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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, July 04, 2011
Happy Fourth of July!
On this day of patriotic fervour my mind goes to the Veterans who have fought and died for the freedoms this country enjoys. Fitting since I work for the Department of Veterans Affairs.
 
I also think about how progressive the VA has been over the years and how the organization has made some amazing progress in patient care. The computerized patient record system (CPRS) has been fully integrated into daily care for at least 15 years. Other organizations are struggling with implementation still. The VA has been cited as providing the "best care anywhere" and that claim is supported by external peer review reports on a consistent basis.
 
Progression in the area of Advanced Practice Registered Nurses (APRNs) is also evident. The VA is the largest employer of Nurse Practitioners, Clinical Nurse Specialists, and Nurse Anesthetists. The largest in the country. That means that the initiatives carried out by the VA in support of APRNs will have a huge impact.
 
The VA recognizes prescriptive authority for all NPs and CNSs. The VA already requires certification as a component of evidence of preparation for provision of care and ability to manage complex care situations. The VA already allows you to practice nursing in any state with any license. For example if you are licensed in Alaska you can practice in Florida. This comes in handy in national emergencies. All of this is in spite of what the state rules and regulations state. It is called federal supremacy and it works as an example of how things can be done consistently and coherently across the country.
 
Don't get me wrong...I am not advocating for federal supremacy in every instance but it seems to be working for APRNs nation wide in the VA system.
 
The latest adventure that the VA system will be undertaking is the implementation of the APRN Consensus Model. The plan is to fully implement the requirments of the model within VA and invoke federal supremacy where state rules and regulations do not match.
 
What do you think? Is this a good thing from your point of view?
7/10/2011
Dr. Kelly A. Goudreau said:
No definitive plans yet since the Office of Nursing Services at VA is awaiting response from the Office of General Counsel. I am sure that there will be significant discussion and dialogue though at the upcoming APRN conference being held in Chicago in August. I will be presenting the content regarding the model at that time to the APRN audience...I expect great discussions to occur at that conference!
7/6/2011
Kimberly Hodge said:
From my point of view, I think it is good that someone is trying to operationalize the model and test it in practice, however, I am concerned about invoking federal supremacy. Do they plan to test and evaluate prior to invoking? Is there a plan for providing feedback where it definitely does not work?
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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