

Provide information on stakeholder Provide information on stakeholder response to response to DraftDraft Vision Paper Vision Paper

Provide information on work to date on Provide information on work to date on APRN issues resulting from feedbackAPRN issues resulting from feedback

APRN Historical PerspectiveAPRN Historical Perspective

19861986 first position paper by NCSBN addressing first position paper by NCSBN addressing Advanced Clinical Nursing PracticeAdvanced Clinical Nursing Practice

19931993 NCSBN Delegate Assembly adopts NCSBN Delegate Assembly adopts position paper on regulation of advanced position paper on regulation of advanced nursing practicenursing practice

19941994 exploratory study on implications of exploratory study on implications of developing a core exam for NPdeveloping a core exam for NP

19951995 met with certifying bodies to establish a met with certifying bodies to establish a process relying on certification for granting state process relying on certification for granting state authorization to practiceauthorization to practice

APRN Historical PerspectiveAPRN Historical Perspective

20002000 APRN Task Force appointed to examine APRN Task Force appointed to examine regulatory sufficiency of certification examsregulatory sufficiency of certification exams

20022002 approved the Requirements for Accrediting approved the Requirements for Accrediting Agencies and the Criteria for Certification Agencies and the Criteria for Certification Programs (based on 1 year foundation work)Programs (based on 1 year foundation work)

20022002 Delegate Assembly adopts Uniform APRN Delegate Assembly adopts Uniform APRN Licensure Requirements and Position Paper on Licensure Requirements and Position Paper on Regulation of Advanced PracticeRegulation of Advanced Practice

1992 and annually1992 and annually—APRN Roundtables held—APRN Roundtables held

APRN Historical PerspectiveAPRN Historical Perspective

2006-2006- Draft Draft Vision PaperVision Paper released in March released in March Volumes of feedback receivedVolumes of feedback received

• Opinions expressed both positive and negativeOpinions expressed both positive and negative Feedback reviewed and acted uponFeedback reviewed and acted upon NCSBN meetings with Stakeholder groupsNCSBN meetings with Stakeholder groups

2007-2007- NCSBN and APRN Consensus Group working NCSBN and APRN Consensus Group working

together and form APRN Joint Dialogue Grouptogether and form APRN Joint Dialogue Group

Current APRN DiscussionsCurrent APRN Discussions

StakeholdersStakeholders NCSBN APRN CommitteeNCSBN APRN Committee APRN Consensus WorkgroupAPRN Consensus Workgroup

• 23 organizations representing education, 23 organizations representing education, accreditation, certification, practice and regulationaccreditation, certification, practice and regulation

APRN Joint Dialogue GroupAPRN Joint Dialogue Group Individual Boards of NursingIndividual Boards of Nursing Stakeholder Professional AssociationsStakeholder Professional Associations

Guest SpeakerGuest SpeakerGail Adcock, MSN, APRN-NPGail Adcock, MSN, APRN-NP

Case study presentation of a new Case study presentation of a new graduate NP who decided to live and work graduate NP who decided to live and work in different states and presented a in different states and presented a comparison of the wide variety of comparison of the wide variety of legislation that this NP faced in the legislation that this NP faced in the practice environment.practice environment.

2006-2007 Developments2006-2007 Developments

NCSBN NP/CNS Role Delineation StudyNCSBN NP/CNS Role Delineation Study NACNS and ANCC certification effortsNACNS and ANCC certification efforts

Based on nationally vetted core CNS Based on nationally vetted core CNS competenciescompetencies

NCSBN APRN Committee meeting NCSBN APRN Committee meeting individually with stakeholder groupsindividually with stakeholder groups

Known areas of agreementKnown areas of agreement Identified areas still holding opportunity for Identified areas still holding opportunity for

further discussionfurther discussion

Reasons Presented at Summit for a Reasons Presented at Summit for a Common APRN ModelCommon APRN Model

Lack of common definitions related to APRN Lack of common definitions related to APRN rolesroles

Lack of standardization in programs leading to Lack of standardization in programs leading to APRN preparationAPRN preparation Initial accreditation/approval necessaryInitial accreditation/approval necessary Blended programs with variable clinical hoursBlended programs with variable clinical hours Inconsistent Master’s Essentials complianceInconsistent Master’s Essentials compliance Programs graduating students that cannot be licensedPrograms graduating students that cannot be licensed

Reasons Presented at Summit for a Reasons Presented at Summit for a Common APRN ModelCommon APRN Model

Proliferation of specialties and subspecialtiesProliferation of specialties and subspecialties Examples-Palliative Care NP, Forensic NP and Examples-Palliative Care NP, Forensic NP and

Homeland Security NPHomeland Security NP

Lack of common legal recognition across Lack of common legal recognition across jurisdictionsjurisdictions Less than 30 states recognize or title protect CNSLess than 30 states recognize or title protect CNS Not all states license/authorize CRNA same as NPNot all states license/authorize CRNA same as NP

Vision Paper GoalsVision Paper Goals

To envision a common future To envision a common future model for APRN legal recognition.model for APRN legal recognition.(additional outcome) To develop (additional outcome) To develop a paper on APRN legal recognition a paper on APRN legal recognition that is complementary to the that is complementary to the APRN Consensus Group paper. APRN Consensus Group paper.

