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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, March 06, 2011
We've talked about Education (a little) and Accreditation (a little)...how about licensure?
The L in LACE stands for licensure...how our practice is regulated. So what will be different with licensure? The beauty of the APRN Consensus Model is that there will be some consistent expectations for all APRN roles....the difficult part of the APRN Consensus Model is that there will be some consistent expectations for all APRN roles...
 
I know that sounds a little silly but let's explore what it means. The expectation will be that ALL APRN roles will have some core foundational concepts to ground them in clinical pratice. Those core elements are commonly called "the three P's" and include Pathophysiology, Pharmacology and Physical/Health Assessment. These courses are expected to provide a strong and common foundation. The reason they were fully integrated is partly history and partly a need to standardize educational core from the perspective of regulatory bodies...some may call this "administrative ease" and that is not always looked upon favorably. Let me tell you the history part...
 
History of the three P's is rooted in a document called the Masters Essentials created by the American Association of Colleges of Nursing (AACN-East). This document was created in 1998 and was adopted by some of the roles (NP primarily) and some of the educational institutions. Some but not all. Many CNS programs included them, but many did not. Part of the issue was a lack of enforcement...the accrediting agencies did not adopt and incorporate the requirements into the accreditation standards until recently.
 
Also adding to the confusion was that the core competencies got included in other programs that are not advanced practice but were Masters level preparations..such as administrative nursing programs and CNL programs. The inclusion was appropriate since these are Masters level education but the confusion that these are not APRN roles (they are advanced nursing practice but not APRN roles) was perpetuated. This confusion has not been fully resolved but is in process as AACN has drafted the DNP core competencies and the three P's are included. That helps to some extent other than the fact that there are still non-APRN DNP roles being created. The new Masters essentials have yet to be released but I am hopeful that there will be clarity regarding the APRN role Masters versus all other Masters level programs...time will tell. 
 
OK that is the history...now how about the "Administrative Ease" part. From a licensure perspective it is much easier to regulate the APRNs in your world if they all have some common elements. It is easier to understand the educational foundations of their roles if they are all the same. So what is wrong with this? It creates somewhat of a 'cookie cutter' effect and a potential loss of the unique characteristics of each of the roles. I am sure there are other issues with this...please let me know your thoughts about this element...
 
What else will change in the licensure world? Clearly aligned education (core role competencies and population competencies), and certification will be expected. All must be in alignment in order to be fully licensed as a CNS. I will talk more about the certification conundrum next week but for now this alignment is a positive thing. I don't know if you know this but there have been folks out there calling themselves CNSs without having the appropriate education. In fact there have been LPNs that have called themselves CNSs in the past and may still be doing that in some states due to a lack of recognition and protection of the CNS title. Although these folks may be providing wonderful care, they should not be identifying themselves as a CNS...
 
 
Also, your title will change and will be consistent with my title regardless of which state you are in...You will be clearly identified as an APRN and a CNS and yout title will be protected. I think that is an EXCELLENT change! The fact that CNSs have been lost in the shuffle and are not clearly identified in the mess of alphabet soup that is out there at the moment is disheartening to me. Let's be consistent in how we label ourselves for the public. They need to understand that we are advanced practice nurses (just like the NP population that they know so well) and that we are proud to be CNSs. By losing the alphabet soup we will simplify and clarify...that is SO important in this day and age of the empowered and enabled patient. They need to know who we are, what we can do and we need to be able to take credit for the work we do. Your title will be APRN-CNS...clean, clear and to the point.
 
So what is happening at the moment...unfortunately we are seeing a lack of understanding on the part of some of the state boards of nursing. They are looking at the model regulatory language that was created by the National Council of State Boards of Nursing (NCSBN) and are trying to implement it NOW...YESTERDAY....too soon...
 
CNSs are caught in the 'messy house' syndrome I have spoken of before. We do not have consistent education, we do not have the three P's in every program, we do not have certification in every area, and we have some very seasoned CNSs mixed in with a new wave of CNSs educated in a model somewhere in between the old and the expected model. We need some time to get our house cleaned up and in alignment. The issue becomes how can we ease into the new expectations without harming those in current practice?
 
We need to be able to identify the CNSs that are out there as a starting point. Then we need to look carefully at the educational programs that are in existence and assist them to align with the new model so that our future is assured to meet the model. Finally, we need to work with the NCSBN and individual state boards of nursing to assure the continuity for the current CNSs and the future CNSs.
 
There are more things I am sure I am missing or have not discussed. What are your thoughts? What are you doing in your state to work with your state board of nursing to implement the model? Let's talk... 
 
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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