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APRN LACE dialogue for CNSs
Blog is about the changes and updates related to the implementation of the Advanced Practice Registered Nurse Consensus Model for Regulation and the Licensure, Accreditation, Certification and Education changes that will need to take place over the next few years.
Monday, January 17, 2011
Getting Started

Do you know about the APRN Consensus Model? Do you have any idea how it will impact your practice? Let’s dialogue about the model, your understanding of it, how it will work in your state, your practice environment, and your life. How will it be a positive change for you? How will it be a negative change for you? What are the unintended consequences that it may have …both positive and negative and how can NACNS help? All of these questions with not many answers yet.

I will start out by orienting you to the APRN Model and then begin by exploring each of the elements within the model and within LACE. Let’s talk about it and what it means to you.

Carol Hartigan said:
I would like to provide some information for those who are concerned about acute care. The American Association of Critical-Care Nurses (AACN) and AACN Certification Corporation led advocacy efforts to retain acute care graduate education and certification competency testing for APRNs within the licensure tier throughout the development of the Consensus Model. As the organization representing the interests of and setting standards for acute and critical care nurses, we value the indispensible role that APRNs play in meeting the healthcare needs of the country’s most medically fragile patient populations and, therefore, believe that protecting the role is imperative. The Consensus Model calls for ALL clinical nurse specialists to be educated, and their competencies tested through national certification examinations, FROM WELLNESS THROUGH ACUTE CARE. We are actively moving our APRN certification programs to be in alignment with the Consensus Model.
Dr. Kelly A. Goudreau said:
Diedre, You raise some interesting points. Let me address them individually: 1) You are correct, there currently is no certification for the family/lifespan population for CNSs but it does fit very well for many of the groups that currently exist such as Emergency CNSs, Perioperative CNSs and Community Health CNSs. Each of these groups address families and/or individuals across the lifespan so would fit within the category. I know that there are discussions pending about how to address this but do not know exactly when an exam will be made available. Folks who are currently in those roles need to advocate for being grandfathered without certification since it was not a requirement for initial licensure as a CNS. More to come in this regard. 2) Can you tell me more about why you are concerned? It is not clear from your post. 3) Looks like your comments were cut off...can you explain more about your concerns? Thanks!!
Dr. Kelly A. Goudreau said:
Let me respond to some of the questions that you are raising in each of your posts: Diana, I would love to see the tool you have created! We are trying to do much the same thing in the VA and have run into some snags. Have you used the new competencies as well? Fiona, according to the model there are six population foci for all of the APRNs (including CNSs, NPs, Nurse Anesthetists, and Nurse Midwives). The six foci are Adult/Gero, Neonatal, Pediatric, Women/Gender Related, psychiatric and Family/Across the Lifespan. There is no longer any designation for Acute so I would assume that the regulatory model in Louisiana will have to change.
Ms. Diana Wortham said:
Kelly... Stimulating thread! What a way to get dialogue started! First, with the release of NACNS’s competencies, our organization’s (Mission Hospital, Asheville, NC) CNSs recognized the need to revise, adopt and validation each other’s practice of these elements as basis for our role performance. The next phase was to ensure our role descriptions were congruent and reflective of these expectations. Today, we have a functional working document by which new CNSs are orientated and practice performance is clearly articulated. In the next blog, I'd like to share background and a glimpse into activities occurring in NC. Diana Wortham, MSN, RN, ONC, AOCNS, APRN-CNS
Fiona Winterbottom said:
In Louisiana the state board requires an NP to be "acute care" trained if they work in a critical care area meaning no FNPs. There was a rumor that this would change with the Consensus Model? Fiona
Deidre D. Wipke-Tevis Ph.D. said:
When will a certification examination be developed for Family/Lifespan CNS? In order for CNSs who function in roles such as Wound/Ostomy CNS, Pain Management CNS, Nutritional Support CNS, or Perioperative CNS that cuts across ages, they will need to be certificated by this mechanism which doesn't exist. Will someone who wants to be a Maternal-Child or Perinatal CNS need to be certified via this mechanism?
Deidre D. Wipke-Tevis Ph.D. said:
I am very concerned that you will be licensed based on your population and your role. This really limits your ability to practice. Physicians are license based on their medical degree. Specialty certification is not a determinate of their licensure.
Deidre D. Wipke-Tevis Ph.D. said:
I am the Coordinator of the CNS area of study at the University of Missouri in Columbia, MO. Overall, I think the APRN consensus model will be a good thing for CNSs in the sense that it will increase the mobility of CNSs since a number of states do not allow CNSs to have prescriptive privileges and/or recognize them as an APRN. That said, I have a couple of major concerns about the structure. First, it makes no sense to me that Adult/Gero has been put together and Neonatal and Pediatrics are separated. Being from a rural state, I see this particularly problematic. Small hospitals cannot afford to have a Neonatal CNS and a Pediatric CNS. A small hospital would expect an APRN to be able to provide and coordinate care from neonatal through pediatrics. For many years, Maternal-Child or Perinatal CNSs have practiced effectively, however, unfortunately there has not been any certification examination available to them. The State of Missouri since 1996 had a mechanism for APRN with a MS de
About the Author

Kelly A Goudreau DSN, RN, ACNS-BC
Kelly A Goudreau DSN, RN, ACNS-BC is an Associate Editor for the Clinical Nurse Specialist Journal and has been a participant on behalf of NACNS in the development of the APRN Consensus Model and subsequent discussions about implementation of the LACE entity.

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