March 2006 Draft Vision Paper March 2006 Draft Vision Paper Overview for AttendeesOverview for Attendees

Discussed the Vision Paper so that all Discussed the Vision Paper so that all attendees had common baseline attendees had common baseline information.information.

Reviewed each recommendation with a Reviewed each recommendation with a summary of feedback received.summary of feedback received.

Shared the outcomes of joint workgroups Shared the outcomes of joint workgroups so baseline knowledge was current.so baseline knowledge was current.

Summit Discussion GroupsSummit Discussion Groups

As a method to facilitate discussion and As a method to facilitate discussion and demonstrate the complexity of the issue, demonstrate the complexity of the issue, small groups discussed each of the 8 small groups discussed each of the 8 recommendations and attempted to recommendations and attempted to achieve some consensus.achieve some consensus.

80 participants representing APRN board 80 participants representing APRN board members, Executive Directors and legal members, Executive Directors and legal counsel (10 per table) gave feedback.counsel (10 per table) gave feedback.

Summit Discussion Group Summit Discussion Group OutcomesOutcomes

Work to achieve consensus on APRN definitions Work to achieve consensus on APRN definitions of role, specialty, subspecialty, and core.of role, specialty, subspecialty, and core.

APRN must be clinically focused.APRN must be clinically focused. Does it matter that the CNS and NP have Does it matter that the CNS and NP have

common role functions?common role functions? How are psych CNS different than psych NP?How are psych CNS different than psych NP? Administer an exam by BON.Administer an exam by BON. Maintain current certification exam system.Maintain current certification exam system.

Summit Discussion Group Summit Discussion Group OutcomesOutcomes

APRN is beyond the scope of the RN.APRN is beyond the scope of the RN. Will take years to change all of the Practice Acts.Will take years to change all of the Practice Acts. Keep our eye on 10-15 years in the future and Keep our eye on 10-15 years in the future and

move beyond historical concerns.move beyond historical concerns. Move beyond vested interests for the good of Move beyond vested interests for the good of

the profession and to meet a growing public the profession and to meet a growing public need.need.

There is no consensus on population or There is no consensus on population or specialty.specialty.

How do you monitor practice site How do you monitor practice site appropriateness, ACNP in primary care?appropriateness, ACNP in primary care?

Summit SummarySummit Summary Much good work was accomplished in one Much good work was accomplished in one

year.year. Everyone was welcomed to the table and Everyone was welcomed to the table and

is participating.is participating. Consensus is difficult to achieve.Consensus is difficult to achieve. Everyone realizes this is hard work that Everyone realizes this is hard work that

requires compromise to be successful.requires compromise to be successful.

Vision Paper:Vision Paper:The Future Regulation of The Future Regulation of

Advanced Practice NursingAdvanced Practice Nursing

March 2006 version was a DRAFTMarch 2006 version was a DRAFT There is not a final documentThere is not a final document All feedback has been reviewed, All feedback has been reviewed,

discussed and seriously considered.discussed and seriously considered.

2006 Vision Paper2006 Vision Paper DRAFTDRAFT

Introduction and discussion lengthy with Introduction and discussion lengthy with the purpose to capture the richness of the purpose to capture the richness of debate and the complexity of the issue.debate and the complexity of the issue.

Proposed 8 recommendations to achieve Proposed 8 recommendations to achieve uniform regulatory requirements.uniform regulatory requirements.

Stimulated national debate.Stimulated national debate. Brought stakeholders together to Brought stakeholders together to

collectively address the issues.collectively address the issues.

RecommendationsRecommendations The following 8 recommendations are presented The following 8 recommendations are presented

as they were written in the as they were written in the March 2006March 2006 DRAFTDRAFT version of the Vision Paper. Areas of version of the Vision Paper. Areas of Agreement and Disagreement of what has Agreement and Disagreement of what has evolved are stated.evolved are stated.

When clarity of terms was appreciated fewer When clarity of terms was appreciated fewer differences actually existed.differences actually existed.

Note that many of these recommended concepts Note that many of these recommended concepts have been revised and will be presented have been revised and will be presented differently in future drafts.differently in future drafts.

Recommendation 1:Recommendation 1: Boards of Nursing Boards of Nursing will be the sole regulators of APRN.will be the sole regulators of APRN.

Areas of AgreementAreas of Agreement

General agreement once General agreement once intent clarified that this intent clarified that this meant BON, and not meant BON, and not BOM or other groups BOM or other groups would regulate APRN.would regulate APRN.

