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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, May 13, 2012
Happy Mothers' Day and a discussion about certification requirements
Let's discuss the requirement for certification. As we get closer to the implementation of the model there are areas that lack clarity in the model. The model was never intended to be fully formed when born...unlike Greek mythology...it was intended to be a roadmap that would have the points of interest and photos of exciting times added along the way.
 
One of the exciting times is related to certification examinations. According to the model, certification will be needed in the future in order to meet licensing requirements as an Advanced Practice Registered Nurse (APRN). The certification examinations that currently exist for ALL APRN groups will need to change. They will need to meet the expectations of the model for assessing minimum competence for entry to practice as an APRN and will need to assess the Three P's, the role, and the population. There are currently NO EXAMS that are structured in this manner...but the certifying bodies (AACN - Critical Care, and ANCC where CNSs are concerned) are working hard to get there by the deadline of 2015.
 
What are the issues though? Well....for CNSs the certification requirement will be brand new. In the past the CNS used certification as a mark of excellence....not minimum competence assessment for entry to practice. That shift needs to occur first. Then, the CNS has really been focused on specialty rather than the structure outlined by the model (3 P's, role, population) so that is the second shift that needs to occur. It is my sincere hope that schools of nursing are working toward the outcomes as outlined. If they are not we will be in deep trouble as a component of the functional roles of APRNs. The final issue is that since the first two issues have not been addressed before, the CNS world is lacking in a comprehensive array of examinations. We have the Adult (soon to be Adult-Gero) population examination, and we have had in the past the gender specific examination although it is now defunct. Additionally we have had elements of the "Across the lifespan" exam in the form of the public health examinations in the past...although this will need to shift significantly also to meet the current model. Finally we have the psychiatric/mental health examination although that too will be undergoing changes as the role definition (per the International Society for Psychiatric Nurses [ISPN] and American Society for Psychiatric Nurses [ASPN]) moves solely to Nurse Practitioner preparation.
 
Confused yet? It gets better!
 
The tests that are created and/or modified must have enough individuals taking them to allow for psychometric analysis that demonstrates that the test is psychometrically sound and legally defensible. In other words...they have to be able to prove that they are measuring what they say they are measuring and they cannot do that if only a few people take the test each year. There has to be enough power in the analysis to allow for variations in the population and that can withstand a legal challenge if presented.
 
So...will we have enough CNSs in each population to be able to ensure the tests are legally defensible and psychometrically sound? Only if we see an increase in the number of students and we can maintain that number over the subsequent years....can you help? Will you help? Tell those young nurses you are working with what you do...let them see your role to its fullest extent and have them decide if your role is what they want to do when they move on in their career trajectory. Help to generate the future and perpetuate the role. You know as well as I do that the health care system needs us now more than ever...do your part to ensure the survival of the role.
 
So what is happening with certification in general? Will we have enough examinations to meet the population bubbles on the model by 2015? What do you think?
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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