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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.
Sunday, April 22, 2012
Accreditors not allowing enough time for CNS programs to respond?
Another one of the issues raised in the NACNS Statement on the APRN Consensus Model Implementation (available on the NACNS web site) was related to the accreditors of schools of nursing not giving enough time for the schools to make the adjustments. The criteria for schools of nursing are changing based on the new requirements being implemented by CCNE and the NLN-AC that are in alignment with the model.
 
The needs as articulated in the APRN Consensus Model for schools of nursing are the incorporation of the three P's (pathophysiology, pharmacology, and physical/health assessment), and a shift from a focus on strictly role and specialty care to that which includes a population focus. The additional requirement of population is over and above role and specialty. Point of clarification....specialty is not included in the regulatory model but must be included in the CNS educational expectations.
 
The struggle that schools of nursing are apparently having is how to get both a population and specialty into the curriculum. Part of the difficulty is that there is no clear interpretation of what role, population and specialty mean to the various schools. The concept of "academic freedom" in the academic world means that each school/faulty group has the right to interpret it differently. That does not lend itself well to the concept of standardization as articulated in the model...so what do we have? Chaos.  
 
One statement in the NACNS document that illustrates the narrow scope that many people have is on page 6 where the document discussed the need for "...balanc[ing] the requirements for education on population, role and specialty education which is unique to the CNS within the mandated 500 clinical hours"(emphasis added). The hours for clinical are not mandated...they are a MINIMUM required by a number of national documents including the APRN Consensus Model document. Also, in the world of evidence based practice there is no evidence that 500 hours is the magic number...it is a number that was literally picked out of the air in the requirements for graduate education published by the AACN in 1996 and has become the standard expectation but there is NO EVIDENCE that this is the "right" number of hours.
 
So narrow thinking begets narrow thinking....
 
The accreditors are making changes to the accrediting requirements and are moving in the direction of the model in a timely manner. As a site visitor for CCNE I have seen some of those changes and the proposed timelines for the implementation. Can we afford to be inflexible though and hold all schools accountable to the proposed date of implementation? I don't know....there are two sides to that sword...if the accreditors do not draw the line in the sand and take a stand the schools may not make the changes until that line is drawn. If the accreditors do take a stand we all risk losing CNS programs for a lack of accreditation due to lack of responsiveness to the requirements. We can ill afford the loss of any CNS program in this volatile time.
 
What is the solution? We need to have some creative and innovative nurse educators out there who can look at the requirements of the APRN Consensus Model and move with them in the curriculum. Just like a large ship that is on the move, it takes a long time for curriculum change to occur in many institutions. Depending on the size of the organization, the size of the faculty, the level of entrenchment of the faculty, and the willingness of the group to change what they are doing overall...it can take a year, two years or longer to make the changes. 
 
Evidence based practice issue aside...we need to move toward the requirements in the model. We need to do it now so that there can be a well prepared and ready group of graduates when the model is expected to be fully in place (2015). Let's get our pending graduates ready for the future...and not set them up for failure before they even begin because they are not prepared in the requirements of the model. It is up to us to shepherd the future...let's do it well.
 
So is it the issue of the accreditors? Or is it the issue of the educators? You decide...but either way we need to move.....
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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