DisagreementDisagreement

ACNM is a proponent of ACNM is a proponent of separate midwifery separate midwifery boards.boards.

Recommendation 2:Recommendation 2: APRN licensure will be in APRN licensure will be in the categories and titles of nurse anesthetist, the categories and titles of nurse anesthetist, nurse midwife and nurse practitionernurse midwife and nurse practitioner..

Areas of AgreementAreas of Agreement

CNS, CNP, CNM, CNS, CNP, CNM, CRNA will be the 4 CRNA will be the 4 roles of APRN.roles of APRN.

CNS will meet same CNS will meet same criteria as other APRN criteria as other APRN roles including roles including education, certification education, certification and practice.and practice.

DisagreementDisagreement Not all stakeholder Not all stakeholder

groups agree to the 2 groups agree to the 2 license concept.license concept.

Unresolved what Unresolved what population foci are population foci are regulatedregulated

Recommendation 3:Recommendation 3: Boards of Nursing will Boards of Nursing will approve APRN programs for the purposes of approve APRN programs for the purposes of licensure.licensure.

Areas of AgreementAreas of Agreement APRN education programs APRN education programs

will be pre-approved before will be pre-approved before admitting students.admitting students.

Programs include masters Programs include masters or doctoral essentials and or doctoral essentials and role competencies in the role competencies in the population context.population context.

Regulation will be at the Regulation will be at the role and population foci.role and population foci.

DisagreementDisagreement

Recommendation 4:Recommendation 4: All programs leading to All programs leading to APRN licensure including clinical practice APRN licensure including clinical practice doctorates and Post Masters Certificates will doctorates and Post Masters Certificates will meet established educational requirements.meet established educational requirements.

Areas of agreementAreas of agreement Must be accredited.Must be accredited. Clinical experience is of Clinical experience is of

sufficient depth and scope sufficient depth and scope to ensure role and to ensure role and population competencies.population competencies.

Clinical experience covers Clinical experience covers the intended scope of the intended scope of practice with sufficient practice with sufficient oversight by qualified oversight by qualified faculty/preceptors.faculty/preceptors.

DisagreementDisagreement

Recommendation 5:Recommendation 5: Requirements for licensure Requirements for licensure as a NP will include successful completion of a as a NP will include successful completion of a core NP licensure examination and a residency core NP licensure examination and a residency program.program.

Areas of AgreementAreas of Agreement The term NP was The term NP was

expanded to APRN roles.expanded to APRN roles. Clinical Experience or Clinical Experience or

Clinical Practicum for all Clinical Practicum for all four roles will replace the four roles will replace the term residency.term residency.

Testing for legal Testing for legal recognition will include the recognition will include the role core, 3 P’s across the role core, 3 P’s across the lifespan and population lifespan and population foci.foci.

DisagreementDisagreement Will there be one test or Will there be one test or

two?two? What constitutes a What constitutes a

meaningful licensure meaningful licensure exam?exam?

Who will administer?Who will administer? How is testing How is testing

accomplished?accomplished? How will transparency How will transparency

between certification between certification bodies and boards of bodies and boards of nursing be achieved.nursing be achieved.

Recommendation 6:Recommendation 6: Evidence of continued Evidence of continued competency will be required for purposes of competency will be required for purposes of licensure renewal.licensure renewal.

Areas of AgreementAreas of Agreement

Maintain competence Maintain competence in area of specialty in area of specialty and practice.and practice.

DisagreementDisagreement How is this How is this

operationalized?operationalized?

Recommendation 7:Recommendation 7: Fully licensed APRN will be Fully licensed APRN will be independent practitioners. After licensure there independent practitioners. After licensure there will be no regulatory requirement for supervision.will be no regulatory requirement for supervision.

Areas of AgreementAreas of Agreement

Stakeholder Stakeholder agreement on the agreement on the general principle.general principle.

DisagreementDisagreement not discussed yet...not discussed yet...

Is there a period Is there a period where some degree of where some degree of supervision will be supervision will be required?required?

Recommendation 8:Recommendation 8: The Advanced Practice The Advanced Practice Compact will be the regulatory model used to Compact will be the regulatory model used to effect mutual recognition of APRN.effect mutual recognition of APRN.

Areas of AgreementAreas of Agreement

Compact promotes Compact promotes consistency between consistency between states for licensure.states for licensure.

DisagreementDisagreement

Some professional Some professional associations and some associations and some Boards of Nursing are Boards of Nursing are not supportive of the not supportive of the compact licensure compact licensure concept.concept.

We have everything we We have everything we need to make good need to make good decisions for the future decisions for the future except perhaps the will to except perhaps the will to act.act. Al GoreAl Gore

Academy Award Winner Academy Award Winner

I am hopeful that the APRN I am hopeful that the APRN Summit and this work has given Summit and this work has given us that will to act.us that will to act. Faith Fields, MSN, RNFaith Fields, MSN, RN

NCSBN PresidentNCSBN President