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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 13, 2011
OK...so what is happening about Certification?
OK...I am back fresh from two things...the Alliance meeting on Tuesday March 8th in DC and the NACNS conference March 10-12th in Baltimore. Some good information to share regarding the accreditation component so let me do that first. At the Alliance meeting the two accrediting agencies were present and both indicated that they are either already offering pre-accreditation review (candidacy for NLN-AC) or are working on the process of how to make pre-accreditation a reality..potentially an answer is to identify a new program as initially a substantive change to a program (CCNE). More to come on this one though as it develops. Bottom line is that both are working on how to make the model come to life in the manner in which it was intended.
 
Certification...the last letter in the LACE acronym that we have to discuss...is one that is perhaps the most difficult for the CNS world. CNSs have traditionally seen the role of certification as specifically recognizing excellence in practice within a specialty. Unfortunately in the 90's the NP world began to see certification as an entry to practice measure. The entry to practice issue meant that the certification examination became a measure of entry level practice competence as measured by a multiple choice examination rather than a mark of experience and excellence. This shift in the level of the questions (from experienced and excellent care measure to entry level competence assessment) has been a very difficult change for CNSs.
 
For many years there has been a strong emphasis in the leadership of NACNS that there is no need to assess entry level competence in CNSs because the Masters level preparation was sufficient as a demonstration of entry level competence. That has had to change as a result of the APRN Consensus Model and the dialogue that created the model.
 
When NPs took the certification exam as a measure of entry level competence it took on the role of being a proxy for a licensure examination. The Nurse Anesthetists and Nurse Midwives had certification examinations prior to entry to practice for many years in their model of education. CNSs are the last to convert to this manner of thought...whether that is either good or bad remains to be seen...
 
The APRN Consensus Model requires that CNSs, along with all the other APRN roles, move to an entry to practice certification examination. The issue with this is the current lack of examinations that meet the model and the needs of the Clinical Nurse Specialist world view.
 
How can we bring the CNS world into the model and require certification without losing the essence of what the CNS is and can do? It will take a tremendous amount of very sensitive work on the part of the Professional/Educational organization (NACNS) and  the certifiers.
 
Initial discussions occurred in 2007 regarding the creation of a core examination for CNS role and the population "across the lifespan." The process of creating the exam, however, was managed by a number of people and the transitions that occured within NACNS and ANCC meant that there were a number of people 'in charge' of the exam development. Unfortunately something got lost in translation and the "across the lifespan" population focus was somehow missing in the shuffle although it was initially intended to be present.
 
Difficulty arose when the exam was not accepted by some state boards of nursing due to a lack of clarity in regards to the population. Another aspect that was troublesome was that many CNSs who wanted and needed the exam did not understand that there was a clause that would allow them to take the exam without having to go back to school to take the 3 P's...instead they were holding themselves accountable to the needs and went back to school before signing up for the exam. Unfortunately due to the low enrollments in the exam there was an inability to truly assess the reliability and validity of the test questions and therefore be able to defend the psychometric measures of the test. For all of these reasons the test was "shelved" by ANCC. You cannot have an exam in the market that is not legally defensible and each of the above elements meant that the exam could not be defended if questions arose.
 
Unfortunately, also for all of the above reasons, it is highly unlikely that the exam will come back.
 
Discussions are under way, however, with ANCC to examine what COULD be done and how best to meet the needs of the CNS population that is now facing many difficulties in being recognized due to a lack of certification. Stay tuned for more on this as the issue develops and more discussions are initiated.
 
What issues have you faced or are you facing as a result of the certification requirement? Tell me what is going on in your world...only by hearing from you can I take that information forward to the LACE discussions. I need to hear from you....
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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